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雄賀多 聡, H. K. Uhthoff
1991 年 15 巻 1 号 p.
1-3
発行日: 1991/09/01
公開日: 2012/11/20
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An embryologic study of the early development of the human clavicle was carried out. Serial sections were obtained from 11 embryos and fetuses, and non-serial sections from 35 embryos and fetuses. We could confirm that the clavicle is formed primarily by two membranous ossification centers which appear by the 6th week of gestation. They fuse approximately 1 week later. Then cartilage develops at both ends of the clavicle, which contributes to its growth in length. The differences in the rate of endochondral ossification at both ends of the clavicle, lead to the characteristic shape of the clavicle. Thus, we believe the junction at the lateral and the second third of the clavicle is the site where primary ossification centers appear.
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動的支持機構のセンサーとして
村上 元庸, 小島 保二, 前田 敏博, 牧川 方昭, 福田 眞輔
1991 年 15 巻 1 号 p.
4-8
発行日: 1991/09/01
公開日: 2012/11/20
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Sensory nerve endings in the monkey shoulder joint capsule were observed by light microscopy. The nerve staining technique was based upon Tago's method which was very sensitive for acetylcholinesterase (Ach E) existing in the peripheral nerve.
Three distinct sensory nerve endings have b een identified: free nerve endings, Ruffini-type corpuscles, and Pacini-type corpuscles.
Ruffini-typc corpuscles a n d Pacini-type corpuscles, which were thought to act as mechanoreceptors, were mainly localized in the transitional portion between the labrum and the capsule, but not within the labrum.
Free ne r ve endiings, which may function as nociceptors (Pain), were distributed widely in the capsule and also in th labrum.
As the results demo n strated that may mechanoreceptors exist in the capsule, it is presumed that the capsule acts not only as a static stabilizer, but also as a sensory apparatus for stress, and plays an important role in the dynamic stabilizing system. It seems that the location of the mcchanoreceptors is the optimum place for sensors to respond to the resultant force which dislocates the humeral head.
Finally, we hypothesize that the dynamic stabilizing effect is performed by a series of reflex effects from the capsule to the surrounding muscle of the shoulder.
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肉眼解剖による検索より
肱岡 昭彦, 鈴木 勝己, 小林 靖幸, 北條 暉幸, 中島 民治
1991 年 15 巻 1 号 p.
9-12
発行日: 1991/09/01
公開日: 2012/11/20
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Abnormal insertions of the pectoralis minor have been reported on by many authors, Most have dealt with its extending beyond the coracoid process and attaching itself to the capsule. We, however, studied the relationship between abnomal insertions of this muscle and the coracohumeral ligament.
53 cadavers, i. e.106 shoulders were examined in this study,38 males and 15 females. The age of the cadavers ranged from 43 to 93, with mean age of 67.5 years.
Abnomal insertions were found in 26 of the 53 cadavers and 39 of the 106 shoulders. This abnormality presented itself more often in females than in males.
The coracohumeral ligament it usualy know as the ligament which occurs from the coracoid and is inserted in the humerus, but in our study this ligament did not clearly exist.
In conclusion, we consider the coracohumeral ligament to be a residual l igament of the pectoralis minor or connective tissues in a part of the capsule.
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筒井 廣明, 山本 龍二, 安楽 岩嗣, 三原 研一, 今里 有紀彦, 保刈 成
1991 年 15 巻 1 号 p.
13-17
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
The shoulder joint is the most mobile joint in the body combined with a small glenoid and a large humeral head. This joint has been thought to be an unstable joint because of its anatomical structure and the recurrence rate from initial dislocations. Our opinion of this joint is that it has most distinguished stabilizing mechanisms for keeping a wide range of motion.
1. The first stabilizing mechanism
This mechanism is the bony combination of the radius between the glenoid cavity and the humeral head. The anatomical study showed the radius of a cross section of the glenoid was 16.8 mm and of the humeral head 22 mm. The computation of the maximum permissible kinetic vector that enables the humeral head to be on the glenoid was 43°.
2. The second stabilizing mechanism
The second mechanism is the function of the anterior capsule including the inferior glenohumeral ligament.
The anterior capsule works involuntary in both its tension and direction as the centripetal force does against the shear force.
3. The disadvantages of these two stabilizing mechanisms
The disadvantages of these two stabilizing mechanisms are; - Inefficiency against the increased anterior kinetic vector during the positioning of the upper extremities vertically against the glenoid
- The decrease of bony structural intensity compared with other joints such as the hip joint.
4. The third stabilizing mechanism
The third stabildzing mechanism is the function of the shoulder girdle.
Its first function is the mobility of the scapula working as shock ab s orber against the share force that falls on the glenohumeral joint.
The second is the function of the shoulder girdle muscles such as the pectoralis major and the deltoid.
In conclusion, therefore, a normal shoulder joint should be the most distinguished joint with these stabilizing mechanisms physically and anatomically maintaining a wide range of motion.
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浦川 正人, 安水 斉, 川島 明, 池田 均, 塚西 茂昭, 信原 克哉, 田中 道夫
1991 年 15 巻 1 号 p.
18-21
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Three dimensional roentogenographic video images of humeral heads were measured and analyzed using a fluoroscope and microcomputer. The subjects were forty healthy right shoulders of males aged between 23 and 39 years ( mean 28.6 ). They were supined on a table with their arms at 90 degrees abducted position, and the shape of the humeral head was photographed by rotating a fluoroscope around the humeral axis in a 180-degree-arc and recorded on a video tape. The relationship between the videotaped images and the angles were recorded by a NAC SELGRAPH 2D SYSTEM. Thity-six images at intervals of five degrees were sampled and each image was analyzed by a PIAS LA500 image analyzing system. Assuming that the surface of the humeral head was an ellipsoid, approximate equations were calculated. Furthermore, the humeral head was divided into four zones according to the major and minor axes, and approximate equations of these were also calculated.
