肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
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31 巻, 2 号
選択された号の論文の65件中1～50を表示しています
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解剖
  • 肩甲下筋の上腕骨付着部形態に関する解剖学的検討
    時吉 聡介, 井手 淳二, 廣瀬 隼, 水田 博志
    2007 年 31 巻 2 号 p. 197-200
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.197
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    Recently many rotator cuff tears including subscapularis are repaired arthroscopically. However, there are only a few reports about the morphology of the subsccapularis muscle insertion to the humerus. The knowledge of the insertion morphology leads to appreciate the tear size and to repair anatomically. In this study, we investigated the cadaveric shoulders to clarify the morphology of the subscapularis muscle insertion and the difference between sexes and sides. We investigated 24 cadaveric shoulders (bilateral shoulders of five males and seven females; mean age 87 years old) and measured the maximum longitudinal distance (proximal-to-distal direction) and transverse distance (medial-to-lateral direction) of the subscapularis insertion. We also measured the distance between the articular cartilage edge and the most medial tendon insertion (bare area) at sites of the proximal end, maximum transverse distance position and the distal end. The data were analyzed with an unpaired-t-test or paired-t-test between sexes and sides. Statistical significance was set at p<.05. The subscapularis muscle insertion was consisted of 2 parts, proximal tendinous part and distal muscular part in all cadavers. The mean maximum longitudinal distance of the tendon insertion was 35.5 (SD, 4.2) mm. The mean transverse distance of the tendon insertion was 15.8 (SD, 2.3) mm. The mean distance of the bare area at sites of the proximal end, maximum transverse distance position and the distal end was 3.1 (SD, 2.0) mm, 5.9 (SD, 1.7) mm, 11.9 (SD, 3.4) mm, respectively. Significant differences existed between sexes in maximum transverse distance (p=0.0006), the bare area at the maximum transverse distance position (p=0.00199) and distal end position (p=0.0015). No significant differences were found between sides in all subjects. We examined the subscapularis insertion to the humerus in cadaveric shoulders. Anatomical measurements in this study may be useful in evaluating and reattaching the subscapularis to the humerus.
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  • 肩甲上腕関節における軟骨の加齢変化に関する解剖学的研究
    後藤 英之, 久崎 真治, 堀内 統, 大塚 隆信, 杉本 勝正
    2007 年 31 巻 2 号 p. 201-204
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.201
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    We evaluated the chondral lesion of the glenohumeral joint among the elder population. In this study, 31 shoulders of 20cases (Male 17 cases, Female 14 cases) were evaluated for the macroscopic investigation. The mean age of the cases was 81.8 years old ranging from 54 to 103 years old. Before the evaluation, the rotator cuff and joint capsule were released from the insertion. The observed site was divided into superior, middle, central, and inferior part for the glenoid side, and greater tuberosity, anterosuperior, anteroinferior, posterosuperior, posteroinferior and long head of the biceps part for the humeral side. Macroscoic findings were evaluated according to the cartilage grading system; Grade 0: normal, Grade I: discolouration, Grade II: mild erosion, Grade III: erosion, Grade IV: ulceration, and Grade V: eburnation. There were 5 rotator cuff tears among the cases. For the glenoind side, the superior part showed normal in the most of the cases, but the inferior part showed more than grade II in the most of the cases. The middle part appeared normal in Grade III, but the central part showed Grade III or Grade IV in most of the cases. For the humeral head side, the superior part showed Grade II to III and the inferior part showed Grade 0 to II. The long head of the biceps part appeared in Grade III to IV. In general, it might be understood that a glenohumeral joint arthritis is rare clinically, because it is not a weight-bearing joint. However, focal chondral lesions are often associated with rotator cuff tears and severe joint contracture. This study provided useful information for an arthroscopic evaluation of chondral lesions of the glenohumeral joint.
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  • 肩甲下筋腱停止部の上腕二頭筋長頭腱安定化機構
    新井 隆三, 菅谷 啓之, 前田 和彦, 森石 丈二, 望月 智之, 松木 圭介, 秋田 恵一
    2007 年 31 巻 2 号 p. 205-207
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.205
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    The subscapularis tendon (SSC) insertion is one of the key structures that stabilizes the LHB. The purpose of this study was to investigate the anatomy of the most superior portion of the SSC insertion and clarify the relation between the SSC insertion and the pathway of the LHB. 20 embalmed shoulder girdles of cadavers were used in this study. After the acromion and the coradoid process were cut off, connective tissues were carefully removed and the SSC insertion was observed. In 4 specimens, muscle fibers of the SSC were carefully removed in water to observe the intramuscular tendons of the subscapularis. The SSC inserted onto the medial portion and the superior surface of the lesser tuberosity. The most proximal insertion of the tendon, derived from the most proximal portion of the intramuscular tendon, formed an anteromedial wall and stabilized the LHB at a more proximal portion continuing from the bicipital groove. Further, the most proximal insertion of the SSC extended superiorly and formed a thin tendinous slip, which attached to the fovea capitis of the humerus. Both of the most proximal insertion of the SSC and the tendinous slip created the semitubular structure and lengthened a channel of the LHB proximally. These results suggested that the most proximal portion of the SSC and the slip can reinforce the channel of the LHB which changes direction from the bicipital groove to the superior tubercle of the glenoid at this portion. Clinically, in shoulders with a SSC injury, repairing the most proximal portion of this tendon was important in terms of the LHB stability.
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  • 棘上筋停止部に関する解剖学的検討
    前田 和彦, 菅谷 啓之, 新井 隆三, 森石 丈二, 望月 智之, 吉村 英哉, 松木 圭介, 秋田 恵一
    2007 年 31 巻 2 号 p. 209-211
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.209
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    It is generally believed that the supraspinatus tendon plays an important role in the shoulder function. However, precise anatomy of the supraspinatus tendon has not been well described. The purpose of this study was to investigate the anatomy of the supraspinatus tendon. 57 cadavers (103 shoulders) were used for this study. The clavicle and humerus were cut off at their proximal parts. After resection of the acromion, the coracohumeral ligament was carefully removed. In some specimens, the infraspinatus was completely removed from the humerus to observe the overlapping portion of the supraspinatus and infraspinatus. The supraspinatus muscle and its origin were carefully investigated macroscopically. In 4 shoulders, muscle fibers were completely removed to examine the direction and insertion of the supraspinatus tendon in detail. The supraspinatus muscle fibers originated from the spine of the scapula and the supraspinatus fossa, and they were running toward and attached to the thickest tendinous portion, which was located at the anterior part of the supraspinatus muscle. This tendinous portion was strongly attached to the most anterior portion of the greater tuberosity adjacent to the bicipital groove or at the lesser tuberosity (21.3%). Another part of the supraspinatus, which was located posteriorly, was attached to the greater tuberosity adjacent to the articular cartilage as a thin membrane. The insertion of the supraspinatus tendon revealed to be the most anterior portion of the greater tuberosity and the lesser tuberosity. These results suggested that the supraspinatus tendon worked more efficiently as an abductor of the shoulder joint with the arm externally rotated than internal rotation.
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  • 棘下筋こそが腱板断裂において最も重要な断裂腱である
    松木 圭介, 菅谷 啓之, 前田 和彦, 森石 丈二, 望月 智之, 秋田 恵一
    2007 年 31 巻 2 号 p. 213-215
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.213
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    The purpose of this study was to examine the anatomy of the infraspinatus including the orientation of muscle fibers and the insertion to the greater tuberosity. Ninety-three shoulders from 52 cadavers were minutely dissected. After resection of the acromion and removal of the coracohumeral ligament, the infraspinatus muscle was carefully investigated macroscopically. After the orientation of muscle fibers was confirmed, the muscle was peeled from the proximal part to the distal part and the insertion of the infraspinatus tendon was examined. In 4 shoulders, muscle fibers were completely removed in water and the direction and insertion of the tendon were examined. The infraspinatus muscle originated both from the inferior surface of the spine of the scapula and the infraspinatus fossa, and inserted to the greater tuberosity. The muscle fibers originated from the spine were running dorsally and horizontally to the greater tuberosity. On the other hand, the fibers from the fossa were running ventrally and diagonally to the greater tuberosity. These fibers were merged at the insertion. The infraspinatus tendon had vast insertion to the greater tuberosity, and the most anterior part of the tendon was inserted to the most anterior portion of the greater tuberosity, bordering on the most anterior part of the supraspinatus tendon. The supraspinatus tendon is regarded as the most affected tendon in rotator cuff tears. However, the results of this study suggested that the infraspinatus tendon could be involved in the majority of rotator cuff tears. The infraspinatus may act not only in external rotation but also in abduction, because the infraspinatus tendon was inserted to the most anterior part of the greater tuberosity.
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  • 小胸筋の停止についての解剖学的研究
    吉村 英哉, 望月 智之, 宗田 大, 菅谷 啓之, 前田 和彦, 秋田 恵一, 松木 圭介, 中川 照彦
    2007 年 31 巻 2 号 p. 217-219
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.217
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    Previous studies reported a presumably unusual bony attachment of the pectoralis minor muscle. However, less attention has been given to the insertion of the continuation to the glenohumeral joint. The purpose of this study was to evaluate the frequency of this abnormal insertion of the pectoralis minor muscle, and also to investigate the relation between this continuation and the capsule. 81 anatomic specimen shoulders from 41 cadavers were dissected. The insertion of the pectoralis minor tendon to the glenohumeral joint was carefully investigated. The pectoralis minor tendon ran beyond the coracoid process and extended to the superior portion of the glenohumeral joint in 28 out of 81 specimens (34.6%). The continuing insertion divided the coracoacrominal ligaments into two limbs. The continuation was more variable, and consisted of the whole tendon in 6, the middle part in 5, the lateral part in 15, and the medial part in 2 specimens. Furthermore, the pectoralis minor tendon inserted to the posterosuperior border of the glenoid in 6, to the greater tuberosity in 7, and both to the glenoid and the greater tuberosity in 15 specimens. The prevalence of the anomalous insertion of the pectoralis minor tendon revealed to be as high as 34.6% in the present study. This may suggest that the pectoralis minor tendon plays an important role in the stability of the glenohumeral joint.
