Search

This retrospective study sought to elucidate the incidence rates of roof impaction (RI) and marginal impaction (MI) and radiological and clinical outcomes of open reduction and internal fixation (ORIF) for RI and MI in geriatric acetabular fractures. The cases of 68 patients aged ≥ 65 years (mean 71 years) treated with ORIF were analyzed. MI was present in 12 fractures (67%) and an RI of the weight-bearing surface was present in 24 (46%) of the potential fracture types. Regarding the reduction quality, 54% of the reductions were graded as anatomical, 37% as imperfect, and 9% as poor. In the clinical evaluations of the 45 patients who had > 1-year follow-up (follow-up rate: 66.2%), 18% were graded as excellent, 53% as good, 16% as fair, and 13% as poor. An anatomic reduction was strongly associated with good or excellent clinical and radiological outcomes. CT was superior to radiographs for detecting the residual displacement postoperatively. Postoperative deep infection occurred in four patients. Three patients (6.7%) underwent a total hip arthroplasty conversion due to secondary osteoarthritis of the hip. We recommend ORIF as the preferred surgical treatment option for displaced acetabular fractures in elderly patients.

Background Many histological, mechanical, and clinical studies have been performed on the medial meniscus posterior root attachment, as it often tears in patients with osteoarthritic knee. Medial meniscal root repair is recommended in clinical situations; however, to date, no studies have examined the differences between meniscal root and horn cells. The aim of this study was, therefore, to investigate the morphology, reaction to cyclic tensile strain, and gene expression levels of medial meniscal root and horn cells. Methods Meniscal samples were obtained from the medial knee compartments of 10 patients with osteoarthritis who underwent total knee arthroplasty. Root and horn cells were cultured in Dulbecco's modified Eagle's medium without enzymes. The morphology, distribution, and proliferation of medial meniscal root and horn cells, as well as the gene and protein expression levels of Sry-type HMG box 9 and type II collagen, were determined after cyclic tensile strain treatment. Results Horn cells had a triangular morphology, whereas root cells were fibroblast-like. The number of horn cells positive for Sry-type HMG box 9 and type II collagen was considerably higher than that of root cells. Although root and horn cells showed similar levels of proliferation after 48, 72, or 96 h of culture, more horn cells than root cells were lost following a 2-h treatment with 5% and 10% cyclic tensile. Sry-type HMG box 9 and α1(II) collagen mRNA expression levels were significantly enhanced in both cells after 2- and 4-h cyclic tensile strain (5%) treatment. Conclusions Medial meniscal root and horn cells have distinct morphologies, reactions to mechanical stress, and cellular phenotypes. Our results suggest that physiological tensile strain is important to activate extracellular matrix production in horn cells.

BACKGROUND: Postoperative thrombosis of the external iliac artery (EIA) following open reduction and internal fixation for acetabular fracture is extremely rare. PURPOSE: To report a patient with EIA thrombosis following open reduction and internal fixation using the modified ilioinguinal approach for acetabular fractures. STUDY DESIGN: This is a case report of a 69-year-old male with a left acetabular fracture who was treated surgically. METHODS: A 69-year-old male presented with left hip pain after a 1.5-m fall. Radiographs revealed left acetabular anterior wall and posterior hemitransverse fractures with dome impaction. Computed tomography (CT) showed atherosclerotic changes in many arteries. Open reduction and internal fixation were performed using the modified ilioinguinal approach. Adhesion around the external iliac vessels was severe, and the external iliac vein (EIV) ruptured during exposure. After EIV repair, anatomical reduction was achieved and the fracture was fixed using a reconstruction plate. Nine hours after surgery, the left lower limb showed acute ischemic symptoms. Contrast-enhanced CT indicated complete occlusion of the left EIA. The patient was immediately taken for a thrombectomy via EIA cut-down using a Fogarty catheter. Postoperatively, he had palpable dorsalis pedis and posterior tibial pulses; however, post-reperfusion compartment syndrome developed. Fasciotomy of the left leg was performed. RESULTS: At the 2-year and 4-month follow-up, he was pain-free in his hip and leg. Although he was walking with a cane, activity was limited due to a mild foot drop. CONCLUSIONS: It is very important for surgeons to consider EIA thrombosis as a potential complication following open reduction and internal fixation. In this case, EIA thrombosis could be explained by preoperative atherosclerotic changes and intraoperative vascular handling procedures. Preoperative screening and management, and meticulous surgical procedures are necessary for patients with a high risk of thrombosis.

