肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
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32 巻, 2 号
選択された号の論文の67件中1～50を表示しています
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  • 腱板断裂に伴う腱板構成筋サルコメア長の特徴について
    冨岡 立, 皆川 洋至, 木島 泰明, 山本 宣幸, 阿部 秀一, 菊池 一馬, 島田 洋一
    2008 年 32 巻 2 号 p. 225-228
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.225
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    Structural changes of rotator cuff muscle after torn rotator cuff tendon are the muscle atrophy, the shortening of muscle fiber length, and fatty infiltration. However, there is no report about the sarcomere length which is one of the factors related to the contractile ability of muscle. The purpose of this study was to clarify the sarcomere length of torn rotator cuff muscle. 14 embalmed cadaver shoulders were enrolled in this study. The average age was 82 years old (range: 74-91). There were 7 full-thickness rotator cuff tear shoulders and 7 normal shoulders. Muscle fiber length was measured using a digital caliper. Sarcomere length of the rotator cuff muscle was determined by laser diffraction.
    In the cuff tear group, muscle fiber length of the supraspinatus: SSP, infraspinatus: ISP, teres minor: TM, and subscapularis: SSC was 33.2±6.3mm, 70.6±9.9mm, 57.4±6.4mm, and 58.2±9.6mm, respectively. In the normal cuff group, that of SSP, ISP, TM, and SSC was 57.3±13.7mm, 73.4±14.0mm, 58.2±11.2mm, and 57.8±11.7mm, respectively. The muscle fiber length of SSP in the cuff tear group was significantly shorter than that of SSP in the normal cuff group (P=0.0157). ISP, TM, and SSC showed no significant difference in the muscle fiber length. In the cuff tear group, the sarcomere length of SSP, ISP, TM, and SSC were 3.07±0.41μm, 3.16±0.42μm, 2.80±0.27μm, and 2.41±0.21μm, respectively. In the normal cuff group, those of SSP, ISP, TM, and SSC were 3.18±0.46μm, 3.21±0.57μm, 3.13±0.34μm, and 2.60±0.22μm, respectively. There was no significant difference in the sarcomere length. Although the muscle fiber length of SSP with rotator cuff tear was significantly shorter than that of SSP without rotator cuff tear, the sarcomere length of SSP had no significant difference between the cuff tear group and the intact cuff group. These results indicate that the number of sarcomere may reduce to adapt the shortened muscle fiber length of supraspinatus to maintain muscle contractile ability.
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  • 棘上筋と棘下筋の上腕骨停止部について －Footprintの計測－
    二村 昭元, 宗田 大, 望月 智之, 山口 久美子, 秋田 恵一, 菅谷 啓之, 中川 照彦
    2008 年 32 巻 2 号 p. 229-232
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.229
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    The purpose of this study was to measure the new footprints of the supraspinatus and infraspinatus we previously reported on. 20 shoulders of 12 cadavers were used in this study. We measured the maximum length and width of the footprint of the supraspinatus and infraspinatus. The distances from the three landmarks; the anterior margin of the greater tuberosity, the border between the highest and middle impressions and the anterior edge of the sulcus, to the border between the supraspinatus and infraspinatus were measured. The footprint of the supraspinatus had an average maximum length of 12.6 mm and width of 6.9 mm. That of the infraspinatus had an average maximum length of 32.7 mm and width of 10.2 mm. On the lateral margin of the greater tuberosity, the border between the supraspinatus and infraspinatus was 1.3 mm posterior to the anterior margin of the greater tuberosity and 6.9 mm anterior to the border between the highest and middle impression. On the medial margin, the border between the supraspinatus and infraspinatus was 12.6 mm posterior to the anterior margin of the greater tuberosity, 2.0 mm anterior to the border between the highest and middle impressions and 13.8 mm anterior to the anterior edge of the sulcus. These numeric data, which supplement our previous reports about humeral insertion of the supraspinatus and infraspinatus, could help the surgeons in the diagnosis and repair of rotator cuff tears.
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  • 烏口肩峰靱帯の変性と弾性との関係－超音波顕微鏡を用いた計測－
    木島 泰明, 皆川 洋至, 山本 宣幸, 冨岡 立, 阿部 秀一, 菊池 一馬, 島田 洋一, 西條 芳文, 佐野 博高, 井樋 栄二
    2008 年 32 巻 2 号 p. 233-235
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.233
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    As the subacromial impingement phenomenon is observed not only in painful shoulders but also in normal shoulders, the elasticity of the coracoacromial ligament may relate to symptoms of shoulder disorders. The purpose of this study was to clarify the relationship between histological degeneration and elasticity of the coracoacromial ligament. Twenty coracoacromial ligaments from cadaveric shoulders (8 men and 12 women, average age 79.5 years old) were studied. Each ligament was divided into 6 parts: superficial and deep side of the acromial, central and coracoid part. These 120 parts of ligaments were evaluated about degeneration and elasticity. It was reported that the collagen fiber orientation of the coracoacromial ligament changes by aging from wavy to straight and that by further degeneration the fiber collapses and becomes irregular. So each part was classified by fiber orientation into wavy-part, straight-part, and irregular-part. And the tissue sound speed that showed a positive correlation to the elasticity was measured by scanning acoustic microscopy. The relationship between histological degeneration and elasticity of the coracoacromial ligament was investigated (ANOVA and Tukey-Kramer method). The mean sound speed of the wavy-part, the straight-part, and the irregular-part was 1592±17.2 m/s, 1626±28.0 m/s, and 1607±29.8 m/s, respectively (P<0.0001, ANOVA). The sound speed of the straight-part was higher than that of the wavy-part (P<0.0001), and that of the irregular-part was lower than that of the straight-part (P=0.0023). The coracoacromial ligament becomes stiffened as histological degeneration progresses from wavy to straight fiber orientation, and when it progresses further to collapsed fiber orientation the ligament becomes softened.
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  • 烏口鎖骨靱帯の解剖学的特徴
    高瀬 勝己, 山本 謙吾, 伊藤 正裕, 宮木 考昌
    2008 年 32 巻 2 号 p. 237-240
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.237
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    Acromioclavicule joint separation was an usual injury in everyday practice. The selection of the surgical procedure on these patients was made from the severity of the separation or the damage of coracoclavicle ligaments. However, evaluation on the radiographic findings was not estimated as the trapezoid ligament and conoid ligament individual, but in the damage of the whole coracoclavicle ligaments. Furthermore, type 2 in Tossy's or Rockwood's criteria did not indicate the severity of damage in the coracoclavicular ligament definitely. On the other hand, anatomy and the function of the trapezoid ligament and conoid ligament were not studied enough. We reviewed the detailed anatomy of trapezoid ligament and conoid ligament in using cadaver. The subjects were 20 cadavers 40 shoulders (eight males, 12 females), and their ages ranged from 62 to 82 years old (mean: 71.3 years old). As an anatomical study in the coracoclavicular ligament, we reviewed the running direction and attachment site of both trapezoid and conoid ligament. The trapezoid ligament began at the front 2/3 in the base of the coracoid process and directed toward the inferior surface of the clavicle. The attachment site extended from 13 mm to 26 mm in length (mean: 18.7 mm) and from 13 mm to 15 mm in width (mean: 14.3 mm). On the other hand, the conoid ligament began at the rear 1/3 in the base of the coracoid process and directed toward to the conoid tubercle in the clavicle. The attachment site extended from 15 mm to 30 mm in length (mean: 21 mm) and from 3 mm to 6 mm in width (mean: 4.7 mm) to 35∼55 (mean: 45.4) mm on the posterior margin of the clavicle. From this study, it is indicated the potency which the differentiation in the severity of damage existed between the trapezoid and conoid ligament on the acromioclavicle joint separation.
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機能
  • 健常人は利き腕と非利き腕を同じパターンで挙上 • 下垂するか？
    矢野 雄一郎, 玉井 和哉, 野原 裕, 吉崎 邦夫, 浜田 純一郎
    2008 年 32 巻 2 号 p. 241-244
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.241
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    To clear whether healthy subjects elevate and lowered their dominant and non dominant shoulder joints in the same manner or not was significantly valuable to understand the pathology of shoulder diseases: rotator cuff tear; impingement syndrome; stiff shoulder; and loose shoulder. 20 young healthy participants (17 males and 3 females, average age 22.6 years old) participated in this study. They randomly elevated and lowered both shoulder joints in the scapular plane at three times and were recorded by 3 dimensional motion analyzer. We calculated the scapulohumeral rhythm in each 10° and analyzed the setting phase. There was statistically no significant difference in the scapulohumeral rhythm between the dominant and non dominant shoulders. Scapulohumeral rhythm was stable (3.5) from 60° in elevation to 50° in lowering, however, individual variation of scapulohumeral rhythm (more than 3.5) was identified except the previous shown angles. To elevate both shoulder joints in the same manner mean that we can compare both shoulders about the scapula motion and arm elevation in patients with shoulder disorders. The setting phase is defined as until 60° in elevation, and moreover, a similar phase as the setting phase with various scapular motion is recognized in the lowering motion.
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  • 外傷性肩関節脱臼症例に見られた機能的問題点の検討
    筒井 廣明, 三原 研一, 鈴木 一秀, 牧内 大輔
    2008 年 32 巻 2 号 p. 245-248
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.245
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    The exercise cure considered to be required for anterior dislocation of shoulder joint was an improvement of the function of the shoulder joint for avoiding reduction in which the humeral head deviated from the glenoid cavity, when external force was added. In this presentation, the functional problems which were related with shoulder joint stability were examined from the x-ray examinations. 23 cases of 21 men and two women who underwent scopic Bankart repair were examined. Their averaged age was 26.4±9.6 years old. The functions of the rotator cuff and scapula were examined in the Scapula-45 x-ray exam. Next, using the x-ray with arm at side and maximum elevation, the mobility of the clavicle and thorax were examined. Finally, from the x-rays of maximum elevation, the angle of shoulder abduction and the height of the glenoid were examined. Dysfunction of the rotator cuff was 53.9% and dysfunction of the upper rotation of the scapula was 76.9%. Decreased mobility of the thorax was 52.2%. 60.9% of the cases demonstrated immobility of elevation of the clavicle. The angle of maximum elevation was decreased about 5 degrees compared to the opposite side. Although dysfunction of the rotator cuff was found in about half of the cases, there was a large number of dysfunction of the scapula, clavicle, and thorax. The exercise cure which raised these motor functions is required for a recurrence prevention.