The humeral head is described as having a similar shape to a spheroid with its rotational axis on the long diameter of te humeral head. It is inferred that this was produced by functionally leaving the most important shape from the original spherical joint in the progress of walking from all fours to two feet. The division of the humeral head into four zones resulted in each zone showing a shape different from each of the others. The posterosuperior, posteroinferior, and anterosuperior zones were spheroids, whereas only the anteroinferior zone showed an irregular shape without any fixed rotational axis. This suggests a marked lack of stability of the humeral head to the glenoid in the internal rotation position of the first plane. It is presumed that in recurrent dislocated shoulders, this area copes with an organic change of the labrum and the shape of this area contributes to the instability.
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A three dimensional roentgenographic study
川島 明, 小西 誠二, 浦川 正人, 松本 真一, 金谷 整亮, 信原 克哉
1991 年 15 巻 1 号 p.
22-27
発行日: 1991/09/01
公開日: 2012/11/20
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Objective: This is a preliminary study to understand better the pathology of fractures in which the proximal humeral epiphyseal plate is involved. The contour of the proximal humeral epiphyseal plate was analysed utilizing a three dimensional roentgenographic video image system.
Methods: Eighteen projections of the proximal humeral epiphyseal plate at every 10-degreerotation were obtained and analysed using a NAC SELGRAPH 2D SYSTEM and PIAS LA-500.
Material: The subjects were sixty healthy shoulders, the age distribution was from 8 to 18 years and the average was 12.9 years.
Results and Discussion: Our result revealed that the proximal humeral epiphyseal plate was conical in shape in face view and trapezoid in side view, and convex inthe humeral head, concave in the greater tuberosity and flat in the lesser tuberosity.
The inclination of the proximal humeral epiphyseal plate in the humeral head and the greater tuberosity becomes maximum on the anatomical axis.
The apex line of the proximal humeral epiphy s e al plate crosses the functional axis at the right angles.
The ratio of the height of the proximal humeral epiphyseal plate in the humeral head to its base increases with growth.
The curvature of the proximal humeral epiphyseal plate in the humeral head also increases with growth. The head-shaft angle decreases with growth. It is dynamically advantageous that the shape of the proximal humeral epiphyseal plate is convex in the humeral head which is the pressure epiphysis and concave in the greater tuberosity which is the traction epiphysis. We conclude that these characteristic shapes are necessary for a wide range of motion and two main functions of the shoulder, namely the hanging joint and the joint needing support.
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田中 誠, 土屋 正光, 武田 修一, H. Hasegawa, H. Ikeda, 森脇 正之, 中川 照彦
1991 年 15 巻 1 号 p.
28-32
発行日: 1991/09/01
公開日: 2012/11/20
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Shoulder instability is a cause of shoulder disorder. Although stress x-p has been used to measure the sinking rate of the head in inferior instability, it had to date not been for evaluating antero-posterior instability. Therefore, we used stress x-p to do so.
Thirty-nine cases ( 78 joints ) were classified into four groups: recurrent dislocation ( 5 joints in 5 cases), subluxation ( 5 joints in 5 cases ), professional baseball players ( 20 joints in 10 cases ), loose shoulder ( 16 joints in 11 cases ), controls ( 32 joints 19 cases ).
After checking shoulder instability manually, anterior instability was measured by x-p. The patients were prone, shoulder abduction was at 90 degrees with no rotation, in the scapular plane and a 5 kg weight in the humeral subcapital region. Posterior instability was examined with the patients supine. We calculated the displacement of the humeral head center after applying a 5 kg weight. Simultaneously, we measured the sinking rate of the head to investigate the correlation between a -p instability and inferior instability.
The group with subluxation show e d greater anterior displacement than did the controls.
The group with loose shoulder showed greater posterior displacement than did the controls.
Groups with subluxation, professional baseball players and loose shoulders showed a greater inferior displacement than did the controls.
There was no apparent correlation b etween a-p and inferior instability.
We suggest that the moving rate of the head in a-p instability shoulders is over 10 %.
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保刈 成, 安楽 岩嗣, 山本 龍二, 三原 研一, 今里 有紀彦, 筒井 廣明
1991 年 15 巻 1 号 p.
33-36
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
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Many studies concerning shoulder instability have been reported. But, there are few studies of the micromovement in the glenohumeral joint. We investigated the micro movement of the shoulder joint based on cineradiography.
We examine d 15 cases ( 5 were normal and 10 had instability ). We measured the glenohumeral angle and the arm angle of each 50 cineradiograms per second during elevation and depression of the arm in the scapular plane.
In the normal gro u p, both the changes of the glenohumeral angle and the arm angle demonstrated a smooth curve. In the instabillity group, the change of the arm angle demonstrated a smooth curve, but that of the glenohumeral angle clearly drew an irregular curve.
Our results proved that instability in the gleno-humeral joint d u ring shoulder motion makes articular cartilagenous lesions occur in unstable shoulders.
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池田 正樹, 広瀬 方志
1991 年 15 巻 1 号 p.
37-41
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
There are some shoulder joint problems in cerebral palsy, such as instability in athetotic cases, but there are few reports on them.
In order to clarify the basic states of the shoulder in cerebral palsy, we investigated the following physical findings ( ROM, tenderness and the instability test ) and analysed X -rays ( loosening of the humeral head-Endo, the glenohumeral angle-Hanamura et al, the glenohumeral index-Saha, instability of the shoulder-Ozaki ) in 22 athetotic patients and 33 spastic patients.
