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We have been trying non-collar fixation and early ambulation after cervical laminoplasty since July 1998.The aim of this report is to evaluate this postoperative physical treatment.In the radiological evaluation, the range of motion of the neck after operation was more or less the same as before operation.This group did not complain of post operative neck pain and showed no complications.The course of postoperative rehabilitation without collar fixation was shorter than traditional rehabilitation.

Fractures of the tibial plateau often associate ligamentous and meniscal injuries. MR imaging is useful for evaluating not only the extent of the fracture depression or displacement but also associated soft-tissue injuries.We compared the findings of MR imaging with those of arthroscopy in thirteen patients with fractures of the tibial plateau. In this series, 8 (61.5%) lateral meniscal tears, 2 (15.4%) anterior cruciate ligamentous tears and 1 (7.7%) posterior cruciate ligamentous tears were seen at arthroscopy. The sensitivity for lateral meniscal tears was significantly less than for other tears. 75% of lateral meniscal tears were peripheral tears. Peripheral tears of the lateral meniscus are especially difficult to detect on MR imaging.In conclusion, special attention should be given to peripheral tears of the lateral meniscus in fractures of the tibial plateau. Even if MR imaging do not show lateral meniscal tears, arthroscopy is recommended.

Treatment regimens for frozen shoulder vary. These include joint distension which is performed in conjunction with the arthrography of the shoulder. Distension arthrography was performed in 19 cases from April 1997 to March 1998, of which nine cases (4 men, 5 women) were available for this study. One case underwent surgical manipulation after joint distension. One case was admitted for surgery but joint distension on the day of admission was so effective that she discharged without surgery. The average JOA score was 55.4 before this procedure and 84.1 at the time of follow-up. As the treatment for frozen shoulder, we recommend this procedure before surgery.

Spinal·medullary diseases may be complicated with neurogenic bladder. At our hospital we measure pressure of bladder and study its diagnostic and thorapeutio usefulness in the cases of spinal-medullary diseases complicated with dysuria. In this paper we report three cases, in which neurological information of the bone marrow not obtainable with orthopedic imaging and clinical findings could be obtained by cystometry.Cystometry is an auxilliary diagnostic method that can easily be done. We intend to use it positively in the future.

This study was performed to assess the accuracy of the operative correction angle in high tibial osteotomy and consider the possible causes for inconsistency between the preoperative and post operative correction the angles.We studied 40 knees in 31 cases (9 males and 22 females) treated by high tibial osteotomy between 1996 and 1998. The mean age was 66.2 years (45 to 81). We used five kirschner wires (∅ 1.8mm as the osteotomy guide, inserted them roentgenographically and performed interlocking wedge osteotomy. Preoperative and postoperative correction angles were measured and the postoperative correction angle was subtracted preoperatively. The inconsistency between the preoperative and postoperative correction angles was within ±2° in 31 knees (77.5%), +3° in 5 knees (12.5%), +4° in 2 knees (5.0%), +5° in 1 knee (2.5%), and -4° in 1 knee (2.5%). Satisfactory results were obtained in a majority of the patients.High tibial osteotomy requires operative technique taking into consideration inconsistency between the preoperative and postoperative correction angles.

The purpose of this study is to estimate the effects of the drip infusion therapy with argatroban and its sustenance.14 patients who had failed conservative treatment were administered argatroban (20mg/day) for 2 weeks. 12 patients showed some improvements in their symptoms following this treatment. No patients worsened. The mean JOA score significantly improved from 12.9 points to 19.4 points. Most subjective symptoms showed significant improvement, but not objective symptoms. 5 patients had continuous improvements for more than a mean of 17.8 months, but 4 patients showed recurrence after a mean follow-up of 3.7 months.These results suggest that drip infusion therapy with argatroban is recommended for lumbar spinal canal stenosis.

We report on 305 patients operated on for lumbar disc herniation between 1989 and 1994.There were 6 cases (5 males, 1 female) with lumbar disc herniation and urinary retention. These patients had an average age of 47.1 years (range 22-62 years). Follow-up was for an average of 3.7 years.5 patients underwent laminectomy with posterolateral fusion and one underwent Love's method.We report on their post-operative results and prognos for urinary retention.

