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両側進行・末期変形性股関節症に両側に大腿骨骨切り術併用のキアリ手術を施行し，2年以上経過を観察した症例について，除痛に成功したかどうかを検討した．対象となる20例（男性3例，女性17例）の手術時年齢は32～57歳（平均47歳），術後の追跡期間は2～25年（平均6年10ヶ月）であった．また両側の手術間隔は最短1年4ヶ月，最長19年であった．除痛について，両側共JOA score疼痛点35点以上は12例60％，30点以上だと15例75％を占めていた．両側例の場合，手術間隔を1年半以上空ける点に注意するほかは，合併手術などキアリ手術の一般的な適応に従って問題のないことがわかった．

Three patients with prostate cancer showed acute paraplegia as a result of multiple osteolytic thoacic spine metastases. Immediate laminectomy induced yecovery of paraplegia. Successful endocrine treatment induced a healing reaction characterized by intensification of the osteoblastic response.

Twenty-five consecutive patients with chordoma, chondrosarcoma, malignant lymphoma, myeloma, osteosarcoma, malignant fibrous histiocytoma, malignant schwannoma, fibrosarcoma, synovial sarcoma, rhabdomyosarcoma, liposarcoma, undifferentiated sarcoma in the pelvis were treated. Ten local recurrences (48%) occurred among twenty-one patients who had local tumor resected. Eight distant metastases (42%) occurred among the nineteen patients with localized disease at presentation. The ten-year overall survival was 32%. Patients with pelvic bone and soft tissue sarcoma continue to have a poor prognosis with standard treatment. In addition to a significant risk of local failure, these patients are at high risk for systemic relapse. Preoperative and/or postoperative intraarterial chemotherapy was useful for local tumor control in patients with pelvic sarcomas.

We describe the evaluation of intra-arterial chemotherapy response for bone and soft-tissue high grade sarcoma. Subjects included 41 with 22 bone and 19 with soft-tissue sarcoma. Surgical stage was I-B (1), II-B (36) and III (4). Pre-operative intra-arterial chemotherapy was performed on 17 patients, pre- and post-operative on 11, and post-operative on 13. Limb salvage procedures were performed on 32 patients (78%) and primary amputation on 9. Over all disease free survival at 10 year follow-up was 54% (bone tumors) and 61% (soft-tissue tumor). 17 patients had CDF, 5 patients NED, 3 patients AWD and 16 patients DOD at a median follow-up period of 31 months (6-202). The prognosis was correlated with the evaluation of change in tumor size, pain and imaging findings, but did not correlate with the change in histopathology and serum alkalinephosphatase.

Magnetic resonance imaging is useful fr diagnosing bone and soft tissue tumors. We report a patient with a schwannoma which gradually grew into a huge mass over a 12 year period. The deagnosis was possible using CT imaging, MRI, amgiogrephy, scintigraphy, and biospy. We recommend that MRI (especially, Gd-enhanced MRI) is useful for detecting the solid area of a huge systic mass for biopsy.

Spinal subarachnoid hematoma is a very rare disorder with few cases reported in Japan. This disorder may be due to tumor, disorders of vessels, coagulation dysfunctions, trauma or of unknown etiology. We report a case of subarachnoid hematoma with hypertension, in which the cause of the bleeding was not found.A 68-year-old male presented with sudden onset of pain in the bilateral femoral area, and gluteal area. He had a decrease of leg muscularity, and developed urinary retention on November 9, 1993. On admission, spinal MRI showed a space occupying lesion in his spinal canal at L1-L3 and lumbar puncture showed bloody CSF, and developed protein. He was suspected of having a spinal tumor and was transferred to our hospital on November 29. We suspected subarachnoid hematoma, so laminectomy was performed and the hematoma was removed on the same. Post-operatively, he had no pain and urinary retention improved. Two months after surgery, he had made a complete recovery.

We report 18 bone tumors treated by curettage followed by implantation of hydroxyapatite (HAP) with or without an auto bone graft. After follow-up of 5 to 53 months (median 23) all 15 patients with benign bone tumor had no signs of tumor recurrence or adverse effects from the implant. However two patients with malignant bone tumors had recurrence and one patient with benign tumor was lost to follow-up. Histology of the re-operative materials taken from one patient with malignant fibrous histiocytoma showed bone ingrowth into the pore structure of HAP by 8 months after implantation. HAP appears to be a useful substitute for bone grafts in the treatment of some benign tumors.