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生化学
  • 家兎棘上筋腱は加齢によりコラーゲン合成が低下する
    高橋 憲正, 佐野 栄, 落合 信靖, 西須 孝, 森石 丈二
    2007 年 31 巻 2 号 p. 221-224
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.221
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    Because of the poor vascularity of the supraspinatus tendon in the articular side, the degeneration of the tendon was considered to start from the articular side. To understand the pathology of a rotator cuff tear, we assessed the effect of aging on the collagen synthesis of the tenocyte in supraspinatus tendon in the rabbit. 12 New Zeeland white rabbits were used, which included 6 mature rabbits aged 1 year old and 6 aged rabbits aged 4-5 year old. After their sacrifice, the supraspinatus tendons were harvested immediately and trimmed to the rectangular shape of 4 mm × 8 mm. They were divided into two pieces, which included the articular side surface and the bursal side surface. They were placed in to cell culture media containing [3H]-proloine (5 μci/ml of media) and incubated at 37°C for 48 hours. Following incubation, [3H]-hydroxyproline (collagen synthesis) was quantified by HPLC after acid hydrolysis. The data were compared to each group using t-test. The collagen synthesis of the tendon in the articular side were significantly higher in both mature (p=0.02) and aged (p=0.014) rabbits. However, the statistical trend, in which the collagen synthesis of the articular side decreased with age, was observed (p=0.058). The collagen synthesis of the tendon in the articular side was significantly higher regardless of age. A more active turn over of collagen might be required for the tendon in the articular side. The decrease of collagen synthesis of the tendon on the articular side with age might induce the degeneration of a rotator cuff tendon from the articular side, resulting in an articular side tear.
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  • 羊腱板由来細胞に対するTGF-β1投与が各種遺伝子発現に与える影響
    山口 浩, 末永 直樹, 三浪 明男, SONNABEND David H
    2007 年 31 巻 2 号 p. 225-228
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.225
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    Although good mid-term clinical results after a rotator cuff repair have been reported on, it was pointed out that complete tendon reattachment to the humerus is very difficult. The aim of the present study was to investigate the effect of TGF-β1 on a sheep infraspinatus tendon cell cultured on Polyglactin910. The cells derived from a sheep infraspinatus tendon by an enzyme digestion method were cultured for 10 days.
    After the culture, expression of genes were investigated by RT-PCR methods after the extraction of RNA with TRIzole treatment. Evaluated genes were type 1 and 3 collagen, MMP-1 and MMP-13, Aggrecan, Biglycan, Decorin, Fibromodulin, Lumican, Elastin, Osteopontin. Statical comparisons were performed using one-way analysis of variance and Fisher PLSD tests. Differences were considered significant for less than 5%. In results, mRNA expression was significantly increased for type 1 collagen, Aggrecan, Elastin. Especially, type 1 collagen, Elastin were revealed a dose dependent positive effect. mRNA expression was, however, significantly decreased for MMP-1, Lumican.
    These results indicated that TGF-β1 may have a significant effect on rotator cuff healing and stimulus for further studies in this field.
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機能
  • 肩関節の三次元運動解析-挙上と回旋の関係-
    乾 浩明, 二宮 裕樹, 駒井 正彦, 橋本 卓, 信原 克哉
    2007 年 31 巻 2 号 p. 229-231
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.229
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    External rotation is obligatory for the shoulder reaching the position of maximum elevation. To clarify the relation between elevation and rotation is essential for understanding of shoulder movement and a variety of pathologic states including instability and contracture. However, there have been few studies approaching this topic in vivo. The present study investigated the relation between elevation and rotation using a 3D motion capture system developed in our hospital. The subjects included 15 men with healthy shoulder. The average age was 31 years old. The latest Qualisys ProReflex System including 7 infrared light CCD cameras analyzed the reflecting markers attached on the bilateral epicondyles of the elbow, the acromion, and several sites of the trunk and the spine of each subject. The arm was actively moved from the dependent position with neutral rotation to the maximum elevated position on 4 planes (0°, 30°, 60°, 90°anterior to the coronal plane). Rotational angles along the axis during elevation were compared among 4 planes. The amount of change in the angle of rotation depended on the path along which the arm was elevated. It averaged about 40°on the scapular plane (30°anterior to the coronal plane). Those values got smaller when the arm was elevated more anteriorly. Tilting of the humeral shaft generated rotational motion on the glenoid during elevation. These angles were different among the 4 planes even if the angles of the humeral rotation in the starting position with the arm at the side and in the end position with the maximum elevation were the same among 4 planes. That would cause differences in the amount of rotational angles along the humeral axis.
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  • Stability ratioと関節窩の深さとの関係
    阿部 秀一, 山本 宣幸, 関 展寿, 菊池 一馬, 皆川 洋至, 井樋 栄二
    2007 年 31 巻 2 号 p. 233-235
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.233
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    The purpose of this study was to determine the stability ratio in various directions of the glenoid and to correlate them with the glenoid depth. 9 fresh frozen cadaveric shoulders were used. All soft tissues were removed and the glenoid was mounted horizontally on a 6-component load cell while the humerus was vertically clamped to a device. A 50-N compressive load was applied. Measurement was performed in 40 different directions and repeated twice. The glenoid depth was measured by a LASER sensor in 8 directions. The forces resisting translation were recorded. Then the stability ratio, defined as the peak translational force divided by the applied compressive force, was calculated. Pearson's correlation coefficient was used to evaluate the relationships between the stability ratio and the glenoid depth. The stability ratio was greater in the superoinferior direction than in the anteroposterior direction. The greatest stability ratio was detected in the inferior direction (52.9% at 180°) and the superior direction (48.3% at 10°). On the other hand, the smallest stability ratio was detected in the anterior direction (27.1% at 90°) and the posterior direction (26.2% at 280°). The glenoid concavity was deepest in the superoinferior direction and shallowest in the anteroposterior direction. A positive strong correlation was observed between the stability ratio and the glenoid depth (r=0.92, p=0.001). The stability ratio was greatest in the superoinferior direction and smallest in the anteroposterior direction. The glenoid depth was strongly correlated with the stability ratio.
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  • 外傷性肩関節前方不安定症におけるGerber's lift-off testの有用性
    久保田 英, 村上 成道, 石垣 範雄, 加藤 博之, 畑 幸彦, 中村 恒一, 小林 博一
    2007 年 31 巻 2 号 p. 237-239
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.237
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    Gerber's lift-off test is a valuable method for studying the function of the subscapularis muscle. Isokinetic muscle tests using a torque machine (BIODEX®) reveal the function of inner muscles in the shoulder. The purpose of this study was to determine the clinical significance of Gerber's lift-off test by using isokinetic muscle tests (BIODEX®) after surgery to repair traumatic recurrent dislocation of the shoulder. We examined 25 cases of traumatic recurrent dislocation of the shoulder. All the operations were performed under the modified Putti-Platt method (Nobuhara-Hospital method). The cases were divided into 2 categories according to Gerber's lift-off test: “weak” and “normal”. Statistically the 2 groups were comparable with regard to clinical histories, the Rowe score, and peak torque per body weight. The operations resulted in 25 “weak” cases becoming 7 “weak” and 18 “normal” cases. There were no significant differences between the 2 categories about clinical histories and the Rowe score. The “weak” cases indicated a smaller peak torque per body weight in flexion at 180 degree/sec, extention at 60 degree/sec and 180 degree/sec, in internal rotation at 60 degree/sec (P<0.05), in external rotation at 60 degree/sec and 180 degree/sec, and internal rotation at 180 degree/sec (P<0.01). Dysfuntion of the subscapularis muscle was detected by Gerber's lift-off test but not by the Rowe score because Rowe score's sensitivity was lower. “Weak” cases in Gerber's lift-off test indicated decreased power in almost all the directions. Dysfunction of the subscaplaris muscle could cause decreased musclar strength in the shoulder and in these cases patients should refrain from sporting activities and physical labor. This study concluded that Gerber's lift-off test was a useful test for high sensitivity and a valuable method for evaluating the function of the shoulder after operations.
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検査
  • 肩関節疾患におけるウイングビューを用いた肩甲骨位置解析
    鞆 浩康, 伊藤 陽一, 中尾 佳裕, 間中 智哉, 仲 哲史, 中村 信之, 中野 元博, 松本 一伸, 高岡 邦夫
    2007 年 31 巻 2 号 p. 241-243
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.241
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    Purpose: We reported on a novel radiogram, “Wing view” for the evaluation of scapular motion in normal shoulders at the 32nd JSS annual meeting. The aim of this study was to analyze the scapular motion in abnormal shoulders with Wing views and to evaluate the pathology. Methods: We evaluated Wing views of 45 patients: 11 massive rotator cuff tears, 18 frozen shoulders and 16 recurrent dislocations of the affected shoulders with the other healthy shoulders. The average age of the time of the evaluation was 50.0 (17-76) years old. Shoulders were postured in 3 ways: (1) 0 degree of horizontal adduction, (2) 90 degrees of horizontal adduction and (3) maximal horizontal adduction. We measured 2 parameters by computerized image analysing software. SS: the angles between the spinal process and medial edge of the scapular, ST: anterior inclination angles of the scapula. We evaluated 2 parameters in 3 shoulder positions and statistically analysed comparison between the affected shoulder and the healthy shoulder. Results: Wing view radiograms of 9 massive rotator cuff tears, 15 frozen shoulders and 14 recurrent dislocations were eligible for evaluation. 7 patients were inadequate for analysis, because of posture difficulties. SS of the affected shoulders in massive rotator cuff tears and frozen shoulders were significantly higher compared to those of the healthy shoulders. ST of the affected shoulders was significantly higher in the same manner in those shoulders. Conclusion: The scapula moves more antero-laterally in massive rotator cuff tears and frozen shoulders.
