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We report two cases with long-standing systemic lupus erythematosus (SLE) who developed widespread calcification in subcutaneous tissue and peri-articular structures. To our knowledge only 26 case reports have appeared concerning this abnormality in SLE. However, there has been no report of calcification in an SLE patient in the literature of orthopaedic surgery. The calcifications of the forearm were marginally removed because of pain surrounding them. X-ray analysis revealed that the calcification was made of pure calcium phosphate.

The objectives of this study were to measure the distribution of axial compressive elastic modulus in the lumbar intervertebral disc and to clarify the differences in distribution between normal and degenerated discs. The authors have proposed a method to measure the local compressive elastic modulus of the intervertebral disc by an indentation test. To estimate the distribution of elastic modulus, sheet specimens were sliced from cadaveric lumbar discs. Two normal and two degenerated discs were utilized to clarify the effect of disc degeneration on the distribution of elastic modulus. The degree of disc degeneration was evaluated macroscopically and radiographically. The distribution of elastic modulus in normal intervertebral discs was symmetric to the midsagittal plane. The elastic modulus in the region of the nucleus pulposus was lower than that of the annulus fibrosus, but was nearly the same as that in the posterolateral regions of the annulus fibrosus. The elastic moduli in the anterior region of the annulus fibrosus were the highest in any area of a disc. In comparison with normal discs, degenerated discs showed asymmetric and irregular distribution of elastic modulus. The elastic moduli of the degenerated nucleus pulposus and annulus fibrosus were much higher than those in the same areas of normal discs.

Between June 1987 and December 1990, an iliac crest prosthesis made of bioactive apatite- and wollastonite-containing glass ceramic (A-W·GC) was used in 60 patients for the reconstruction of the iliac crest defect after harvesting autogenous tricortical iliac bone graft. The clinical results of this prosthesis were satisfactory. No patients felt spontaneous pain in the reconstructed area, and 93% of the patients had no tenderness there. In the radiological evaluation at the final follow-up, no apparent “radiolucent clear zone” was detected at the prosthesis-iliac bone junction in 98% of the patients. Excellent new bone formation between the prosthesis and the iliac crest was also noticed in 96% of the patients. The A-W·GC iliac crest prosthesis was beneficial for reconstruction of the iliac crest defect.

The effects of freezing and stress-shielding on the mechanical properties and histology of the patellar tendon (PT) were studied with the use of 28 mature Japanese white rabbits. The PT was frozen in situ by liquid nitrogen to kill the fibroblasts and then, for stress-shielding, a stainless-steel wire, installed between the patella and the tibial tubercle, was stretched to release all tension in the PT. After being allowed unrestricted activity in their cages for 1, 2, 3, or 6 weeks, the animals were killed, and the PTs were excised for mechanical and histological study. The cross-sectional area of the frozen and stress-shielded PT started to increase significantly 1 week after the treatment and leveled off at 3 weeks. In contrast, the tensile strength and elastic modulus began to decrease significantly at 1 week, falling to 15% of the control values at 6 weeks. Histologically, cells were absent until 2 weeks after freezing and stress-shielding, although new cells appeared by 3 weeks. Splitting and fragmentation of collagen bundles were observed beginning at 2 weeks. These results indicate that complete stress-shielding led to substantial changes in the mechanical properties of the once-frozen PT, even in the absence of the tissue remodeling process by fibroblasts.

Surgery of the hip and pelvis should be performed in the light of three-dimensional concepts. We recently applied a three-dimensional 3-D milling system (MCP-70-SE; Hek, Germany), with which we obtained hands-on solid models before surgery, to the preoperative planning of hip surgery. This method was used for patients with hip dysplasia who were candidates for acetabuloplasties, including shelf operation, Chiari pelvic osteotomy, and total hip replacement. Utilizing this method, it was possible to make preoperative decisions on the level and size of the shelf in the shelf operation, on the height and size of the socket, and on the size of the acetabular bone grafting in the total hip replacement. This method was also useful as a teaching tool for residents and medical students.