We report two cases of cystic spinal neurinoma. Though cystic neurinomas are commonly seen, these two cases are rare because of their complete cystic change. In one case, during myelography, the cyst was punctured and endocystography was performed by accident. In both cases, the cysts wall were clearly enhanced with gadolinium-DTPA in MRI images.

This article describes a right forearm osteosarcoma reconstructed using a free vascularized fibular graft. A 16-year-old girl was admitted to the Fukuoka University Hospital in March 1993 with an 8-week history of pain and swelling of the right forearm. Roentgenography of the right forearm revealed sclerotic change with spiculation and an extended soft tissue mass in the distal region of the radius. The patient received combination chemotherapy with cyclophosphamide, adriamycin, parapulatin, and caffein. Because chemotherapy was clinically effecitive, the neoplasm was removed with a limb salvage operation and reconstruction carried out using a free vascularized fibular gragt. Five months after the operation, the grafted fibular bone fused with the remaining radius, and the function of the right elbow, foream, and wrist joint are excellent. Vascularized bone grafting may be useful for reconstruction of large bone defects in malignant tumors as well as in this case.

We expeienced a case of rapid bone absorption of the femoral neck. A 55-year-old female who had been treated with oral medications for nearly thirty years for schizophrenia, was injured in a fall. She complained of right coxalgia, but fracture of the femoral neck was not diagnosed by anteroposterior radiograph in the local orthopaedic clinic. The pain didn't improve and she visited our hospital 50 days after the injury. Radiographs showed abnormal bone absorption of the femoral neck. The authors consider that the rapid bone absorption in this case was partly due to the mental disorder.

Twenty-three patients were treated with spinal instrumentation from January 1983 to July 1992. Patients comprised 15 males and 8 females with a mean age of 37 years (range; 12 to 79 years). Subjects had 12 spinal injuries, 4 spinal deformities, 3 spinal tumors, 3 degenerative disorders, and 1 ossification of the yellow ligament. The following four types of instruments were used: Harrington instrumentations in 13 cases (Distraction system: 10, Compression system: 3), CD systems in 7 cases, 1 Luque system, 2 ISOLA systems. Instrumentation failure occured in four cases two of which were reoperafed upon.

A case of low grade malignant lymphoma in the axillary region of a 49-year-old man is described. The patient presented with an asymptomatic thumb-tip sized and elastic-soft tumor of the left axillary region in the Summer of 1988. The tumor gradually increased to become first-sized in June 1992. The pathological diagnosis from a biopsy specimen was non-Hodgkin's malignant lymphoma. Lymph nodes in other regions did not increase in size, and therefore the axillary tumor was dissected. The period of Postoperative follow-up is short, but at present there has been no relapse. Although stage 1 non-Hodgkin's lymphoma, such as this case, is generally treated with radiation therapy, surgery was performed in this case. The authors consider that low grade lymphoma may be dissected, thereby avoiding any possible post radiotherapy disorders.

A case of Failed total knee arthroplasty with difficulty in reoperative planning is reported. A 65-year-old women with rheumatoid arthritis, complained of severe pain in her left knee. Radiographs revealed displacement and loosening of both femoral and tibial components with the femoral lateral condyle and tibial medial condyle refleching the amount of bone that had been lost. We reimplanted a Press Fit Condyler modular type with metal spacers using the thickest stabilized HDP spacer. Excellent results were obtained. Histological evaluation of synovial tissue revealed many lymphocytes and foreign-body giant cells containing polyethylene parhcles. It was suggested that polyethylene debris may have induced the osteolysis.

We report a 17-year-old female who presented complaining of back pain. A mass, the size of 5cm×6cm was seen on the right laminae of Th5. The tumor had a radio-lucent area on X-P and a cystic lesion was seen on CT scanning. T1-weighted images showed high intensity and T2-weighted images were of high intensity in a low intensity area on MRI. On angiography, the mass was shown to be hypervascular. A pathological diagnosis of ‘Benign osteoblastoma’ was made.