A well-organized, thoughtful study design is essential for creating an impactful study. However, pressures promoting high output from researchers can lead to rushed study proposals that overlook critical weaknesses in the study design that can affect the validity of the conclusions. Researchers can benefit from thorough review of past failed proposals when crafting new research ideas. Conceptual frameworks and root cause analysis are two innovative techniques that can be used during study development to identify flaws and prevent study failures. In addition, conceptual frameworks and root cause analysis can be combined to complement each other to provide both a big picture and detailed view of a study proposal. This article describes these two common analytical methods and provides an example of how they can be used to evaluate and improve a study design by critically examining a previous failed research idea.

Background Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS. Method Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement. Results The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = − 0.33; 0–12 months, r = − 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below. Conclusion NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.

Evidence regarding the effectiveness of arthroscopic débridement for a triangular fibrocartilage complex tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of débridement for triangular fibrocartilage complex tears.The authors searched all available literature in the PubMed, Embase, and MEDLINE (Ovid) databases for articles reporting on triangular fibrocartilage complex tear débridement. Data collection included arc of motion, grip strength, patient-reported outcomes, and complications.A total of 1723 unique studies were identified, of which 18 studies met the authors' criteria. The mean before and after arc of wrist extension/flexion motion values were 120 and 146 degrees (six studies). The mean before and after grip strength values were 65 percent and 91 percent of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (six studies) and pain visual analogue scale scores (seven studies) improved from 39 to 18, and from 7 to 3, respectively. The mean pain visual analogue scale score after débridement was 1.9 in the ulnar-positive group and 2.4 in the ulnar-neutral and ulnar-negative groups. Eighty-seven percent of patients returned to their original work.Patients reported reduced pain and improved functional and patient-reported outcomes after débridement of triangular fibrocartilage complex tears. Most patients after débridement returned to previous work, with few complications. Although some of these cases may require secondary procedures, simple débridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.

Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated the effectiveness of the Masquelet technique in the treatment of bone defects caused by trauma or infection. However, only few studies have reported the use of this technique for septic arthritis in small joints of the hand, and its effectiveness in treating septic arthritis in DIP joints remains unclear. We report the clinical and radiological outcomes of three patients who were treated with the Masquelet technique for septic arthritis in DIP joints. One patient had uncontrolled diabetes and another had rheumatoid arthritis treated with methotrexate and prednisolone. The first surgical stage involved thorough debridement of the infection site, including the middle and distal phalanx. We placed an external fixator from the middle to the distal phalanx and then packed the cavity of the DIP joint with antibiotic cement bead of polymethylmethacrylate (40 g) including 2 g of vancomycin and 200 mg of minocycline. At 4-6 weeks after the first surgical stage, the infection had cleared, and the second surgical stage was performed. The external fixator and cement bead were carefully removed while carefully preserving the surrounding osteo-induced membrane. The membrane was smooth and nonadherent to the cement block. In the second surgical stage, an autogenous bone graft was harvested from the iliac bone and inserted into the joint space, within the membrane. The bone graft, distal phalanx, and middle phalanx were fixed with Kirschner wires and/or a soft wire. Despite the high risk of infection, bone union was achieved in all patients without recurrence of infection. Although the Masquelet technique requires two surgeries, it can lead to favorable clinical and radiological outcomes for infected small joints of the hand., Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated...

Background Transtibial pullout repair of a medial meniscus posterior root tear (MMPRT) is a commonly used procedure, and several techniques have been reported. We hypothesised that pull-out repairs using two simple stitches (TSS) would have similar postoperative outcomes as those using the modified Mason-Allen suture with FasT-Fix (F-MMA). We aimed to investigate the clinical outcomes of these techniques, including the meniscal healing status and osteoarthritic change. Methods The data of 68 patients who underwent transtibial pull-out repair were retrospectively investigated. The patients were divided into two groups of 41 and 27 patients using F-MMA and TSS, respectively. The clinical outcomes were assessed preoperatively and at second-look arthroscopy (the mean period from surgery was one year) using the Knee injury and Osteoarthritis Outcome Score. The meniscal healing status, evaluated at second-look arthroscopy, was compared between the two groups. The cartilage damage was graded as per the classification of the International Cartilage Repair Society and compared at the primary surgery and second-look arthroscopy. Results Both groups showed significant improvement in each clinical score. No significant difference was seen in the clinical outcome scores and the meniscal healing status between the two groups at second-look arthroscopy. Moreover, no significant progression of cartilage damage was observed in both groups. Fourteen patients in the F-MMA group developed a complication of suture bar failures postoperatively; however, there were no complications in the TSS group. Conclusions The TSS and F-MMA techniques showed favourable clinical outcomes and would be established as clinically useful techniques for the MMPRT treatment.