1. Instability and tenderness of the shoulder joint were frequent in athetotic cases.
2. Analyses of the X-rays supported this instability of the shoulder joint in a thetotic cases.
3. On examination of the glenohumeral index, there was no evidence of glenoid dysplasia.
These results suggest that the pathogenesis of unstable shoulders in athetotic type of cerebral palsy is related with looseness of the capsule and the tendon in the shoulder joint caused by muscle tension imbalance or an abnormal pattern.
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鈴木 隆之, 山本 龍二, 土持 綱正, 今里 有紀彦, 平川 誠, 黒木 良克, 三笠 元彦
1991 年 15 巻 1 号 p.
42-44
発行日: 1991/09/01
公開日: 2012/11/20
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The present study was undertaken to investigate the biochemical characteristics of collagen in the capsule and skin from patients with Ehlers-Danlos syndrome ( E-D ).
1. Collagen was extracted from human joint capsule and skin in 2 case s with E-D aged 26 and 38years old.
2. The amounts of collagen in the joint capsules; 10-15 %, the skin; 20-25 % per tissue wet weight.
3. The amount of soluble collagen in the joint capsules and the skin were 1.5-2.0 %.
4. The amounts of reducible cross-links in every tissue were richer in E-D thas in th e L-S. But the skin results were similar to those in the L-S with a re-operation.
5. These data were different from the biochemical c hanges of collagen in canine joint capsules and muscles in traumatic dislocations.
6. These suggest that the biochemical characteristics of collagen in the L-S are similar to those in E-D, especially in the L-S with a re-operation.
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今里 有紀彦, 山田 勝久, 蜂谷 将史, 山本 龍二, 土持 綱正, 鈴木 隆之, 平川 誠, 筒井 廣明, 黒木 良克
1991 年 15 巻 1 号 p.
45-48
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
The present study has been performed to investigate the biochemical and pathophysiological characteristics of capsules, the glenoid labrum, the deltoid, the major pectoral muscles and the skin of normal shoulders and loose shoulders.
1. Human shoulder, elbow, h ip, and knee joint capsules, and the glenoid labrum, the acetabular limbus, deltoid muscles, major pectoral muscles ad skin were obtained from 8 case immediately after their accidental death ranging in age from 16 to 26 years old,8 cases with loose shoulder ranged in age from 14 to 21 years old.
2. Collagen from shoul der joint capsules and the glenoid labrum produce relatively immature collagen fibers compared with other joint tissues.
3. Collagen from capsules and deltoid muscles in the loose shoulder produce relatively more immature collagen fibers than normal shoulder joint.
4. In re-operation cases of loose shoulder, the collagen fibers were more immature.
5. Muscle tissues in loose shoulder had marked characteristic pathophysiolo gical changes compared with the normal shoulder.
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松井 猛, 町田 拓也, 隅田 潤, 島野 晃, 下川 寛一, 大井 宏一, 木村 展生
1991 年 15 巻 1 号 p.
49-51
発行日: 1991/09/01
公開日: 2012/11/20
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To simplify subacromial bumsography, we injected a contrast medium ( a mixture of 5 ml of 60% Urographin,4 ml of 1 % Lidocaine and 4 mg of Decadron ) into the subacromial bursa without using X-ray television control, then several X-rays of the shotilder were taken within ten minutes.
56 shoulders of 51 patients were examined over a pariod starting on October 1, 1989, to September 1, 1990 at our outpatient consulting clinic.
The results were as follows:
1. In all cases, intrabursal injec tions of the medium had pain alleviating effects.
2. In 55 shoulders, simplified subacromial bursographies showed clear bur sograms, although one shoulder failed.
3. In 27 shou lders of 24 patients, rotator cuff tears were recognized. In 3 shoulders, although a cuff tear was not proved bursographically, additional arthorography showed a cuff tear. In o ne shoulder, a cuff tear was not recognized by arthorography though it had been prevdously, b ut simplified subacromial bursography revealed this cuff tear.
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原 正文, 緑川 孝二, 竹下 満, 高岸 直人
1991 年 15 巻 1 号 p.
52-56
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
We began to perform arthroscopic subacromial decompression ( A. S. D. ) for impingement symdrome in 1987 and have since been faced with some problems, namely. But, we overcome these problems as developed new technique and new instruments.
1) Insertion of an 4.0mm arthroscope into an abnormally narrowed subacromial bursa ( S. A. B. )in impingement syndrome is very difficult. To overcome this difficulty, we developped new instruments for safe and reliable insertion of an arthroscope which we designated STEP CANNULATION SYSTEM ( S. C. S. ).
2) What is the narrowable limit of the acromion?
Success in A. S. D. depends upon whether the acromion can be resected to a maximum necessary extent. To define this limit, we carried out an anatomical study of the acromion on cadavers.
3) How to resect bone accurately to a maximum safe extent?
We first developed ACROMION MEASURE to measure 2 cm posteriority from anterior acromion edge. Then we developed a gauge for mesasurement of the thickness of acromion that can be used with easy, named it ACROMIN GAUGE.
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松井 健郎, 小川 清久
1991 年 15 巻 1 号 p.
57-61
発行日: 1991/09/01
公開日: 2012/11/20
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The subjects of this investigation were 419 patients ( 643 shoulders ) between the ages of 16 and 79 ( 162 males [252 shoulders] and 257 females [391 shoulders] ) who had never experienced to date any trauma, rest pain or pain of motion of the shoulder joint.
The patients were examined for the presence of bony spurs of the acromion radiographically. As in our previous investigations, radiograms of the scapular Y view were used to measure the length of the bony spur.
The results confirmed that in some patients with asymptomatic shoulders, bony spurs began to develop in their 20s, after which the emergence rate increased with age. The rate reached about 50percent for patients in their 60s, and as high as 68 percent for those in their 70s. The findings indicate that, some factor which develops the bony spur begins to stimulate the front edge of the acromion incessantly from youth. This factor was thought to be either a subclinical or physiological impingement generated between the coraco-acromial arch and the lower tissues.