Malignant schwannomas are too delicate for a definite diagnosis before operation. Chemotherapy and irradiation do not improve the local control of tumors. We have treated 4 cases with malignant schwannoma since 1974. 3 patients were female and 1 was male, whose mean age was 47.8 years old. The mean follow-up period is 65 months. 2 patients died from the disease, while the other two were cured. Adjuvant chemotherapy had a no effects on the local control of the disease. Irradiation controlled local recurrence in 1 patients. All of marginal resection procedure caused local recurrences. We concluded that a complete wide surgicalexcision was necessary to achieve optimal local control and overall survival.

A 20 year-old woman with a recurrent tumor was admitted to the Fukuoka University Hospital in October 1995 with 4-year history of each resection for a primary tumor and twice recuring tumors in the left quadriceps at another hospital. The recurrent tumor diagnosed as biphasic type synovial sarcoma involved the femoral artery, vein, and nerve in the left femoral triangle. So it is suspected that MRI demonstrated not only a lesion of the left femoral triangle but also a small lesion of the left vastus lateralis. A curative wide resection of the entire left quadriceps and the left femoral neurovascular band was performed in November 1995. Consequently, the left femoral artery and vein were reconstructed by artificial vessels. After the reconstruction, massive skin necrosis of the left thigh and obstruction of the reconstructed artery wee occured. Rectus abdominal graft for massive skin necrosis and reconstruction for obstruction of the reconstructed artery were then performel. She has been disease-free. 4 years after the last resection.

Limb-saving surgery plays an increasingly important role in the treatment of malignant tumors of the extremities.This type of surgery may pose special problems in longterm survivors. The different possibilities of reconstruction after a tumor resection and repercussions in growth are discussed.Case 1. In this ten year old girl with osteosarcoma of the left distal femur, wide excision of the tumor site and a total knee replacement were done in September 1983, Two years postoperatively she presented late hematogenous infection of total knee replacement. Three times of surgery, debridement only, remove of prosthesis and two stage revision, wase done. In September 1989 rotationplasty were done because of uncontrolled infection. Case 2. In this twentytwo year old female with malignant fibrous histiocytoma of the left proximal tibia, wide excision of the tumor site and a total knee replacement were done in December 1983. Four years postoperatively she presented patellar tendon rupture, In July 1988 repair of the tendon with the use dacron ligament prosthesis to reattatch the tendon to the tibial component were done. To date, they had been followed for seven years with good function of limb, but without any indication of either local recurrence or metastases.The role of recostruction by means of a rotation plasty versus other methods of recostruction, and the repair of the tendon using ligament prosthesis and autotendon to reattatch the tendon to the tibial component is specially cosidered.

A radiographic study was carried out in eighteen patients of degenerative spondylolisthesis, in thirty patients of spinal cannal stenosis and in fourteen patients of lumbar disc hernia. The fatigue of facet joint, the angle between vertebral body and lamina, the facet joint angle and the rotation angle of spinal process were investigated by roentgenogram and computed tomography.The result was as follows.1. The fatigue of facet joint and the angle between vertebral body and lamina were characteristic of the degenerative spondylolisthesis group.2. From the facet joint angle and the rotation angle of spinal process, it seemed that development of degenerative spondylolisthesis was attributable to rotational strain on the facet joints at the level of involvement.

Three patients with three different types of vascular tumors of the hand were treated using an Nd-YAG laser. The patients, one male and two females were aged 32, 15, and 51 years old, respectively. The resection of the venous hemangioma in the right palm and little finger of the 32 year old male resulted in a good range of motion, good function, and a pain free state. Equally good results were achieved in both a 15-year-old female, who had cavernous hemangiomas in her left thumb, index, and middle fingers; and a 51-year-old female, who had spindle cell hemangioendotherioma in her right elbow and right hand. Partial excisions were performed in all three cases because the tumors involved digital or ulnar nerves. Blood loss was minimal (averaged 230 grams) compared with usual surgical excisions. The Nd-YAG laser is the only current laser capable of direct tissue contact and the best possible available thermal coagulator giving good penetration with distinct advantage in this type of surgery.