High tibial osteotomy (HTO) was performed on 86 medially osteoarthritic knees in 78 patients. Twelve patients died during the follow-up period. Fifty-six knees of 51 patients were evaluated twice postoperatively: once at six years after surgery and again after ten to 15 years. Results were satisfactory in 88% of the knees at the six-year follow-up evaluation and in 63% at the post-ten-year follow-up evaluation. Ten-year follow-up results significantly deteriorated. The femorotibial angle (FTA) at the time of bone union after HTO was a significant factor that contributed to the ten-year results. In patients maintaining excellent improvement of knee function at the post-ten-year follow-up evaluation, the mean FTA at one year after surgery was 165 degrees; this value was constant through ten years after HTO. An FTA of 164 degrees-168 degrees should be attained to ensure favorable long-term results in HTO.

We have compared the value of magnetic resonance imaging (MRI) with computed tomography (CT) in assessing the extent and the localization of osteosarcomas. Twenty patients were examined by both systems, and the results related to the clinical and histological findings. While both investigations are valuable, MRI may be more useful for defining the local extent of an osteosarcoma.

The mechanical and structural properties of the patellar tendon fascicle-bone units of rabbit knees were determined by tensile tests, particularly focusing on their local differences. There were no significant differences in the strains measured by a video dimension analyzer among the proximal, middle, and distal regions of the central portion of tendon. The mechanical properties of the medial portion agreed well with those of the central portion. However, significant differences were observed in the tensile strength between the lateral and the other two portions: the tensile strength of the lateral portion was about 16 percent larger than those in the other portions.

Twenty-two patients with neurologic deficit due to delayed posttraumatic vertebral collapse after osteoporotic compression fractures of the thoracolumbar spine underwent anterior decompression and reconstruction with bioactive Apatite-Wollastonite containing glass ceramic vertebral prosthesis and Kaneda instrumentation. Eighteen patients previously had minor trauma that resulted in a mild vertebral compression fracture without any neurologic involvement and were either conservatively treated or not treated at all. Four had no history of back injury. The preoperative neurologic status was incomplete paralysis in all patients. The average age at surgery was 66 (53-79) years. The average follow-up was 34 (20-58) months after surgery. All patients had returned to their daily living with neurologic recovery and stable spine. This type of anterior procedure is effective in the osteoporotic patients and there was a very low incidence of instrumentation failure and very low morbidity.

The physical evaluation and exercise program of trunk muscles in patients with chronic low-back pain (CLBP) is still controversial. Many studies have been performed in the isometric and/or concentric contraction mode. Few data, however, have been reported on trunk-muscle strength during eccentric contraction, which plays a significant role in functional activities. To evaluate whether trunk-muscle strength on eccentric contraction could be applicable to the assessment and exercise of the patients with CLBP, trunk strength was measured in 20 healthy men and 16 healthy women, as well as 15 male and 10 female patients with CLBP. Maximum voluntary concentric and eccentric strength was measured during attempted flexion and extension in a seated position. In the healthy subjects, the maximum torque of extensors was greater than that of the flexors during both concentric and eccentric contraction (p less than 0.05). In flexors and extensors, maximum torque exerted on the eccentric contraction was always greater than that on the concentric contraction (p less than 0.05). Although strength was likely to be weaker in the patients with CLBP than in the healthy subjects, there were no statistical differences between the two groups. In terms of the flexor/extensor ratio of maximum torque, there were also no statistical significances between the two groups in either contraction mode. In the flexors, correlation coefficient (r) between concentric and eccentric torque was 0.84 for the healthy subjects and 0.48 for the CLBP subjects (p less than 0.05). In the extensors, the coefficient was 0.90 for the healthy patients and 0.71 for the CLBP patients.(ABSTRACT TRUNCATED AT 250 WORDS)

In a series of 100 modified Chiari pelvic osteotomies in ninety-six patients, who were followed for an average of nine years and three months (range, six years to fourteen years and eight months), an excellent or good clinical result was obtained in seventy-eight hips. The level of the osteotomy line on postoperative radiographs was compared with the clinical result. The average clinical result was good in seventy-four (84 per cent) of the eighty-eight patients in whom the osteotomy was at the I-I, I-II, or II-II level, according to the classification of levels by Azuma et al., but was good in only four of the twelve patients in whom the osteotomy was at another level (p = 0.0003). We found that smooth anterior and lateral coverage can be obtained by the use of a dome-shaped osteotomy line.