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  • 超音波断層機器を利用した視覚的フィードバック腱板機能訓練
    村上 成道, 石垣 範雄, 中村 恒一, 伊坪 俊郎, 加藤 博之, 畑 幸彦, 小林 博一
    2007 年 31 巻 2 号 p. 245-247
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.245
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    We investigated the postoperative condition of patients who underwent surgery for rotator cuff tears using sonography. The sonographic findings displayed an unclear superficial layer during working pain caused by rotator cuff dysfunction.
    As a method of improving this pain, we devised rotator cuff exercises for patients to do with a direct monitor.
    We reviewed the reduction of postoperative pain due to these exercises. We surgically treated 76 shoulders in 75 patients with rotator cuff tears that displayed an unclear superficial layer on sonographic findings. The patients were divided into 2 groups: a non-exercise group (29 shoulders) and an exercise group (47 shoulders).
    There were no significant differences between the groups in patient characteristics for gender, cuff tear size, or age.
    We evaluated the clinical results based on the Japanese Orthopaedic Association (JOA) score. The JOA pain score for the exercise group was significantly higher at 12 months than at 6 months, but was not significantly different in the non-exercise group. In this study, patients with postoperative rotator cuff pain were able to significantly reduce their pain by doing visual feed-back rotator cuff exercises using sonography.
    We believe that this is an effective method of renewing rotator cuff function.
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  • MRAによる腱板delaminationの引き込み距離評価
    仲 哲史, 伊藤 陽一, 中尾 佳裕, 間中 智哉, 中村 信之, 中野 元博, 鞆 浩康, 松本 一伸, 高岡 邦夫
    2007 年 31 巻 2 号 p. 249-251
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.249
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    Delamination is one of the horizontal tears combined with articular side tears and bursal side tears observed in full-thickness rotator cuff tears. However, this pathology is not well known about in detail. MR arthrography was reported by us to be an effective imaging procedure for intra-articular lesions. The aim of this study was to investigate the characteristics of delamination by measurements of their sizes with MR arthrography. We retrospectively evaluated 43 patients in which we observed delamination arthroscopically. Computerized measurements of the sizes of the superficial tears and the difference between superficial tears and deep tears were performed using the method previously reported by Toyoda et al. We statistically analyzed correlations between superficial tear sizes and the differences as well as patients' age and the differernces. Thirty-seven shoulders (86%) in 43 patients were eligible for evaluation by MR arthrography. There was no correlation between patients' ages and the differences. The differences in each full-thickness tear sizes' group were small: 1.32±0.64, medium: 1.20±0.52, large: 0.37±0.88, massive: -1.66 respectively. The smaller difference between superficial tears and deep tears with delamination were observed in the larger sizes of superficial tears. The smaller difference between superficial tears and deep tears with delamination were observed in the larger sizes of superficial tears.
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  • 関節唇損傷に対する放射状MRAの有用性
    水掫 貴満, 緑川 孝二
    2007 年 31 巻 2 号 p. 253-255
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.253
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    The purpose of this study was to investigate the efficiency of radial plane of MR arthrogram (R-MRA) for labral lesions of the shoulder. 64 shoulders were examined and all patients had either signs and symptoms of labral lesions. There were 53 men and 11 women, aged 15-45 years old (mean, 21.5 years old), with 48 right and 16 left shoulder abnormalities. The patients were referred to us because of a recurrent dislocation (32 cases), a superior labral abnormality (24 cases), a traumatic first dislocation (6 cases), a recurrent dislocation with a superior labral abnormality (2 cases). Each patient underwent R-MRA after intra-articular injection of 10ml of 0.5% mepivacaine. R-MRA was performed with 1.0-T system (Siemens Harmony). All patients were supine with the humerus in the neutral position. After a radial localizing imaging, intensity and morphological changes in the labrum through all the o'clock positions of the glenoid rim in T2 star images by the FRASH method were evaluated. Labral lesions of all patients were categorized according to Kim and Yamasaki's classification, and the findings on the R-MRA were correlated with the arthroscopical findings. This study showed 68% of sensitivity, 92.7% of specificity, and 82.7% of accuracy through all the o'clock positions of the glenoid rim on the radial plane of MRA. A radial MRA was useful to diagnose the labral leision of the shoulder precisely and from all viewpoints. Though 0.5% mepivacaine is cheaper than gadopentetate meglumine, it did not influenced the enhancement effect.
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  • 肩腱板修復術における術後MRIの経時的変化
    後藤 英之, 堀内 統, 久崎 真治, 大塚 隆信, 杉本 勝正, 竹内 宏幸
    2007 年 31 巻 2 号 p. 257-260
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.257
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    The purpose of this study was compare the integrity of the rotator cuff between the post operative MRI within 3 months and the MRI at final follow-up for a rotator cuff repair. In this study, 20 cases of partial to large rotator cuff tears were treated by either arthroscopic (15 cases) or mini-open rotator cuff repair (5cases). The mean age of all cases was 64.1 years old. The postoperative MRI was performed at the time within 3 months and 1 year after surgery. The rotator cuff integrity was evaluated by means of Sugaya's classification. The post operative findings of MRI within 3 months were classified as Type I : 0,Type II : 5, Type III : 2, Type IV : 8, Type V : 5, respectively.
    The final follow-up findings of MRI were classified as Type I : 4, Type II : 2, Type III : 3, Type IV : 6, Type V : 4, showing morphological improvement of the rotator cuff configuration. In conclusion, the present study shows that the signal intensity of the rotator cuff detected by postoperative MRI had a changed time course.
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  • 腱板断裂術後MRIにおける修復腱の経時的変化
    大泉 尚美, 末永 直樹, 久田 幸由, 三浪 明男, 福田 公孝
    2007 年 31 巻 2 号 p. 261-264
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.261
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    Although MRI has been proved effective in diagnosing a re-rupture of repaired rotator cuff tendon, there are only a few studies about the signal changes of the repaired tendon over time. The objective of this study was to follow the changes of the MRI findings of the repaired cuff tendon over 1 year. Twenty-two shoulders, which received open tendon-to-bone repair by a pull-out method and acromioplasty, were evaluated with MRI postoperatively at least twice within 1 year and over 1 year. There were 10 males and 12 females; their age at the operation was 50-80 years old (average: 63.8). There were 6 incomplete, 3 small, 6 medium, 3 large, and 4 massive tears. MRI was performed on an 0.5-T system and T2-weightened images were obtained. Intensity of the tendon or the bone-tendon interface was defined as ‘high’ when it was as high as joint fluid, as ‘low’ when it was the same as the normal tendon, and as ‘medium’ when it was between ‘high’ and ‘low’. The follow-up period was 12-106 months (average: 21.8). The re-rupture rate was 18% in the whole and 27% in the large and massive tears. In 6 shoulders which showed ‘low’ within 1 year, 5 remained ‘low’ and 1 changed to ‘high’ at the final follow-up. In 10 shoulders which showed ‘medium’ first, 2 remained ‘medium’, 7 changed to ‘low’, and 1 changed to ‘high’ finally. In 6 shoulders which showed ‘high’ first, 3 remained ‘high’, 1 changed to ‘low’, and 2 changed to ‘medium’ finally. The JOA scores significantly improved from 43.5-88 points (average: 63.1) preoperatively to 75-100 points (average: 93.1) postoperatively. There was no correlation between the size of the tear and the intensity. In 50% of the cases, high intensity changed to low over 1 year. Therefore, it is suggested that high intensity of the tendon within 1 year after repair does not necessarily mean a re-rupture.
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  • 高齢者の上腕骨頭海綿骨における骨密度と骨強度の検討
    山田 光子, 山路 哲生
    2007 年 31 巻 2 号 p. 265-268
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.265
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    Since bone mineral density (BMD) and bone strength of the proximal humeral head affect the stability of the internal fixation material at the operative treatment, we tried to evaluate the relationship between BMD and bone strength in the proximal humeral head cancellous bone using cadaver humerus. The BMD of 6 cadavers humerus (2 males and 4 female, mean age 83.2). BMD was analyzed by XP-26 (Norland Co.). BMD, distinguished by several colors, was measured at 3 regions of interest (region A: top of humeral head at the acromion side, region B: the area of subchondral bone at the glenoid side, region C: the middle of the humeral head). On the coronal plane the osteotomy was performed on the middle of humeral head and sliced 1 cm thickness. The maximum load value at three regions were measured by the compression test of the humeral head slice using a universal material examination machine (Instron 4505) with the compression bar (8.5 mm diameter) at the speed 0.04 mm/sec. Mean BMD (g/cm2) of the region A was 0.469, B 0.712 and C 0.466. Region B was significant difference from A and C (p=0.05). The mean maximum load value (N) was 134 at region A, 211 at B and 84 at C. There were significant difference A Vs B and B Vs C (p=0.05). There was positive correlation between BMD and the bone strength at the region A and B. Our result shows that the BMD measurement is the useful method to judge the stability when elderly patients with proximal humeral head fracture are treated by screw fixation.
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先天性疾患
  • スプレンゲル変形に対する肩甲骨骨切り術 －至適手術年齢の検討－
    西須 孝, 亀ヶ谷 真琴, 見目 智紀, 藤田 耕司, 高橋 憲正, 森石 丈二
    2007 年 31 巻 2 号 p. 269-272
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.269
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    Wilkinson's scapular osteotomy for Sprengel's shoulder has been historically performed on patients after the age of 5. We have been trying this procedure in younger children because we believe that early gain of scapula mobility is important to obtain more normalized clinical results. The subjects were 9 shoulders in 8 patients with a mean age of 5.7 years old (range, 3.3-11.2 years old) at the time of operation. The mean follow-up term was 5.5 years. The operation time, the amount of blood lost, the scapula height on plain radiographs, the cosmetic grade (Cavendish) and the range of motion before and after the operation were investigated. The final results in the younger age group (Group A), in which osteotomy was performed before the age of 5, was compared with those in the older age group (Group B). There were no statistical differences in operation time, the amount of blood loss, the cosmetic grade (Cavendish) between the 2 groups. The mean maximum active abduction at the final follow-up was higher in Group A than that in Group B, although there was no statistically significant difference. Improvement of the scapula height on plain radiographs after the operation in Group A was significantly better than that in Group B. We concluded that a scapular osteotomy could be safely done at the age of 3 or 4 and an osteotomy at a younger age could provide a better result.