The operation was performed on 52 patients, 51 patients we could follow-up for more than one year, 30 with ossification of the posterior longitudinal ligament (OPLL) and 21 with cervical spondylosis or spinal stenosis (CSM), which consisted of 8 cases and 11 cases of the aged respectively. The series was composed of 33 men and 18 women. Their ages ranged from 45 to 78 years, with an average age of 60.8 years, that of the aged, 69.9 years. The length of follow-up ranged from 1 to 10 years (average: 4.5 years). The clinical results were evaluated using J. O. A. score of cervical myelopathy and recovery rates of Hirabayashi's method.The recovery rates of OPLL (64.2%) were superior to CSM (52.6%), each was well improved from preoperative status.Their ages were not correlated with the recovery rates.The recovery rates of mal-alignment groups, such as kyphotic and Sigmoid type, tended to decrease in the follow-up study.Operative indication should be determined carefully before deciding on mal-alignment groups.In spite of the aged, surgical treatment should be considered, if general condition is permitted.

Osteosarcoma is generally believed to originate from a single lesion. Rarely, however, there are cases presenting with bone lesions involving multiple bones. Such a condition is called multicentric osteosarcoma and is regarded as representing a unique entity among osteosarcomas. This particular condition of bone malignancy may be classified into two types, i. e. synchronous type in which multiple lesions occur at the same time and metachronous type which is characterized by the occurrence of multiple lesions at a certain interval after that of the primary.This paper reports 2 cases of osteosarcoma probably of the metachronous type experienced by us recently, with comment of relevant literature.

We presented two cases of aneurysmal bone cyst; one case in the second lumbar vertebra and the other case in the second cervical vertebra.Case 1: a 15-year-old manHis chief complaint was low back pain. CT showed a expanded and destructive mass lesion from the transverse process to body of L2. After curettage of the lesion and bone grafting in the involved area of the vertebral body, a posteroeateral fusion was done. At 5 months following the operation, the patient had no recurrence showing a solid bony fusion on the roentgenograms.Case 2: a 20-year-old womanHer chief complaint was swelling of the posterior region of neck and severe pain referred to the left shoulder. Roentgenograms revealed a spherical tumor surrounded with a thin bone-shell. The tumor was resected and a left laminectomy of C2 was performed. Roentgenograms and CT showed no recurrence at 15 year after the operation. She was free of complaints.

A Case of bilateral anterior interosseous nerve plasy in discussed and the literature reviewed.A 25 old man developed pain in his left elbow flexion side. As the pain subsided, the patient noted the inability to flex his left index finger DIP joint. He had not had any previous trauma nor medical history related to the problem. Showing no recovery, he underwent operation three months after the onset. The operation, showed no evidence of the entrapment of the anterior interosseous nerve. Two months after the operation, the patient recovered functions of the index FDP.Five years later the patient experienced pain in his right elbow flexion side. The next day, he could not flex the IP joint of the thumb nor the DIP joint of the index finger actively. We performed neurolysis eight months after the onset, and found fascicular constriction of the anterior interosseous nerve fasciculus within the main trunk of the median nerve by interfascicular neurolysis.

Recently, it has been shown that osteosarcomas can be classified into various subtypes, including a low-grade central type. Twenty-two patients with osteosarcoma were reexamined to clarify their therapeutic problems. Four of the twenty-two cases were histologically diagnosed as having different tumors. Two of the four neoplasms were previously diagnosed as low-grade central osteosarcomas, but this was changed to dysplasia and fibrous histiocytoma from the biopsy and surgical specimens. Two remaining cases which were first diagnosed as osteosarcomas after surgery and autopsy were further differentiatid as being high-grade osteosarcomas. Nine patients developed pulmonary metastases leading to death. The surgical effects of pulmonary metastasis correlate well with the occurring periods. We found that the time between the initial surgery for the osteosarcoma and that of the second surgery for metastasis correlated well with survival. For example, if surgery was required to treat the pulmonary metastasis within 2 years from the initial surgery, there was a Slight effect on the patients prognosis. However if metastatic lesions occurred more than 2 years after the primary treatment given for the osteosarcoma, then there was a longer survival period due to the pulmonary partial resection.