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検査
  • 健常者の上腕骨後捻角：性 • 利き腕 • スポーツ歴との関係
    小林 修三, 小川 清久, 池上 博泰, 井口 理, 渡辺 安里
    2008 年 32 巻 2 号 p. 249-252
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.249
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    The purpose of this study was to evaluate the humeral head retroversion in asymptomatic shoulder. We compared the differences between the dominant side and the non-dominant side, and sex differences. CT was done on 470 shoulders (235 healthy volunteers). 113 were males (mean, 30.4 years old) and 122 were females (mean, 30.0 years old). 104 males and 119 females were right-handed, and 9 males and 3 females were left-handed. We classified the materials into 4 groups according to the history of sports activities for two years or above in the growth period until 18 years old. We adopted our original measuring method utilizing Nobuhara's anatomical axis to draw the humeral head axis. The mean value of the humeral head retroversion on the dominant side of men was 37.7±10.4°, and 31.6±9.3° on the non-dominant side. Women's humeral head retroversion was 31.2±9.2° on the dominant side, and 25.9±10.2° on the non-dominant side. There were the significant differences between the dominant side and non-dominant side, or male and female as evaluated with the unpaired t-test (p<0.0001). The measurements of humeral head retroversion on the dominant side were larger than the non-dominant side regardless of sex in all groups classified based on sports career during a growth period. In addition, the measurements in males tended to be larger than females regardless of the dominant hand side with the sports classification. However, when the sex and the dominant hand side were the same, there were no significant differences in measurements of humeral head retroversion between the 4 groups. If there were some acquired elements except unilateral sports strain affecting the development of humeral torsion, it is possible that the differences of the measurements between the dominant side and non-dominant side, or male and female meant the differences of the degree of the exposure.
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  • 骨シンチグラフィーによる拘縮肩の骨代謝定量化評価
    仲 哲史, 伊藤 陽一, 中尾 佳裕, 間中 智哉, 中村 信之, 鞆 浩康, 松本 一伸, 坂口 公一, 高岡 邦夫
    2008 年 32 巻 2 号 p. 253-255
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.253
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    Stiffness was a consistent but nonspecific symptom of primary frozen shoulder. Theories and descriptions of the pathological condition had not yet been determined. Severe pain was observed in the early stage: freezing phase and global limitation of shoulder motion was recognized in the next stage: frozen phase. Complex regional pain syndrome type I: CRPS type I was known as presenting post-traumatic chronic pain and autonomic nervous abnormalities and was reported to present bone scintigraphic abnormalities. We hypothesized that primary frozen shoulder resembled CRPS and the aim of this study was to investigate the characteristics of bone metabolism with scintigraphy in this disease. We retrospectively evaluated bone scintigraphic findings in 25 cases of frozen shoulder: 15 cases of freezing phase and 10 cases of frozen phase. Quantitative computerized analyses of each scintigraphic image were performed in three areas: anterior, posterior and inferior scapula. Each data was revised with the reference determined at the healthy humeral bone. Scintigraphic comparisons between affected shoulders and healthy shoulders and those between freezing phases and frozen phases were statistically evaluated. Scintigraphic uptake in the affected side was significantly increased compared to the healthy side. Those in the freezing phases were significantly increased than in the frozen phases. Bone metabolism in frozen shoulders determined by bone scintigraphy was significantly increased in the affected shoulders and in the freezing phases.
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  • 腱板断裂に対する術前超音波検査
    中井 大輔, 鈴木 英一
    2008 年 32 巻 2 号 p. 257-260
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.257
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    The purpose of this study was to investigate the usefulness of preoperative evaluation by ultrasonography (US) of rotator cuff tears (RCT). 23 shoulders in 23 cases with rotator cuff tears were examined using 7.5-13 MHz linear phased transducer in both the long and short axial plane. The ultrasonic surface contour of the rotator cuff tendon in the long axial plane was classified into convex, flat, concave and defective. We defined the size of RCT measured using US (the US size of RCT) was the product of width of RCT in the long axial plane by that in the short axial plane. We compared the ultrasonic surface contour and the US size of RCT with the arthroscopic findings according to the classifications of Deorio and Cofield. In the arthroscopic findings, there were four bursal-side incomplete tears, 2 articular-side incomplete tears, 8 small tears, 5 medium tears and 4 large tears. It was difficult to predict the arthroscopic findings from the ultrasonic surface contour of the rotator cuff tendon in the long axial plane, especially when the surface was flat or concave. In the US size of RCT, there were significant differences between a large tear (258 ± 70 mm2) and a medium tear (168 ± 33 mm2) or a small tear (102 ± 35 mm2) in the arthroscopic findings (p<0.05). We proposed a new diagnostic criteria that included 2 factors, the ultrasonic surface contour and the US size of RCT. In the criteria, a small rotator cuff tear was diagnosed with less than 150 mm2, a medium tear was more than 150 mm2 and less than 250 mm2 and a large tear was more than 250 mm2 in the US size of RCT. In 22 out of 23 cases in this study, the diagnosis by the criteria corresponded to the arthroscopic findings.
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脱臼
  • Athlete の初回外傷性肩関節前方脱臼に対する鏡視下 Bankart 法
    鈴木 一秀, 筒井 廣明, 三原 研一, 牧内 大輔, 西中 直也
    2008 年 32 巻 2 号 p. 261-263
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.261
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    The purpose of this study was to evaluate the short term results of arthroscopic Bankart repair using suture anchor device , in athletes with initial traumatic anterior dislocation of the shoulder. We retrospectively studied thirteen athletes (12 males and a female) ranging from 16 to 25 years of age (average, 20.5 years of age). The mean term from initial dislocation to operation was 18.8 days (5-32). The mean follow-up was at 20.5 months (range 4-53 months) after surgery. We performed arthroscopic Bankart repair for 5 cases using 2 to 4 (average, 3.6) Panalok suture anchors and for 8 cases using 2 to 4 (average, 3.1) Panalok loop anchors that 1 more suture was added to (1 anchor 2 sutures method). We evaluated the rate of return to preoperative sports activities and the rate of recurrences after surgery. The clinical evaluations were performed using the JSS shoulder instability score instability score) and Rowe score. All cases returned to their preoperative sports level from 3 to 8 months (average 4.8 months). At the time of the last investigation, the average instability score was 97.9 points (86-100), the average Rowe score was 97.7 points 90-100) and all of the cases had a rating of excellent. The short term results of arthroscopic Bankart repair for athletes with initial traumatic anterior shoulder dislocation was satisfactory. It was important to do primary repair in young athletes of 1st-time traumatic anterior shoulder dislocation.
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  • 上方関節唇損傷を合併した外傷性肩関節前方不安定症
    大関 信武, 山崎 哲也, 内田 繕博, 明田 真樹
    2008 年 32 巻 2 号 p. 265-267
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.265
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    The purpose of this study was to evaluate the arthroscopic findings in shoulders with superior labrum anterior and posterior (SLAP) lesions combined with traumatic anterior glenohumeral instability.118 patients (118 shoulders) who underwent arthroscopic surgery for anterior glenohumeral instability were investigated. There were 100 males and 18 females and the mean age at surgery was 21.7 years old. Arthroscopic findings were evaluated concerning the type of SLAP lesions, pathology of glenohumeral instability, property of the anterior inferior glenohumeral ligament (AIGHL) and the middle glenohumeral ligament (MGHL), and the presence of Hill-Sachs lesion. The shoulders with obvious detachment of the superior labrum were 37 (S group), and others were 81 (N group). There were no significant differences among the two groups about the age, sex, number of dislocation history or the type of sports activity. Among the S group, superior labrum lesions were classified as Type II in 31 and Type II + III in 6 shoulders according to Snyder's classification, and 33 of them had a continuation with Bankart lesion. The pathology of glenohumeral instability was classified according to Kumagai's classification, and ligament-labrum complex detachment type were seen in 26, small bony fragment type in 10 and glenoid bony defect type in 1 shoulder. AIGHL was found well developed in 25 and poorly defined in 12. MGHL was detected in 28 shoulders including 5 with cord-like MGHL. On the contrary, among the N group, AIGHL was poorly defined in 63 and MGHL was absent in 39. Anterior glenohumeral instability with detachment of the superior labrum likely had well developed AIGHL and continuation with Bankart lesion. According to these results, we hypothesized that traumatic traction force during shoulder dislocation might extend the Bankart lesion superiorly.
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  • 上腕骨骨幹部骨折を合併した肩関節脱臼骨折の 1 例
    住浦 誠治
    2008 年 32 巻 2 号 p. 269-271
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.269
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    Shoulder fracture dislocation associated with ipsilateral humeral shaft fracture was an uncommon combination. We reported on a case of anterior shoulder fracture-dislocation and ipsilateral fracture of the shaft of the humerus. A male aged 37 years old sustained a motorcycle accident. There was deformity and painful swelling of the left shoulder and arm. No neurovascular deficit was found and all other clinical findings were normal. After failure of closed reduction of the dislocation, operation was undertaken. Under general anesthesia, open reduction of the dislocation was performed and the humeral shaft & humeral head fracture was treated internal fixation with plate and screws. The fractures and dislocation healed without any problems at 6 to 12 months postoperatively. At final follow-up,the patient had returned to work and regained normal mobility.