The purposes of this in vitro study were to analyse the three-dimensional (3D) movements of the fresh whole human lumbar spines and natural L5 spondylolysis spine to clarify the instability of this lesion. The representative values of the movements of the human whole lumbar spine were presented. In flexion, the mean values showed an increasing range of motion from L1/2 to L5/S1, and L5/S1 had the greatest motion (10.0°). In extension, similar magnitudes of motions were seen at L1/2, L2/3, L3/4, and more motion took place at L4/5 (5.6°) and L5/S1 (7.8°). In axial rotation, the maximum range of motion was under 3°. The least motion took place at L5/S1 (1.3°). In lateral bending, similar magnitudes of motions were seen on the left and right sides. The greatest motion was seen at L2/3 (7.0°) and the least motion was seen at L1/2 (4.9°). The main motions of the lumbosacral junction in the natural L5 spondylolysis specimen were 14.8° in flexion, 9.0° in extension, 7.7° in left axial rotation, 7.5° in right axial rotation, 10.7° in right lateral bending, and 7.6° in left lateral bending. The lumbosacral movements of the L5 spondylolysis specimen were bigger than those of the normal specimens in all directions. Especially the rotational instability was remarkable in the natural L5 spondylolysis specimen.

Preoperative and postoperative chemotherapies and operative techniques have been developed to control malignant bone and soft tissue tumors [1, 2]. In addition, Enneking et al. reported that a surgical staging system of musculoskeletal sarcoma had a high degree of compliance and accuracy in both surgical planning and end result studies [3]. Limb-saving procedures have been attempted for malignant tumors in the extremities, and it was found that radical oncological surgery is not always incompatible with the preservation of limb functions [4–6]. On the other hand, vascularized bone graftings (VBGs) have been applied to various orthopedic diseases, of which many excellent results have been reported [7–10]. We have performed reconstructive surgery by VBGs for bone defects after wide removal of malignant bone and soft tissue tumors in the extremities. The following is a report on the operative procedures of VBGs and the limb functions regained after such surgery.

Giant cell tumor of bone (GCT) is a distinct clinicopathological entity. However, its biological behavior and cells of origin are still controversial. Differential diagnosis of GCT and bone lesions with giant cells is most important from the radiological and histological points of view. Concerning its treatment, wide resection has been recommended by many previous workers. However, our results indicate that most GCT could be cured by curettage and bone grafting as initial treatment, thus preserving the function of the nearby joint. Regarding the histogenesis of GCT, both stroma cells and giant cells are speculated to be derived from monocyte-macrophage-osteoclast lineage, and several cytokines appear to have important roles in the activation of both stroma and giant cells.

We measured the changes in distance between the tibial and femoral attachment points of the extraarticular ACL substitute during knee motion. To measure the changes in distance continuously and directly, a com puter-assisted experimental system was developed using an electrolyte-in-rubber transducer. We used 6 cadaveric knees to measure changes in distance of 15 combinations during a simple flexion and extension knee motion. The distance became longer with flexion in each pair of attachment locations. Although the small est change in distance was obtained between the pos terolateral site of the femoral distal metaphysis and a point posterior to the Gerdy tubercle (percent average of the maximum strain was about 12%), it was con cluded that the extraarticular ACL reconstruction is not recommended from a standpoint of isometry of the substitute.

To assess the effects of stress shielding on the stress-strain behaviour of the in situ frozen tendon, which simulates an ideally oriented autogenous graft, patellar tendons (PT) of 26 Japanese white rabbits underwent in situ freezing with and without the stress shielding treatment. The patella-PT-tibia complexes excised at 3 and 6 weeks postoperatively were loaded between 0% and 3% strain. The material constants were computed by fitting the data to a constitutive equation. The material constants showed that the initial slope of the stress-strain curve of the group without stress shielding was significantly steeper than that of the group with stress shielding at 3 weeks, but not at 6 weeks. The increase in the slope of the stress-strain curve of the group without stress shielding was significantly more than that of the group with stress shielding at both 3 and 6 weeks.

