Twenty-six patients with cervical myelopathy due to spondylosis and ossification of the posterior longitudial ligament underwent cervical laminoplasty using the modified Ito's method.The mean age at surgery was 65.1 years and the mean follow-up period was 29.2 months. Clinical results were evaluated using the Japanese Orthopaedic Association (JOA) score and recovery rate of Hirabayashi's method. The average preoperative JOA score was 9.4 and improved to 14.7 postoperatively. The average recovery rate was 57.3%.Radiologically, change of alignment in the cervical spine was seen in 4 cases post-operatively. The loss of lordosis was 7 degrees. A-P diameter of the spinal canal was enlarged by 8mm postoperatively and this was preserved at final follow-up.Mobility of cervical spine was reduced to 54.5% of the preoperative range. Cervical laminoplasty by modified Ito's method is a useful procedure for treatment of cervical myelopathy.
The external variety of snapping hip is well known, but the internal variety is rare and poorly understood. We experienced a case of an internal variety of snapping hip in a young KARATE athlete. Iliopsoas bursography demonstrated that an iliopsoas tendon jerk on the iliopectineal eminence or the anterior capsule of the femoral head. It was effectively treated by partial release of the iliopsoas tendon.
Scoliotic change of the lumbar spine due to lumbar disc herniation is regarded as the sciatic scoliosis. It is generally believed that the shape of the curve is oriented as to keep the nerve root away from the herniated disc. In our study of 40 cases with lumbar disc herniation, the curves were observed in 14. In 11 out of the 14 cases with scoliosis (79%), the convex side corresponeded with the side of the herniation, and after operation the curve subsided. Therefore, we consider that most of the shape of the curve is decided whether the herniation is at the right or left side.
We performed serial MRIs after Gd-DTPA injection in 30 patients with lumbar disc herniation, and their findings were classified into the following 3 groups. Group A: no enhancement, Group B: partial enhancement, Group C: circulatory enhancement (socalled wrap-around disc). Axial area of the herniated mass in MRI and pain of the lower limbs were continuously evaluated. Decrease in lower limb pain correlated closely with reduction in the herniated mass. Regression of the herniated mass in group C occurred within two or three months, and leg pain in group C was reduced by half within two months.On the other hand, in patients with a large central herniation, reduction of the herniated mass and decrease in leg pain were hardly recognized. It is considered that enhanced MRI is useful for predicting the natural history of the lumbar herniated disc.
Blood loss is an important aspect of total knee arthroplasty. This report is a retrospective study of blood loss comparing drain-clamped and non drain-clamped cases. From September 1986 to February 1989, Miller-Galante total knee arthroplasty was performed in 34 patients (48 knees). 22 patients (32 knees) were affected with osteoarthritis, and 12 patients (16 knees) with rheumatoid arthritis. Of those. 31 patients (43 knees) were replaced without using bone cement. Of these 43 knees, the total blood loss for drain-clamped cases (19 knees) was 540±251ml (mean±sd), whereas for non drain-clamped cases (24 knees), the total blood loss was 994±301ml (mean±sd). This difference was statistically significant at p<0.01. Our study indicates that the drain-clamped method is very useful for preventing blood loss in total knee arthroplasty.
Bone metabolism abnormalities observed in liver cirrhosis are refered to as hepatic osteodystrophy. Osteodystrophy consists of osteoporosis and or osteomalacia1,2. Our study investigated the prevalence of osteoporosis in fifty patients with liver cirrhosis and searched determinant factors of bone loss.
Methods
Fifty patients (29 females and 21 males, mean age 55 years) with liver cirrhosis were enrolled in this study. The bone mineral density (BMD) was evaluated by dual energy x ray absorptiometry of the lumbar spine (L1-L4) and total hip. A detailed questionnaire was used to assess: risk factors of osteoporosis and characteristics of the cirrhotic disease (such as etiology, child-pugh stage, complications, meld score and blood samples…). Univariate analysis was used to determine correlation with low BMD.
Results
A low BMD was finding in 37 patients (74%), 25 females and 12 males. Osteoporosis (TScore≤-2,5) was noted in 20 (40%) and osteopenia (-2.5 < TScore ≤ -1) in 17 (34%) patients. Mean BMD was 0.980±0.17g/cm2 in lumbar spine and 0.900±0.32g/cm2 in total hip. Ten patients have sustained osteoporotic fracture. Etiology of cirrhosis was chronic viral hepatitis (48%), primary biliary cirrhosis (20%), primary sclerosing cholangitis (6%) and autoimmune hepatitis (4%). The cause was indeterminate in 10% of patients. In univariate analysis, a positive correlation with low BMD was noted with an age≥50 years (p=0.021), female sex (p=0.021), previous osteoporotic fracture (p=0.034), more than two complications of the cirrhotic disease (p=0.024), child-pugh stage B and C (p=0.006) and low albumin level (p=0.02).
Conclusions
The prevalence of osteoporosis in our study (40%) is concordant with literature data (20 to 56%)3,4. Determinant factors of low body mass were an age≥50, female sex, previous osteoporotic fracture, more than two complications of the cirrhotic disease, child-pugh stage B and C and low albumin level. The limits of our study were mainly the low effectif and the absence of a control group.
References
Long RG, Meinhard E, Skinner RK, Varghese Z, Wills MR, Sherlock S. Clinical, biochemical, and histological studies of osteomalacia, osteoporosis, and parathyroid function in chronic liver disease. Gut 1978:19(2):85-90. Long RG, Wills MR. Hepatic osteodystrophy. Br J Hosp Med. 1978; 20(3):312-21. Goral V, Simsek M, Mete N. hepatic ostéodystrophie and liver cirrhosis. World J Gastroenterol 2010; 16:1639-1643. German Lopez-Larramona, Alfredo J Lucendo, Sonia Gonzalez-Castillo, Jose M Tenias. Hepatic ostéodystrophie: An important matter for consideration in chronic liver disease. World J Hepatol 2011; 3 (12):300-307.
One of the problems in patients of imcomplete cervical cord injury is limb pain. We treated three cases with lumbar sympathetic ganglion block.The first case was a 61-year-old man with right leg dull pain. After the block, he became better. The second case was a 41-year-old man with left leg pain and coldness. After the block he became better. The third case was a 77-year-old man with left leg paresthesia. The effect of blocd was fair. We considered the reason that the block was imperfect, and the complaint was not pain.From now, we will treat the patient who had lower limb pain by lumbar sympathetic ganglion block.
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cg id='b'%3e%3cpath id='a' stroke='%23000' stroke-width='2' d='M-6-25H6m-12 3H6m-12 3H6'/%3e%3cuse xlink:href='%23a' y='44'/%3e%3c/g%3e%3cpath stroke='%23fff' d='M0 17v10'/%3e%3ccircle r='12' fill='%23cd2e3a'/%3e%3cpath fill='%230047a0' d='M0-12A6 6 0 0 0 0 0a6 6 0 0 1 0 12 12 12 0 0 1 0-24z'/%3e%3c/g%3e%3cg transform='rotate(-123.69)'%3e%3cuse xlink:href='%23b'/%3e%3cpath stroke='%23fff' d='M0-23.5v3M0 17v3.5m0 3v3'/%3e%3c/g%3e%3c/svg%3e)