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腰椎黄色靱帯内血腫により根性症状と馬尾性間歇性跛行を呈した2例を報告する．症例1；71歳，男性．草刈り中に尻餅をついてから腰痛出現．腰痛軽減するも左臀部痛出現し増強．MRIにてL4/5左側に黄色靱帯と連続するT1WおよびT2Wで不均一な高信号を呈する腫瘤性病変を認めた．症例2：56歳，男性．机等の重量物を運び，数日後より腰痛・両臀部痛出現．MRIにてL3/4右側から正中にかけて黄色靱帯と連続するT1Wで淡い高信号T2Wで低信号と高信号の混在を呈する腫瘤性病変を認めた．腰椎伸展させてから症状増悪し間歇性跛行が顕著となる．MRIにて腫瘤性病変の増大，内部信号の変化を認めた．2例とも部分椎弓切除と血腫を含む黄色靱帯全切除を施行し症状は軽快した．病理組織検査では変性靱帯内に肉芽組織の形成，血腫を認めた．

From January 1996 to January 2002, we operated on 18 cases of subtrochanteric fractures of the femur, using the ¥-nail on 8 cases, CHY-nail on 5 cases, IMHS on 4 cases, and Gamma nail on 1 case. In this study, we evaluated the post-operative results of the ambulation status and alteration in X-rays. Eleven (69%) of the 16 patients who could walk before injury regained the ability to walk. In 15 patients (83%), bone union was obtained. Two cases of delayed union developed nail fracture. It is necessary to consider dynamization for delayed union. If good reduction can not be achieved, we should expose the broken bone location and reduce it.

This report describes a 53-year-old male with polyostotic fibrous dysplasia of the thoracic and lumbar spine. He had back pain in the lumbar spine for 1 month and had no evidence of any endocrine abnormality. Plain radiographs of the spine demonstrated lytic lesions from the first to the fifth lumbar spine. Computed tomogram and Magnetic Resonance Image were very useful to evaluate the expanse of the lesions. Biopsy findings confirmed the diagnosis of fibrous dysplasia.

Between 1991 and 1996, one hundred and ten hands of eighty-six patients with carpal tunnel syndrome were treated surgically and followed (mean, twenty months; range, three to sixty months). Sixteen hands were treated with open carpal tunnel release using a conventional incision from palm to forearm, and ninety-four hands using a palm alone incision.All patients were symptomatically improved following surgery. There was no neurovascular complications. Two of sixteen hands (12.5 per cent) with the conventional incision had hypertrophic scars. In contrast, all with palm alone incision had no complaints of excess scar.Carpal tunnel release using palm alone incision is a safe and simple procedure, which is not associated with any significant neurovascular complications nor discomfort in the operative scar.

Three new tetrahydrofuranoid-lignan glycosides, tanegosides A, B and C, were isolated from Trachelospermum liukiuense HATSUSIMA, along with 8 lignan glycosides already known in T. asiaticum, and the structures were elucidated by spectral and chemical methods.

Stress fracture of the sesamoid bone are quite uncommon. Specially the fibular sesamoid is more rarely injured. We experienced two stress fractures of the sesamoid bone of the great toe. The cause is a repeated microtrauma. The treatment consisted of compression bandaging and non-weight bearing. But when clinical sign continued, surgical treatment is necessary.

For the last eight years, fifty-two calcaneal fractures were treated in our hospital and forty-one of them are reviewed in this report. We made a valuation on the treatment of calcaneal fractures. We studied the interrelation between our valuation, the type of fracture, Bohler's angle and our treatment. Also, we studied the interrelation between our valuation and patients' mental factors which were checked by means of Y-G test and CMI test.

103 cases (106 joints) of malleolar fracture of the ankle were treated during past nine years in our hospital.67 cases (70 joints) were followed-up for more than six months and their prognosis was studied.The results were good in 49 joints, fair in 14 joints and poor in 7 joints.We conclude that anatomical reduction, rigid internal fixation and eary joint movement are the principal points of treatment to prevent secondary osteoarthritis.

Ninety-seven patients with supracondylar fractures of the humerus in children were treated during 11-year period from 1977 to 1987; 47 were available for follow-up assessment.Out of ten patients with poor results, nine were from ulnar displacement type fracture, and one from medial crush type fracture.To have satisfactory results, it is important to obtain good reduction, especially in coronal tilting, as soon as possible and to keep it until the enough callus formation occurs.

Children with fractures of the femoral shaft have been treated in our hospital for the past eight years; twenty-one children returned for our follow-up study. Fourteen of them were bodys and seven were girls and they injured between two and ten years of age and the term of one to seven years passed since their injury. Nineteen of them were treated conservatively and two operatively. Particular attention was paid to the overgrowth, alignment of femur, joint motion, gait pattern and complication of pain. Following conclusions were made:a) Shortening of about 10mm on average is an allowed extent.b) Lateral flexion angle of over 10 degrees and anterior-posterior flexion over 20 degrees should he avoided.c) Rotation must be avoided.