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  • 肩鎖関節損傷における脱臼程度と造影 MRI による靱帯損傷の比較検討
    高瀬 勝己, 山本 謙吾
    2008 年 32 巻 2 号 p. 273-275
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.273
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    The acromioclavicle joint separation was divided into three types by Tossy. Generally type 2 presented subluxation of acromioclavicle joint and did not indicate the damage of coracoclavicule ligaments. On the other hand, type 3 presented dislocation of that joint and suggested rupture of the coracoclavicle ligaments. However, the trapezoid and conoid ligaments, which were composed of the coracoclavicle ligaments, were not estimated in detail on that classification. We thought that the damage of trapezoid or conoid ligament participated in the severity of joint subluxation on type 2. On the patients with type 2 or 3, we performed the enhanced MR images and studied the damage of both ligaments. There were 8 patients (6 males, 2 females), and their ages ranged from 24 to 58 years old (mean: 37 years old). According to Tossy's criteria, these patients consisted of 1 case in type 1, 3 cases in type 2 and 4 cases in type 3. We performed the enhanced MR images in all cases within 3 days after injury, and evaluated coracoclavicle ligaments consisting of the trapezoid and conoid ligaments. Both trapezoid and conoid ligaments ruptured in all cases of type 3. On the other hand, the conoid ligament did not recognize clear abnormal findings, but trapezoid ligament ruptured in all cases of type 2. We recognized the rupture of the trapezoid ligament in all cases of type 2. From the results, we thought that detailed evaluation of acromioclavicular joint separation could not be made by a used classification.
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  • 肩鎖関節損傷に対する新しい烏口鎖骨靱帯再建術術式
    高瀬 勝己, 佐藤 由佳, 山本 謙吾
    2008 年 32 巻 2 号 p. 277-280
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.277
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    There are many surgical procedures on the patients with type 5 acromioclavicle joint separation classified by Rockwood's criteria. The results of the surgical procedures were satisfactory. However, these procedures did not reconstruct a correct coracoclavicle ligament. In this study, we tried to reconstruct the conoid ligament and trapezoid ligament, which was composed of the coracoclavicle ligaments, using the palmaris longus tendon and artificial ligament with an end button. We reviewed the postoperative results of the seven patients on whom we performed the reconstruction of a correct coracoclavicle ligament more than postoperative 6 months. There were 7 patients (6 males, one female), and their ages at the time of treatment ranged from 22 to 58 years old (mean: 39 years old). The waiting periods to the surgical procedure were 10 to 24 days (mean: 14.5 days), and 2 cases were only reconstructed the conoid ligament. Pain, including night pain and motion pain, was not noted in every patient. The disturbance of range of motion in the shoulder joint had recovered in only one month postoperatively. On the radiographic evaluations, 2 patients, who had had only reconstruction of the conoid ligament, remained subluxation of the acromioclavicle joint, but the other 5 patients kept the reduced position in that joint at their final consultation. Nevertheless, the demerits of excision of the palmaris longus, the results of our procedure were highly satisfactory.
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  • 肩鎖関節脱臼 Rockwood 分類 Type III の治療方針
    中瀬 順介, 北岡 克彦, 宗廣 鉄平
    2008 年 32 巻 2 号 p. 281-283
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.281
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    Although treatment of acute grade III acromioclavicular separation remains controversial, there has been a recent trend toward initial conservative treatment in most cases. We have performed conservative treatment of acute grade III acromioclavicular separations since 2001. If symptoms remain after conservative treatment, we perform surgery by a modified Dewar method. The present study was performed to review our therapeutic strategy.
    Eight patients were treated conservatively with a sling for comfort through progressive early range of motion as tolerated. We investigated the clinical results with JSS (Japan Shoulder Society) AC joint score.
    The results of conservative treatment were favorable in 6 of 8 patients, and the average JSS AC joint score was 95.2 points. Two patients underwent surgery by the modified Dewar method because of pain and easy fatigue. The JSS AC joint scores in the 2 patients that underwent surgery improved from 74 and 80 points to 98 and 100 points, respectively.
    The use of a sling without reduction of the acromioclavicular joint, followed by a graduated exercise program led to acceptable clinical results. Treatment of patients with persistent pain of the acromioclavicular joint using the modified Dewar method resulted in improvement. These observations confirmed the efficacy of our therapeutic strategy for the treatment of acute grade III acromioclavicular separation.
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  • 鎖骨遠位端粉砕骨折に対する Bosworth screw と Plate の比較
    廣岡 孝彦, 橋詰 博行, 名越 充
    2008 年 32 巻 2 号 p. 285-288
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.285
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    We compared patients who had undergone surgery with a clavicle hook plate for comminuted clavicle distal end fracture to those with an additional Bosworth screw. 24 patients were examined. Bosworth's method was performed on 14 shoulders and plating was performed on eleven shoulders. The final outcome was assessed with the elevation of the shoulder, JOA scores and the rate of bone union. The mean elevation of the shoulder was 167.9 degrees in the Bosworth's group and 155.0 degrees in the plating group, the Bosworth's group were significantly higher than the Plating group. The mean JOA pain score was 28.9 points in the Bosworth's group and 28.6 points in the plating group, showing no significant difference between the 2 groups. The complications were 2 cases of Bosworth screw loosening, 1 case of screw broken and 1 case of non-union in the Bosworth's group, and 2 cases of clavicle shaft fracture at the immediate proximal site of plate in the plating group. The advantages of Bosworth's method were relative less invasive surgery, low operation expense and early recovery of function after removal of Bosworth screw, and those of the plating methods were rigid fixation and comparatively good acquisition of bone union.
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  • 反復性肩関節前方（亜）脱臼に伴う関節包側不全断裂の検討
    中村 恒一, 畑 幸彦, 石垣 範雄, 村上 成道, 小林 博一, 伊坪 敏郎, 内山 茂晴, 加藤 博之
    2008 年 32 巻 2 号 p. 289-292
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.289
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    This study was intended to investigate characteristics of recurrent anterior subluxation or dislocation of the shoulder with a partial thickness tear of the rotator cuff. We reviewed patients' pre-surgery medical histories and clinical results. We studied 81 shoulders of 81 consecutive patients who had undergone surgery for recurrent anterior subluxation or dislocation of the shoulder. Of 81 shoulders, 25 were diagnosed preoperatively using arthrography and MRI as partial thickness tears of the rotator cuff. We divided the cases into two groups according to whether the partial thickness cuff tear was complicated or not. The differences between the two groups were tested for statistical significance about age at surgery, sexuality, dominant side, duration from trauma to surgery, the number of dislocation, whether dislocation of subluxation, the size of Hill-Sachs lesion and Bankert lesion, the score of clinical results, and muscle strength after surgery using BIODEX. Cases with partial thickness tears had a significantly more frequent history of dislocation compared to other cases ( p <0.05). Furthermore, cases with partial thickness tear had significantly larger Hill-Sachs lesion than other cases ( p <0.05). The muscle strength of extension at 6 months after surgery was significantly less in cases with partial thickness tears, but no significant difference was found 1 year after surgery. Remaining factors showed no significant differences between groups. For a safe return to sports activities, attention must be given to reduced muscle strength at 6 months after surgery in cases with partial cuff tears.
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  • 外傷性肩関節前方不安定症に対する Bankart 法の術前 • 後の関節症
    －術後5∼20年の追跡調査の解析－
    吉田 篤, 小川 清久, 池上 博泰, 宇井 通雅
    2008 年 32 巻 2 号 p. 293-296
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.293
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    163 patients (167 shoulders) with the Bankart operation were investigated for presence of osteoarthrosis by preoperative CT, XP and postoperative XP at follow-up, and causes of the osteoarthrosis were analyzed by ages, periods, number of recurrent dislocations, size of bone defect of anterior glenoid and restriction of ROMs. The average age at first dislocation was 18years old (range, 7 to 29yeares old), at operation was 22years old (range, 14 to 34years old), and at follow-up was 31years old (range, 21 to 42years old). Osteoarthrosis existed in 44 shoulders by preoperative CT, which included 12 shoulders (7.2%: 12/167) by preoperative XP, and in 30 shoulders by postoperative XP. 167 shoulders were classified into the following five groups: postoperative occurrence group which were only detected by postoperative XP in 6 shoulders, progress group which were detected by preoperative CT and postoperative XP in 12, preoperative occurrence group which were detected by preoperative CT, XP and postoperative XP in 12, non-progress group which were only detected by preoperative CT in 20, and non-occurrence group in 117. Statistical analysis showed 30 shoulders with osteoarthrosis by postoperative XP had more frequent preoperative dislocations and large bone defects than the remaining 137 shoulders. Osteoarthrosis developed postoperatively had a low rate (4.9%: 6/167-44) and was related to the preoperative large number of recurrent dislocations and large bone defect. It is thought that a basic cause of the osteoarthrosis is in preoperative condition. Although Bankart operation could not prevent development of osteoarthrosis, the operation itself may not promote progress of osteoarthrosis.
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  • 我々の Bristow 変法の術後成績
    黒田 重史, 石毛 徳之, 三笠 元彦, 丸田 喜美子
    2008 年 32 巻 2 号 p. 297-300
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.297
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    We wished to report on the results of our modification of Bristow procedure. In our modification the coracoid process was transferred on the anteroinferior glenoid rim to extend the glenoid. 203 joints, which were followed-up for over five years after surgery, were investigated. 44 cases were female patients and 159 were male. Their mean age at the surgery was 25.3 years old. The mean follow-up period was 7 years and 10 months. Recurrence of dislocation was not recognized. The mean external rotation with arm at side after surgery was 45.6 degrees. The mean JSS shoulder instability score was 55.8 before surgery and 93.4 after surgery. Screw breakage occurred in 4 cases. Slight deformity of the humeral head was recognized in 4 cases. The sports return was as follows: full return: 63(36.4)%, level down: 23.9(36.4)%, changed sports: 8.7(13.6)%, stopped playing: 4.4(13.6)%(in cases which affected the dominant hand in overhead sports). No recurrence, easy procedure, wide application, and minimal complication were the most important results of the surgery for recurrent dislocation. In our modification of Bristow procedure, we can get a wide view of the gleno-humeral joint and we could transfer the coracoid process to the best position of the glenoid with the best direction. The operation could be finished within 45 minutes. Full return to the overhead sports was only 36.4% in cases affecting the dominant hand. It is the limit of this procedure. No recurrence was recognized and the results of our method were satisfactory.