Most bony spurs which developed in asymptomatic shoulders were less than 5 millimeters in size, and only 7 percent were large or medium-sized. From the survey results of the operation cases reported previously, patients with severe rotator cuff tear had a high concentration of large to medium-sized bony spurs. When the present findings are also taken into consideration, the factor which increases the size of the bony spur is assumed to be not aging, but clinical impingements which are represented by rotator cuff tears.
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冨田 恭治, 尾崎 二郎, 仲川 喜之, 桜井 悟良, 松倉 光晴
1991 年 15 巻 1 号 p.
62-66
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
The present study was undertaken to delineate the pathological relations of the subacromial bursa associated with rotator cuff tears.
Specimens of subacromial bursa were randomly obtained during surgery from 43 shoulders with rotator cuff tear. Gross appearances and pathohistological images of the bursa were observed. In a part of the specimens, the neurohistology of the subacromial bursa was also studied by a modified technique of Gairns gold chloride stain for neural elements.
Macroscopically, the subacromial bursa appeared to be reddish and congested, remarkably at the location opposite the torn cuff, in most cases. In cases with a relatively short duration of symptoms, the bursa appeared specifically edematous. In contact, cases with a long duration of symptoms showed a somewhat thickened bursa under visual inspection. Histologically, vascular channels were scattered in sections and small round cells infiltrated into the connective tissue. The bursa, in cases with a massive cuff tear or a chronic cuff tear, demonstrated fibrosis and hyalinization. In none of the cases did inflammatory leukocytic cells infiltrate the bursal tissue.
Neurohistologically, three morphologic types of mechanorecepto r s and free nerve endings were clearly identified in the connective tissue of the subacromial bursa with a comparative fresh cuff tear.
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田村 正吾
1991 年 15 巻 1 号 p.
67-70
発行日: 1991/09/01
公開日: 2012/11/20
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Casel. A 59-year-old woman had severe pain in her right shoulder and was unable to elevate her right arm, when she lifted a heavy box with her right hand. She visited us complaining of persisting pain in her right shoulder for 6 months. On examination, there was a tenderness on the bicipital groove. Roentgenographic examination showed a deformity of the lesser tuberosity. Under operation, the lesser tuberosity lacked the subscapularis muscle, and the long head of the biceps tendon was partially torn and was dislocated at the bicipital groove. The long head of the biceps tendon was fixed to the bicipital groove. In addition, acromioplasty was performed. We did not suture the subscapularis muscle.
Case 2. A 64-year-old man fell down from a 2m hight, and hit his right shoulder. There was a tenderness on the bicipital groove. Under operation, the subscapularis muscle was absent at the lesser tuberosity. We administered the same treatment as in the previous case. Both postoperative courses were satisfactory.
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森澤 佳三, 片岡 泰文, 山鹿 真紀夫, 高木 克公
1991 年 15 巻 1 号 p.
71-73
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Yergason's Test and Speed Test are popular diagnostic technics for tendinitis of long head of the biceps brachi. So, we tried to clarify what kind of lesions show up in these tests, mainly in the Speed Test. From April 1988 to March 1990, there were 10 patients with positive Yergason's Test or Speed Test, on whom we carried out arthroscopic procedures. Eight of these were positive in only the Speed Test, two cases were positive in both Yergason's Test and the Speed Test. We could not determine what kind of lesion shows up in Yergason's Test, for we had only a few cases that were positive to Yergason's Test. In patients positive to the Speed Test, we found some pathological abnormalities around the biceps long head tendon and superior labrum complex. We believe these lesions and S. L. A. P. lesions have almost the same conditions. All the cases were classified Type 1 or Type 2. From these arthroscopic findings, we concluded that the Speed Test demonstrates a S. L. A. P. lesion.
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酒巻 忠範, 遠藤 寿男
1991 年 15 巻 1 号 p.
74-78
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
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A total of 11 cases were treated, namely,1 case of burst type fracture of the glenoid cavity,3cases of glenoid cavity, and 7 cases of communicated fracture of the neck.
The treatment was mainly conservative.
Surgical reconstruction was only performed in those cases in which it was impossible to obtain a mutual relation of the glenoid cavity with the humeral head. Conservative treatment was a combination of manual reduction and continuous olecranon pin traction toward the zero-position.
The results were as follows. When the results of the treatment were evaluated for labor facility,10 out - of the 11 cases were able to do heavy labor, and nearly all obtained satisfactory results.
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吉田 篤, 小川 清久, 高橋 正明, 松本 隆志
1991 年 15 巻 1 号 p.
79-84
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
We treated two patients who developed a narrowing of the glenohumeral joint space for no apparent.
Case 1: A 25-year-old man. At the age of 21, the patient fell and hit his left shoulder. A diagnosis of subluxation of the acromioclavicular joint was made. Since pain in his left shoulder persisted, he underwent an acromioclavicular arthroplasty at the age of 23. The pain resolved completely. At the age of 24, he fell and hit his left shoulder again. The pain disappeared in a week. Half a year later, however, he consulted us with recurrent pain. The X-ray film revealed the disappearance of the left glenohumeral joint space.
Case 2: A 49-year-old woman. The pa t i ent had continued pain in her right shoulder three months after a traffic accident when she was 46 years old. A diagnosis of a rotator cuff tear was made. Rotator cuff repair was performed, which resolved the pain. At the age of 48, she had a recurrence of pain and consulted our hospital. The X-ray film showed the disappearance of the right glenohumeral joint space.
In both cases, a marked disappearance of articular cartilage was noted during the operations. However, there were no findings of infectious diseases or rotator cuff tears, and a biochemical profile did not show any particular abnormalities, which could be diagnosed as chondrolysis of the shoulder.
