日本リウマチ・関節外科学会雑誌
Online ISSN : 1884-9059
Print ISSN : 0287-3214
ISSN-L : 0287-3214
19 巻, 3-4 号
選択された号の論文の13件中1~13を表示しています
  • 佛淵 孝夫
    2000 年 19 巻 3-4 号 p. 171-174
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
  • -A Biomechanical Study-
    Yasunori SUDA, Hideo MATSUMOTO, Toshiro OTANI, Yasuo NIKI, Kyosuke FUJ ...
    2000 年 19 巻 3-4 号 p. 175-180
    発行日: 2001/02/25
    公開日: 2010/12/10
    ジャーナル フリー
    The effect of isolated posterior Cruciate ligament (PCL) reconstruction to eliminate combined posterior instability and posterolateral rotatory knee instability was investigated experimentally, using four anatomical knee specimens. The magnitudes of posterior tibial translation and of external tibial rotation were measured at flexion angles between 0°and 90°, under a 147 Newton (N) posteriorly directed force applied on the tibia. Measurements were made at four stages: firstly with all the ligaments preserved, secondly after complete sectioning of both the PCL and posterolateral structures (PLS), thirdly after reconstruction of the PCL, and finally after reconstruction of the PLS. Isolated PCL reconstruction significantly reduced both posterior translation and coupled external rotation at all flexion angles except 30°, but increases in posterior translation (7.0-9.5mm) and in external rotation (11.5-21.5°) remained. These increases then disappeared after PLS reconstruction. Therefore, it was concluded that both the PCL and PLS must be reconstructed to eliminate this combined instability.
  • Eisuke SHONO, Masatoshi NAITO
    2000 年 19 巻 3-4 号 p. 181-183
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    Total elbow arthroplasty (TEA) may be indicated for elbows damaged by rheumatoid arthritis (RA), and sufficient joint function is often obtained. This is a report of treatment of a patient who suffered from ulnar never paralysis and joint contracture following TEA for the treatment of RA. Corrective surgery of the elbow joint and neurolysis of the ulnar never were done to relieve the pain and sensory dysfunction, improve the articular range of motion, and ease the disabilities associated with daily activities. The patient was well satisfied with the outcome.
    Accurate and precise surgical technique in TEA in very important in achieving a satisfactory outcome. The risk of early postoperative complications, such as ulnar nerve palsy, can be minimized by skillful technique.
  • 澤井 宏和, 田窪 伸夫, 小西 義克, 山田 一人, 仲田 三平, 山本 純己
    2000 年 19 巻 3-4 号 p. 185-190
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    Objective: Patients with inflammatory arthritis pose unique systemic problems because of the possibility of inflammatory involvement of many organs, especially the lungs, heart, gastrointestinal tract, and kidneys, so it is very important to recognize preperative complications, to facilitate an uncomplicated operative course.
    The aim of this study was to evaluate general complications in patients who were to have total joint replacements.
    Methods: 451 patients (301 patients with rheumatoid arthritis, 149 patients with osteoarthritis) who were admitted to have hip or knee arthroplasty were submitted to electrocardiogram, echocardiogram, intravenous dipyridamole stress thallium myocardial perfusion imaging, computed tomography of the upper intestinal organs and the lungs, upper gastrointestinal fiberscopy, and 75g oral glucose tolerance test.
    Results: 70% of the patients had some preoperative medical problems; in particular. ischemic heart disease and impaired glucose tolerance were not recognized before this assessment. There were no significant differences between RA and OA patients in that report.
    The rheumatologist must make thorough evaluations of systemic complications preoperatively in patients who are going to have total joint replacement, and interact closely with anesthesiologists and physicians to facilitate an uncomplicated operative course.
  • 崎原 春幸
    2000 年 19 巻 3-4 号 p. 191-195
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    From 1994 to 1998, at Hitachi Ltd., Taga General Hospital, 12 hips of 11 rheumatoid arthritis (RA) patients with protrusio acetabuli were treated with total hip arthroplasty (THA) using a socket implant technique. The surgical procedure was done in three stages.
    Firstly, the acetabular rim was reamed out to make a seat for the bearing-socket, using a reamer slightly larger than the original rim (mean size 4.9 mm larger) .
    Secondly, morsellized bone was grafted into the acetabular bottom.
    Thirdly, a socket 1-2 mm larger than the reamer was implanted without cement, and fixed with 3 screws.
    Clinical results, assessed by JOA hip scores, showed improvement (from a mean of 23.3 before THA to a mean of 69.3 after THA) . X-P films showed that trabecular bridging of graft bone occurred in a mean of 46.3 days, and that trabecular reorientation of graft bone occurred in a mean of 153.3 days. Resorption of graft bone, and socket migration were not found.
    These results seem satisfactory.
  • 長岡 亜紀子, 中澤 明尋, 酒井 直隆, 竹内 良平, 高木 敏貴, 斎藤 知行, 岡本 連三, 腰野 富久
    2000 年 19 巻 3-4 号 p. 197-202
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    The purpose of this study was to describe the clinical course of steroid induced osteonecrosis of the humeral head, and to investigate the relationship between radiological stage, pain, and range of motion (ROM) .
    Nine patients (16 shoulders) were examined directly at our out-patient clinic, with an average follow-up period of 4.2 years. There were 2 men and 7 women, with an average age of 42 years at the first visit. Correlation between radiological stage and both pain and ROM of the shoulder was evaluated with Spearman's rank correlation coefficient.