In patients with a degenerative lumbar spine, stenosis can occur, not only at the entrance zone but also at the mid and exit zones of the nerve root canal. Symptoms of degenerative lumbar stenosis relate to two types, due to either caudal or root involvement. Extracanal (mid and exit zone) lesions are an important cause of failed back surgery. Patients suffering from root symptoms may have an extra-canalicular lesion, especially in senile patients.We classified stenotic lesions in the degenerative lumbar spine from the viewpoint of extra-canalicular lesions. We diagnosed stenosis from abnormal MRI findings and selective radiculography. Stenotic lesions were classified into three groups; extra-canalicular only, intra- and extra-canalicular, and migrated hernia. The second group of both intra- and extra-canalicular was further classified into three types. Double crush, defined as one root with two lesions at two disc levels; Double root, defined as two roots involved at one disc level and a combined type.We treated 31 patients surgically according to that classification. Twenty eight patients achieved pain relief after the operations, but 3 patients operated on twice complained of residual leg pain. Osteoplastic facet laminectomy was a useful procedure for exposing the extracanal region and provided a good operative field and safe decompressive method.

As a result of severe deformity caused by ankylosing spondylitis, patients may be able to see only a few feet beyond their toes. Several surgical methods have been used for treating deformities caused by ankylosing spondylitis. Reported cases were operated on before the age of 50 years. We surgically treated a patient aged 72 years. Wedge osteotomy in the lumbar region was carried out and a manipulative procedure achieved good correction, but we abandoned instrumentation because of marked osteoporosis. He received further bone grafting due to delayed union and following surgery was able to see straight ahead. No major complications such as rupture of the great vessels occurred during surgery.

A flexed posture is seen to develop in association with increasing age. Patients with such a flexed posture have several problems, and it is difficult to treat these favorably. To treat this type of deformity, we must understand the alignment of the patient's spine.We classified lumbosacral kyphosis into three types depending on sacral inclination and disc degeneration in the lower lumbar spine. Patients with a deformity due to loss of sacral inclination and malalignment in lower lumbar spine showed marked disability in daily life and had severe lumbago.Sacral inclination seemed to be an important factor in the treatment of patients with deformity both surgically and non-surgically. We may operate on them using lumbosacral fusion and correction using Galveston technique with ISOLA instrumentation.

Two men aged 36 and 38 years, both with osteosclerosis, renal tubular acidosis, symmetric cerebral calcification of basal ganglia and cerebellum, and hypoparathyrpidism were diagnosed as having carbonic anhydrase II (CA II) deficiency. Biochemical and immunological eveidence confirmed the deagnosis, showing that they had a virtual absence of CA II in their erythrocytes. CA II activity as tested by Maren's method was almost totally absent in the patient's erythrocyte hemolysates. CA II prptein levels in the hemolysates were undetectable by radial immunodefusion testing. Their parents, who were asymptomatic heterozygotes, exhibited about half th normal enzyme protein level of CA II.

Thigh abscesses are relatively rare with only a few cases previously reported in Japan. We report a case of thigh abscess occurring in a 31-year-old female, who complained of pain and swelling in her right thigh. MRI showed an abscess within the quadriceps femoris.Surgical excision of the abscess was carried out and Staphylococcus aureus was identified from the culture. The patient remains sympton-free seven months after surgery, with no recurrence.

We report on three patients, two boys and one girl, each of whom sustained a fracture separation of the lateral part of the clavicle which gave the clinical and radiological appearance of a complete acromioclavicular dislocation.Two cases were treated surgically. At operation a longitudinal tear was found in the periosteum, and the lateral part of the clavicle was displaced throughout; the joint itself was intact. Rockwood classified acromioclavicular injury in children into 6 types. He suggested that reduction and internal fixation is indicated only for type IV, V and VI.It would appear from both the pediatric and adult literature that surgical treatment for injuries involving the distal clavicle in children is mostly for cosmetic rather than functional improvement.

We report a 25-year-old male with bilateral idiopathic transient osteoporosis of the hip. At first the left hip was affected. Six months later the right hip was affected.MR-imaging showed regional decreased signal intensity on T2-wei-ghted images bilaterally. This finding reverted to normal earlier than other radiographic findings.Bone scintigrams showed diffuse increased uptake in the left femoral head. A regional hot area was seen in the lateral joint surface of the right femoral head before coxalgia developed. This finding indicates that stress to the joint surface may be involved in the etiology of this disease.

