ADL and QOL in Patients with Osteoporosis…Hiroshi HAGINO, Mari OZAKI, Hideki YAMASHITA, Mika YAMAWAKI 481

Risk Factors for Fracture : Making a Diagnosis from the Viewpoint of Vitamin D and Vitamin K Insufficiency…Mayumi SAKUMA, Naoto ENDO, Kana AOKI, Shinji KIMURA 484

Therapeutic Exercise for Osteoporotic Fracture Prevention : Improving Muscular Strength and Balance…Naohisa MIYAKOSHI, Michio HONGO, Yoshinori ISHIKAWA, Yoichi SHIMADA 488

Osteoporosis Management : Current Pharmacological Therapy…Tomoaki YAMAMOTO 492

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Current Trends in treating Incomplete Spinal Cord Injuries in Elderly Patients…Mikio SUMIDA 495

Evaluating the Severity of Acute Spinal Cord Injuries using Blood Biomarkers…Toru OGATA, Kazuhito MORIOKA, Yoshiko TOBIMATSU, Kozo NAKAMURA, Masami AKAI, Rentaro OKAZAKI, Kentaro HAYAKAWA, Takaaki UENO 501

Diagnostic Criteria of Traumatic Cervical Central Cord Syndrome and the Rehabilitation Outcomes…Toshikatsu TOMINAGA 504

Robot-assisted Gait Training in Persons with Incomplete Spinal Cord Injury…Futoshi WADA 508

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Pharmacological classification, based on a so-called drug challenge test (DCT), is one method to evaluate intractable pain following experimental administration of medicines. In this scenario, the appropriate medicine is prescribed for a patient with intractable pain based on the result of the DCT. A 61-year-old man was healthy until 2003, when he sustained a brachial plexus injury caused by a gas explosion. He had experienced fulgurant pain in his left upper limb since 2006, and had undergone stellate ganglion blocks, and treatment with amitriptyline. He was admitted for further treatment in 2010 because these treatments did not alleviate his fulgurant pain. He could not move his shoulder, elbow, wrist and fingers because of severe paralysis and arthrodesis of his left shoulder joint, and complained of fulgurant pain and persistent dullness in his left upper limb. He was diagnosed to have complex regional pain syndrome (CRPS) due to the brachial plexus injury, and electromyographic examinations showed evidence of a partial regrowth after sural nerve transplantation. Gabapentin was prescribed for the patient's CRPS based on the remarkable effect of thiamilal on this fulgurant pain. The frequency of the fulgurant pain decreased following the initiation of gabapentin therapy, and the persistent dullness disappeared. DCT is recommended for patients with intractable pain such as CRPS, in addition to neurological and electromyographic examinations, in order to elucidate the details of the pain and select the appropriate medication.

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When treating coxarthrosis, each treatment method including conservative treatment, osteotomy, or artificial joint replacement, has an optimal stage for treatment of the disease. Joint preservation surgery has a good result for cases in the early stage, but total hip arthroplasty (THA) is selected for advanced stage hip osteoarthritis, and in Japan, more than a 40000 THAs are performed each year. Good postoperative results lasting up to 15 years are reported today, but, on the other hand, postoperative problems still clearly exist. Deep venous thrombosis/pulmonary embolism (VTE/PTE) are given as perioperative problems, and postoperative dislocation and postoperative range of motion of the hip joint are given as the problems that most relate to ADL. These days, information about THA is abundant so that there is extensive demand for the procedure amongst patients, and elevated technique is demanded of the surgeon. The onset of postoperative VTE/PTE as a lethal complication and interest about its prevention have risen these days with the increase in the number of artificial joint replacements performed in Japan. This time, we introduce a postoperative THA rehabilitation schedule and report the results of our postoperative complication prevention efforts carried out in our hospital. When THA of late years is thought about, for a patient, it is natural that the long-term results are good, and the postoperative satisfaction degree from an early stage is the demand that it is necessary. In consideration of these things, the range of hip motion needed about the origin and preventing dislocation that were one element of long-term satisfaction since only a short-term of normal ADL movement was investigated, and this was viewed from the aspect of joint stability against postoperative dislocation by difference in the approach method of surgery. Finally, we also discussed the importance of early rehabilitation after surgery for the prevention of VTE/PTE as a serious complication of surgery.

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