OBJECTIVECompression of the spinal cord by thoracic ossification of the posterior longitudinal ligament (T-OPLL) often causes severe thoracic myelopathy. Although surgery is the most effective treatment for T-OPLL, problems associated with surgical intervention require resolution because surgical outcomes are not always favorable, and a small number of patients experience deterioration of their neurological status after surgery. The aim of the present study was to examine the surgery-related risk factors contributing to poor clinical outcomes for myelopathy caused by T-OPLL.METHODSData were extracted from the records of 55 patients with thoracic myelopathy due to T-OPLL at institutions in the Fukuoka Spine Group. The mean follow-up period was 5.3 years. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale. To investigate the definitive factors associated with surgical outcomes, univariate and multivariate regression analyses were performed with several patient-related and surgery-related factors, including preoperative comorbidities, radiological findings, JOA score, surgical methods, surgical outcomes, and complications.RESULTSNeurological status improved in 33 patients (60.0%) and deteriorated in 10 patients (18.2%) after surgery. The use of instrumentation was significantly associated with an improved outcome. In the comparison of surgical approaches, posterior decompression and fusion resulted in a significantly higher neurological recovery rate than did anterior decompression via a posterior approach and fusion or decompression alone. It was also found that postoperative neurological status was significantly poorer when there were fewer instrumented spinal levels than decompression levels. CSF leakage was a predictable risk factor for deterioration following surgery.CONCLUSIONSIt is important to identify preventable risk factors for poor surgical outcomes for T-OPLL. The findings of the present study suggest that intraoperative CSF leakage and a lower number of instrumented spinal fusion levels than decompression levels were exacerbating factors for the neurological improvement in T-OPLL surgery.

In Japan, microsurgical skill development and a system to transfer patients to an appropriate hospital for upper extremity amputation have been promoted; however, information about trends of replantation is limited. Therefore, the aim of this study was to clarify the trends in the treatment for upper extremity amputation using the Japan Trauma Data Bank (JTDB).Data derived from JTDB (2004-2015) were used to quantify trends in the volume of replantation for upper extremity amputation including finger amputation. Trauma was diagnosed based on the Abbreviated Injury Scale code; a subgroup of patients who underwent replantation was delineated. We investigated patient demographics, infection rate, and characteristics of treating facilities.A total of 1240 patients underwent upper extremity amputation. Among these, 510 (41.1%) underwent replantation, and the rate of replantation did not change over the study period. The average age of patients who underwent or did not undergo replantation was 45.5 and 47.2 years, respectively. The proportion of the patients who were transferred to another hospital for treatment significantly decreased between 2004 (28.5%) and 2015 (16.3%) (P 0.01). Time taken for transfer from the accident site to hospitals increased. The rate of patients who underwent replantation differed among different hospitals; however, higher-volume hospitals were more likely to perform replantation.The rate of patients transferred to another hospital decreased between 2004 and 2015; however, the rate of patients who underwent replantation remained unchanged. This suggests that the number of patients who were transported directly from the accident site to an appropriate hospital has increased, whereas the indication for care in each hospital remains unchanged. Common criteria for amputations are needed to address the differing rates of replantation among hospitals.

This article shows trends in triangular fibrocartilage complex (TFCC) repair since 1990 by geographic area and year. The repair methods presented in the literature were inside-out, outside-in, all-inside, and open repair. The outside-in technique was reported most often for ulnar-side tears, whereas the inside-out technique was reported most frequently for radial-side tears. Recently, a foveal reattachment technique for ulnar-side tears has garnered attention and has been reported with increasing frequency, especially in Asia, because the deepest portion of TFCC, attached to fovea, plays a key role in stabilizing the distal radioulnar joint. Understanding these trends can help clinicians best treat TFCC tears.

Purpose: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. Methods: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. Results: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8–12.0%, n = 45). Log-rank test revealed that previous fractures ( p = 0.003), Barthel index (BI) at discharge ( p = 0.011), and place-to-discharge ( p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking ( p = 0.007), length of hospital stay (LOS; p = 0.009), and BI ( p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI 2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS Conclusions: Previous vertebral fractures and BI 2, TCCI ≥5, smoking history, LOS