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  • 外傷性肩関節(亜)脱臼の無作為比較試験(直視下 vs 鏡視下手術)
    内山 善康, 繁田 明義, 新福 栄治, 大見 博子, 持田 讓治, 福田 宏明, 宮崎 誠司
    2008 年 32 巻 2 号 p. 301-304
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.301
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    To clarify the relative effectiveness of modified Neer's inferior capsular shift (MICS) as open procedure and arthroscopic Bankart repair (AB), we compared these 2 methods in a randomized controlled study. We investigated 28 shoulders of 27 patients (males 21, females 6) for the MICS (13 shoulders of 12 patients) and AB (15 shoulders of 15 patients). The average follow-up was 27 months (range, 24-37 months). 3 bioabsorbable anchors were used for Bankart repair in both operations. No augmentations such as rotator interval closure or capsular shrinkage were added to AB. Clinical evaluation included rate of recurrent instability, range of motion and period of rehabilitation after surgery. All patients were assessed by the scoring systems of Rowe and UCLA preoperatively and at the final evaluation. The rates of recurrent instability were not significantly different between the MICS (0 %) and AB (3 patients, 20 %) (p=0.067). Limitation of elevation in AB was smaller than in MICS at 3 months after surgery (p<0.05). Furthermore, limitation of external rotation at 90° abduction in AB was smaller than in MICS at 3, 6, 12 and over 24 months after surgery (p<0.05). Further, period of postoperative rehabilitation in AB (ave. 16 weeks) was shorter than in MICS (ave. 25 weeks) (p<0.01). The mean JOA sports and Rowe scores of both procedures were not significantly different at final follow-up. Our data suggested that MICS yielded less recurrent instability than AB. The JOA sports and Rowe scores were not significantly different between 2 procedures at final follow-up. However, AB recovered faster than MICS with less limited external rotation.
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  • 鏡視下 Bankart 法術後の肩関節内外旋筋力の経時的変化
    尼子 雅敏, 今井 智仁, 岡村 健司, 古賀 龍二, 田中 祥貴, 渡邉 樹一, 有野 浩司, 根本 孝一
    2008 年 32 巻 2 号 p. 305-308
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.305
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    The object of this study was to investigate the shoulder rotational muscle power recovery after arthroscopic Bankart procedure. Isokinetic concentric shoulder rotational muscle strength was evaluated in 19 patients diagnosed with the recurrent dislocation of the glenohumeral joint and treated with arthroscopic Bankart repair. We measured the peak torques at 60, and 180° /sec angular velocities at the pre- and 1.5, 3, 4.5, 6, 9, 12 months post-operatively, and calculated peak torque to the pre-operative ratios (pre-op. ratio), and the peak torque to body weight ratios (weight ratio). The pre-op. ratios, and the weight ratios significantly decreased to 60% at 1.5 months after the surgery on both the 60 and 180° /sec angular velocity conditions during the external and internal rotation exercise. They rapidly increased to the preoperative level at three months, and kept at a high level until 12 months postoperatively. We evaluated the shoulder rotational muscle power recovery after open Bankart & Bristow procedure, and concluded that the muscle power recovery was required more than 6 months after the surgery. Using the arthroscopic Bankart repair, the muscle strength was recovered to the preoperative level by three months after the surgery.
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  • 術後外旋位固定を行った鏡視下バンカート修復術後の筋力回復について
    佐藤 英樹, 加納 深吉, 長尾 秋彦
    2008 年 32 巻 2 号 p. 309-312
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.309
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    The purpose of this study was to clarify the recovery term of the shoulder muscle strength in patients who underwent arthroscopic Bankart repair with postoperative external rotational position. Ten patients underwent arthroscopic Bankart repair for recurrent anterior shoulder instability and were placed in a postoperative rotational position for 3 weeks. Before surgery, at 6 weeks, 3 months, and 6 months after surgery, the shoulder muscle strength at 90° of flexion, 90° of abduction, internal rotation and external rotation at 90° of flexion was measured with a Kin ComTM. Side-to-side differences were evaluated for each measurement, and the strength of the operated shoulder was compared with the preoperative strength. The strength in all directions of the operated shoulder was significantly reduced at 6 weeks after surgery. The strength of flexion, abduction and internal rotation was recovered to the preoperative level by 3 months after surgery, and the strength of external rotation did not change throughout the study period. The percent strength of the operated shoulder to the healthy side was 91% in flexion, 85% in abduction, 87% in internal rotation, and 83% in external rotation at 6 months after surgery. In this study, the recovery of the muscle strength of the Bankart repaired shoulders required more than 6 months. However, the clinical results showed that no patients had recurrence after surgery, indicating that the muscle strength at 6 months after surgery could be adopted as the index of postoperative rehabilitation.
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  • 広範囲腱板断裂を伴った中高齢者反復性肩関節脱臼に対して鏡視下修復術を行った 2 例
    佐野 栄, 藤田 耕司, 石毛 徳之
    2008 年 32 巻 2 号 p. 313-315
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.313
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    The purpose of this report is to report on two middle aged and more patients who underwent simultaneous arthroscopic rotator cuff and Bankart repair for recurrent dislocations of the shoulder associated with the massive rotator cuff tear. [Case 1] A 58 years old Female. She had her 1st dislocation of the shoulder when she fell off her bicycle at 57 years old. After more than five times dislocations, she underwent an arthroscopic Bankart and capsular and rotator cuff repair. Postoperative the ROM at 1 year was Flx 170°, Abd 170°, ER 60°. [Case 2] A 74 years old Female. She had her 1st dislocation of the shoulder when she fell down in the bathroom at 74 years old. After more than 10 times dislocations, she underwent an arthroscopic Bankart and biceps tendon and rotator cuff repair including subscapularis repair. Postoperative the ROM at 1 year were Flx 160°, Abd 145°, ER 45°. Although more cases and longer-term assessments will be needed, it is possible that simultaneous arthroscopic anatomical repair including rotator cuff repair will lead to better clinical results without obvious complications.
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  • High Demand 症例に対する鏡視下 Bankart 修復術の成績
    永田 義彦, 望月 由, 横矢 晋, 越智 光夫
    2008 年 32 巻 2 号 p. 317-320
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.317
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    Arthroscopic Bankart Repair with suture anchors had been thought not to be suitable for high demand patients. The purpose of this study was to compare the results of arthroscopic Bankart repair using suture anchors between high demand patients and non high demand patients in traumatic anterior glenohumeral instability. 74 shoulders in 74 patients with traumatic unilateral anterior shoulder instability were evaluated using the Rowe score, rate of recurrence, range of motion at an average 38 months after arthroscopic surgery. Of the 74 shoulders, 45 shoulders (45 patients) were high demand patients, participating in judo, karate, boxing, wakeboarding, snowboarding, basketball, handball, baseball, or rugby. In the 45 high demand patients, the average Rowe score improved from 30.2 to 92.4 points, and was not statistically different from that in non high demand patients (from 31.5 to 90.6 points). The high demand patients had lost a mean of 4 degrees of external rotation in abduction, and this was not statistically different from that in non high demand patients (3 degrees of external rotation). There was no significant differentiation between the recurrence rate in the high demand patients (4.4% 2 of 45) and that in non high demand patients (3.4% one of 29). All patients returned to their respective sports at the same. Arthroscopic stabilization is as reliable a procedure in high demand patients as it is non high demand patients.
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骨折
  • 上腕骨近位端外反嵌入骨折
    －JSSデータベースの検討－
    玉井 和哉, 大野 弥
    2008 年 32 巻 2 号 p. 321-324
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.321
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    We reviewed 661 proximal humeral fractures registered to the JSS database to clarify the incidence, nature and treatment of valgus impacted fractures. Three shoulder experts from Matsudo Orthopaedic Hospital, Nippon Medical School and Dokkyo Medical University independently classified all the registered fractures according to the Neer classification (1970), and picked up possible valgus impacted fractures (N=71, 11%) according to the description of Jakob (1984, 1991). Disagreement of the classification among the 3 reviewers (226 / 661 cases) was discussed, and additional criteria for valgus impacted fractures (Neer 2002, Robinson 2003) were referred to. Reassessment, again performed independently by the same reviewers, revealed 19 (3%) valgus impacted fractures. Of these, 3 were treated conservatively, 10 by osteosynthesis, and 6 by hemiarthroplasty. The active shoulder elevation at the follow-up was generally good in patients who underwent osteosynthesis, whereas poor in those who had been treated conservatively. The authors conclude that (i) valgus impacted fractures consist of 3-11% of proximal humeral fractures, (ii) the 2002 Neer classification which categorized this type of fracture is a better option for clinical use, and (iii) valgus impacted fractures should be treated by osteosynthesis with care not to insult the blood supply to the humeral head through the medial periosteum.
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  • Neer 分類 minimal displacement（1-part）
    上腕骨近位端骨折における成績不良因子
    橋口 宏, 伊藤 博元, 飯澤 典茂
    2008 年 32 巻 2 号 p. 325-328
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.325
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    The purpose of this study was to analyze factors inducing poor outcomes of Neer's minimal displacement (1-part) fractures of the proximal humerus. The subjects were 183 patients with one-part fracture, including initial and follow-up X-rays and results of shoulder motion at the final follow-up, in the JSS database of proximal humeral fractures. There were 134 females and 49 males whose average age was 60.6 years old. Surgical neck (SN) fracture was observed in 88 patients, greater tuberosity (GT) fracture in 57 patients, and SN-GT fracture in 38 patients. 3 groups classified according to results of shoulder elevation were as follows: excellent (E) group (150° or more) in 97 patients, good (G) group (90 to 150°) in 62 and fair (F) group (90° or less) in 24. Factors induced poor outcomes were analyzed and compared between the 3 groups. The average age of the E-group was significantly lower than that of the G-group or the F-group. With regard to fracture type, 91.2% of GT fractures, 97.4% of SN-GT fractures and 79.5% of SN fractures belonged to the E-group or the G-group. Varus displacement at the final follow-up increased in 66.7% of the patients with SN fractures of the F-group. 10 patients who had suffered from complications or other diseases such as dementia or rotator cuff tears obtained poor outcomes. This study suggested that treatment and rehabilitation should be applied to patients with 1-part proximal humeral fractures in consideration of the patients' backgrounds and fracture types.