Sixty-two patients with early medial compartment osteoarthritis of the knee were treated with lateral heel wedges and followed for from 7 years and 5 months to 12 years. Those who were treated with heel wedges and analgesics showed a significantly greater improvement in pain score than those treated with analgesics only, but not in the walking ability score at the second follow up. The lateral heel wedge had no effect on the progress of the radiographic changes. The lateral heel wedge is useful for patients with early medical compartment osteoarthritis provided it is used with an understanding of the indications and its limitations.

The authors examined the stability of combined distraction and compression rod instrumentation with posterolateral fusion in 40 consecutive patients with unstable degenerative spondylolisthesis. All operations were performed by floating fusion of L3-4 or L4-5 after decompression procedures. Mobility at the fused level was checked every 4 weeks after operation by the disc space angle on the functional radiographic films without brace. The average period of postoperative follow-up was 26 months. In 30 patients, no mobility was found at any time. In six patients, any mobility disappeared within 24 weeks, and in three patients, within 1 year. Pseudoarthrosis was found in one patient. The solid fusion rate was 97.5%. The values of percent slippage and slip angle were slightly improved. Lumbar lordosis was in the normal range at follow-up.

We evaluated the long-term clinical results of multiple muscle transfer for reconstruction of shoulder function in 10 patients with birth palsy. Multiple muscle transfer consists mainly of Harmon's deltoid shift, Ober's biceps muscle transfer, and Hoffer's latissimus dorsi muscle transfer. The follow-up ranged from 5 to 14 years with an average of 10.5 years. Two of the 10 patients showed no improvement, one due to severely atrophied latissimus dorsi muscle, and the other who had not received Hoffer's latissimus dorsi muscle transfer. Except for these two patients, an averaged flexion and external angles were 114 degrees and 25 degrees, respectively. Harmon's deltoid shift and Hoffer's latissimus dorsi muscle transfer for reconstruction of shoulder function in patients with birth palsy have proven to be a useful method in reconstructing and maintaining the function of active elevation and external rotation of the shoulder.

Study Design. Biomechanical evaluation was performed to investigate the stability of the thoracic spine. Unilateral resection of the intervertebral disc, the rib head joint, and the costotransverse joint were sequentially performed, and nondestructive cyclic loading tests were conducted at each injury stage to examine the roles of the intervertebral disc and the costovertebral joint of the thoracic spine. The effects of each resection were three-dimensionally analyzed as the main motion and the associated coupled motions. Objective. To examine the role of the intervertebral disc and the costovertebral joint in stability of the thoracic spine. Summary of Background Data. The effects of unilateral resection of the intervertebral disc and the costovertebral joints in the thoracic spine with the rib cage have not been documented three-dimensionally in a biomechanical study. Materials and Methods. Ten canine rib cage-thoracic spine complexes, consisting of the sixth to eighth ribs, the sternum and T5-T8 vertebrae, were used. Six pure moments along three axes, flexion-extension, lateral bending, and axial rotation, were applied to the specimen, and the angular deformation between T6-T7 was recorded by a stereophotogrammetric method. After the intact specimens were tested, staged resections were conducted in the following manner: partial resection of the T6-T7 intervertebral disc, performed as a resection of the anterior longitudinal ligament, the nucleus pulposus, and the annulus fibrosus on the approach side, leaving the posterior longitudinal ligament intact; resection of the right seventh rib head with the joint capsule: and resection of the right seventh costotransverse joint. At each stage, the main motion and associated coupled motions were determined three dimensionally. Results. The ranges of motion (ROM) in flexion-extension, lateral bending, and axial rotation were significantly increased after partial discectomy (P < 0.01). Moreover, along with large increases in the ROM of the main motions in left axial rotation and right lateral bending, coupled motions, expressed by right lateral bending and left axial rotation, showed marked increases after resection of the rib head joint (P < 0.05). The neutral zones also increased in lateral bending, axial rotation, and flexion-extension after partial discectomy (P < 0.01). A further increase in the neutral zone was observed in lateral bending after resection of the right seventh rib head (P < 0.01). Conclusions. in this canine spine model, the intervertebral disc regulates the stability of the thoracic spine in flexion-extension, lateral bending, and axial rotation. Moreover, the articulation of the rib head with the vertebral bodies provides stability to the thoracic spine in lateral bending and axial rotation. Unilateral resection of the rib head joint after partial discectomy on the same side produces significant coupled motions in lateral bending and axial rotation, resulting in a significant decrease in thoracic spinal stability, and integrity.