【目的】当院は200床の二次救急病院である. 救急搬送された外傷症例中, 一般外科に入院となった高エネルギー外傷症例の臨床学的特徴を明らかにした. 【対象と方法】’08. 4月-’12. 3月の4年間の全救急搬送症例7,826例中, 外科系各科に入院となった外傷症例831例を対象とした. 対象を非高エネルギー外傷群(非高エ群), 高エネルギー外傷群(高エ群)に分類し, 各々につき一般外科入院となった症例を解析した. 【結果】(1)対象831症例は非高エ群741例(89.2%), 高エ群は90例(10.8%)であった. (2)一般外科入院は非高エ群で741例中11例(1.5%), 高エ群で90例中18例(20.0%)と後者において高頻度であった(p < 0.01). (3)非高エ群9例は内臓損傷を伴わない症例であったのに対し, 高エ群18例は胸腔, 腹腔内臓器損傷を伴う症例であった. (4)高エ群18例においてISS15以上の重症患者は11例(61.1%)で，多発外傷は9例(50.0%)であった. (5)胸部, 腹部各単独損傷は6例ずつであり, 残り6例が胸腹部同時受傷であった. (6)治療法は胸腔ドレーン挿入6例, 血管造影下止血術4例, 腹部手術3例であった. (7)ISS15以上の症例の防ぎ得た外傷死は9.1%(1/11)で, 症例数は少ないものの, 三次救急病院を中心とした日本外傷データバンクの報告とほぼ同じ成績であった. 【結論】高エネルギー外傷群では, 胸腹腔内臓器損傷を来たしたために一般外科への入院となった症例が高頻度に認められた. 治療成績は概ね良好であり, 二次救急病院は地域の外傷診療体制において一定の貢献を成し得ると考えられた., Objective : We clarified the characteristics of the high energy trauma patients that entered the general surgery ward of Fukuoka city hospital (FCH), a 200 bed secondary emergency hospital in Japan. Patients and Methods : Of the 7,826 total ambulance cases treated from April 2008 to March 2012 in our emergency room, 831 trauma patients who entered our hospital were analyzed. These patients were classified into a non high energy (NHE) and high energy trauma (HE) group based on the mechanisms of injuries. Results : Of the 831 trauma cases, 741 (89.2%) were in the NHE and 90 (10.8%) were in the HE group. Eleven of the 741 cases (1.5%) in the NHE group and 18 of the 90 cases (20.0%) in the HE group entered the Department of General Surgery as inpatients, with the frequency being significantly higher in the latter group (p < 0.01). 11 of the 18 cases (61.1%) of Department of General Surgery in the HE group were diagnosed to have an injury severity score (ISS) of 15 or higher, and the rate of preventable trauma deaths (PTDs) of those 11 cases was 9.1% (1/11). Conclusions : The proportion of the patients that entered the Department of General Surgery was higher in the HE group than in the NHE group. The surgical departments of secondary emergency facilities are expected to contribute to the local trauma emergency systems.

Objective: To investigate the inhibitory effects and the regulatory mechanisms of histone deacetylase (HDAC) inhibitors on mechanical stress-induced gene expression of runt-related transcription factor (RUNX)-2 and a disintegrin and metalloproteinase with thrombospondin motif (ADAMTS)-5 in human chondrocytes. Methods: Human chondrocytes were seeded in stretch chambers at a concentration of 5 x 10(4) cells/chamber. Cells were pre-incubated with or without HDAC inhibitors (MS-275 or trichostatin A; TSA) for 12 h, followed by uniaxial cyclic tensile strain (CTS) (0.5 Hz, 10% elongation), which was applied for 30 min using the ST-140-10 system (STREX, Osaka, Japan). Total RNA was extracted and the expression of RUNX-2, ADAMTS-5, matrix metalloproteinase (MMP)-3, and MMP-13 at the mRNA and protein levels were examined by real-time polymerase chain reaction (PCR) and immunocytochemistry, respectively. The activation of diverse mitogen-activated protein kinase (MAPK) pathways with or without HDAC inhibitors during CTS was examined by western blotting. Results: HDAC inhibitors (TSA: 10 nM, MS-275: 100 nM) suppressed CTS-induced expression of RUNX-2, ADAMTS-5, and MMP-3 at both the mRNA and protein levels within 1 h. CTS-induced activation of p38 MAPK (p38), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (INK) MAPKs was downregulated by both HDAC inhibitors. Conclusion: The CTS-induced expression of RUNX-2 and ADAMTS-5 was suppressed by HDAC inhibitors via the inhibition of the MAPK pathway activation in human chondrocytes. The results of the current study suggested a novel therapeutic role for HDAC inhibitors against degenerative joint disease such as osteoarthritis.

Summary Objective To investigate the mechanism of mechanical stress-induced expression and regulation of aggrecanases and examine the role of runt-related transcription factor 2 (RUNX-2) in chondrocyte-like cells. Methods SW1353 cells were seeded onto stretch chambers at a concentration of 5×10 4 cells/chamber, and a uni-axial cyclic tensile strain (CTS) (0.5Hz, 10% stretch) was applied for 30min. Total RNA was extracted, reverse transcribed, and analyzed by polymerase chain reaction (PCR) and real-time PCR. RUNX-2 overexpression and small interfering RNA (siRNA) targeting RUNX-2 were used to investigate the role of RUNX-2 in CTS-induced gene expression. The involvement of diverse mitogen-activated protein kinase (MAPK) pathways in the activation of RUNX-2, MMP-13 and ADAMTS-5 during CTS was examined by Western blotting. Results CTS induced expression of RUNX-2 , MMP-13 , ADAMTS-4 , -5 , and -9 . Overexpression of RUNX-2 up-regulated expression of MMP-13 and ADAMTS-5 , whereas RUNX-2 siRNA resulted in significant down-regulation of mechanically-induced MMP-13 and ADAMTS-5 expression. CTS induced activation of p38 MAPK, and CTS induction of RUNX-2 , MMP-13 and ADAMTS-5 mRNA was down-regulated by the selective p38 MAPK inhibitor SB203580 but not by the p44/42 MAPK inhibitor U0126, or the JNK MAPK inhibitor JNK inhibitor II. Conclusions RUNX-2 might have a role as a key downstream mediator of p38's ability to regulate mechanical stress-induced MMP-13 and ADAMTS-5 expression.