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  • 高齢者上腕骨近位部における骨密度と骨強度の関係
    山田 光子, 山路 哲生
    2008 年 32 巻 2 号 p. 329-332
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.329
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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 operation, we evaluated the relationship between BMD and bone strength in the proximal humeral head using cadaver humerus. The BMD of 10 cadavers humerus (mean age 79.2 ) was analyzed by XP26 ( Norland Co. ). BMD was measured at 4 regions of interest ( top is top of the humeral head, medial is the area of subchondral bone at the glenoid side, middle is the middle of the humeral head and GT is the greater tuberosity ). On the coronal plane the osteotomy was performed on the middle of the humeral head and sliced 1 cm thickness to compare the anterior slice with the posterior slice at the same region. The maximum load value was measured by the compression test using a universal material examination machine ( Instron 4505 ). Mean BMD ( g/cm2 )the top was 0.50, the medial 0.64, the middle 0.44 and the GT 0.51. The medial region was significant difference from the middle ( p < 0.05 ) . The mean maximum load value ( N ) was 347 at the top, 437 at the medial 136 at the middle and 209 at the GT. The medial was significant difference from the top and the middle ( p < 0.05 ). By comparison between the anterior slice and the posterior slice at the same region, there was significant difference at the top, the medial, the middle and GT ( p < 0.01 ). There was positive correlation between BMD and the bone strength at each region ( p < 0.05 ). Our result shows that the BMD indicates the bone strength in the proximal humeral head. To get more stability of the screws, the edge of screw must be inserted into the top or medial region at the posterior side.
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  • 上腕骨近位端骨折に対する T2 上腕骨ネイル近位骨折用を用いた手術治療経験
    島田 憲明, 井上 純一, 酒井 宏哉, 相澤 智史
    2008 年 32 巻 2 号 p. 333-336
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.333
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    The purpose of this study was to evaluate the surgical outcome for the osteosynthesis of proximal humeral fractures with T2 proximal humeral nails. We examined 18 shoulders in 18 patients with proximal humeral fracture treated using T2 proximal humeral nailing system from January 2005 to December 2006 with a minimum follow-up of three months after surgery. There were 7 males and 11 females, and the average age was 69.7 years old (32-91 years old). All patients were injured by a fall down. The fracture type was 2-part fracture in 15 patients and 3-part fracture in 3. Under general anesthesia fracture was reduced using fluoroscope and the nail was inserted from the proximal end of the humerus. Interlocking screws were inserted to both ends of the nail. The average operation time was 50.4 minutes (35-113 minutes). The range of motion exercise was started the day after the operation. Bony union, range of motion in flexion of shoulder joint, and postoperative complication were examined. The average follow-up period was 8.1 months (3-19 months). No redisplacement of the fracture was seen after surgery. A bony union was obtained on an average of 17.1 weeks (12-25 weeks). The mean postoperative range of motion was 107.8° in flexion (60°-170°). There were 2 cases with a back-out of proximal interlocking screw. Good stability was obtained with the T2 proximal humeral nailing system. The range of motion exercise was started immediately after surgery. However, the range of motion at the follow-up was not satisfactory. The postoperative exercise program should be reconsidered. It is necessary to improve the system for the prevention of the coming back-out of the proximal interlocking screw.
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  • 上腕近位端骨折の術後成績と内反変形の検討
    畠山 雄二, 小林 志
    2008 年 32 巻 2 号 p. 337-339
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.337
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    The purpose of this study was to investigate the effect of humerus varus deformity in proximal humeral fractures. 15 patients who underwent open reduction and plate fixation between February 2004 and November 2006 were used. There were 2 males and 13 females. All patients involved surgical neck, 2-part proximal humeral fractures. Those patients were divided into two groups. Group A had 8 patients with humerus varus deformity less than 25°, and Group B had 7 patients with humerus varus deformity more than 25°. The mean age was 71.8 and 76.4 years old respectively, and the average follow-up periods were 19.5 and 20.4 months respectively. There were no significant differences in the age and follow-up periods among the 2 groups. In group A the mean active flexion was 119°, abduction 110°, ER 46°, IR T10 and the average JOA score was 87.7 points. In group B the mean active flexion was 121°, abduction 108°, ER 40°, IR T10 and the average JOA score was 88.6 points. All patients obtained bone union except for 1 patient who had pseudarthrosis. There was no humeral head avascular necrosis. The average humeral head inclination angle was 130°(the mean humerus varus deformity 10.9°) in group A and 109°(36.4°) in group B (p = 0.0006). The average interval between acromion and greater tuberosity were 12.5 mm/9.5 mm in group A and B. There was no significant differences in the range of motion and JOA score among the 2 groups. Humerus varus deformity more than 25° did not show any significant differences in the outcome of the operative treatment.
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  • 上腕骨大結節単独骨折
    －骨折形態と骨片転位の関係について－
    仲川 喜之, 奥本 洋樹
    2008 年 32 巻 2 号 p. 341-344
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.341
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    The purpose of this study was to show the new classification of the isolated fractures of the greater tuberosity of the proximal humerus, and to report the relationship between fracture type and displacement. This study consisted of 94 cases (56 females and 38 males, 55 cases without dislocation and 39 cases with dislocation) with isolated fractures of the greater tuberosity. The mean age was 60.2 years old (range 18 to 96 years old). The greater tuberosity consisted of the three facets; superior facet, middle facet and inferior facet. Fractured facets and the amount of displacement of the greater tuberosity were investigated. In cases without dislocation, the superior facet was fractured in 8 cases, the middle facet in 14 cases, the superior and middle facets in 9 cases, the middle and inferior facets in 14 cases, the superior and the middle and the inferior facets in 10 cases. In cases with dislocation, the superior and middle facets were fractured in 16 cases, the middle and inferior facets in 2 cases, the superior and middle and inferior facets in 21 cases. Advance of the displacement of the greater tuberosity was seen in 2 cases without dislocation and in 8 cases with dislocation, whose mean age was 75.7 years old. Various fracture types showed in cases without dislocation, and cases with dislocation had large fractured fragment including the middle facet. The cases with dislocation often had advance of the displacement of the greater tuberosity, and should be treated carefully, especially in the aged.
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  • 5 mm∼1 cm 転位がある上腕骨大結節骨折の手術療法と保存療法の比較
    大沢 敏久, 高岸 憲二, 小林 勉, 鈴木 秀喜, 山本 敦史, 設楽 仁, 篠崎 哲也, 有田 覚
    2008 年 32 巻 2 号 p. 345-348
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.345
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    Operative treatment was recommended for great tuberosity fracture of the humerus with more than 5mm-upper displacement. The purpose of this study was to compare the operative treatment with conservative treatment of great tuberosity fracture of the humerus displaced between 5mm and 1cm. We retrospectively evaluated ten shoulders in 10 patients with great tuberosity fracture of the humerus. In all patients, there were 5mm∼10mm-displaced fragments of great tuberosity fracture of the humerus. The operative group was consisted of 5 shoulders (3 males and 2 females). Their mean age was 55 (47-71) years old. The average duration of follow-up was 16.2 (12-24) months. The conservative group had 5 shoulders (5 females). The mean age was 67.4 (61-73) years old. The average duration of follow-up was 24.8 (6-47) months. We evaluated the range of motion (flexion, abduction, external rotation) and the JOA score. In the operative group, flexion was 143±25.6°, abduction was 144.4±25.2°, ER was 34.4±15.7° and the JOA score was 84.3 points. In the conservative group, flexion was 138±34.2°, abduction was 131±24.1°, ER was 35±15.4° and the JOA score was 83.6 points. There were no significant differences between the operative group and the conservative group. In this study, we have the same clinical results for operative treatment and conservative treatment of the great tuberosity fracture of the humerus with more than 5mm-upper displacement.
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筋腱疾患
  • 肩腱板断裂における肩甲骨の位置異常の特徴
    小林 博一, 君塚 康一郎, 畑 幸彦, 村上 成道, 加藤 博之
    2008 年 32 巻 2 号 p. 349-351
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.349
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    In the example of rotator cuff tears with a scapula malposition, especially the scapula was often accepted. This study investigated the characteristics of the rotator cuff tears with a scapula malposition. 100 consecutive shoulders in 100 patients who underwent rotator cuff repair were studied retrospectively. The age of the patients ranged from 33 to 79 (mean 62.4) years old and the man and woman ratio was the male 57 shoulders and female 43 shoulder. Roentgen-rays of an about the upper arm descent were photographed to preoperation, the straight line which connects a scapula socket inferior extremity and the angulus inferior scapula with a scapula side image was defined as the scapula length axis, and this angle was measured by making the angle with the straight line which connected the surface of the rib of the superior extremity located in that range, and the inferior extremity was the scapula angle of inclination. The peak of this angle facing up was the peak of a scapula anteversion group and facing down were the scapula retroversion group. Comparison examinations were performed about medical histories, range of motion and the cuff tear size at operation. The range of motion that internal rotation in 2nd position, in the retroversion group was significantly smaller than that in the anteversion group (P<0.05).The size of rotator cuff tear in the retroversion group was significantly larger than that in the anteversion group (P<0.05).The inclination of a scapula was understood to be the size of rotator cuff tear was one of the factors. By investigating the angle of gradient of a shoulder blade by a shoulder blade Roentgen-rays side image showed that it was possible to guess the size and shoulder joint function of a rotator cuff tear roughly.