Long term outcome of osteochondritis dissecans of the humeral capitellum was determined for 53 patients. The average age of the patients at the time of treatment was 16.6 years (range, 10-34 years). The average followup was 12.6 years (range, 3-25 years). Seven of 14 (50%) patients who were treated conservatively and 18 of 39 (46%) who were treated by surgical removal of the fragment were found to have residual elbow symptoms associated with daily living activities (poor outcome). The initial radiographs of the elbow were available for 45 patients; a poor outcome was seen in six of 19 (32%) early lesions and 13 of 26 (50%) advanced lesions. Fourteen elbows had evidence of osteoarthritis on the initial radiographs, and a poor outcome was seen for nine (64%) of these elbows. After removal or detachment of the fragment, seven osteochondral defects were assessed as large, and all seven had a poor outcome. These long term results suggest that the residual elbow symptoms associated with daily living activities in approximately 50% of patients may be associated with advanced lesions, osteoarthritis of the elbow, and a large osteochondral defect.

Seventy-two femoral heads in 63 patients in whom avascular necrosis of the femoral head was in the early stage were followed up prospectively for a mean period of 6 years 1 month. All of the necrotic lesions were confirmed by magnetic resonance imaging. At the time of final outcome, 46 (64%) of the 72 hips were symptomatic. Necrotic lesions greater than 2/3 of the weightbearing portion on T1 weighted central coronal images indicated a high risk of clinical deterioration. Fifty-nine of the 72 hips initially had necrotic lesions greater than 2/3 of the weightbearing portion, and 44 (75%) of these 59 hips were symptomatic at the final outcome. However, in the radiographic assessment of 15 (25%) asymptomatic hips, even when the necrotic lesions were greater than 2/3 of the weightbearing portion as shown by magnetic resonance imaging, the continuous absence of any radiographic abnormality indicated the possibility of a continuous asymptomatic stage for at least several years.

Fifty-three cases of isthmic spondylolisthesis were treated with distraction rod instrumentation and posterolateral fusion with or without nerve root decompression, and they were followed for an average of 39 months. Thirty-one cases without neurologic deficit were treated with instrumentation and fusion only. In 22 cases of predominant sciatic pain with neurologic deficit signs, nerve root decompression and instrumentation with fusion were conducted. The results showed a 90.6% solid union rate with satisfactory clinical improvement. Realignment of the vertebral displacement such as reduction of olisthesis and widening of the olisthetic disc spaces was obtained to some extent. No serious complications were encountered.

✓ Four cases of calcification of the cervical ligamentum flavum are reported, all in women over 60 years of age. Neurological findings were not significantly different from those of other cervical compressive diseases. Among radiological examinations, computerized tomography was the most valuable diagnostic tool. Calcification might have been induced by the degeneration or abnormal nutritional state of the ligamentum flavum. Endocrine abnormalities and inflammatory processes might also have been contributory factors.

Prosthetic treatment procedure of the patient with diffused gingival hyperplasia is reported in this paper.When we make the prosthetic appliances for these patients, we must take their oral hygienic managements for their future into consideration.Then it is desirable to keep in contact with oral surgeon, periodontist and dental technician.The patient in this report was female of 56 year old housewife.A chief compliant was the pain and the masticatory disturbance on the lower right side of mandible.She had no family history of this disease and dilantin sodium was not taken internally.This case was diagnosed as diffused gingival hyperplasia according to pathological examination.After talking this case over with our clinical team, the treatments were determinated as follows;1. Extracting 13 teeth.2. Curratage of infected gingiva and alveolar bone.3. Plaque control.4. Endodontic therapy of remained 5 teeth.5. Making upper and lower complete dentures with OPA attachments.6. Oral hygienic evaluation with Periotron.7. Masticatory rhythms analysis with EMG and MKG.