We reported a rare case of severe OPLL in an adult case of vitamin-D resistant rickets.The case was 56-year-old female. We started 50-150 thousand units of vitamin-D treatment about 16 years ago.About 2 years before operation, she was complaint of gait disturbance and dysuria.X-ray examination showed a severe OPLL from C1 to Th2 (max. stenosis 79%, C1, 2).We performed a surgery of canal-expansive laminoplasty and suboccipital craniectomy.

In 1983, Neer et al in the article entitled “Cuff-tear Arthropathy” reported 26 patients that shared the character-istic clinical and radiological features.We reported 2 cases that shared several of the clinical and radiological features as the cases reported by Neer.2 cases visited our hospital with complain of bloody joint effusion.We performed arthroscopic synovectomy on these cases and got good results.

We reported the results of 14 cases of articular fracture of the distal end of the radius, which were treasted with Clyburn external fixator. After completion of bony union, ulnar tilt was 20.2°±7.3°, palmar tilt 8.9°±6.6° and ulnar variant was 0.7±1.1mm. According to the point system of Saito and Shibata, 3 Cases had excellent results and 11 cases had good results. In conclusion Clyburn external fixator is recommended for articular fracture of the distal end of the radius.

Reconstruction of brachial plexus palsy (BPP) involves many difficult factors. We had 35 patients with BPP of whom 23 were surgically treated. The BPP palsy was total in 16 patients, upper in 6 and lower in 1. Ages at injury ranged from 15 to 39 years (mean 20.4). Motor cycle accidents caused the injury in 24 cases, while are cases was caused by a motor car and another after being caught in a rolling machine. Cerical roots were explored first and avulsion of the root confirmed by SEP. In post-ganglionic lesions, a nerve graft was carved out, and in pre-ganglionic lesions, the following operations performed. The inter costal nerve (C3, C4) was transfered to the musculocutaneous nerve in 15 patients; the accessory nerve was transferred to the musculo cutaneous nerve in 3 cases; the accessory nerve was transferred to the thoracodorsalis nerve in 1 cases; the intercostal nerve (C5, C6) was transferred to the thoracodorsalis nerve in 4 cases.The following results were obtained evaluation using manual muscle testing in the years after the operation: 7 cases good, 1 case Fair, 3 cases Fain Fair. Are both categories Fair a if so, why are they not written as 4 cases Fair, and 1 case zero. Nine cases (69.2%) regained flexion of the elbow joint against gravity. The intercostal or accessory nerve transfer to the thoracodersalis nerve produced wrist flexion and inter constalnerve transfer to the ulnar nerve had wrist flexion.

There have been many reports of the postoperative results of carpal tunnal syndrome.We treated 18 cases of carpal tunnal syndrome, 13 being femal and five male.An average age was 50.5 years old. All 18 cases were operated using the incision of the transverse carpal ligament.The distal latency of median motor nerve was recorded preoperatively, soon after release of the carpal tunnel and postoperatively.The distal latency was 6.26+1.43msec in the pre-operation and 5.96+1.59msec soon after the release of transverse carpal ligament and 5.76+1.54msec in the post-operation. Soon after the release of transverse carpal ligament, 13 out of 18 cases showed recovery in the distal lateny. Soon after external neurolysis and skin suture was done, 17 out of 18 cases showed recovery.Two months after the operation, all cases showed recovery.

22 cases of complete dislocation of the acromioclavicular joint (Allman' grade III) treated by Dewar procedure was reviewed. The post-operative duration ranged from 12 months to 61 with an average of 37 months.Post-operative results were evaluated on the base of shoulder evaluation by the Jpn. Orthop. Assoc.The average of total point was 96.7 (100 to 87 points).We discussed about the Dewar procedure, too.

The pathology of rotator interval lesion has been reported in detail, but there are lots of problem in making diagnosis of rotator interval lesion.Generaly speaking, rotator interval lesion is most common amomg young athletes.We can get arthroscopic findings from 5 cases of rotator interval lesion. We can make diagnosis depending on physical findings and cine-arthrography.The arthroscopic findings should suggest that dysfunction of rotator interval may induce the symptom of rotator interval lesion, and throwing shouldr injury what we call may occur on the base of instabity caused by dysfunction of rotator interval.

