Masao Eto

Ultrasonographic measurement of humeral torsion

This article presents a new method for the measurement of humeral torsion with the use of ultrasonography and discusses clinical applications of the method such as the evaluation of cubitus varus deformity after a supracondylar elbow fracture. Torsion angle increased 14 degrees from the time the patients were newborns to when they were adults. No significant difference was found between the right and left sides in healthy subjects. When humeral shaft or supracondylar fractures are treated, or when rotational deformities of the humerus are corrected, this method of measurement is very practical, because the humeral torsion of the unaffected side provides a standard for the individual. With this method of measuring humeral torsion, we also found that cubitus varus deformity after supracondylar fracture in children is caused not only by an increase in varus angulation but also by internal rotation of the distal fragment.

One Example of Osteochondoroma Generating in the Cervical Vertebrae with Spinal Cord Symptoms

［はじめに］頚椎に発生し脊髄症状を呈した骨軟骨腫の一例を経験したので報告する．［症例］13歳女性．多発性骨軟骨腫の既往があり3度の摘出術（右前腕，右手，両膝）を施行されている．入院2ヶ月前より右上腕から前腕にかけてしびれ，脱力感が出現．入院1ヶ月より箸の保持困難を自覚．歩行時につまずくようになり近医受診．頚部脊柱管を狭窄する椎弓由来の腫瘍を指摘され当科入院となった．腫瘍はC5椎弓より発生，脊柱管内に達し硬膜を圧迫していた為，これによる脊髄症状と診断．腫瘍摘出術を行い，症状の著明な改善を得た．病理診断は骨軟骨腫であった．［考察］骨軟骨腫は長管骨骨幹端部に好発する良性骨腫瘍としてよく知られているが，脊椎発生はまれである．今回我々は，頚椎に発生し脊髄症状を呈した骨軟骨腫の1例を経験したので若干の文献的考察を加えて報告する．

A Case of Multiple Bone Tuberculosis with Bilateral Lower-Leg Paralysis

症例は29歳男性．14ヶ月前より頸背部痛，腰痛が出現．近医外来にて加療したが症状軽快せず，総合病院入院．頸椎から仙椎にかけての多発する溶骨性変化，Th1/2，3/4，7の硬膜外膿瘍および腸骨，肋骨に溶骨性変化を認めた．骨生検にて乾酪性肉芽腫，ラングハンス巨細胞，抗酸菌を認めたことから多発性骨結核と診断され，抗結核薬の内服を開始したが，内服加療開始後よりTh4以下のしびれが出現し，両下肢不全麻痺を呈した．約6ヶ月間の抗結核薬内服と臥位安静加療を行ったが麻痺の十分な改善が得られなかったため当科入院．Th3，4に認めた膿瘍が硬膜管を圧排しており，後方よりインストゥルメンテーションを使用した7椎間におよぶ脊椎固定術，骨移植術を施行し，症状の著明な改善を得た．術後4ヶ月で再発兆候はなく，独歩も可能となった．今回我々は，病変が極めて広範囲である稀な骨結核の1例を経験したので若干の文献的考察を加えて報告する．

Measuring the Tension of Repaired Rotator Cuff.

Our purpose is to evaluate the relation between the tension of the repaired rotator cuff, size of the tear, linear bands of the supraspinatus muscle scanned by MRI, and postoperative JOA score. The subjects were 18 patients (15 males, 3 females) with rotator cuff tear of the shoulder aged 52 to 74 years. We measured the tension of the repaired rotator cuff at the arm at the 0°, 30°, 60° abduction positions using a simple spring scale, and we classified into three grades the linear bands of the supraspinatus by MRI. As a result, there were two grade 1 shoulders, six grade 2 shoulders, and ten grade 3 shoulders. The larger tears require higher tension repair, in particular the tension when the arm was elevated by 30° and size of the tear were found to be related. No significant difference was seen between the size of the tear and the JOA score in this study for every grade.

Surgical Treatment for Cervical Spondylosis in Long-Term Hemodialysis.

Dialysis-associated spondylosis is increasingly recognized in long-term dialysis patients. We reviewed 13 patients who had dialysis-associated cervical spondylosis and required surgical treatment. There were 7 males and 6 females with an average age of 55 years (range 38 to 77). The duration of hemodialysis ranged from 8 to 26 years (mean : 17.2 years) and the follow-up time ranged from 6 months to 6 years and 9 months, averaging 3 years. We performed anterior fusions on 4 cases, laminoplasty on 7 cases, posterior fusion on 1 case and occipito-cervical fusion on 1 case. In 12 cases (excluding 1 case of AAS), we assessed the clinical results by the JOA score and the recovery rate using Hirabayashi’s method. The mean recovery rate was 46%. Eight of the 13 cases had good to excellent results, 3 had fair, and 2 poor. The cases with poor results developed by post-operative infection in the operative wound, and died at 7 and 17 months after operation respectively.

Operative results of scapular fracture

Most of the scapula fracture are usually treated conservatively, however, in some cases complications like malunion, suprascapular nerve palsy and snapping scapula occur. We carried out plate fixation for the displaced glenoid fracture, unstable neck fracture and displaced body fracture along with clavicular fracture. We investigated the factors that affected the results of these operated cases. The age of 8 patients(6 males, 2 females)with scapular fracture from 22 years to 61 years with a mean age of 48 yeaes.The mean follow-up period was 30 months. Considering the type of the fracture, 2 cases had displaced glenoid fractures, one cases had displaced body fracture along with clavicular fracture and the rest 5 cases had unstable neck fractures. We evaluated the result by using JOA score. We investigated the influence of the fracture type, the preoperative complications, period from the trauma to the beginning of elevation exercise and the JOA score. The average postoperative JOA score was 92.3 ± 10.2. The score of the patients with glenoid fracture was 77.5 ± 10.6 and that of the other fractures was 97.3 ± 2.4 and this difference between two groups was mainly due pain score. The score of the cases with complications was 90.2 ± 11.1 and that of without complications was 99 but there was no signiticant difference between two groups. There was a negative correlation between the period from the trauma to the beginning of elevation exercise and JOA score. The correlation coefficient was -0.68.