We consider these injuries and operative invasions to be greatly involved clinically. The condition may be regarded as the post-traumatic chondrolysis, but the pathogenesis of the chondrolytic process is still unknown.
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久津間 智允, 土屋 崇, 樋代 洋平, 松江 練造
1991 年 15 巻 1 号 p.
85-91
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Neviaser's procedure for a complete dislocation of the acromioclavicular joint can reduce surgically the acromioclavicular joint and repair the acromioclavicular joint by transfering the coracoacromial ligament to the distal end of the clavicle. However, it is said the fixation of the coracoacromial ligament to the clavicle is problematic. In our modified Neviaser's procedure, the coracoacromial ligament is detached with a small piece of bone from the acromial portion and the ligament is transfered and fixed to the clavicle using a small A-0 cancellous screw.
Thirty-one cases have been treated using this method since 1984. We stud i ed the results of 23cases which progressd for more than the postoperative 6 months. Tossy's grade 3 classification was noted in all the cases. Nineteen male and 4 female patients were treated, and the ages at the time of surgery ranged from 19 to 58 years old ( 38 years old in average ).
The follow-up period ranged from 6 months to 6 years and 4 mo n ths ( 2 years and 9 months in average ).
A favorable bony union was obtained in all the cases with a coracoid process bone setion which had been transferred to the clavicle. The postoperative results were evaluated according to Kawabe' criteria. From the results, there were 17 excellent cases ( 74% ),3 good cases ( 13% ),3 fair cases ( 13% )and no poor case.
A roentge n ographic evaluation of the reduction state was studied using the A-P view of the acromioclavicular joint. Sixteen cases with a reduction state ( 70% ),6 cases with subluxation ( 26%)and 1 case with a complete dislocation ( 4% ) were observed.
We believe that when fixing the detached coracoi d prcess to the posterior and upper surfaces of the distal end of the clavicle, it is important that the tension of the coracoacromial ligament be left as intact as possible in a modified Neviaser's procedure.
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高岸 憲二, 荒木 崇一, 米本 光一, 堀内 訓, 糸満 盛憲, 塚本 行男, 山本 亘
1991 年 15 巻 1 号 p.
92-94
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Thirteen patients with complete acromioclavicular separation were treated with reconstruction of the coracoclavicular ligament using a fascia of the short head of the biceps, supplemented with a temporary fixation of the acromioclavicular joint. The fascia of the biceps was not long enough to fix the clavicle in one case. All the patients were re-examined on an average of 1.9 years after the operation. The functional results were relatively good but no better than that of other methods already reported. The roentgenographic evaluations revealed various changes, including subluxation, osteophyte of the acromioclavicular joint and calcification of the coracoclavicular ligament. Especially, subluxation of the acromioclavicular joint was observed in seven patients. These findings suggest that the Vargas method might not be a good operation for a complete acromioclavicular separaion.
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広瀬 一郎, 佐藤 克巳, 小島 忠士, 大平 信広
1991 年 15 巻 1 号 p.
95-99
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Since 1980,21 patients who had a Grade III injury were operated on and they consist of 20 males and 1 female whose average age was 30 years. All the patients were followed up for an average period of 23 months. The clinical exam focused on the evaluation of 5 parameters: pain, motion, strength, deformity and activity level. Satisfactory results were obtained in most of the patients. The roentgenographic evaluation revealed various changes, including bone hyperetrophy of the distal end of the clavicle, calcification in the coracoclavicular region and in the acromioclavicular joint and subluxation of the acromioclavicular joint. There were no bony changes of the clavicle of the coracoid process.
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村岡 博, 福原 千史, 志村 司, 竹本 正瑞, 村上 恒二, 生田 義和
1991 年 15 巻 1 号 p.
100-103
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Dislocation of the shoulder joints is estimated to account for about 50% of all joint dislocations. But, bilateral and simultaneous dislocation of the shoulder joints is extremely rare. We wish to present a case of traumatic simultaneous dislocation of the bilateral shoulder joints.
The patient was a 51-year-old female with SLE. As she was getting on a bus, she was left hanging out of the entrance with both her hands-up and both her arms were out stretched.
On admission to our hospital, both her shoulders were swollem, painful and i m mobile. X-rays revealed bilateral anterior dislocations. Under intravenous anesthesia, the dislocations were easily reduced using Hippocrates' technique. Both arms were secured by Desault's fixations for 3 weeks. The arthrograms and CT findings revealed a Bankart's lesion and Hill-Sachs lesion.
Only 7 cases of this type of dislocation have been traced in Japan. In this c a se, we believe that the injury was caused simply by each humeral head being pulled anteriorly out of the glenoid cavities.
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桜井 悟良, 尾崎 二郎, 冨田 恭治, 仲川 喜之
1991 年 15 巻 1 号 p.
104-107
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Luxatio erecta of shoulder was first reported by Middledorpf in 1859. This condition is rare and the incidence approximating 0.5% of all gleno-humeral dislocations. We have experienced four cases of luxatio erecta. All of the patients were female and their average age was 57 years. The follow up period averaged 15.5 months. The clinical appearance is characteristic, with the arm locked in an elevated position. Attention should be paid for possible complications, especially for a neurovascular injury. There were no neurovascular complications in this series. Closed reduction succeeded in each case and internal fixation by tension band wiring were performed in two cases with associated fractures. Three patients are free of symptoms and one patient with a three part fracture complains slightly of reduced range of motion.
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堀井 基行, 清水 長司, 弥永 邦彦, 三浦 清司, 久保 俊一, 平澤 泰介, 黒川 正夫
1991 年 15 巻 1 号 p.