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脱臼
  • 縫合糸の数の違いにおけるスーチャーアンカー引き抜き強度の比較 ― 引っ張り強度と修復組織の変位に着目して ―
    洞口 敬, 加藤 有紀, 龍 順之助, 加藤 敦夫, 元島 清香, 根岸 慎一, 岡野 達正, 斎藤 明義
    2007 年 31 巻 2 号 p. 273-277
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.273
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    The purpose of this study is to compare the pullout strength of a suture anchor with different numbers of sutures. We specifically reviewed the load at approximately 3mm of displacement at the repair site to be a clinical fixation failure. Anchors were tested in the glenoid of the porcine scapulas. Anchors tested included the Panalok with single No2 Ethibond (PS Group), the Panalok with double No2 Ethibond (PD Group), Panalok Loop with single No2 Ethibond (PLS Group), Panalok Loop with double No2 Ethibond (PLD Group), GII with single No2 Ethibond (GS Group), and GII with double No2 Ethibond (GD Group). An autograph AG-2000TB machine (Shimazu, Japan) applied tensile loads parallel to the axis of insertion to failure, and the mean strength to make 2 and 4mm gaps was calculated. In the cases of forming 2mm gap formations, the PLD group was significantly stronger compared to the PLS group (P=.008). There was also a significant difference between the GS group and the GSD group (P=.008). In the 4mm gap formations, the PS group was significantly stronger compared to the PD group (P=.029). There was a significant difference between the PLS group and the PLD group (P=.032). It is possible that the repair tissues are displaced from the glenoid rim before the ultimate pullout strength is reached. This study demonstrated that the load to create 2 and 4mm of displacement was increased by increasing the number of sutures threaded through an anchor.
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  • HAGL lesionの画像診断と治療成績
    上原 大志, 鈴木 一秀, 牧内 大輔, 西中 直也, 山口 健, 三原 研一, 筒井 廣明
    2007 年 31 巻 2 号 p. 279-282
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.279
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    We described the evaluations for diagnosis by images and the surgical outcome of HAGL lesion. We reviewed 6 cases (6 males) of HAGL lesion out of 225 cases of traumatic anterior shoulder instability on whom we performed surgical treatment at our institutions from March 2001 to March 2005. The mean age at the time of operation was 24.8 years old (range 17-36 years old) and the mean of follow-up after surgery was 18.2 months (range 12-24 months). All cases had been involved in an athletic activity. All cases had undergone MR arthrography (MRA) before arthroscopy. The criterias for the preoperative diagnosis of an HAGL lesion on MRA were to detect the dilation of the axillary pouch on the oblique coronal image and the disrupted edge of the capsule on the axial image and in the ABER position. Finally we diagnosed using arthroscopy. In the treatment, open repair using suture anchors was performed. We evaluated the preoperative diagnosis by MRA, the JSS Shoulder Instability and Rowe's Score. All cases of HAGL lesion could be detected by MRA preoperatively. All cases returned to their preoperative sports level from 6 to 10 months (mean 7.2 months) after. The mean JSS shoulder Instability Score and Rowe's Score had improved from 54.3 and 24.2 points preoperatively to 98.1and 97.5 at the time of final investigation. The preoperative diagnosis of HAGL lesion by MRA was possible, and we could have a good clinical outcome with an open repair using suture anchors.
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  • Bankart-Bristow変法術後の肩関節内外旋筋力の回復時期
    尼子 雅敏, 津田 悦史, 金子 正利, 有野 浩司, 根本 孝一, 今井 智仁, 岡村 健司
    2007 年 31 巻 2 号 p. 283-286
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.283
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    We assessed the shoulder rotational muscle power recovery using the surgical/non-surgical ratio, and concluded that the muscle power recovery was retarded compared with our rehabilitation program. However, the retardation could be influenced by the contra-lateral side. We reexamined the muscle power recovery only using the surgical-side data. Isokinetic concentric shoulder rotational muscle strength was evaluated in 40 patients treated with open Bankart and modified Bristow procedure. We measured the peak torques in the surgical-side shoulders at 60, and 180 deg/sec angular velocities at the pre- and post-operatively, and calculated the peak torque to the preoperative ratios (pre-op. ratio), and the peak torque to the body weight ratios (weight ratio). Positive coefficient correlations were obtained between the pre-op. and weight ratios and the postoperative period. Both ratios increased to the preoperative level by 6 months postoperatively. The surgical-side muscle power was recovered strongly enough for the stability of the gleno-humeral joint by 6 months postoperatively. This recovery period was consistent with our rehabilitation program.
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  • 関節包縫縮術を併用した Bristow 変法術後の再鏡視所見 ―関節上腕靭帯様組織の変化に関して―
    田久保 興徳, 仲川 春彦, 森原 徹, 岩田 圭生, 本多 宏明, 久保 俊一, 黒川 正夫
    2007 年 31 巻 2 号 p. 287-290
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.287
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    Anterior inferior glenohumeral ligament (AIGHL) is important for the anterior stability of the shoulder. As to the operation for anterior instability of there shoulder without sufficient AIGHL, we have performed the Bristow procedure with the capsulolabral reconstruction of anterior capsule (modified Bristow procedure). Several reports have described that the clinical results after a modified Bristow procedure were better than those after a Bristow procedure. To clarify the reasons, we investigated the arthroscopic findings 1 year after our modified Bristow procedure. We examined 13 patients (13 shoulders, 10 males and 3 females) who underwent modified Bristow procedures. Their mean age was 28 years old (range, 17-47 years old). In their 1st-time arthroscopy, AIGHL was considered insufficient in all cases, and they all underwent modified Bristow procedures. 1 year after the operation, an arthroscopy was performed in the lateral-position under a general anesthesia. The relationship between their intraarticular findings and clinical results were evaluated. In 12 cases (92%), a tissue like glenohumeral ligament was detected in arthroscopy. In this study, we clarified that the tissue like glenohumeral ligament regenerated after a modified Bristow procedure in almost all cases, in which AIGHLs were insufficient at the 1st time arthroscopy. Even if AIGHL was insufficient, the capsulolabral reconstruction of the anterior capsule may result in the regeneration of AIGHL.
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  • 反復性肩関節脱臼・亜脱臼に対する治療法の比較： Modified Inferior Capsular Shift 法 vs. 鏡視下バンカート修復術
    設楽 仁, 高岸 憲二, 鈴木 秀喜, 大沢 敏久, 石川 隆, 荒牧 雅之, 饗場 佐知子, 小林 勉, 篠崎 哲也
    2007 年 31 巻 2 号 p. 291-294
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.291
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    The purpose of this study was to compare patients with recurrent anterior dislocation and subluxation of the shoulder who were treated with a modified inferior capsular shift method with those treated with an arthroscopic Bankart suture repair. 51 shoulders were surgically treated. The patients were divided into 2 groups. In group M (21 shoulders), modified inferior capsular shift method was performed, and in group B (30 shoulders), arthroscopic Bankart suture repair was performed. The groups were homogeneous in gender, dominance, age, age at 1st dislocation (subluxation), number of dislocations or subluxations, time elapsed between 1st dislocation (subluxation) and surgery. The average follow-up for group M was 15.1 months, and for group B, it was 17.7 months. The postoperative rehabilitation was the same in both groups. Follow-up evaluations included JOA, Constant, JSS-SSI, Rowe shoulder scores and limitation of range of shoulder motion. Statistical analysis of data was performed using Welch's t test (significance for P <0.05). In group M, one of the 21 patients had experienced apprehension in the follow-up period, but no patients had a dislocation. In group B, 2 (6.7%) of the 30 shoulders experienced a dislocation. The follow-up JOA, Constant, JSS and Rowe shoulder scores of the 2 groups were not significantly different. The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score and JSS-SSI score. The mean value for group M was significantly greater than that for group B (Constant; p=0.036, JSS; p=0.028,). Though the follow-up reported was short, arthroscopic Bankart suture repair was an effective surgical technique as well as the modified capsular shift method. In our study, Bankart suture repair was superior for an internal rotation and flexion than a modified inferior capsular shift method.
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  • Suture anchor法による鏡視下Bankart修復術： 2年以上経過例の成績と術後再発例の検討
    岩堀 裕介, 加藤 真, 佐藤 啓二, 花村 浩克
    2007 年 31 巻 2 号 p. 295-298
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.295
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    The purpose of this study was to evaluate the minimum 2-year follow-up result of arthroscopic Bankart repair, using suture anchors for traumatic anterior glenohumeral instability. We retrospectively studied 147 shoulders of 140 patients. There were 99 male and 41 female patients. The average age at operation was 23.3 years old (range, 14 to 43). 133 shoulders had recurrent dislocations or subluxations, and 14 shoulders had initial dislocations. The mean interval from the time of the operation to the final follow-up evaluation was 35 months (range, 24 to 116). We performed an additional anterior capsular suture on 12 shoulders, superior labral repairs on 18 shoulders, a rotator interval closure on 22 shoulders, and a thermal capsulorrhaphy on 20 shoulders at the time of their operations. Postoperatively, the average loss of external rotation was 8.2° with the arm at the side, and 5.2° with the arm in 90° of abduction. The Rowe's score ranged from 40 to 100 points (average 92.2), and 129 shoulders (87.8%) had a rating of good or excellent at the time of their final follow-up. Postoperatively, 12 shoulders experienced re-dislocation or re-subluxaion, and 13 shoulders demonstrated a mild anterior apprehension sign. Revision surgeries were performed on 7 out of 12 re-injured shoulders. Recurrence of Bankart's lesion with a suture breakage was observed in every shoulder during revision surgery. The factors related to a recurrence are supposed to be a large glenoid bony defect, multidirectional instability, insufficient anterior capsular shift, and poor healing of the anterior capsular mechanism on the anterior glenoid rim cartilage. To obtain a better clinical outcome, careful selection of patients and refinement of repair technique raising initial fixation strength and healing potential are necessary.