One hundred and forty-seven patients underwent anterior interbody fusion for lumbar disc derangement and lumbar spondylolisthesis. The gross fusion rate was 93% of the disc derangement and 71.5% of the spondylolisthesis. The fusion rate was related to the level of operation and to the number of discs operated on. In the patients with fifth lumbar spondylolisthesis, nonunion occurred in 50% and fusion rate was lowest. In those patients with slip rate above 30%, anterior spinal fusion with segmental spinal fusion seemed to be much better than without this. For improvement of the fusion rate, the Baycast spica is the most effective in restricting the mobility of the lower part of the lumbosacral spine. Baycast spica is used chiefly postoperatively.

Femoral head fracture associated with traumatic hip dislocation was a rare injury. However now it is becoming a more common injury as a result of traffic accident.We reported the treatment and results of 13 cases.The important factors of the femoral head fracture are the severity of the trauma and the duration of time from injury to reduction. We concluded that the incidence of both avascular necrosis of the femoral head and secondary osteoarthrosis decreased if primary open reduction was done and bone fragments and debris were removed.

Follow-up study was done for periods of one to eight years on 97 cases of lumbar disc prolapse.Of these 25 cases were operated on by the posterior route without fusion and 72 cases by the anterior route with fusion. Two groups of patients were compared from the standpoint of clinical results.The results of surgery in the former group were: excellent in 40%, good in 40%, fair in 16%, and poor in 4%, whereas those in the latter were: excellent in 44.4%, good in 33.3%, fair in 18.1% and poor in 4.2% of the patients.Between these two groups there were few significant statistical differences.

From May, 1975 to April, 1982, fifty patients of pelvic fractures with, primarily pelvic ring disruptions were treated. These fractures were classified according to the direction of force by the method devised by Pennal et al. Five representative cases were described with special reference to their pathologic and therapeutic view points. There included one open-book fracture, one ipsilateral compression fracture, one contralateral compression fracture, and two four-rami fractures of lateral compression. Following results were obtained: 1) 86% of the patients (43) had lateral compression type fractures. 2) Of lateral compression type fractures, the most common pattern was the four-rami fracture with posterior disruption comprising 44% of all fifty patients. 3) Four patients (8% of the total) showed stable open-book fractures requiring pelvic sling therapy. This number was smaller than at first expected. This study suggested that pelvic ring disruptions should be accurately classified and the grade of injury accurately estimated so that an appropriate method of therapy can be determined promptly.

The results of the treatment of six children with fractures of the neck of the femur are reviewed. Three cases were Type-II fractures and three were Type-III fractures. Four of the six cases had displaced fractures and from these, two cases with displaced Type-II fractures underwent an operation for open reduction and internal fixation. The other four cases were treated with skeletal traction or plaster spica casts. Four cases achieved good results, one fair, but the other one was por. This poor result was due to other traumatic injuries. One Type-II fracture had avrscular necrosis and premature epiphyseal closure. Coxa vara was found in two of the cases with displaced fractures. We think, undisplaced Type-II and Type-III fractures are best treated with conservative therapy.

A modified new method for funnel chest correction using Zimmer osteosynthetic plates is reported. This operative method has great advantages in the treatment of asymmetric funnel chest in adolescents and adults. This techique offers the righd and cosmetic normal chest wall.

Thirty-one children with fractures of the lateral humeral condyle were reviewed.The age the time of injury varied from one to thirteen years and the follow-up period from eight months to eight years.Bone union was achieved in all cases. Clinically all patients had normal elbows, with a full range of motion and a carrying angle almost equal to that of the other arm.Radiologically mild fish-tail deformity was observed in sixty-five percent of the patients and this deformity occurred due to incomplete reduction of the displaced fractures.Those fractures with an initial displacement of the distal fragment of three millimeters or more is recommended surgical intervention.

Long-term review of thirty-eight supracondylar humeral fractures in children demonstrated cubitus varus deformity in ten cases (26.3% of patients). The majority of cubitus varus deformity were noted in the patients treated by plaster cast. The deformity occurred more frequently in the cases with medial displacement (particularly medial tilt) than with lateral displacement. There is no case that the varus deformity occurred due to growth imbalance.

Twenty-nine hips in 27 patients of acetabular fractures were treated in our hospital. We reported the treatment and results of 27 hips in 25 patients which were followed for more than six months. Twenty hips had excellent or good results. Anatomical congruity of the acetabular fragments and stability of the hip joint are the goals of treatment.

A case of dislocation of the ankle without fracture is reported.A 20-year-old male was admitted to our hospital after a traffic accident. The diagnosis of postero-medical dislocation of the ankle without fracture was comfirmed roentgenographically.The dislocation was reduced by gentle traction without anesthesia. Check X-ray films showed a satisfactory reduction.The ankle was immobilized in a below-knee plaster and the cast was removed after six weeks. Two years and eleven months later, dorsiflexion of the ankle was lacked slightly. But, he had no complaint of pain or swelling and no instability of the ankle. Roentgenograms revealed calcifications on the medial and posterior parts of the ankle. Secondary posttraumatic osteoarthrosis is related to the prognosis of this injury, so long term follow up is necessary.