閉鎖孔ヘルニアは非常に稀な疾患で，発症頻度は全腸管ヘルニアの0.1％である．触診や視診による診断が困難なことから治療開始が遅れ，腸管の壊死や穿孔に続発した感染症による致死率が高い疾患である．腸閉塞などの腹部症状のみならず，嵌頓した腸管によって閉鎖神経が圧迫され，下肢痛や股関節痛をしばしば認め，閉鎖孔ヘルニアに特徴的な所見である．今回我々は，左下肢痛と股関節部痛を主訴に整形外科を受診し，腹部症状のない早期に診断が可能であった症例を経験したので報告する．

今回，我々は胸椎横断性骨折により遅発性脊髄麻痺を来たした強直性脊椎骨増殖症（以下ASH）の一例を経験したので報告する．症例は71歳男性，転倒後に背部痛が出現し，近医整形外科にて第10胸椎圧迫骨折の診断にて保存的治療を受けていた．受傷後1カ月目より，両下肢の筋力低下を認め立位不能となったため，当院へ紹介受診となった．CTでは第10胸椎レベルにおける横断性骨折を，MRIでは同部での脊髄圧迫を認め，これによる脊髄麻痺と診断し後方除圧固定術を施行した．術後は徐々に下肢麻痺の改善を認め杖歩行が可能なレベルまで回復した．ASHにおける脊椎横断性骨折では骨折部に応力が集中し，さらに3 column injuryによる不安定性のため，保存的治療では骨癒合が得られにくい．その結果，本症例のように遅発性神経麻痺を生じる危険性があるため，受傷後早期の内固定術が望ましいと考えられる．

骨粗鬆症性椎体骨折後の偽関節に対する椎体形成術＋後側方固定術の治療成績を検討した．症例は10例（男性2例，女性8例），手術時年齢は73.8歳，罹患椎体高位はT12が3例，T11，L2，L3がそれぞれ2例，L1が1例であった．椎体形成術にはハイドロキシアパタイトブロックを使用した．固定椎間数は平均3.5椎間で，術後経過観察期間は平均11.7ヶ月であった．最終経過観察時，麻痺（歩行能力）の改善は良好であったが，形成椎体高に前後壁ともに平均2.5 mm，矢状面での後弯Cobb角に平均5.3°の矯正損失を認めた．重篤な全身合併症は認められなかったが，5例に術後新規の椎体骨折を認めた．後弯矯正の理想角度に関しては明確な指標がないが，本法は本疾患に対して有効な方法であると考えられた．また，新規椎体骨折の発生も含めて，術後は既存の骨粗鬆症に対する厳重な薬物療法とX線学的経過観察が重要である．

【症例】61歳，男性．約4年前にL5/S1左外側型ヘルニアに対してPLIFを施行された．術後，左下肢痛は消失するも左母趾の知覚異常が残存した．術後3年6か月経過後，左下腿外側，足背の痛みとシビレが出現し，いったんは改善するも4か月経過したころから同症状が再燃し歩行困難となった．理学所見上，左股関節外転筋と左前脛骨筋にMMT4の筋力低下を認めた．MRIにてL4椎体レベルの脊柱管内左側にT1強調像でやや高信号を呈する腫瘤影を認めた．術中所見にて同腫瘤はL45左黄色靭帯内から頭側へと連続性に進展する血腫であり，これらを全て摘出した．術後，左下肢痛は消失し筋力も回復した．【まとめ】黄色靱帯内血腫は比較的まれな疾患であるが，MRIにおける経時的な輝度変化を捉えることにより術前診断が可能であると考えらえた．

透析性破壊性脊椎骨関節症に伴う腰部脊柱管狭窄症の3例に対してセラタイトスペーサー®（ヒドロキシアパタイトカルシウムとリン酸三カルシウム複合緻密体）を用いたPLIFを施行した．手術は椎弓と下関節突起を切除した除圧術を施行して椎間板を全摘出後，スペーサーを骨破壊が比較的少ない側の椎間に挿入し，対側には局所自家骨を移植，さらに後方からペディクルスクリューシステムを用いた固定を行った．術後全例で下肢痛は消失して歩行可能となった．またXPまたはCTによる評価で，骨癒合が得られていた．骨強度が脆弱化して骨癒合の得られにくい透析性破壊性脊椎骨関節症患者のPLIFにおいて，椎間へのセラタイトスペーサー®挿入は，有用な方法であると考えられた．