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  • 腱板断裂肩における烏口肩峰靱帯の弾性
    木島 泰明, 皆川 洋至, 山本 宣幸, 冨岡 立, 阿部 秀一, 菊池 一馬, 島田 洋一, 西條 芳文, 佐野 博高, 井樋 栄二
    2008 年 32 巻 2 号 p. 353-356
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.353
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    The tissue sound speed that correlated to its elasticity changed according to the collagen fiber orientation of the coracoacromial ligament. The purpose of this study was to clarify the characteristics of the elasticity of the coracoacromial ligament in shoulders with rotator cuff tear. Twenty coracoacromial ligaments from cadaveric shoulders were studied. They were classified into 3 groups: ligaments with rotator cuff tear (RCT-group), ligaments with subacromial spur and normal rotator cuff (Spur-group) and ligaments without subacromial spur and rotator cuff tear (Control-group). Each ligament was divided into 6 parts: superficial and deep side of the acromial, central and coracoid part, and each part was classified by fiber orientation into wavy-part, straight-part, and irregular-part. The sound speed of each part was measured by scanning acoustic microscopy. The number of degenerated part and the sound speed were compared among the 3 groups (chi square test and ANOVA). The RCT-group and the Spur-group had more straight-parts (P=0.0002) and less wavy-parts (P<0.0001) than the Control-group. Significant differences of the sound speed were observed in each group (P<0.0001), the Control-group: 1596±19.1 m/s, the Spur-group: 1630±31.5 m/s, and the RCT-group: 1612±28.6 m/s. Especially in the acromial side, the sound speed of the Spur-group was higher than that of the Control-group (P=0.0050), and that of the RCT-group was lower than that of the Spur-group (P=0.018). In conclusion, the coracoacromial ligament with rotator cuff tear and the ligament with subacromial spur were stiffened. The ligament with rotator cuff tear was more softened than the ligament with subacromial spur. These differences of elasticity were remarkable in the acromial side.
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  • 生体肩における烏口肩峰靱帯の弾性
    －超音波エラストグラフィーを用いた計測－
    木島 泰明, 皆川 洋至, 冨岡 立, 山本 宣幸, 菊池 一馬, 阿部 秀一, 島田 洋一
    2008 年 32 巻 2 号 p. 357-360
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.357
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    The purpose of this study was to clarify the elasticity of the coracoacromial ligament in live shoulders with rotator cuff tear. Forty-one shoulders in 24 persons were enrolled in this study. The average age was 52 years old (range, 15-84 years old). We investigated the presence of rotator cuff tear and measured the elasticity of the coracoacromial ligament by ultrasound elastography (EUB-7500, HITACHI, Japan). Ultrasound elastography was a useful method to quantify the strain of soft tissue when pressure was added. The strain ratio (the ratio of strain of the coracoacromial ligament to that of the rotator cuff) was used as the index of the elasticity. Thus, the higher the strain ratio was, the softer the ligament was. Pearson coefficient and Student t-test were used for the statistical judgment. The strain ratio of the coracoacromial ligaments without rotator cuff tear (29 shoulders) showed a negative correlation to the age (r=-0.825, P<0.01). The strain ratio of the ligaments with rotator cuff tear (23.75±15.05, 12 shoulders, 69.6 years old) was higher than that of the older ligaments without cuff tear (12.62±7.94, 10 shoulders, 64.6 years was) (P=0.0486). In shoulders with rotator cuff tear, the strain ratio of the ligaments with pain (14.37±10.15, 6 shoulders, 66.7 years old) was lower than that of ligaments without pain (33.12±13.59, 6 shoulders, 69.1 years old) (P=0.0221). In conclusion, the coracoacromial ligament became stiffened with aging but softened with the existence of rotator cuff tear. The ligaments with symptomatic cuff tear are more stiffened than the ligaments with asymptomatic cuff tear.
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  • 腱板修復モデルとしてのブタ棘下筋腱の生体力学的特性，形態的特徴の検討
    福原 徹太郎, 三幡 輝久, 堀之内 崇, 安井 憲司, 浅井 重博, 渡辺 千聡, 木下 光雄
    2008 年 32 巻 2 号 p. 361-363
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.361
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    Arthroscopic rotator cuff repair has become increasingly popular. There have been several procedure related studies using human cadaveric shoulders. In some studies, animal shoulders have been used as the consistency of their tissue. To our knowledge, there has been only one biomechanical study using porcine shoulders. However the properties of the tendon were not examined in the study. The objective of this study was to know the biomechanical properties of the porcine infraspinatus tendon.
    5 fresh frozen porcine shoulders (6 months old) were dissected, while the infraspinatus tendons were left intact. The thickness of the infraspinatus tendons and the size of the footprints were measured. To evaluate the biomechanical property, tensile testing was performed using a material testing machine AUTOGRAPH AG-ITM. The specimens were loaded to failure at the rate of 1mm/s. The structural properties of linear stiffness, yield load, and ultimate load were calculated using software TRAPEZIUMTM. The geometric properties were as follows: the mean thickness of the infraspinatus tendon, 5.9±1.6mm; the mean size of the footprint, 25.9±4.5mm in the anterior-posterior direction, 13.8±1.7mm in the medial-lateral direction. The biomechanical properties of the infraspinatus tendon were as follows: yield load, 643.1±200. 6N; ultimate load, 868.7±190. 1N; linear stiffness, 136.0±44.6N/mm. According to previous cadaveric studies using human shoulders, the thickness of the supraspinatus tendon was 5.8mm, the footprint was 16.3mm to 25mm in anterior-posterior direction and 12.3mm to 12.7mm in medial-lateral. The ultimate load of supraspinatus tendon ranged from 652N (average age, 64 years old) to 1007N (average age, 55 years old). The geometric and biomechanical properties of the porcine infraspinatus were similar to those of the human supraspinatus tendon. Therefore, the porcine infraspinatus tendon can be used for the biomechanical testing to evaluate the rotator cuff repair techniques.
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  • 無症候性腱板断裂の疫学
    中島 大輔, 山本 敦史, 大沢 敏久, 小林 勉, 設楽 仁, 高岸 憲二
    2008 年 32 巻 2 号 p. 365-367
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.365
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    Rotator cuff tear was one of the typical diseases causing pain in the shoulder joint, but it is also known that asymptomatic rotator cuff tear occured with aging. This study investigated the clinical epidemiology of asymptomatic rotator cuff tears. Local medical examinations were given to 5,660 residents of a village. Of these, 683 people (1,366 shoulders) were included in this study. The subjects were 229 males and 454 females with an average age of 57.9 years old (range22∼87 years old). Background data were collected by questionnaire including sex, dominant hand, occupation, presence of shoulder joint pain,and the presence or absence of rotator cuff tear was determined by ultrasonography. We classified the subjects into the following 3 groups, symptomatic cuff tear group, asymptomatic cuff tear group, and no tear group, and compared the findings of the 3 groups. Rotator cuff tear was demonstrated in 283 shoulders (total 20.7%), and 185 shoulders (total 13.5%) were asymptomatic.55 shoulders(29.7%) of subjects with asymptomatic rotator cuff tears had previously noticed shoulder pain. The frequency of both symptomatic and asymptomatic tears tended to rise with age. There was no difference between each group in age, sex or dominant hand. Although the frequency of rotator cuff tear was high in the heavy worker compared with the light worker, the difference between symptomatic and asymptomatic was not recognized.
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  • 腱板断裂の診断における関節造影後 CT の有用性
    福田 昇司, 西山 武, 土井 英之, 大森 貴夫
    2008 年 32 巻 2 号 p. 369-372
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.369
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    It was important to evaluate the preoperative state of a torn rotator cuff to perform a successful arthroscopic rotator cuff repair. The purpose of this study was to determine the usefulness of CT arthrography (CTA) for diagnosing rotator cuff tears (RCT). 87 shoulders from 87 patients who had undergone both magnetic resonance imaging (MRI) and CTA preoperatively and subsequent arthroscopy were included in this study. There were 52 men and 35 women. The average age of the patients was 63.4 years old, with a range of 17 to 82 years old. Images of CTA were reconstructed in the oblique-sagittal and oblique-coronal planes same as MRI. The presence and size of RCT were evaluated separately and these results were compared with arthroscopic findings. In CTAs, there were 55 shoulders diagnosed as RCT. There were 16 small tears (less than 1 cm), 17 medium-sized tears (1 to 3 cm), 16 large tears (3 to 5 cm), and six massive tears (more than 5 cm). The presence and size of RCT in CTAs was approximately matched to our arthroscopic findings. MRIs could not detect a complete tear in 15 of 18 small tears diagnosed in CTA. In RCT with a size of larger than 1 cm, findings of MRI and CTA were similar. CTA had a sensitivity of 100%, a specificity of 90.6% and an accuracy of 96.6% for the diagnosis of tears of the supraspinatus. The sensitivity, specificity, and accuracy of MRI was 75.8%, 96.6%, 82.8%, respectively. CTA is useful in evaluating RCT and more sensitive than MRI for detecting a small tear.
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  • 鏡視下腱板修復術における新しい重層固定法とその臨床応用
    森原 徹, 岩田 圭生, 田久保 興徳, 立入 久和, 小椋 明子, 木田 圭重, 久保 俊一, 平田 正純, 黒川 正夫, 堀井 基行
    2008 年 32 巻 2 号 p. 373-376
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.373
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    Arthroscopic rotator cuff repair was carried out with suture anchors. The double row fixation has been popular instead of the single row fixation. We developed a new double row fixation using suture reel technique. In this study, we introduce the technique and the characteristics. Firstly, an anchor was inserted in the proximal side of the greater tuberosity and mattress sutures were performed. Then, two anchors were inserted in the distal side of the greater tuberosity. Single suture was passed through the cuff. After making the suture and one end of the fastened suture in the mattress suture together as post strand, we tied a sliding knot (suture reel technique). In vitro study using a bone model, the pressure and area of contact were compared among a single row fixation, dual row fixation and our new dual row fixation. We clinically performed this procedure on 6 shoulders in 6 patients with medium rotator cuff tear seen from January 2007 to March 2007 in our hospitals. There were 4 men and 2 women, the mean age 63 years old (range, 54-73 years old). We evaluated the troubles during the surgery and the short term clinical results.
    (Results) In vitro study, the size of the contact area in our new fixation was significantly larger than the other single and double row fixations. There were no significant differences of pressure on the contact area among them. In all 6 cases there was no trouble during the surgery. Our new double row fixation using the suture reel technique is considered to be one of the useful methods for arthroscopic rotator cuff repair.
