Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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Review Case Reports
Transient talipes equinus deformity of bilateral lower limbs following malignant hyperthermia: a case report and review of literature.
Malignant hyperthermia (MH) is a potentially fatal disease triggered by general anaesthesia. Four cases of compartment syndrome complicating MH have been reported. ⋯ MRI revealed high intensity in the bilateral soleus muscles but not in the gastrocnemius muscles. We discuss the possible mechanisms of the deformity of the lower limbs after the MH crisis.
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Multicenter Study
Nationwide survey on complications of spine surgery in Japan.
The Japan Spine Research Society carried out a nationwide survey on complications of the spine, enrolling a total of 16 157 patients who had undergone spine surgery in 196 institutes in the 1-year period from January to December 2001. Diseases, surgical procedures, and complications were surveyed in detail. Forty-nine percent of patients were aged 60 years or older, which was remarkably increased in comparison with the percentage reported by the 1994 survey (37.3%). ⋯ Posterior lumbar interbody fusion has been increasingly used in cases of lumbar degenerative disease. Complications of spinal surgery were reported in 1383 patients (8.6%). The incidence of complications associated with instrumentation surgery was 12.1%, being twice as much as that associated with noninstrumentation surgery (6.8%).
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The variation in symptoms of spinal nerve root damage may be caused by the difference of the size of damaged nerve fiber or difference between the mechanical influence and some chemical factors. We studied the relative vulnerability of small versus large myelinated fibers to a focal compression and/or an application of nucleus pulposus. We prepared the mechanical compression model by clipping the nerve root and the nucleus pulposus model by applying autologous nucleus pulposus on the nerve root in a rabbit and evaluated nerve root damage with respect to its fiber diameter. ⋯ Histologic study showed the number of damaged small fibers increased significantly in the compression group compared with sham after 7 days. However, in the NP group the number of damaged fibers did not increase compared with sham. In conclusion, large myelinated nerve fiber was damaged earlier than small myelinated nerve fiber by compression, while nerve fiber damage caused by only the nucleus pulposus had no relation to nerve fiber size.
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Comparative Study
Bone-preserving prosthesis with a single axis for treating osteonecrosis of the femoral head: midterm results for the thrust plate hip prosthesis.
We studied 27 patients (31 joints) who underwent total hip arthroplasty (THA) using the thrust plate hip prosthesis (TPP) for osteonecrosis of the femoral head. The mean follow-up period was 56 months (range 38-72 months). Clinical evaluation by the Merle d'Aubigne and Postel system showed a significant improvement from a preoperative mean score of 8.1 to a final mean follow-up score of 16.6. ⋯ Grade 1 stress shielding was observed in four joints. Although indications for the TPP are restricted to certain cases, unlike the conventional intramedullary stem, much can be expected of TPP. It is an outstanding prosthesis for osteonecrosis of the femoral head of young patients in terms of bone preservation and physiological load transfer.
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The purpose of this study was to determine the sensitivity and specificity for the current perception threshold (CPT) test during clinical examination of idiopathic carpal tunnel syndrome (CTS). We studied 71 patients (102 hands) with CTS; 50 healthy individuals (100 hands) served as a control group. ⋯ The sensitivity of the CPT test using both range and ratio analyses was 73%, and its specificity was 74%. Based on these results we concluded that the CPT test is a reliable quantitative sensory function test.