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  • 鏡視下バンカート修復術における新しい複合体固定法の短期治療成績
    平田 正純, 森原 徹, 岩田 圭生, 本多 宏明, 久保 俊一, 黒川 正夫, 堀井 基行
    2007 年 31 巻 2 号 p. 299-302
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.299
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    Nowadays, single layer fixation of inferior glenohumeral ligamament(IGHL) -labral complex is commonly accepted at arthroscopic Bankart repair using suture anchor technique. Using this conventional method, the complex was repaired by pin point fixation and edge slack phenomenon after surgery was reported. We introduce a new repair technique that provides double layer foot print fixation using PANALOK LOOP anchor™ . After resurfacing the glenoid rim, we added another suture through eyelet loop(suture A,B) and inserted the anchor on the glenoid at the 5 o'clock position. Mobilized IGHL-labral complex was conventionally fixed by the suture A. Second anchor with two sutures(suture C,D) was placed under the glenoid at the 4 o'clock position. Both of the sutures were passed through the IGHL-labral complex using suture relay technique. The suture B and C were tied outside the portal and the knot was placed on the complex. Another ends of the suture B and C were tied on the complex by non-sliding knot. Third anchor with two sutures(suture E,F) was inserted on the glenoid at the 3 o'clock position. Suture D and E were tied in a same manner. Using this new technique named double bridging fixation method, double layer foot print fixation of IGHL-labral complex was achieved. This method is considered to be a useful and a further follow-up is required.
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骨折
  • 上腕骨近位部ＡＯ分類Ｃ型，２・３part骨折の治療成績
    酒本 佳洋, 水掫 貴満, 仲川 喜之, 奥本 洋樹, 桜井 悟良, 橋内 智尚
    2007 年 31 巻 2 号 p. 303-306
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.303
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    The purpose of this study was to produce the clinical results of AO type C 2-,3-part fractures. 36 cases without a dislocation were classified into 3 types; 2-part fractures of the anatomical neck (C1-3), 3-part fractures of the valgus type (C1-1, C2-1), 3-part fractures of the varus type (C1-2, C2-2). 2 cases classified in the 2-part fracture of the anatomical neck were 94 year-old-women. 1 was treated by prosthetic replacement, the other was treated conservatively, and healed without avascular necrosis (AVN). 25 cases were classified in the 3-part of valgus type. They were 23 women and 2 men with an average age of 68 years old (ranging from 47 to 85). 21 cases were treated surgically, and 4 cases were treated conservatively. All cases healed without AVN, but 1 case fell into osteoarthritis. 9 cases were classified in the 3-part of varus type. They were one man and 8 women with an average age of 72 years old (ranging from 62 to 80). All cases were treated surgically and healed without AVN. We had one rare case of valgus type, which included both an anatomical and a surgical neck fracture. It was treated surgically and healed without AVN. We evaluated the results of AO type C 2-, 3-part fractures and all cases had no AVN. But this study had a problem. It was difficult to classify these fractures only by X-P. It is possible that our materials included type B fractures. We suggest that 3D-CT was very useful to classify these fractures.
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  • 上腕骨近位端骨折に対するターゴンPHネイル™の治療成績
    佐藤 英樹, 長尾 秋彦, 三浦 一志
    2007 年 31 巻 2 号 p. 307-310
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.307
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    The purpose of this study was to evaluate the clinical results of the osteosynthesis for proximal humeral fractures using the Targon PH nail™. 22 patients underwent osteosynthesis using the Targon PH nail from 2003 to 2005. 15 of these patients were followed up for more than 6 months (range, 6 to 37 months) after surgery. The average age at surgery was 69.7 years old. According to the AO classification, 3 fractures were classified as A2.1, 2 as A2.2, 3 as A3.1, 2 as B1.2, 1 as B3.1, 3 as C3.1, and 1 as C3.1. The clinical results were evaluated based on the JOA score and the UCLA score. Postoperative osteoarthritc changes were radiographically classified into 4 stages. All the patients obtained a bony fusion. The mean postoperative JOA and UCLA scores were 88.4 (range, 59.5 to 100) and 31.6 (range, 22 to 35), respectively. The mean range of shoulder flexion and external rotation was 136 degrees (range, 85 to 165) and 50 degrees (range, 20 to 80), respectively. Postoperative osteoarthritic changes were graded into early stage in 2 cases, advanced stage in 2 cases, and the end stage in 1 case. In 10 cases, no osteoarthritic change was seen. Metaphyseal comminution was associated with advanced or end stage osteoarthritis. Our results showed osteosynthesis using a Targon PH nail is a reliable treatment for proximal humeral fractures. It was very important to position the proximal end of the nail the just below the subchondral bone to insert multiple screws into the humeral head in the case of a metaphyseal comminution.
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  • 上腕骨近位端・近位骨幹端骨折に対する transmedullary support screwの応用
    池上 博泰, 中道 憲明, 小林 修三, 小川 清久, 浪花 豊寿
    2007 年 31 巻 2 号 p. 311-314
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.311
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    In the wake of recent improvement of intramedullary nails, the application of intramedullary nailing to a fracture of the humerus has been expanding as well as to the lower extremities. However, conventional intramedullary nailing has problems in reduction and fixation in some fracture types. This paper reports on the method and clinical results of our treatment using intramedullary nailing and transmedullary support screws combined together. During the period between 2003 and 2006, we had 12 cases (males5, females7) of intramedullary nailing combined with transmedullary support screw use for the fracture of the humerus, of which 6 cases were fresh and 6 were non-union after conservative treatment at former clinics. All the cases had the fracture lines running spirally or obliquely. The average age of the patients was 60 (42-69 years old), the average follow-up period was 22 months (3-40 months). We studied these 12 cases about fracture types and treatment methods and evaluated the results with x-rays and from the ROMs of the shoulder and elbow joints. As for fracture types, there were three 11-A3.1, two 11-A3.2, five 12-A1.1, two 12-A2.1 cases by OTA classification. As for the insertion point of the deltoid, seven cases were at the proximal fragment, and five at the distal fragment. We used transmedullary support screws in the proximal fragment in eight cases, and in the distal fragment in four cases. Among six non-union cases, we transplanted the iliac bone in only one case. We observed bone-union in all the cases. The ROM was the same as the non-affected side in eight cases, however we observed limitation of external rotation and elevation of the shoulder joint in four cases. In 1999, Krrettek reported on a method using screws around intramedullary nails by the name of Pollerscrews. This method has been mainly applied to fractures of the tibia and femur, however it is an effective method also for spiral or oblique fractures in proximal metaphysis as long as you keep a close watch on the insertion of the humerus and the type of fracture.
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  • 上腕骨近位端骨折の治療経験　―成績不良例の検討―
    古川 敬三, 衛藤 正雄, 進藤 裕幸
    2007 年 31 巻 2 号 p. 315-318
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.315
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    The purpose of this study was to evaluate the surgical results for proximal humeral fractures by analysis of patients obtaining a poor recovery. We studied 23 patients who underwent a surgical procedure for a proximal humeral fracture and were followed-up more for than 6 months from 1987. 10 were males and 13 were females. The average age was 59 years old (34-84 years old) and the average follow-up period was 34 months. The fracture type was a 2-part fracture in 10 patients, a 3-part fracture in 4 patients and a 4-part fracture in 9 patients. We investigated the surgical results aiming at Japan Orthopaedic Association (JOA) scores and range of active elevation of the shoulder joint. The mean JOA score and the mean range of active elevation was 88 points and 125 degrees in a 2-part fracture, 79 points and 110 degrees in a 3-part and 72 points and 86 degrees in a 4-part. 9 of the patients (a 2-part fracture in 2 patients, a 3-part in 1, a 4-part in 6) obtained under 70 points of the JOA score or under 90 degrees in active elevation. 8 patients over 66 years old made significantly poorer recoveries than the 65 years old and under. The patients with poor shoulder function before injury and the elderly patients tended to obtain poor results with surgical treatments.
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  • 烏口突起骨折に対する経皮的スクリュー固定による治療経験
    杉原 隆之, 中川 照彦, 尾澤 英彦, 多嶋 佳孝, 二村 昭元, 石突 正文, 宗田 大, 四宮 謙一, 平塚 建太郎
    2007 年 31 巻 2 号 p. 319-322
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.319
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    The clinical results of percutaneous cannulated cancellous screw fixation for a coracoid process fracture were investigated. The percutaneous cannulated cancellous screw fixations for coracoid process fracture were performed on 6 shoulders from 1997 to 2006 in our hospitals. There were 4 males and 2 females with an average age of 45.2 years old. There were 2 right sides and 4 left. 1 case was an isolated coracoid fracture, 4 cases had an acromioclavicular joint dislocation and 1case had a distal clavicle fracture. With the anteroposterior view, the scapulolateral view and the axillary lateral view by image intensifier, the direction of the screw was determined. A bone union occurred in all cases, and the alignment of the acromioclavicular joint dislocations were good. The postoperative ranges of motion of their shoulders were mostly good. During the operation, the axillary lateral view by the image intensifier was useful to determine the direction of the screw. The clinical results of percutaneous cannulated cancellous screw fixation for a coracoid process fracture were good.
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  • 肩甲骨烏口突起骨折 －肩甲帯部重複損傷からみた発生機序－
    仲川 喜之, 奥本 洋樹, 酒本 佳洋
    2007 年 31 巻 2 号 p. 323-327
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.323
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    Fractures of the coracoid process of the scapula apparently are rare. The purpose of this study was to investigate the pathogenesis, treatment and results of fractures of the coracoid process of the scapula associated with a complex injury of the shoulder girdle. The fractures were classified into 3 groups according to the fracture site; base type (57 cases, including 4 epiphyseal separations): base of the coracoid process was fractured, intermediated type (3 cases, including 1 epiphyseal separation): intermediate portion between base and tip of the coracoid process was fractured, tip type: (7 cases) tip of the coracoid process was fractured. The associated injuries were as follows; dislocation of the acromioclavicular joint: 45 cases, fractures of the acromion: 13 cases, fracture of the distal clavicle: 15 cases, fracture of the middle clavicle: 5 cases, dislocation of the shoulder: 3 cases. Only 3 cases which were a tip type, had no associated injuries. 18 cases were treated conservatively. 49 cases were treated surgically. Both the acromioclavicular joint mechanism (the acromiolcavicular joint, the acromion, the distal clavicle) and the coracoid process were operated on in 29 cases. Only the coracoid process was operated on in 6 cases. Only associated injury was operated on in 4 cases. Dewar's method was performed in 10 cases. Most of all healed satisfactorily, but 6 cases treated conservatively had a nonunion of the coracoid process and complained of discomfort. The fractures of the coracoid process were often associated with complex injuries of the shoulder girdle. Especially, when the acromioclavicular joint mechanism were injured, we were careful of its diagnosis, because fractures of the coracoid process were often overlooked. In unstable fractures associated with complex injuries of the shoulder girdle, better results were achieved with surgical treatment.