108-112
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Recentry, interest in the use of MR images of the shoulder joint has been increasing, but it seems that little attention has been paid to its application in the imaging of shoulder joints with recurrent anterior dislocation. FE, Tl weighted and proton density weighted MR images of 5 shoulder joints were evaluated with respect to imaging of the humeral head, anterior labrum and anterior capsular insertion and subsequently their corresponding arthroscopic findings.
Labral abnormalities were demonstrated most clearly on FE images, and manifested themselves as increased signal intensity in 4 cases and the absence of labral space in 1 case. A glenoid fracture, which was present in one shoulder, was clearly observed on FE images. The Hill-Sachs lesion was most clearly detected on T1 weighted images, and was also clearly revealed on FE and proton density weighted images. Capnular stripping, which was confirmed in all joints by arthroscopy, was suggested by MR images in 3 joints.
In conclusion, MR images, particularly FE images, confirmed themselves to be very useful in the detection of abnormalities associated with recurrent anterior dislocation of the shoulder.
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鍋島 祐次, 藤田 直己, 水野 耕作
1991 年 15 巻 1 号 p.
113-118
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Bankart's operations were performed on 51 patients with recurrent dislocation or subluxation of the shoulder joint from 1975 to 1989. The mean age was 23 years old at operation time. The average duration of the postoperative follow-up was 5 years. We classified Bankart's lesion into 3 groups; mild, moderate and severe; by operative findings. Then we examined the clinical and radiological findings and the results of the surgical treatment.
There was no relation between the stage of the lesion and the clinical findings.
Both subscapular leakage on arthrograms and non-triangular shadows o n CT arthrograms were seen at higher ratios in the severe group of lesion than in the mild group.
The overall results of the operation were excellent. Four patients still had mild apprehension at follow-up, and three of them had a severe lesion. It seems that the patients with severe Bankart's lesion had inferior results to those with a mild lesion.
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糸川 秀人, 下崎 英二, 伊藤 貴夫, 松本 忠美, 富田 勝郎
1991 年 15 巻 1 号 p.
119-123
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this study is to assess the results of treatment of ten shoulders with recurrent anterior dislocation and eight shoulders with recurrent anterior subluxation during a six-year period ( 1982-1988 ). The patients were 6 women and 12 men, with a mean age of 22.5 years ( range 16 to 57 ). Modifie Bristow's procedure was performed on ten shoulders, and a modified inferior capsular shift ( M. I. C. S. ) on eight. These shoulders were followed-up for a 10 to 98 month period. The results were jndged on evidence of significant pain, redislocation, instabillity, range of motion etc.. In three of the ten shoulders on which modified Bristow's procedure was performed, inferior instability which was found preoperatively had become residual by follow-up time. In the other seven shoulders, satisfactory results were obtained. Eight shoulders on which M. I. C. S. was performed had had anterior and inferior instability preoperatively, and the instability was controlled at follow-up time. If a shoulder has not only anterior instability but also inferior insability, M. I. C. S. is thought to be a suitable procedure. However, modified Bristow's is thought to be more suitable than M. I. C. S. if a shoulder has only anterior instability, because the modified Bristow's is an extra-articular procedure.
In conclusion, it seems that modified Bristow's procedure gives good results in cases in which the shoulder has only anterior instability. However, in cases in which the shoulder has not only anterior instability but also some other directioal instability, M. I. C. S. should be used.
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相澤 利武, 阿部 博男, 熊谷 純, 桜井 実
1991 年 15 巻 1 号 p.
124-127
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Modified Bristow's procedure is satisfactory surgery for recurrent anterior dislocation and subluxation. But difficulty in throwing still remains postoperatively. Muscular strength after this surgery was objectively examined to analyse this problem.
[Materials] We evaluated 9 cases, all of which were male and operated on the non-dominant side. The age at operation time ranged from 21 to 41 years with an average of 25 years. The average period from the operation to the evaluation was 1.8 years ( from 1.2 to 2.7 years ). As a control,20normal individuals were examined.
[Method] Using Ka w asaki Heavy Industries Ltd's Rehamate, we measured the flexion muscle strength at 0° abduction and the internal rotation and external rotation muscle strength at 90°abduction. Each motion was repeated 10 times continuously. The angular testing velocity was 120deg. /sec and 180 deg. /sec.
[Results] In normal cases the peak torques of IR and ER ( 0°-90° ) and ER ( to 45° ) were diminished by about 10% on the non-dominant side. In operated cases peak torques of IR ( from 45° )were less than 25% of the controls. The mean torques of flexion and IR ( from 45° ) were diminished. We presume that the decrease of muscle strength of IR ( from 45° ) is the real effect of an operation and not for a change in the range of motion. This may influence the follow through phase of pitching.
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黒田 重史, 住吉 徹是, 斉井 政憲, 森石 丈二, 李 鐘勲
1991 年 15 巻 1 号 p.
128-131
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Since Dec.1986 a newly-designed modification of Boytchev's procedure in which the subscapular muscle is cut and resutured on the conjoined tendon has been performed in 38 cases of recurrent shoulder dislocation and subluxation. Among these,20 cases of recurrent dislocation and 8 cases of recurrent subluxation which were followed-up over one year after surgery were investigated. Twenty-three cases were male and 5 cases were famale. The mean age at surgery was 26.1 years old. In 9 cases out of 20 recurrent dislocations and 6 cases out of 8 recurrent subluxations, an additional Protzman's procedure was performed at the same time. The mean follow-up period was 28.8 months. Sensory deficits in the musculocutaneous nerve area were recognized in one case but the patient recovered within 6 months. One case complained of an unstable sensation once after surgery. In one case, anterior dislocation was induced by vigorous trauma while playing ice hockey 3 years after surgery. The other patients were enjoy weekend sports and have had no disabillities nor anxieties to date.
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特にCT関節造影を中心に
吉田 仁郎, 小林 利男, 松本 真一, 菊地 臣一
1991 年 15 巻 1 号 p.