A stress analysis of a human lumbar motion segment (L3-L4) containing two adjacent vertebrae and the intervertebral disc under compression was carried out using the finite element method. In the plane model traced precisely from an X-ray photograph, the five substructures were incorporated: each of the vertebral bodies, the annulus fibrosus, the nucleus pulposus, the anterior and the posterior ligaments. As a result, for a lumbar segment with a healthy disc, the region of highest stresses in the cortical bone was found at the center of the vertebral end plate in contact with the nucleus pulposus and at the posterior wall of the lower vertebral body. In addition, below the nucleus pulposus to the posterior wall of the lower vertebral body, the weakest region was observed in the cancellous bone. Therefore, the mechanism of burst fracture at a lumbar spine was estimated from this analysis.

The pressure exerted on the buccal and lingual polished surfaces of the lower denture from the surrounding soft tissues during various functions of the mouth was investigated to compare the standard denture (St-D) with the flange technique denture (Fl-D) . Five subjects who were missing their right and left first lower molars or more teeth participated in this study. The pressure was recorded by four miniature pressure sensors placed on the buccal and lingual polished surfaces of each side during the following movements. 1. Directed movements (jaw opening, tongue protrusion, upper and lower lips protrusion) 2. Swallowing (empty, water) 3. Chewing (right side, left side) The results were as follows: 1. The same tendency was observed in the case of the pressure between the St-D and the Fl-D during the various functional movements. 2. The Fl-D generally exerted more pressure than the St-D.

Twenty-seven burst fractures with neurologic deficits of the thoracolumbar-lumbar spine were treated with an one-stage anterior operation consisting of anterior decompression through vertebrectomy, realignment and stabilization with Zielke instrumentation (12 patients), and our new anterior instrumentation (15 patients). Only two disc spaces directly related to the injury were fused. No patient showed neurologic deterioration after surgery. All 26 patients with incomplete lesions improved postoperatively, with 19 of them entering the next Frankel subgroup. The newly designed anterior instrumentation afforded enough stability to enable early ambulation with alignment and solid fusion.

The authors describe six cases of thoracic disc disease successfully treated by anterior spinal cord decompression via the transpleural or retroperitoneal approach. The patients included two with ossification of the posterior longitudinal ligament, one with a soft disc, and three with spondylosis (two of whom had ossification of the yellow ligament at the level of the spondylosis). The lesions were situated at the Th7 to L2 levels. In all cases the protruding disc, spur, or ossified ligament was completely removed. In five cases bone grafting was performed, and in three, anterior internal fixation was accomplished with a Kaneda device. All six patients' neurological deficits improved. Thus, when neurological deficit results from anterior pressure on the dural tube at the thoracic level, anterior decompression is an effective therapeutic procedure.

The purpose of this study is to evaluate the masticatory function of the complete denture wearers by examining the foods patients can eat with the dentures. A qustionnaire with listings of 35 foods was given to 39 patients who have been wearing newly made denture for 6 months and were asked to select the answer out of the following 5 categories.mark point*can be eaten easily 2 2can be eaten with difficulty 1 1cannot be eaten 0 0I do not eat it because I dislike it Δ 0I have never eaten it since wearing of denture 0The results were as follows:1. Each answer was given a score (2, 1, 0). 35 foods were classified into 5 grades showing the difficulty by each total scores.2. The“ standard masticatory ability of complete denture wearers ” was established as the diagnostic criteria by calculating the rate of food-taking ability in each grade.3. Masticatory ability of each individual was shown as the “ masticatory score”.4. Applying this qustionnaire to the alveoplasty case, the rate of food-taking ability and the masticatory score were correlated with masticatory ability and it was suggested that the qustionnaire was useful for the evaluation of the masticatory function.