A malignant tumor of the thigh sometimes needs amputation of the sciatic nerve. Well understandings of soft tissue neoplasms have made it possible to perform limb saving procedure in carefully selected cases. We performed a limb saving operation for patients involving sciatic nerve.In an effort to determine the results of this procedure, the functions of the lower extremities were assessed in 9 patients. In 9 cases it was found by imaging studies that the sciatic nerve and vessels were located near the tumor mass. Eight patients had a local resection associated with the amputation of the sciatic nerve, and one underwent splitting of the nerve sheath. The function of the lower extremities has been assessed regularly by Enneking's evaluation system. All patients who had an amputation of the nerve had 50 to 70% function, although one exception of nerve sheath splitting gained 96%. An almost normal gait was seen in the latter patient, the other 8 patients showed major gait disturbances because of the lack of active knee flection and extension of the ankle. In contrast, patients who had amputation or disarticulation gained about 70% functional score. In this aspect the local procedure does not produce results nearly as functional as a prosthesis. Therefore, in carefully selected patients, amputation is superior to a spared limb with sciatic nerve palsy in our opinion.

We treated 4 cases of rupture of the biceps tendon. Durations between injury and operetion was 2, 3, 4 and 6 weeks in each case. We concluded that we had to reconstruct the biceps tendon by 6 weeks after injury on the basis of the operative findings.

Subcutaneous rupture of the brachial triceps tendon is relatively rare. To our knowledge, there have been 21 reports within the Japanease literature. We report a case of subcutaneous rupture of the brachial triceps tendon. A forty-one year old man fell on his left elbow, and complained of severe pain and swelling on his olecranon. Clinical examination and X-ray films showed rupture of the brachial triceps tendon, therefore surgery was performed. The triceps tendon was sutured to the olecranon with a non-absorbable suture. Clinical examination of the patient 7 month after surgery revealed almost normal elbow function except for slight loss of extension, allowing the patient to return to his usual activities.

We experienced 8 cases (7 surgically treated) of extraforaminal lateral lumbar disc herniation. Symptoms were femoral neuralgia in one patient with on L3-4 lesion and for most patients with L4-5 lesion; sciatic neuralgia for two patients with L5-S lesions, some patients with L4-5 lesions complained of both types of neuralgia. We operated using the posterior approach for 3 patients, but 2 required re-operation due to residual low back pain. All patients operated on with the anterior approach achieved good recovery. Anterior spinal fusion appears suitable for extraforaminal lateral lumbar disc herniation especially for degenerated segments above the L4-5 disc level, after first excluding sequestrated types of hernia.

We surgically treated 20 cases of thoracic myelopathy caused by ossification of the yellow ligament (OYL) and combined OPLL. Subjects included 10 males and 10 females. The duration between the occurrence of symptoms and time of surgery ranged from 1 month to 2 years (average 8.3 months).The average age at surgery was 58 years. All patients had had laminectomy. We found difficulty in some cases in performing decompression of the ossified spinal lesions.

5 elbow joints of 3 cadavers were dissected to investigate the anatomical characteristics of the lateral collateral ligament. We could identify the existence of the posterior fiber of the lateral collateral ligament in all cadavers.The anterior fiber of the lateral collateral ligament ran from the lateral epicondyle to the annular ligament.The posterior fiber originated from the lateral epicondyle and inserted into the crest of the supinator of the ulna.We concluded that meticulous dissection was needed to identify the posterior fiber of the lateral collateral ligament and the posterior fiber had the important function of keeping the elbow stable.

Twelve patients with infected decubitus ulcers were treated surgically. Four of twelve patients infected with MRSA were treated with continuous wound irrigation using diluted povidone-iodine. Three of twelve patients received continuous wound irrigation with a diluted antibiotic solution. Two patients irrigated with this diluted antibiotic solution died from the MRSA infection. The four patients irrigated with diluted povidone-iodine were cured, however high iodine levels were found in these patients although they had no complications.

Elbow arthrodesis was performed in one patient as a salvage procedure for treatment of an unreconstructable elbow open-complex fracture. The elbow was stable, free of pain, with a fusion angle of 67 degrees flexion, and a range of motion of 90 degrees pronation and 70 degrees supination.

A Prospective study was performed to evaluate the role of microfibrillar collagen hemostat (Avitene) in the blood loss of total knee arthroplasty (TKA). Of 103 TKAs (93 patients) with osteoarthritic knees studied to analyze blood loss, 41 TKAs used avitene on the cut tibial surfaces and 62 TKAs did not. TKAs in the avitene group demonstrated an average 429ml in suction drainage, whereas those in the non-avitene group averaged 440ml. An average calculated total blood loss was 1039ml in the avitene group and 1088ml in the non-avitene group. Avitene did not statistically decrease blood loss.