全身骨転移中約30%を占めると言われている骨盤骨転移の実態は明らかではない. 当科受診患者中, 骨盤部に骨転移を確認できた62症例について年齢・性別・症状・転移部位・原発腫瘍の種類・予後などを調査した. 全62例, 男性42例女性20例, 20歳から84歳平均59.2歳. 初診時の症状は, 腰痛, 下肢痛で約5割を占め, 転移部位は腸骨部に約50%が集中していた. 原発腫瘍を検索したところ前立腺癌, 肺癌, 直腸癌で約50%であった. また骨盤内臓器からの転移例は25例 (47.2%) と高率であった. 初診時原発病巣不明であったものの55.2%は骨盤内原発であり, 肺原発を加えると80%を越える. 予後は前立腺癌のみが平均2年以上の生存期間を有す他は, 平均半年から1年と予後不良であった.

Cervical orthoses are always used to treat neck diseases and injuries. In these diseases, the orthotic goals may be to relieve pain and to support the unstable spine.However cervical orthoses are not comfortable for patients with rigid fixation.Since 1990, we have used the “Neck—Chest brace” following surgery on the cervical spine (C2 or C3-C7).Features of this orthosis are:(1) This brace is very light (about 300g)(2) We are able to use this orthosis for patients confined to bed.(3) After cervico—thoracic fixation, we can use this as a collar.

Heterotransplantation of a human liposarcoma in nude mice was used to evaluate the efficiency of Menogaril as a new antitumor agent. The in vivo model was successfully produced by tranplantation of cloning cells from a human liposarcoma cultured cell line. The cultured layer was established from a myxoid liposarcoma. The drug was administered orally to the models by 3 different methods. The administration group demonstrated marked growth inhibition of the tumors. In conclusion, administration of Menogaril was effective in the in vivo model.

Lipoblastomatosis was an entity defined by Vellios, F. et al. in 1958, as a relatively uncommon benign tumor of embryonal adipose tissue which had occurred in infants under 1 year old. A 4-year-old male with lipoblastomatosis is reported. He had a soft part tumor of left lower leg which existed between the soleus and the peroneus muscles, and which invaded a part of the flexor hallucis longs.The patient was treated with local excision and had no evidence of local recurrence or metastasis 6 months after the surgery.

A total of 70 patients with acute spinal cord injury were identified in Tottori-ken from January 1988 to December 1989. The population of Tottori-ken during that period was 0.61 million. Therefore the incidente of traumatic spinal cord injury of Tottori-ken was 56.7 per million population per year. The average age was 48.5 years, which was significantly older in Japan compared to that in Australia, California and Taipei.

Spindle cell hemangioendothelioma is a new entity defined by Weiss and Enzinger in 1986, as a low-grade malignant vascular tumor. Although the neoplasm has involved in the dermis and subcutaneous fatty tissues, no case has occurred in the muscle. The first case of spindle cell hemangioendothelioma originated from the muscle is reported. A 48-year-old female had a tumor which occurred in the extensor digiti minimi of right forearm.CT scan demonstaratetd multinodules in an isodensity region within the skeltal muscle.MRI showed multinodules in a high signal intensity region on both T1-and T2-weighted images.The patient was treated with wide excision and had no evidence of local recurrence or metastasis 5 months later.

A case of intradural rupture of a lumbar intervertebral disc at L4/5 is reported, and the literature is reviewed. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The pathogenesis of this condition is uncertain, but the common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament.Intradural disc herniations should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression, since preoperative roentgenographic diagnosis is quite difficult.

In the past, as a posterior decompression surgery for OPLL, Iaminectomy was perfomed. Howerver, postoperative follow-up was made difficult by such negative factors as instability of the operated part, abnormal alignment, scar formation, etc. Therefore, to counteract these negative results, a variety of Iaminoplasty are being tried in recent years. We have performed Iaminoplasty both by the Kirita and Hirabayashi methods at our hospital since 1983, and we hereby report our evaluation of the operative results and the postoperative complications.With the Hirabayashi method, we observed the limitation of the range of movement in the posterior flexion. We could observe no difference in the improvement rate of the clinical condition when using different operative techniques. Postoperatively, we had no case where OPLL's growth could be clearly observed.In case of the unilateral existence of ossifications with a high rate of stenosis, we thought it was necessary to practice sufficient caution at the time of operation in order to prevent complications.