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  • 鏡視下腱板修復術における術中腱板の緊張度と術後短期成績
    中溝 寛之
    2008 年 32 巻 2 号 p. 377-380
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.377
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    This study was conducted to measure the tension of torn cuff during arthroscopic rotator cuff repair (ARCR) and to evaluate the short-term postoperative results. 12 men and 8 women with complete rotator cuff tear were included in this study. Their mean age was 60.7 years old. The mean follow-up period was 10.3 months. All patients underwent ARCR using the dual-row fixation technique. The tension of torn cuff was measured with a tension meter during operation. The postoperative MRI was performed at six months after the operation. The short-term clinical results were evaluated with the JOA score and postoperative MRIs. The mean tension of torn cuff was 2.46kg (1.7 to 4.8kg). The tension of small, medium and large tear was 1.87kg, 2.32kg and 3.56kg, respectively. The average JOA score was improved from 61.6 to 90.5 points postoperatively. However, the postoperative MRI showed 3 cases of re-torn cuff; 1 case of medium and 2 cases of large tear. We believe that to decrease the tension of the cuff is one of the important factors to improve the postoperative cuff integrity. This study indicated that the rate of postoperative re-torn cuffs becomes high when the tension of cuff during ARCR is high.
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  • 超音波検査による鏡視下腱板修復術後の棘下筋厚の経時的変化
    石谷 栄一, 松浦 恒明
    2008 年 32 巻 2 号 p. 381-384
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.381
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    We reported that the cross-sectional area ( CSA ) by MRI did not show any significant recovery until postoperative one year, however the muscle strength of shoulder showed significant recovery after the operation. In this study, we evaluated the changes of thickness of the infraspinatus ( ISP ) by ultrasonography after arthroscopic rotator cuff repair, and investigated the differences with CSA of it and the differences of thickness of it between static state ( at rest ) and dynamic state ( active ).
    We investigated 27 cases ( 16 males and 11 females ) that had ultrasonography and MRI before operation, 6 months and 1 year after the operation. The mean age at operation was 60.9 years old ( 48 - 78 ). The thickness of bi-lateral sides were measured by ultrasonography at rest and active. The point of the measurement was medial 1/4 and 3cm inferior from the scapula's spine. We measured CSA in the inside 1cm part from the joint with an MRI oblique-sagittal T2 image. Changing in thickness on the affected side: it changed from 11.1mm to 11.3mm to 11.7mm at rest. It changed from 13.2mm to 13.9mm to 14.5mm on active. The thickness at rest did not show a meaningful change, but showed a statistically significant increase at both postoperative 6 months and 1 year. Changing of CSA: it changed from 4.76cm 2 to 4.49cm2 to 4.57cm2. We showed a significant decrease in the postoperative 6 months.
    ISP muscle volumes of static state ( the thickness of ISP at rest and CSA ) did not increase, but it's dynamic state ( the thickness of ISP on active ) increased significantly. We thought that the muscular fiber's volume increased to respond to recovery of a nervous factor. The measurement of thickness of dynamic state is a very useful method to evaluate the recovery of a muscle after an operation.
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  • 鏡視下腱板修復手術における疼痛コントロール法の比較
    下川 寛一, 伊藤 仁
    2008 年 32 巻 2 号 p. 385-387
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.385
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    The purpose of this study was to assess the efficacy of an alternative method of postoperative pain control with continuous epidural and single-shot interscalene block for arthroscopic rotator cuff repair(ARCR). 100 consecutive patients who underwent ARCR were enrolled. Continuous epidural (CE) group consisted of 52 cases, 32 men and 20 women, whose average age at surgery was 64.5 years old. Single-shot interscalene block (IS) group consisted of 48 cases, 28 men and 20 women, whose average age at surgery was 63.9 years old. Surgery was done under general anesthesia, performed by a single surgeon in a beach-chair position. The patients' backgrounds of both groups were not uneven. In group-CE, a 2%-lidocaiine was administrated intra-operatively and 0.2%-ropivacaine was given via a continuous epidural catheter for 2-4 days postoperatively. In group-IS, a 0.75%-ropivacaine was injected into the interscalene compartment following induction of general anesthesia. Postoperative rehabilitation started at 1POD, in the same regimen for all patients. We evaluated pains at the time of recovery from general anesthesia, at night of the surgery, at the time of the 1st postoperative rehabilitation and the patients' satisfaction of postoperative pain using VAS-scales (0-10). We also investigated complications related to anesthesia, functional evaluation using the Japanese Orthopaedic Association shoulder score (JOA-SS) and QuickDASH.
    The ratio of patients who had pain at recovery from general anesthesia was 7.6% in group-CE and 8.3% in group-IS, without a difference. Pain the night of the surgery, patients' satisfaction also had no significant differences. Pain at first postoperative rehabilitation was significantly lower in group-CE. No complications including infection or prolonged nerve palsy were observed in any cases. Postoperative functional scores using JOA-SS and QuickDASH after surgery had no difference in either group. We conclude that a single-shot interscalene block was safe and effective for arthroscopic rotator cuff repair equal to a continuous epidural block.
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  • 鏡視下腱板修復術後の肩峰下滑液包内ロピバカイン持続投与
    津田 英一, 石橋 恭之, 塚田 晴彦, 井上 亮, 藤 哲
    2008 年 32 巻 2 号 p. 389-392
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.389
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    The purpose of this study was to determine the analgesic efficacy of subacromial infusion of ropivacaine after arthroscopic rotator cuff repair. 53 patients who underwent arthroscopic rotator cuff repair under general anesthesia were involved in this study. All patients received postoperative NSAID medication (lornoxicam 12mg/day) for 5 days. In 34 patients, a single-dose subacromial injection with 10 ml of 0.75% ropivacaine was administered at the end of surgery and followed by a postoperative subacromial infusion of 0.75% ropivacaine at 2ml/hr for 1 to 4 days (R group). As a control, 19 patients did not receive an injection or infusion of ropivacaine (C group). A visual analog scale pain score and consumption of postoperative additional analgesic were compared between the two groups. In the R group, visual analog scale at the 1st, 2nd and 3rd postoperative days was 4.2±1.7, 3.3±1.3 and 2.3±1.2, respectively. This was significantly lower compared to the 5.9±1.2, 5.3±1.0 and 4.6±0.5 in the C group. Additional suppositories (diclofenac 50mg) and intramuscular injections (pentazocine 15mg) analgesics were administered to 6 patients (18%) and 4 patients (12%) in the R group, and 14 patients (74%) and 8 patients (42%) in the C group, respectively. Subacromial administration of ropivacaine is an efficient analgesic technique to reduce shoulder pain after arthroscopic rotator cuff repair.
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  • 腱板断裂術後早期の積極的後療法プログラムは
    安全に良好な臨床成績が期待できるか？
    大泉 尚美, 久田 幸由, 三浪 明男, 末永 直樹, 綿谷 美佐子
    2008 年 32 巻 2 号 p. 393-396
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.393
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    It was sometimes difficult to perform early passive exercises after surgery for rotator cuff tear due to pain and increased muscle tonus during passive shoulder exercise. We developed a new rehabilitation protocol with using an original shoulder mobilizer which can apply traction and rotational motion and active exercises in supine flexed position, and reported favorable early passive ROM. The objectives of this study were to compare ROM after the start of anti-gravity active exercises and to evaluate the postoperative cuff integrity using MRIs. Sixty-three shoulders were classified as group I (GI); no tendon-to-bone repair, or group II (GII); with tendon-to-bone repair. In the former protocol, passive exercises started the next day of the surgery (GI) or in one week (GII). In the 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, 22 former-GII, and 22 new-GII. Postoperative flexion, external-rotation, and internal-rotation at 1, 2, 4, 8 weeks were evaluated. In shoulders that carried out the new rehabilitation program and were followed-up for more than 1 year, JOA score was evaluated and postoperative cuff integrity was classified according to Sugaya's classification of MRIs at 1 year. The ROM of the new-GI and new-GII was comparable or better than that of the former-GI and former-GII. Especially, the lag between active and passive flexion at the start of anti-gravity active exercises was smaller in the new program groups. The JOA score at 1 year was 96.0 points in the new-GI and 94.5 points in the new-GII. The cuff integrity in MRIs was classified as type 1 in all shoulders. The new postoperative rehabilitation program was proved to be safe and useful in this study.
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  • Surface-holding repair technique を用いて修復した
    腱板広範囲断裂の術後成績
    山口 浩, 末永 直樹, 大泉 尚美, 三浪 明男, 細川 吉博
    2008 年 32 巻 2 号 p. 397-400
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.397
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    Although various surgical procedures have been reported on for rotator cuff tears, the reported re-tear rate after open, mini-open, and arthroscopic repair has ranged from 24% to 94%, as demonstrated by arthrography, ultrasonografy, and magnetic resonance imaging. Especially in massive rotator cuff tears, the clinical outcome was distinctly less satisfactory than that for patients who had a smaller tear, and repair may not always be warranted for massive tears. The recent biomechanical studies have demonstrated that the double row tendon-to-bone fixation was stronger and footprint coverage of the double row fixation was larger than the single row or transosseous fixation technique. Therefore we have devised a new suture technique without suturing on the tendon named the surface-holding repair technique. The objectives of this study were to determine whether a new repair technique of rotator cuff tendons can yield a lower re-tear rate and to obtain a better clinical outcome than previous reported methods. With regard to repair integrity of the rotator cuff at a mean of 36.8 months postoperatively, according to Sugaya's classification, MRI scans revealed 14 shoulders with a type-I, four shoulders with a type-II, 4 shoulders with a type-III, 2 shoulders with a type-IV, and nothing with a type-V repair. Synthetically, 2 shoulders had a discontinuous cuff. Therefore the re-tear rate was 8.3% (2 of 24 shoulders). In conclusion, satisfactory clinical results were obtained with the surface-holding repair technique for massive rotator cuff tears. Although OA glenohumeral joint and upper migration of the humeral head, both had progressed postoperatively in some shoulders, the incidence rates were no higher than those of other procedures. In re-tear rate, the rate was lower than that of other procedures. Therefore this technique will be one of the good procedures in rotator cuff operations.