腰椎の手術後に頭蓋内出血を来たした1例を経験した．症例は65歳女性．他院にてL3/4，4/5の部分椎弓切除術の既往あり，右下肢痛の再燃のために当科を受診した．腰椎MRI上，L4/5右側に椎間板ヘルニアを認め，L4/5 PLIFを施行した．術中に前回手術時の瘢痕組織上より硬膜を損傷し，少量の脳脊髄液流出を認めた．創閉鎖前に用手的胸腔内圧加圧試験を施行したが明らかな髄液の流出を認めず，損傷部は縫合せずに手術を終了した．術当日の経過は良好であったが，翌朝，頭痛，嘔吐の後，意識消失が出現し，頭部CTにて急性硬膜下血腫ならびに小脳出血を認めた．緊急開頭手術を行い，最終的には意識レベルも清明となり右下肢痛も軽快し独歩にて退院した．開頭手術時の所見にて外傷性や特発性の硬膜下出血は否定的であり，腰部髄液漏による低髄液圧から脳ヘルニア，硬膜下の静脈性出血へと至った可能性が推察された．

2004年2月～2007年9月までに化膿性腰椎椎間関節炎の4症例を経験したので，若干の文献的考察を加えて報告する．症例は男性2例，女性2例で平均年齢67歳（55～73歳）．既往歴は糖尿病1例，アルコール性肝機能障害が2例，腎盂腎炎が2例，脳梗塞後遺症が1例，高血圧症が2例で，1例は感染性心内膜炎および心臓弁膜症を合併していた．罹患椎間はそれぞれL3/4：2例，L4/5：1例，L3/4＋L4/5：1例で，すべて片側性であった．MRI脂肪抑制T2強調像が診断にきわめて有用であった．4例中1例で手術療法と術後の抗生剤投与を行い，他3例は抗生剤投与のみで治癒した．本疾患は極めて稀であるが，腰痛と発熱を呈する症例において鑑別疾患の一つとして念頭に入れておくべきである．

腰椎後方椎体間固定術（PLIF）の合併症としての脊椎炎の早期診断に MRI が有用であるか検討した．当科で PLIF を施行した18例（21椎間）について，術後2週から3週で MRI 矢状断像を撮影して評価を行った．非感染例においても高率に椎体の信号変化・終板の不整像を示し，PLIF 後の脊椎炎の診断においては術後早期の MRI は信頼性が低く，臨床経過から総合的に判断する必要があると思われた．

腰椎除圧固定術後に隣接椎間の変性が起こることはよく知られており，その結果として，隣接椎間での脊柱管狭窄や椎間板ヘルニアなどの障害が発生するという報告が散見される．そこで我々は，平成11年の1年間に腰椎除圧固定術を行った症例のうち，2年間以上経過観察可能であった66症例について，術後の隣接椎間への影響を単椎間のみ固定を行った症例と多椎間にわたり固定を行った症例（2椎間以上）の2群に分け，臨床症状，骨癒合，上位隣接椎間へ及ぼす影響に関して，この2群間で有意差があるか比較・検討を行った．今回の検討においては，多椎間固定群の方がより隣接椎間の不安定性をきたしやすいのではないかという結果であった．

We reviewed 11 cases (5 boys and 6 girls) of atlantoaxial rotatory fixation (AARF). The mean age of the patients was 6.0 years (range : 4 to 8 years) and the mean duration between symptom onset and first consultation was 5.3 days (range : 0 to 13 days). Of the patients, 10 were treated with cervical collar fixation. In these 10 patients, 2 had undergone manipulative reduction under general anesthesia because of relatively longer duration of disorder and elder age. The other one patient who was injured in a motor vehicle accident underwent manipulation and was subsequently fixed with a halo-vest. Our clinical results suggest that earlier reduction and appropriate fixation are more beneficial in patients with AARF.

We reviewed 36 patients who had been diagnosed as pyogenic spondylitis in our department between 1987 and 2002. All patients were treated conservatively at first by the administration of intravenous antibiotics and the bed rest with orthobrace. Twenty-six patients were treated by this conservative therapy alone (conservative group), and the remaining 10 were obliged to undergo operative therapy (operative group) because of the poor reaction to chemotherapy (6 cases) and the appearance of neurological deterioration (4 cases). In the conservative group, clinical results were good in 23 patients and poor in 3 patients suffering general complications including diabetes mellitus, rheumatoid arthritis and gastric cancer. In the surgical group, neurological deficits remained in 2 patients.Although the application of spinal instrumentation for osteomyelitis surgery is still controversial, it is considered to be a good modality for cases whose inflammatory signs become negative.