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  • 肩鎖関節脱臼を伴う烏口突起骨折の治療
    新村 光太郎, 高瀬 勝己, 山本 謙吾
    2007 年 31 巻 2 号 p. 329-332
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.329
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    A coracoid process fracture with an acromioclavicular joint (AC-j) dislocation is a comparatively rare injury. The purpose of this study was to evaluate the therapeutic results for this injury. We treated 12 patients (all male) with a mean age of 45 (24 to 82). Two patients were treated conservative. On the other patients, the surgery was performed with screws for a coracoid process fracture; additionally we used K-wire (6 cases) or Wolter-Clavicular plate (4 cases) for an AC-j fixation. We evaluated the therapeutic results more than 6 months post injury using the Japan Shoulder Society AC-j score. In all cases who underwent the surgery, a bone union was accomplished without infection and breakage of the hardware. Postoperative subluxation of the AC-j was recognized in 3 patients. One of them needed the resection of the distal end of the clavicle for severe pain caused by osteoarthritis of the AC-j. Excluding this case, there was no patient who recognized the AC-j pain or subcoracoid impingement. The AC-j score was a mean 93 points (81 to 100 points). On the other hand, pain remained in 2 patients treated conservatively, and one of them got a no-union. The AC-j scores were 50 and 52 points. In the surgical treatment for a coracoid process fracture with an AC-j dislocation, it was possible to obtain satisfactory therapeutic results. However, the patients treated conservatively obtained poor results.
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  • 鎖骨遠位端骨折の治療成績
    南村 武彦, 森原 徹, 田久保 興徳, 岩田 圭生, 仲川 春彦, 久保 俊一, 黒川 正夫
    2007 年 31 巻 2 号 p. 333-336
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.333
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    The aim of the study was to evaluate the clinical results of distal-end fractures of the clavicle. We evaluated 72 distal-end fractures of the clavicle. There were 48 men and 24 women, the mean age was 45.1 years old (range, 12-90 years old) and the mean follow-up period was 7.9 months (range, 6-13 months). The types of fracture were classified by Takubo's classification. The clinical results were evaluated by the range of elevation and duration of bone union on X-rays. Type I fractures were 30 cases, 20 cases were treated non-operatively. In the non-operative group, a complete union was obtained in 17 cases and the average duration of bone union was 3.6 months. The other 3 cases were nonunion, and these patients were significantly older than the patients in the union group, but were free from pain or restriction of the ROM. Type II b fractures were 26 cases, in 18 cases treated with a tension band wiring, a complete union was obtained in 16cases. The other 2 cases were cutout, and these patients were significantly older than patients in the union group. Type V fractures were 8 cases treated with tension band wiring or plate fixation. A complete union was obtained in all cases. Type VI was 5 cases treated with a tension band wiring, all cases obtained a complete union.
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筋腱疾患
  • 肩挙上困難な腱板広範囲断裂に対する長掌筋腱を用いた腱板再建術
    廣岡 孝彦, 橋詰 博行
    2007 年 31 巻 2 号 p. 337-340
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.337
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    Some elderly patients with a massive rotator cuff tear have severe impairment of the shoulder joint elevation. When the rotator cuff is severely degenerated and fragile, tear is very likely to occur during rehabilitation after surgery by the McLaughlin's method alone. In this study, we investigated the usefulness of Palmaris longus graft in elderly patients with a massive rotator cuff tear accompanied by impaired elevation of the shoulder joint. The subjects were 13 patients with 13 impaired shoulders incapable of active elevation of the shoulder joint from the lowered position for 3 months or longer due to a rotator cuff tear, and diagnosed with massive rotator cuff tear by MRI before surgery. The age at the time of surgery was 62-81 years old. 12 patients had no clear cause of injury. 2 patients had rheumatoid arthritis, and 1 patient had Parkinson's Disease. Rotator cuff repair and Palmaris longus graft were performed on these patients. The postoperative acquisition of shoulder joint function was investigated. The average point of the post-operative JOA score was 85.7 points. 9 patients became capable of active elevation of the shoulder joint for more than 150 after surgery. 2 patients with a poor outcome had rheumatoid arthritis and Parkinson's Disease. Palmaris longus graft may be effective for a massive rotator cuff tear in elderly patients with advanced impairment of the shoulder joint, but caution of complications such as rheumatoid arthritis is necessary, and application of the procedure should be carefully selected.
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  • 腱板完全断裂に対する保存療法の効果
    牧内 大輔, 鈴木 一秀, 三原 研一, 松久 孝行, 西中 直也, 山口 健, 筒井 廣明
    2007 年 31 巻 2 号 p. 341-344
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.341
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    The aim of this study is to investigate the clinical outcome of conservative treatment for full-thickness rotator cuff tears (FTRCTs), and to analyze factors that influence the clinical outcome. We selected 35 patients who were diagnosed as having FTRCTs by MRI or MR arthrography and were treated conservatively. There were 19 males and 16 females with an average age of 65.3 years old. All patients were evaluated with use of JOA score and were classified into two groups; an excellent group with over 80 points and a poor group with below 79 points. Comparative assessments of JOA score, range of motion, age, sex, dominant versus non-dominant side, traumatic history, night pain, the size and location of the cuff tear, and duration from the onset to the first consultation were carried out between the two groups. The mean JOA score revealed an overall improvement from 59.9 at the time of initial examination to 87.2 at the last examination. The mean range of active flexion improved from 87.86°at the time of initial examination to 142.86°at the last examination. In the cases with poor results, pain and ROM score revealed an improvement at one month after treatment, but no significant improvement at the further follow-up examinations. In the several factors, the size of cuff tear had statistical significance in the clinical outcome. Our clinical results of the conservative treatments were almost effective for the patients with FTRCTs. However, our results suggested that if the patients reported no or less improvement of JOA score within two or three months after conservative treatment, an operative procedure should be recommended.
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  • 自家腱移植モデルを用いた腱板修復過程における宿主，移植細胞の動態
    岩田 圭生, 森原 徹, 立入 久和, 藤原 浩芳, 久保 俊一, 堀井 基行, 黒川 正夫
    2007 年 31 巻 2 号 p. 345-348
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.345
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    The purpose of this study is to examine the behavior of the host and graft cells in early remodeling process after tendon implantation to the defect using green fluorescent protein (GFP) transgenic rat. 20 Sprague Dawley (SD) rats and 20 green fluorescent protein (GFP) transgenic rats were used in this study. Tendinous defect were made close to the supraspinatus tendon insertion. In group A, the Achilles tendons of SD rats were transplanted into the defect of GFP rats. In group B, the Achilles tendons of GFP rats were transplanted into the defect of SD rats. At 0,1,3,7 and 28 days after surgery, sections stained with hematoxylin and eosin were assessed histologically, and localization of GFP positive cells were also evaluated. The graft was surrounded by inflammatory cells at 3 days. At the bone-tendon insertion, fibroblastic cells started to infiltrate histologically and increased in number in 28 days. In Group A, a small number of signal positive host cells were found around both the bursal and articular side of grafted tendon at 1 day. The host cells increased at 7 days. In Group B, signal positive graft cells were found in the graft at 1 day, which decreased over time. Replacement of graft cells by host cells occurred in the early remodeling process. Infiltrated host cells to both the bursal and articular side play an important role in the early remodeling process after tendon implantation for a defect of the rotator cuff.
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  • 腱板広範囲断裂に対する大腿筋膜パッチ法術後肩筋力評価と術後成績
    武居 功, 村 成幸, 桃井 義敬, 鶴田 大作, 荻野 利彦, 後藤 康夫, 松田 雅彦
    2007 年 31 巻 2 号 p. 349-351
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.349
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    Fascia lata patch grafting is one of the possible methods for repair of a massive rotator cuff tear for which we are unable to perform a primary suture. However, some researchers have indicated that shoulder muscle power recovery of such cases is not always adequate. So we evaluated muscle power and postoperative results of the fascia lata patch grafting method for massive rotator cuff tear, as there is few precise reports elucidating muscle power recovery, though. The cases were 12 patients (9 males and 3 females) with a primary massive rotator cuff tear who underwent fascia lata patch grafting. The age on average was 60.9 years old at the time of surgery. They were followed up for over 2 years postoperatively (34 months on average), and could be examined directly in our offices at the last time we saw them. The results were evaluated using the Japanese Japan Orthopaedic Association (JOA) score and it significantly improved from 67.0 to 89.5. Isometric muscle power was measured with MicroFET. Shoulder abduction strength significantly improved from 18.5 to 75.8 N at 45 degrees of abduction, from 14.2 to 55.4 N at 90 degrees of abduction. External rotation strength significantly improved from 19.9 to 53.7 N. Internal rotation strength improved from 77.2 to 122.4 N, but it was not significant. The external rotation strength did not recover well compared with that of abduction. This may be because a massive rotator cuff tear often includes infraspinatus muscle atrophy and fatty degeneration, so that it is fundamentally difficult to recover external rotation strength. We concluded that fascia lata patch grafting is an effective method for repair of massive rotator cuff tear and both abduction and external rotation strength can significantly recover, but we should do something more to improve the extent of the external rotation strength recovery.