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  • 鏡視下支援による大腿筋膜パッチ併用の Debeyre 変法
    田久保 興徳, 仲川 春彦, 森原 徹, 岩田 圭生, 堀井 基行, 久保 俊一, 黒川 正夫
    2008 年 32 巻 2 号 p. 401-404
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.401
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    We have performed an arthroscopically assisted modified Debeyre's procedure with a fascial patch graft (AMDFP). The short clinical results and the low invasiveness were evaluated.
    Eight shoulders (6 males, 2 females, age; 63∼76 years old, average; 67.5 years old) were examined. The shoulders of which tendon edges could not reach to the top of the greater tuberosity arthroscopically were selected for an AMDFP. The method was indicated as follows; the modified Debeyre's procedure was performed with a small (3∼4cm) incision. The deltoid was split (3∼4cm) along the muscle fibers at the junction of the anterior and middle 1/3. The fascial patch graft was folded back, and inserted into the subacrominal space. The medial end of the graft was sutured to the tendon edge arthroscopically. The distal end was sutured to the top of the greater tuberosity with open technique. For evaluation of invasiveness, we examined the length of the skin incisions, the Hb and Ht data between before and after surgery, and compared the data between in the AMDFP and in the modified Debeyre's procedure (D method) at our hospital. The 4 shoulders (4 cases) of AMDFP were observed for more than 6 months. These clinical results were evaluated using the JOA scores. The length of skin incisions, and the changes of the Hb and Ht data of AMDFP were less than D method. The JOA scores of AMDFP improved 81 points postoperatively from 72.6 points preoperatively. The AMDFP was little invasive, and the short clinical results are good.
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  • 肩関節腱板広範囲断裂に対する棘下筋移行術の術後成績
    安里 英樹, 比嘉 丈矢, 照屋 均, 金谷 文則
    2008 年 32 巻 2 号 p. 405-408
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.405
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    The treatment for massive rotator cuff tear with supraspinatus muscle atrophy has not been established. We reported on satisfactory results in patients who suffered from massive rotator cuff tear with supraspinatus muscle atrophy by infraspinatus muscle transfer (Patte 1990). 5 patients received infraspinatus muscle transfer. There were 4 males and 1 female with an average age of 72 years old (55 to 81 years old). All were affected in the right side (dominant side), The etiology of rotator cuff tear was fell down in 3 and unknown in 2. All patients had rest and motion pain. Contracture of the shoulder was not observed and active-ROM (active range of motion) was under 90 degrees except a patient. The follow-up period averaged 13 months (11 to 15 months). A brace with 30 degrees abduction was applied in all patients after surgery. Passive ROM exercises were started the day after surgery. Active ROM exercise without a brace was started from 6 weeks after surgery. Shoulder pain disappeared in 3 patients, and improved in 2 patients. The average active ROM improved from a preoperative 72° to postoperative 150° in flexion, 68° to 165° in abduction, and 37° to 45° in external rotation, respectively. Supraspinatus test became negative in all patients after surgery. The average JOA score improved from 46 to 92. Infraspinatus muscle transfer is an effective method for massive rotator cuff tear with severe supraspinatus muscle atrophy.
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  • 無症候性腱板断裂の臨床像
    山本 敦史, 高岸 憲二, 大沢 敏久, 小林 勉, 中島 大輔, 設楽 仁
    2008 年 32 巻 2 号 p. 409-412
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.409
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    The purpose of this study was to investigate clinical characteristics of asymptomatic rotator cuff tears. 211 of 283 shoulders diagnosed with rotator cuff tears by ultrasonography (male: 81 of 114 shoulders, female: 130 of 169 shoulders, mean age; 65.5 years old) were divided into two groups according to the presence or absence of pain: asymptomatic rotator cuff tear group (group A) and symptomatic rotator cuff tear group (group S). Age, sex, occupation, dominant arm, trauma history, impingement sign, degree of active anterior elevation, abduction strength and external rotation strength were compared between these 2 groups. Using logistic analysis, the clinical characteristics of asymptomatic rotator cuff tears were also investigated. There were 185 shoulders (65.4%) in group A, and 98 shoulders (34.6%) in group S. Although there was no significant difference in age, sex or occupation, dominant arm injury (A;51.9%, S;72.4%), positive impingement sign (A;5.9%, S;41.8%), active anterior elevation (A;150.7, S;146.1), weakness of abduction strength (A;16.8%, S;40.8%), and weakness of external rotation strength (A;12.4% S;36.7%) significantly differed. Logistic analysis showed that dominant arm (odds ratio=2.99), impingement sign (odds ratio=10.18) and external rotation strength (odds ratio=3.10) were significant. When all 3 factors were negative, 93.8% of the rotator cuff tears in this series were asymptomatic. Asymptomatic rotator cuff tear more frequently involved the non-dominant arm, was negative for impingement sign, and showed greater active anterior elevations preserved abduction strength and external rotation strength.
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  • 矢状面における腱板断裂サイズと棘下筋萎縮の関係
    松木 圭介, 菅谷 啓之, 森石 丈二
    2008 年 32 巻 2 号 p. 413-416
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.413
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    The purpose of this study was to evaluate infraspinatus muscle atrophy with regard to sagittal extent of rotator cuff tears using magnetic resonance imaging (MRI). A consecutive series of 43 patients (45 shoulders), who underwent MRI because they were suspected to have rotator cuff tear, was evaluated. Subjects consisted of 24 males and 21 females with an average age of 60 years old (range, 19-82). Rotator cuff tear size was determined using each slice of T2-weighted oblique coronal images of MRI. There were 16 intact shoulders (group A) and 29 rotator cuff tears, including eight tears localized only in the anterior 1/2 of the superior facet (group B),10 tears which extended to the posterior half of the superior facet (group C), and 11 tears which extended to the middle facet (group D). The infraspinatus was divided into 4 compartments using proximal muscular slices in T2-weighted oblique sagittal images and muscle atrophy in each compartment was classified into 4 grades (grades I, II, III, and IV) based on Goutallier's staging. Regarding muscle atrophy, no significant difference was observed between groups A and B. However, significant muscle atrophy was observed in group C in the upper 2 compartments and in group D in all compartments compared with group A. Infraspinatus muscle atrophy increased in both extent and degree in accordance with posterior extent of tears. Infraspinatus muscle atrophy increased in both extent and degree in accordance with posterior extent of tears. Recently, it has been reported through anatomical investigation that the infraspinatus muscle was inserted to the most anterior part of the greater tuberosity. The fact that group C demonstrated infraspinatus muscle atrophy indicated that the infraspinatus tendon could be involved in this type of rotator cuff tears.
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  • 鏡視下腱板修復術における修復腱板の経時的 MRI 所見と臨床成績
    －単層固定法と重層固定法の比較－
    小松田 辰郎, 小池 洋一, 佐藤 克巳
    2008 年 32 巻 2 号 p. 417-420
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.417
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    Although several clinical and anatomical results after arthroscopic rotator cuff repair were reported, the longitudinal improvement of cuff integrity was not studied. The purpose of this study was to compare the morphologic improvement of repaired cuff and the functional outcome of single-row (SR) and double-row (DR) fixation after arthroscopic rotator cuff repair. A consecutive series of 131 shoulders with rotator cuff tears were evaluated using the Japanese Orthopaedic Association (JOA) shoulder index. There were 66 shoulders (55 males, 11 females, mean 59 years-old) in the SR group and 65 shoulders (47 males and 18 females, mean 61 years-old) in the DR group. Average follow-ups were 30 and 22 months, respectively. To evaluate the postoperative cuff integrity, MRIs were performed at three, 6 and 12 months postoperatively. The signal change in the repaired cuff was classified into 3 categories: Low(L), Intermediate(I) and High(H). The average JOA score improved from 62.4 to 95.0 in SR and from 62.5 to 93.3 in DR. There was no statistical difference between the groups. On MRIs (3,6,12months), the rates(%) of H were (36,27,23) in SR, (30,15,10) in DR. The rates of I were (55,27,27) in SR, (50,45,15) in DR. The rates of L were (9,46,50) in SR, (20,40,75) in DR. In both groups, H or I decreased but L increased longitudinally. At 12months, however, the rate of low signal in DR (75%) was significantly higher than in SR (50%, p=0.004). MRI findings of repaired cuff after arthroscopic rotator cuff repair revealed serial signal changes in both groups. Repaired-cuffs after DR fixation showed a faster morphologic improvement than those after SR, suggesting that the DR method is suitable for tendon-bone fixation.
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  • アンカーを用いない鏡視下腱板修復術の治療成績
    石毛 徳之, 黒田 重史, 丸田 喜美子, 三笠 元彦
    2008 年 32 巻 2 号 p. 421-424
    発行日: 2008年
    公開日: 2008/08/30
    DOIhttps://doi.org/10.11296/katakansetsu.32.421
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    Arthroscopic rotator cuff repair without anchor has been done since April 2005. We reported on the clinical results of this operative method. We reviewed the 28 shoulders which were operated on from April 1st 2005 to July 31st 2007. The average age was 62.4 years old at operation (18 males, ten females). The operation was performed as follow: several sutures went through the footprint and the rotator cuff by perforated K-wire from the distal of the greater tubercle, and torn rotator cuff was put on the footprint by mattress sutures and bridging sutures. We used Kuroda's knot as a suture method and tied them at the distal of the greater tubercle. The average postoperative periods were 12.8 months. We reviewed the preoperative periods, the torn widths, the JOA scores, and the postoperative MRIs. The average preoperative period was 6.2 months and the average torn width was 1.4 cm. The average of the total score of JOA was improved significantly from 72.8 preoperative to 94.0 postoperative. There were 2 cases with broad high intensity on the attachment of the rotator cuff in postoperative MRIs. Only 1 case had a lower functional score than at preoperation. Without anchors, we got a good result and this method seemed to be useful. However, there were some cases that have poor ROM of external rotation. We have to review the direction of repair of torn rotator cuff, the physical therapy and so on.
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