BACKGROUND: There is no standard therapeutic regimen for low-grade glioma (LGG). We have suggested extent of resection (EOR) was strongly associated with prognosis of LGG. About half of LGG eventually show malignant transformation (MT), MT is an important factor in determining prognosis of LGG. Therefore, it is important to definite factors associated with MT. In this study, we investigated correlation between MT and genetic profile and adjuvant therapy in LGG. METHOD: 151 patients (Male: Female = 80:71) with LGG treated in our institute from 2000 to 2010 were retrospectively analyzed. Median follow-up period was 41months, follow-up ratio was 96°, and the average age was 39.1 year-old (15-65). Diffuse astrocytoma (DA) accounted 47 patients (31°), oligodendroglioma (O) was 55 patients (37°), oligoastrocytoma (OA) was 44 patients (29°). The median Mib-1 index was 4.8°. IDH1 mutation and co-deletion of 1p19q locus were analyzed by immunohistochemistry and FISH method, respectively. RESULT: The average and median EOR of T2 high area was 85° and 95°, respectively. ACNU based chemotherapy was performed in 35 patients and radiotherapy in 48 patients. IDH1 mutation and 1p19q co-deletion were 75° and 57%, respectively. 48 patients out of 151 recurred and 29 patients were MT. Patients without IDH1 mutation (P = 0.025) or 1p19q deletion (P = 0.001) showed significant higher rate of MT. In analysis of all patients, EOR strongly correlated with MT (P = 0.0002). EOR correlated with MT in DA (P = 0.0003) but not in oligodendroglial subtypes (P = 0.7). In IDH1 mutant group, chemotherapy reduced MT (P = 0.004), however, in IDH1 wild-type group, both radiotherapy (P = 0.004) and chemotherapy (P = 0.006) brought higher incidence of MT. CONCLUSION: EOR significantly prevented MT in DA. It was suggested that IDH1 was a predictive factor for MT following radiotherapy and chemotherapy in LGG. Extensive resection is required for IDH1 wild type DA.

To investigate the inhibitory effect of hyaluronan (HA) on mechanical stress- induced expression of a disintegrin and metalloproteinase with thrombospondin type 1 motifs (ADAMTS)-4, -5 and matrix metalloproteinase (MMP)-13 by human chondrocytes.Normal human articular chondrocytes were pre-incubated with or without 1.0 mg/mL HA (2700 kDa) for 12 h at 37 °C in stretch chambers, then they were exposed to uni-axial cyclic tensile strain (CTS, 0.5 Hz, 10% elongation). The expression of ADAMTS-4, -5, and MMP-13 were analyzed by real-time polymerase chain reaction and Immunocytochemistry. The concentration of IL-1β in the supernatant was measured using enzyme-linked immunosorbent assay (ELISA). The nuclear translocation of runt-related transcription factor 2 (RUNX-2) and nuclear factor-κB (NF-κB) was examined by ELISA and immunocytochemistry, and phosphorylation of NF-κB was examined by western blotting.HA inhibited mRNA expression of ADAMTS-4, -5, and MMP13 after 24 h CTS via inhibition of IL-1β secretion and NF-κB activation. However, HA failed to inhibit CTS-induced RUNX-2 expression and subsequent expression of ADAMTS-5 and MMP-13 1 h after CTS.Our results demonstrated that HA significantly suppressed mechanical stress-induced expression of catabolic proteases by inhibition of the NF-κB-IL-1β pathway, but did not suppress mechanical stress-induced RUNX-2 signaling.

Chondrosarcoma arising from the thoracic vertebra is rare. Total excision in such cases is quite difficult because of its proximity to the vital structures such as the spinal cord, aorta, etc. Here we report two cases arising from the thoracic spine-One involved the T7 to T10 vertebral bodies and ribs and the other the T4 to T7. Both cases were histopathologically diagnosed as chondrosarcoma (Gradel) by open biopsy.The lesions were surgically removed through thoracotomy. The chest wall defects were reconstructed with Marlex meshes and posterior spinal instrumentations were employed in both cases.Preoperative detailed evaluation by MRI and CT is necessary for the surgical procedure for such tumors.

We investigated the relationships between cervical spondylotic alignment and motion in 30 patients with cervical spondylotic myelopathy or ossification posterior longitudinal ligament who underwent expansive laminoplasty. These 30 patients included 19 males and 11 females, with an average age of 59.7 years at operation. The postoperative results were evaluated by cervical lateral radiographs with a mean follow-up period of 38.3 months. We found that postoperative cervical lorodosis had a strong relationship to postoperative cervical range of motion.