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  • 40歳未満に発生した腱板断裂の特徴
    中川 滋人, 水野 直子, 米田 稔, 山田 真一, 林田 賢治
    2007 年 31 巻 2 号 p. 353-355
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.353
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    The purpose of this study was to clarify the clinical feature of rotator cuff tears occurred in a relatively younger population. Among patients who underwent arthroscopic rotator cuff repair, 19 patients younger than 40 years old were investigated. Regarding their injured mechanism, 6 shoulders in the overuse group were injured through repetitive overhead activity, and 13 shoulders in the trauma group were injured during a sports activity or a traffic accident, including 10 shoulders injured by a fall. Several clinical features were retrospectively investigated. As a result, there was an articular-side partial tear in 10, a bursal-side partial tear in 3, and an intratendinous horizontal tear in 6, and their mean age was 30.4, 37, and 27.3 years old, respectively. While the overuse group showed 4 articular-sides, 1 bursal-side and 1 intratendinous tear, in the trauma group there were 6, 2 and 5, respectively. Shoulder pain was recognized in all shoulders, and disturbed their daily activity in 15. Moreover, difficulty in elevation was complained of by 8 shoulders in the trauma group, and among them disability of active abduction was recognized in 4. Regarding their location of tears, in the trauma group most tears were recognized at the anterior aspect of the supraspinatus tendon, and 4 of 6 horizontal tears were recognized at the central aspect of the supraspinatus tendon. Posterior capsular tightness and presence of the greater tuberosity notch on the humeral head were not so frequent in the trauma group. While inflammation in the subacromial bursa was rarely seen in either group, granulation tissue was recognized after the exposure of the tear site in 2 in the overuse group and in 3 in the trauma group and it was especially frequently seen in horizontal tears (3 of 6 tears). In conclusion, in relatively younger patients showing recalcitrant shoulder pain after trauma, attention should be paid to the presence of a partial rotator cuff tear, including a horizontal tear.
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  • Weight Bearing Shoulderに対する手術治療成績
    笠島 俊彦, 末永 直樹
    2007 年 31 巻 2 号 p. 357-360
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.357
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    Although it has been reported that a large percentage of persons with paraplegia suffer from a tear of the rotator cuff, there are few reports addressing the surgical treatment, and no report on the evaluation of repaired tendon using MR imaging. The purpose of this study was to evaluate the clinical results and MRI findings of repaired tendon in the weight bearing shoulder. 7 male patients (8 shoulders) with rotator cuff tears underwent rotator cuff repair. Their ages averaged 53 years old and ranged from 45 to 62 years old. There were 5 middle, 1 large and 2 massive tears. Tendon-to-bone repair was accomplished in 7 shoulders. Synovectomy, capsular shift and rotator cuff repair was done in one shoulder with a massive tear and severe synovitis. Postoperatively manual wheelchair use was prohibited until 8-12 weeks after the procedure, and transfers were until 10-14 weeks. The follow-up period averaged 36 months (range, 8-74 months). The patients were evaluated with JOA score and MRI findings of the repaired tendon. The preoperative JOA score averaged 53 points, ranging from 21 to 68. The postoperative JOA score improved 94 points (range, 87-100). The postoperative range-of-motion and strength improved in all shoulders. All patients could transfer independently. There were no MRI findings of re-rupture in all shoulders except 1 shoulder with a massive tear. This study showed that surgical repairs in a weight bearing shoulder were effective methods that provided improvement of shoulder function at intermediate follow-up evaluation.
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  • 腱板断裂の理学所見による断裂形態の判別
    山本 敦史, 高岸 憲二, 大沢 敏久, 鈴木 秀喜, 小林 勉, 設楽 仁, 篠崎 哲也
    2007 年 31 巻 2 号 p. 361-364
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.361
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    There are a lot of evaluation methods for a rotator cuff tear, but there are few reports that estimate these findings, generally paying attention to the tear type. The purpose of this study was to examine whether the type of tear in a rotator cuff tear could be distinguished from physical findings. We evaluated 89 cases 89 shoulders who had been surgically diagnosed as a type of tear and had been able to estimate all attempted physical findings. There were 54males and 35 females, 60 right sides and 29 left with an average age of 61.6 years old (35 to 85 years old). The subjects were divided into 3 groups by type of tear : an articular side tear(AST), a bursal side tear(BST), and a full-thickness tear(FTT). 24 values were obtained from the preoperative findings : muscle atrophy (trapezius or supraspinatus, infraspinatus, deltoid), tenderness (coracoid process, supraspinatus tendon, greater tubercle, intertubercular groove, anterior joint space, posterior joint space), muscle weakness (abduction, external rotation), active range of motion (flexion, abduction, external rotation, internal rotation), sulcus of suprasupinatus tendon, crepitus, Neer's impingement sign, Hawkins-Kennedy impingement sign, painful arc sign, Speed test, drop arm sign, initial abduction test, and lift off test. Discriminant analysis was carried out to distinguish 3 types of tear from these 24 values. We surgically diagnosed 11 shoulders with AST, 15 shoulders with BST, and 63 shoulders with FTT. Discriminant analysis successfully distinguished three groups [F(24.150)=2.741, >1.91]. The crepitus (partial F=6.5123) and initial abduction test (partial F=3.6880) contributed significantly to the discrimination. This study showed the possibility that we could distinguish the types of tear in a rotator cuff from a suitable choices of clinical findings.
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  • 腱板断裂におけるX線分類と術後早期運動療法を併用した手術成績
    高橋 晃, 齋藤 知行
    2007 年 31 巻 2 号 p. 365-368
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.365
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    Clinical results of rotator cuff repairs using the same therapeutic exercises from an early stage after surgery were investigated and compared with the preoperative X-ray findings. 70 shoulders with rotator cuff tears treated operatively and followed by active-assistive exercises in a supine position from 1 week and active exercises standing from 3 weeks after surgery were evaluated. The average age was 63 years old and follow-up periods were 11.9 months. The operative procedures were McLaughlin's method in 41 shoulders, side to side sutures in 9, acromioplasty in 17 and a tendon transfer in 3. The preoperative X-ray findings were classified into 5 groups: group A, superiorly migrated humeral head and narrowed joint space in 4 shoulders; group B, only superior migration in 7; group C, only narrowed joint space in 3; group D, no changes in 36; group E, subacromial spurs more than 5 mm without superior migration in 20. The postoperative results were assessed according to the JOA score and the failure rate of each group was investigated. No significant differences in the preoperative JOA score were found in the 5 groups. The postoperative JOA scores were 62.9±3.6 in group A, 75.1±12.6 in B, 78.0±12.2 in C, 90.4±7.5 in D, and 83.6±11.1 in E. Especially groups D and E treated by McLaughlin's methods showed a significant higher score at follow-up. Rotator cuff repairs with the same therapeutic exercises from an early stage after surgery for groups A, B and C showed poor results. Groups A and B with a superior migration of the humeral head showed a high failure rate of 40 % compared with 4.7% in group C, D and E with no superior migration. For these cases more careful postoperative exercises were recommended.
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  • 肩関節モビライザーと挙上位自動運動を用いた腱板断裂術後早期後療法の有用性
    大泉 尚美, 末永 直樹, 久田 幸由, 三浪 明男
    2007 年 31 巻 2 号 p. 369-372
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.369
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    Early passive exercises after an operation for a rotator cuff tear often creates difficulty due to pain and increased muscle tonus. We developed a new rehabilitation protocol using an original shoulder mobilizer and an active exercise in the supine flexed position. The objective of this study was to compare the ROM and pain of the shoulder between the former and new protocol. Fifty-two shoulders were classified as group I (GI); no tendon-to-bone repair, or group II (GII); with a tendon-to-bone repair. In the former protocol, passive exercises started the next day after the surgery (GI) or in 1 week (GII). In our new protocol, the active exercises and the mobilizer started the next day; no passive exercises were applied. There were 10 former-GI, 9 new-GI, former-GII, and 14 new-GII. The postoperative passive flexion (Flex), the external-rotation (ER), and the internal-rotation (IR), and the amount of pain relief suppository used postoperatively were evaluated. The ROM (deg.) was Flex (1w/2w/4w); 109/139/133, ER; 34/53/44, IR 44/53/54 in the former-GI, Flex; 130/144/154, ER 51/71/70, IR; 49/59/54 in the new-GI, Flex; 117/134/145, ER 43/60/65, IR; 36/35/46 in the former-GII, Flex; 117/139/153, ER 37/53/63, IR; 44/52/53 in the new-GII. All motions but the ER in GII improved in the new protocol. The amount of suppositories used in day 1 and 2 significantly increased in the new-GII than the former-GII; it is probably because the exercises started earlier in the new protocol than the former protocol. Favorable ROM was obtained in most motions without any passive exercises by using the mobilizer and the active exercise. It is considered that the active exercises assisted in getting better concentric motion of the humeral head and the mobilizer provided muscle relaxation. To improve ER in GII, additional exercises should be considered.
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  • 腱板修復術後の除痛に創部への局所麻酔薬は有効か？
    渡辺 千聡, 木下 光雄, 福西 邦素, 三幡 輝久, 阿部 宗昭
    2007 年 31 巻 2 号 p. 373-375
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.373
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    Postoperative pain from cuff repair surgery is so severe that it may influence postoperative rehabilitation, and often lead to complex regional pain syndrome. This study investigated the effect of local anesthetic use before skin closure. 15 patients (average age 56.1 years old ) undergoing rotator cuff repair surgery were studied. They received local anesthetic (0.5% pubivacaine: 20-30cc) infiltrated into the wound and joint before skin closure. In addition, 15 patients (average age 54.1 years old) who did not receive a local anesthetic were studied as the control. Pain intensity after surgery was measured by the amount of NSAID (Diclofenac Na) and opioid (Pentazocine) used within 48 hours after surgery. The degree of flexion at 3, 6 months after surgery and the clinical results using the JOA score were evaluated. The amount of NSAID (110±67.3 mg) was significantly(p< 0.01) lower than that in the control group(176±70.0 mg ). The amount of opioid (4.0±6.87 mg) was significantly(p< 0.01) lower than that in the control group(17.0±13.73 mg). There was no significant difference between the two groups in either the degree of flexion or the clinical result. Local anesthetic use into the wound and joint before skin closure was an effective method of pain control and it did not influence the clinical result.