132-136
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Patients with recurrent dislocation of the shoulder were treated by Oudard-lwahara-Yamamoto's procedure and a short-term follow-up was carried out. The shoulder were evaluated by the JOA score and computed tomography. The average JOA score was 91 points. This procedzre is a simple technique which produces good results for patients with recurrent dislocation.
On the computed tomography with doulble contrast arthrography, the grafted bone was found in the conjoined tendon, which was confirmed by a computed tomographic study and a cadaver also undergoing this procedure.
The absorptio n rate of the grafted bone suggests that the role the conjoined tendon plays on the influence of a grafted bone should be studied more.
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浦田 節雄, 桃崎 和彦, 米満 弘之
1991 年 15 巻 1 号 p.
137-140
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
From 1985 to 1990, we have operated on 28 patients with recurrent anterior dislocation or subluxation of the shoulder.
22 patients were males and 6 patients females.
Their affected sides were right 17, left 10 and both 1.
The follow-up range was from 6 months to 60 month s with an average period of 30 months.
We the used a new operation which we called the Rotator interval suture procedu r e on 28patients. We conducted follow-up studies of 15 cases of which recurrent only one was.
( 3.5% )We had good results in 13 cases of 15 cases by evaluating them on the basis of the J.O.A score.
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浜田 一寿, 福田 宏明, 中島 知隆, 三笠 元彦
1991 年 15 巻 1 号 p.
141-147
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
This paper discusses the comparison between arthrographic and operative findings in 163 full-thickness rotator cuff tears.
Materials and Methods: Weclassified positive arthrograms for rotator cuff tears into four groups with reference to the continuity of the contours of the humeral head and subacromial bursa. Three A-P projections were taken with the arm in neutral,60 degrees internal, and 30 degrees external rotation.
Group 1 : The contours of the articular cartilage of the humeral head and the roof of the subacromial bursa were discontinuous in any projections.
Group 2 : These were continuous only in external rotation.
Group 3 : These were continuous in external and n e utral rotation.
Group 4 : These were continuous in all projections.
The size of the tear verified at each oper a tion was correlated to the above described classification. Sensitivity, specificity, accuracy, and positive predictive value were calculated in each group.
Results : Small tears of the supraspinatus tendon were observed in 84 % of the Group 1arthrograms. Medium-sized tears of the supraspinatus tendon in 73 % of the Group 2 arthrograms, massive tears in 98 % of the patients with Group 4 arthrograms. On the other hand, massive tears were in 49 % and mediumsized tears in 44 % of the Group 3 arthrograms. The errors in arthrographic interpretation were divided into two groups. The one was the problem of arthrographic techniques, which contained poor diffusion of dye, excessive dye, and excessive internal rotation. The other one was the problem of the tendon stumps, which mainly consisted of thinning of stump, large intratendinous tear, and hypertrophy of stump.
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熊谷 英夫, 三笠 元彦, 石橋 徹
1991 年 15 巻 1 号 p.
148-151
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
We evaluated the ability of our high resolution MR imagig in diagnosing rotator cuff tears. We performed MR imaging of the shoulders of seventy patients who had symptoms and signs suggesting rotator cuff tears. Sixty of them underwent arthrography and/or MR arthrography. All the complete tears in twenty-nine cases which were confirmed by arthrography and/or MR arthrography could be demonstrated as high signal lesions like fluid on T2-weighted images.
Slightly high signal lesions on T2-weighted images in ten cases wer e considered to be partial tears because in five cases they were confirmed by surgery or MR arthrography. Our high resolution MR imaging could demonstrate all complete tears and some partial tears and we consider it to be more effective than arthrography or MR arthrography.
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三原 栄一, 伊藤 信之, 衛藤 正雄, 高木 信吾, 手島 鍛, 岩崎 勝郎
1991 年 15 巻 1 号 p.
152-157
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this study is to evaluate the results of surgery for patients with rotator cuff tear. The surgical procedures were composed of cuff repair ( Mclaughlin's method ), partial lateral acromionectomy and resection of the coraco-acromial ligament.
Patients consisted of 56 men and 10 women with a n average age of 53 years and they were followed up for 6 months to 8 years 8 months with an average of 4 years 5 months. Postoperative results were assumed by using both the Japanese Orthopaedic Association's criteria and Wolf gang's criteria. The average score at follow-up time was 93.5 points and 14.8 points respectively. The good results were not related to the age of the patients but partially to the size of the cuff tear. Better results were obtained in patients of under 50 years of age whose time lapse between the accident and the operation was short. In addition, we found that the clinical results became even better in those cases with a longer follow-up period.
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Follow up 調査
山中 芳, 中村 俊夫, 長谷川 秀彦
1991 年 15 巻 1 号 p.
158-162
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
In order to clarify the factors which affect the end results of the operated therapy for full thickness tear of the rotator cuff, we have performed a clinical study of operative therapy for full thickness tear of the rotator cuff. This clinical study includes 49 cases with full thickness tears of the rotator cuff which were treated operatively.36 cases were followed up and were examined physically and radiologically and evaluated by the JOA Shoulder Score. The following results were obtained.
The 36 cases consist of 29 males and 7 females.24 were right shoulder ( 23 of which were the dominant side ) and 12 were left shoulder ( 4 of which were the dominant side ).26 cases had a history of trauma. The average age on first hospital visit was 63 years old. The average period of suffering before visiting a hospital was 1,201 days and the average follow-up period was 1,277 days. The JOA shoulder score on first visiting the hospital was 61 points and at follow-up it was 89 points on average.
The follow-up score was significantly high if the patient was younger than 62 and had a small or medium sized tear ( maximum width of the tear was less than 2 cm ) and McLaughlin's procedure was performed.