To find out if we can predict postoperative instability before an operation, we measured the preoperative radiographic factors we proposed for inducing spondylolisthesis. Thirty-three patients who underwent lumbar decompression without fusion for acquired lumbar spinal canal stenosis between 1983 and 1997 were included in this study. The mean time of the postoperative observation was 30 months. Degenerative spondylolisthesis was seen in 14 patients. Postoperative slipping was seen in 5 patients. We found no relationship between each preoperative radiographic factor and the progression of slipping after lumbar decompression. Postoperative slipping had a tendency to increase if a preoperative narrowing of the disc space was present. We concluded that it is difficult to predict postoperative slipping by preoperative roentgenogram.

In this report, we discuss two cases of upper thoracic myelopathy, treated successfully with anterior decompression and fusion utilizing sternum manubrium splitting approach. When considering surgical approach to lesions around the spinal canal, lesions existing in the anterior of spinal canal can basically be treated more effectively from the anterior approach. This is especially true at the thoracic level, because of physiological kyposis of the thoracic spine. Since the conventional anterior approach is difficult for the upper thoracic spine, this approach proves very useful for the treatment of intracanal lesions at the upper thoracic level localized at the anterior of the spinal canal.

The importance of surgical resection for patients with supratentorial low-grade glioma (LGG) remains controversial. This retrospective study of patients (n = 153) treated between 2000 to 2010 at a single institution assessed whether increasing the extent of resection (EOR) was associated with improved progression-free survival (PFS) and overall survival (OS). Histological subtypes of World Health Organization grade II tumors were as follows: diffuse astrocytoma in 49 patients (32.0%), oligoastrocytoma in 45 patients (29.4%), and oligodendroglioma in 59 patients (38.6%). Median pre- and postoperative tumor volumes and median EOR were 29.0 cm(3) (range 0.7-162 cm(3)) and 1.7 cm(3) (range 0-135.7 cm(3)) and 95%, respectively. Five- and 10-year OS for all LGG patients were 95.1% and 85.4%, respectively. Eight-year OS for diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma were 70.7%, 91.2%, and 98.3%, respectively. Five-year PFS for diffuse astrocytoma, oligoastrocytoma, and oligodendroglioma were 42.6%, 71.3%, and 62.7%, respectively. Patients were divided into two groups by EOR ≥90% and

We reviewed 27 cases who underwent Cotrel-Dubousset Instrumentation (CDI) for lumbar degenerative disorders and studied the major complications encountered. Intra-operative complications experienced were pedicular fractures in 2 cases, post-operative complications were local infection, non-union of the grafted bone, instrument failure, and decubitus at the screw head in 1, 4, 6, and 1 case, respectively. To avoid these complications, it is important to restrict the indication for using instrumentation in lumbar degenerative disorders and to develop good surgical techniques.

INTRODUCTION: Currently, there is no standard therapeutic regimen for recurrent gliomas. Bevacizumab is a recombinant anti-vascular endothelial growth factor (anti-VEGF) antibody. After its approval by the US Food and Drug Administration for recurrent glioblastoma, this drug has been an emerging treatment option for recurrent gliomas; however, the European Medicines Agency has rejected the use of bevacizumab for gliomas. METHODS: We retrospectively analyzed the clinical data of bevacizumab-treated recurrent glioma patients in our department. We included 25 patients (20 men, and 5 women) with recurrent malignant gliomas, aged between 18 and 63 years (median, 39 years), who had undergone bevacizumab-based treatment between February 2009 and September 2012. RESULTS: The median follow-up period was 4 months (range, 1-17 months). The median number of bevacizumab cycles that were administered was 6 (range 1-18 cycles). All of the patients showed radiological reduction of gadorinium -enhanced lesion and 20 (83.3%) patients showed improvement of Karnofsky performance score (KPS) after bevacizumab treatment. The overall response rate was 70%. The median progression-free survival (PFS) for the entire group was 3.3 months and the 6-month PFS (PFS-6m) was 20.8%. The median overall survival (OS) and the 1-year OS (OS-1y) for all patients were 6.7 months and 33.2%, respectively. Patients with primary glioblastoma (pGB) had better OS than those with secondary glioblastoma (sGB); the median OS for pGB and sGB were 7.6, and 4.1 months, respectively (P = 0.06). CONCLUSION: Anti-angiogenic therapy using bevacizumab for recurrent gliomas appears to improve patients the activity for daily living for a few months. However, this therapy did not improve patient overall survival. Further, this therapy cannot be recommended for patients with sGB from grade II and grade III gliomas.

We studied 18 cases of idiopathic scolisis who had been surgically treated with the TSRH hook and rod system. The curve magnitudes and spinal balances in the standing radiographs were evaluated before and after surgery. The results were generally good except for the decompensation problem in the King type II curves. The TSRH hook and rod system is a good modality for the surgical treatment of scoliosis.