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  • 関節包側腱板不全断裂の回復に対する拘縮の影響
    中村 恒一, 畑 幸彦, 村上 成道, 石垣 範雄, 伊坪 敏郎, 加藤 博之, 谷川 浩隆, 君塚 康一郎, 小林 博一
    2007 年 31 巻 2 号 p. 377-379
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.377
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    In our study, 71% out of the patients with partial thickness joint side tears (PTT) of the rotator cuff had contracture of the shoulder at their initial visit. There is no report about the influence of the contracture on PTT of the rotator cuff. The purpose of our study was to assess the influence of the contracture on recovery for PTT of the rotator cuff. We studied 71 patients who had been diagnosed with joint side tear of the rotator cuff by arthrogram during their initial examination. Their mean age was 47.3 years old and the mean interval from onset of sympton to first visit was 9.5 months. We defined cases in which the position of the greater tuberosity was a prerotational glide or a rotational glide as a “contracture”, cases in which there was a postrotational glide as an “non-contracture” at arthrogram of shoulder elevation. 46 shoulders had a contracture. We classified the shoulders as the contracture group (46 shoulders) and non-contractured group (25 shoulders). The differences between those groups were tested for statistical significance according to age, duration from onset of symptoms, gender, presence of trauma, location of PTT, size of PTT, course of PTT and UCLA score before and after treatment. In the results, the 2 groups exhibited no significant differences in age, sex, duration of treatment, traumatic presence, or location and size of PTT. 28 shoulders (61%) out of the contracture group showed an extension of PTT after conservative treatment. On the other hand, 8 cases (32%) out of the non-contracture group showed an extension of PTT after conservative treatment. There was a significant difference (P<0.05). The UCLA score of both groups improved significantly after treatment. The total score and function item of the UCLA score were higher in the non-contracture group than that in the contracture group. In conclusion, recovery of a PTT with a contracture was obstructed compared with a PTT without a contracture. Recovery of ADL was behind if PTT had a contracture.
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  • 腱板断裂における手術侵襲の検討 ―鏡視下腱板修復術と直視下腱板修復術の比較―
    篠田 毅, 柴田 陽三, 熊野 貴史, 内藤 正俊
    2007 年 31 巻 2 号 p. 381-383
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.381
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    Whether surgical invasion of an arthroscopic rotator cuff repair (ARCR) is really less than 1 of the open rotator cuff repairs (ORCR) is unknown. The purpose of this study was to determine the surgical invasion level of ARCR and ORCR. 14 patients underwent ARCR and 10 patients did ORCR. The patient groups were similar with regard to age and tear size. In each group, interleukin-6 (IL-6), C-reactive protein (CRP), and hemoglobin (Hb) levels were evaluated before and a day after the surgery. The surgical time was also examined in each group. There were statistical significances in IL-6 level and surgical times in both groups. The IL-6 in the ARCR group was statistically lower than that in the ORCR (P < 0.01). The surgical time in the ARCR group was longer than that in the ORCR (P < 0.05). The ARCR was a less invasive procedure than the ORCR.
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  • 関節鏡視下腱板修復術のラーニングカーブについて
    武田 浩志
    2007 年 31 巻 2 号 p. 385-387
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.385
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    Arthroscopic rotator cuff repair (ARCR) is a technically demanding procedure. The purpose of this study was to quantify the learning curve by analyzing the operative time. 180 cases of ARCR(mean age 59 years old, range 21 to 79 years old, 127 males, 53 females) were performed between March 2003 and February 2006 by a single surgeon. A subacromial decompression was added to all cases except those with massive tears. Suture anchors were used to repair the cuffs. If the cuff was mobile enough, the double row method was applied (49/180 cases, 27%). There were 20 partial thickness(11%), 47 small(26%), 69 medium(38%), 25 large(14%), and 19 massive tears(11%). The learning curve was analyzed with the operative time. Also, the correlation of the operative time with the number of suture anchors used and the size of the tear were evaluated. Consecutive blocks of 20 cases were analyzed. The mean operative time and the standard deviation for the first block was 153+25 minutes (122-194 min.), and 72+21 minutes (42-112 min.) for the last block. At the third block (case number 61-80), the mean operative time became less than 2 hours. The operative time decreased rapidly during the first 100 cases. The mean number of the suture anchors used was 2.0, and it was correlated with the operative time (Spearman's rho = 0.43, p<0.0001). The size of the tear was also correlated with the operative time (Spearman's rho = 0.39, p<0.0001). The operative time rapidly decreased during the first 100 cases. The size of the tear and the number of suture anchors were correlated with the operative time.
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  • 鏡視下腱板修復術における修復腱板のTraction-MRI評価
    小松田 辰郎, 小池 洋一, 佐藤 克巳
    2007 年 31 巻 2 号 p. 389-392
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.389
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    The purpose of this study was to reveal the functional outcome of arthroscopic rotator cuff repair and to evaluate the postoperative cuff integrity by traction-MRI. 47 shoulders (39 males, 8 females, mean 57 years) were included. All 47 tears (35 complete type (10 small, 21 medium, 4 large), 12 incomplete type (9 bursal-side, 3 articular-side) were repaired using the single-row technique. The mean follow-up period was 31 months (range 17-48) and the clinical outcome was assessed using the JOA score. Postoperative cuff-integrity was evaluated by traction-MRI, performed at both 4 and 12 months postoperatively. MR findings of T2WI were classified into 3 categories (low, intermediate and high). On MRs, low signals were observed in only 21% at 4 months but increased significantly to 53% at 12 months. Intermediate signals were seen in tendons in 63% of the shoulders at 4 months and in 37% at 12 months. High signals were seen in tendons in 16% of the shoulders at 4 months. This rate decreased to 11% at 12 months. In the shoulder joint, high signals were seen in 56% at 4 months, the rate which decreased to 26% at 12 months. In the bursa, high signals were seen in 74% at 4 months and 63% at 12 months. The average total JOA score improved from 66.2 (pain: 9.1, function: 14.8, ROM: 23.6) to 93.5 (pain: 27.2, function: 19.5, ROM: 26.7) in all the cases, from 65.5 to 95.9 in the low group, from 66.6 to 94.9 in the intermediate group and from 68.4 to 76.8 in the high group. The functional outcome of this procedure was quite satisfactory. MR findings revealed serial signal changes after surgery, which suggested the morphologic improvement at the tendon-bone junction. This study suggested that better functional outcome may be established in shoulders with better postoperative cuff integrity.
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  • 腱板断裂に対する鏡視下腱板修復術の治療経験
    神戸 克明, 井上 和彦, 井上 靖雄
    2007 年 31 巻 2 号 p. 393-396
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.393
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    Excellent results of arthroscopic rotator cuff repair have been reported recently. However, a skillful arthroscopic technique may be one of the factors to lead to this excellent outcome. We treated rotator cuff tear arthroscopically 38 shoulders of 37 patients. To clarify the results of our cases, we investigated the outcome of surgery by JOA scores and MRI. The patients included 24 males, 13 females with a mean age of 64 (23-79) years old. The mean follow-up period was 15 months (8-27 months). A complete tear was in 14 shoulders including 3 small, 5 medium, 4 large and 2 massive rotator cuff tears. An incomplete tear was in 24 shoulders including 5 glenohumeral joint side, 19 subacromial bursal side. We performed a double-row method for a rotator cuff tear using suture anchors. A PTFE felt patch was used for massive rotator tears. Arthroscopic subacromial decompression (ASD), debridement and side to side sutures were performed for incomplete tears. The JOA score had improved from an average of 57.5 to an average of 87.2. MRI findings after 15 months were type I, 2 shoulders, type II, 4 shoulders, type III, 4 shoulders, type IV 2 shoulders and type V, 2 shoulders. The Re-rupture rate was 28.6%(4/14) by MRI including 3 cases of large tear. ASD and side to side suture was effective for an incomplete tear. A PTFE patch had excellent clinical results. Therefore, we need to analyze a more effective arthroscopic skill of large rotator cuff tear in the future.
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  • 腱板断裂に対する重層固定法を用いた鏡視下腱板修復術の臨床成績
    堀籠 圭子, 岡村 健司, 広瀬 聡明, 山本 宣幸, 合六 孝宏
    2007 年 31 巻 2 号 p. 397-400
    発行日: 2007年
    公開日: 2008/01/30
    DOIhttps://doi.org/10.11296/katakansetsu.31.397
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    The purpose of this study was to evaluate the clinical results after arthroscopic rotator cuff repair using the dual-row technique (ARCR-DF) for full-thickness rotator cuff tears. We evaluated 11 patients (10 males and 1 female) repaired by the dual-row technique, from November 2004 and were consequently followed-up for more than 1 year postoperatively. The affected shoulder was on the right side in 10 patients and on the left side in 1 patient. The average age at operation was 60.3 years old (36 to 75 years old); the mean pre-operation period was 11.3 months (0.5 to 48 months); and the mean follow-up period was 15.3 months (12 to 23 months). The tear type was small in 1, medium in 6, and large in 4. We arthroscopically performed subacromial decompression and sutured the torn cuff to the greater tuberosity using suture anchors according to the dual-row technique. We put the arm on a shoulder abduction brace for 4 weeks. For a clinical follow-up, we used the Japanese Orthopaedic Association score (JOA score). According to the JOA score, the average total score increased from 69.6 points to 96.8 points. The average scores of pain, function, and motion improved from 10.9 to 28.2 points, from 16.2 to 20 points, and from 23.2 to 28.8 points, respectively. We evaluated the shoulder muscle strength. The average abduction strength increased from 3.38±2.48kg to 6.1±2.26kg. The average external rotation strengths at the side and at the 90 degree abduction increased from 4.33±2.68kg to 8.11±2.22kg, and 4.58±3.13kg to 9.18±2.53kg, respectively. We also evaluated the postoperative MRIs. Postoperative MRIs showed 18.2% of re-torn cuff. The clinical outcome of the ARCR-DF was almost satisfactory, but patients with large tears tend to retear.
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