    At the first examination, 9 of 16 shoulders were evaluated as radiological Stage III or IV, and only 7 as II. During follow-up, the stage advanced from Stage III to IV in 2 of 5 shoulders, but no advance-ment from Stage II to III was observed. Thus, the radiological stage did not progress in a time-dependent manner. A positive correlation was found between radiological stage and pain grade (p<0.0001), and between that and limitation of active movement (p=0.0064) .
  • ―Anteriorly joined typeとPosterior cruciate typeの比較―
    伊藤 淳, 岡本 連三, 三ツ木 直人, 高木 敏貴, 腰野 富久, 斉藤 知行
    2000 年 19 巻 3-4 号 p. 203-210
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    We evaluated 17 rheumatoid knees, followed-up over 15 years, after total knee arthroplasty without patella replacement. All cases were women. Ten knees (AJ group) were replaced with an anteriorly joined type, and seven knees (PCR group) were replaced with posterior cruciate retention type of kinematic prostheses. The average age at surgery was 47.5 years (range 30 to 62) in the AJ group and 46.9 years (range 43 to 52) in the PCR group.The average follow-up periods were 15.4 years (range 15 to 17) in the AJ group and 15.9 years (range 15 to 18) in the PCR group. Knee functions were evaluated according to the criteria of the Japanese Orthopaedic Association (JOA score) . The average ROM preoperatively was 40°-108.7°in the AJ group, 14.8°-99.5°in the PCR group. The average ROM postoperatively was 0°-100°in th AJ group, -2.8°-104.2°in the PCR group. The mean total JOA score for the AJ group was 37.0 (range 13 to 48) preoperatively, 73.5 (range 43 to 88) postoperatively. The mean total JOA score for the PCR group was 42.7 (range 26 to 51) preoperatively, 80.0 (range 56 to 89) postoperatively in the PCR group. The total scores improved from 10 preoperatively (poor) to 5 (excellent) at last follow-up in the AJ group, and 7 (poor) to 4 (excellent) in the PCR group. The patella was resurfaced in one knee in the AJ group and 4 knees in the PCR group later. The results.suggested that knee function was well maintained over 15 years from surgery.
  • ―リウマチ症例と非リウマチ症例との比較―
    関矢 仁, 坂口 亮人, 刈谷 裕成, 星野 雄一
    2000 年 19 巻 3-4 号 p. 211-214
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    We evaluated the radiological changes after total hip arthroplasty using hydroxyapatite (HA) granules around the femoral components in 10 hip joints with rheumatoid arthritis and in 51 hips with osteoarthritis or femoral head necrosis. The average postoperative observation periods were 6.5 years and 6.4 years, respectively. We used HA granules, aiming to prevent micro-motion of the femoral component. As a result, loosening of the femoral stem was found in 10% of both groups. Bone atrophy at the greater trochanter was found in 80% of both groups, and the atrophy was thought to be a sign of stress shielding. The wear-rate of HDP was 0.18 millimeters per year, and that rate rate was identical with previous reports. We thought the use of HA granule around the femoral stem might reduce the incidence of loosening of the femoral stem, and use of HA granules might not increase the wear-rate of HDP, but the incidence of stress shielding might be increased with the use of HA granules.
  • 尾木 祐子, 牛山 敏夫, 井上 康二, 川崎 拓, 江川 雅章, 福田 眞輔
    2000 年 19 巻 3-4 号 p. 215-220
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    We present 3 cases of patients with rheumatoid arthritis who developed spontaneous fracture of the femoral neck within 3 months after total knee arthroplasty (TKA) . One patient had bilateral spontaneous fracture of the femoral neck after bilateral TKA. All the patients were female, with osteoporosis, aged from 57 to 68. Before TKA, they had severe limitation of walking, due to knee pain, for several months. Postoperatively, they gained pain relief and recovery of walking ability with a cane.
    Osteoporosis and increased walking activities after TKA are thought to be the main etiologic factors for the fractures. When TKA is done in patients with osteoporosis and a prolonged limitation of walking, gradual return to full weight bearing and daily activities should be considered, to prevent spontaneous fracture of the femoral neck that occurs in about 1 % as a complication after TKA.
  • 藤井 英紀, 安藤 義博, 石川 斉
    2000 年 19 巻 3-4 号 p. 221-225
    発行日: 2001/02/25
    公開日: 2010/10/07
    ジャーナル フリー
    A case of osteochondritis dissecans (OCD) accompanied by localized pigmented villonodular synovitis (LPVS) in the ankle joint is reported.
    At first, this fifteen-year-old girl with a locking-type complaint was diagnosed as suffering OCD, and LPVS was overlooked, because a synovial nodule could not be seen by X-ray films and CT, and was too small to be found by arthroscopy and MRI. At the operation we found no osteochondral fragment, but a small synovial mass (LPVS) which impinged into the tibiotalar joint. This patient's symptoms disap-peared after removal of the LPVS lesion.
    PVS commonly occurs in the knee and the hip joint, while only about five percent of these lesions are reported as involving the ankle. Although LPVS and diffuse-type PVS have identical pathology, the clinical manifestations of these subtypes are quite different. From a therapeutic standpoint, LPVS is non-aggressive and can be treated by simple excision, but diagnosis of this lesion is sometimes not easy.
    Although early use of MRI and arthroscopy are useful to diagnose many joint diseases, surgeons should keep in mind the presence of an“overlap-lesion”like this case.
  • 2000 年 19 巻 3-4 号 p. e1a
    発行日: 2000年
    公開日: 2010/10/07
    ジャーナル フリー
  • 2000 年 19 巻 3-4 号 p. e1b
    発行日: 2000年
    公開日: 2010/10/07
    ジャーナル フリー
  • 2000 年 19 巻 3-4 号 p. e1c
    発行日: 2000年
    公開日: 2010/10/07
    ジャーナル フリー
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