The improvement rate was significantly high if the patient was younger than 62 and if his / her radiological score on first hospital visit was more than 3 ( 3 on the average ). The improvement rate was also significantly high if his / her type of tear demonstrated by arthrography was group 1 or 2and if his / her tear size revealed by operation was regarded as small or medium.
In summary, full thickness tear of the rotator cuff should be treated o p eratively if the patient's disability of ADL persists and the end results seem to be good if the patient is younger and the tear size is smaller.
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黒川 正夫, 堀井 基行, 三浦 清司, 弥永 邦彦, 清水 長司, 平澤 泰介, 寺脇 稔, 千保 一幸
1991 年 15 巻 1 号 p.
163-167
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Between 1983 and 1989,19 cases ( 19 shoulders ) of massive rotator cuff tear were surgically treated at our hospital. Massive tears indicate a 3 cm or more extensive tear, which runs from the ruptured end to the greater tuberosity. There were 16 males and 3 females, ranging in age from 47to 74 years ( mean: 58.4 years ). The surgical procedure selected was McLaughlin's operation in 11cases ( reinforced with the long head of the biceps in 2 cases ), Debeyre's operation in 7 and transposition of the trapezius muscle in 1.
The mean preoperative score w e re 58.8. Of the cases, the therapeutic results were poor in 5reruptured cases, which were conplicated by anterior dislocation of the shoulder and some nerve injuries. When these 5 cases were excluded, the results were good, the mean score being 88.0. The mean score after Debeyre's operation ( 91.7 ) was higher than McLaughlin's operation ( 86.7 ). Moderate restriction of adduction and internal rotation were sometimes observed in cases which underwent McLaughlin's operation. Muscle strength and endurance did not decrease in all the cases which underwent Debeyre's and McLaughlin's operations. Debeyre's operation is a good procedure for massive rotator cuff tears.
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花田 多雅, 浜田 一寿, 福田 宏明, 中島 知隆
1991 年 15 巻 1 号 p.
168-171
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Paraplegic patients tend to develop shoulder problems in the transfer. Four rotator cuff tears in three paraplegic patients, all polio victims, were analyzed. The JOA score was used for assessment. Anterior acromioplasty and tenorrhaphy were performed in two supraspinatus tears and one massive cuff tear with functional improvements. The same procedures for another massive cuff tear resulted in a retear which necessitated performing a glenoidplasty untilizing a fascia lata graft. The final results were poor. Surgery is indicated for rotator cuff tears in the paraplegic, in order to preserve both the transfer and the ADL. Early recognition, meticulous repair and rehabilitation are essential to obtain good results. The antero-posterior roentgenogram of bilateral shoulders on weight bearing (" push-up view") is helpful in the assessment of postoperative functions of the rotator cuff.
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佐野 博高, 田畑 四郎, 井樋 栄二
1991 年 15 巻 1 号 p.
172-176
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Few reports have been made on the highly unusual rotator cuff tears in adolescents.
Four cases of rotator cuff tears in adolescents are presented here. The i ncidence of tears in adolescents was 1.4 %. A single trauma was considered the primary cause of the tears in three cases. But one case presented here had no major traumatic episode. In this case, repeated minor injuries while playing baseball was considered to be closely assosiated with the rotator cuff tear. They all presented a deep surface tear of the supraspinatus, and a pinhole-sized complete tear was also found in one case. The tears were surgically repaired with satisfactory results in a short-term follow-up.
Histological examinations demonstrated hyaline degeneration in all the cases and calcified deposits in two of them, which could be interpreted as a reparative process of the tear.
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中村 隆二郎, 原田 征行, 藤 哲, 岡村 良久
1991 年 15 巻 1 号 p.
177-183
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
An opening between the supraspinatus and subscapularis tendons ( rotator interval tear ) and a rotator cuff tear may complicate recurrent anterior dislocation or subluxation of the shoulder.
We have treated 11 shoulders of 10 patients with recurrent anterior dislocation or subluxation of the shoulder in the last two years.8 patients ( 9 shoulders ) were male and 2-female.9 patients, ages ranged from 16 to 33 years old and the last was 63 years old.
For diagnostic procedures, we performed arthrography on all shoulders, arthroscophy on 10shoulders and MRI on 8 shoulders.
Five shoulders were complicated with rotator interval tear and a rotator cuff tear was observed in one shoulder.
We used Putti-Platt's procedure or Rowe's capsulorrhaphy in the treatment of recurrent anterior dislocation or subluxation and also repaired rotator interval tears at the same time. The rotator cuff tear was repaired by McLaughlin procedure.
Inferior shoulder instability is present in cases with rotator interval tear. We think, it is important that the rotator interval tear or rotator cuff tear also be repaired in cases of recurrent anterior dislocation of the shoulder.
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高山 景範, 白井 康正, 伊藤 博元, 井上 惣一郎, 柴崎 徹, 藤井 信人, 浦田 伸一, 橘田 雅美, 橋口 宏
1991 年 15 巻 1 号 p.
184-188
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Two cases of rotator cuff tear caused by large subacromial spur are presented.
Case 1. A 59-year-old farmer developed night pain in the right shoulder during four months. Plain roentgenogram showed large subacromial spur, but only sonogram could be detected bursal side partial thickness rotator cuff tear. Surgery was performed at which 15 x 10 mm bursal side incomplete tear was found in the supraspinatus tendon. Wedge resection and side to side suture following anterior acromioplasty was carried out.
Case 2. A 56-year-old carpenter struck on h is right shoulder and increased insidious pain for six months. Large subacromial spur was showed on plain roentgenogram and massive cuff tear was revealed by arthro- and sonogram. At surgery it was found that anterior edge of 20 x 40 mm spur attenuated torn cuff end. Tear was repaired with McLaughlin technique after anterior acromioplasty.
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