肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
33 巻, 3 号
選択された号の論文の64件中1~50を表示しています
解剖
  • 落合 信靖, 松浦 龍, 佐藤 進一, 杉岡 佳織, 見目 智紀, 西須 孝, 藤田 耕司
    2009 年 33 巻 3 号 p. 591-594
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Although innervation level of the glenohumeral joint was reported, innervation level of subacromial bursa was not clarified. The purpose of this study was to evaluate the dorsal root ganglion neurons innervating the glenohumeral joint and subacromial bursa. In this manner, dichotomizing axons projecting to the glenohumeral joint and subacromial bursa were also evaluated. 6 Wister rats were used in this study. 2 kinds of neurotracers such as fluorogold (FG) and dioctadecyl-tetramethyl-indocarbocyanine-perchlorate (DiI) were used to detect the glenohumeral joint and subacromial bursa separately. After anesthesia, FG was injected into the glenohumeral joint and DiI were injected into the subacromial bursa. Dorsal root ganglia were harvested between C1 and T1 7 days after injection. The number of FG labeled-neurons, DiI-labeled neurons and double-labeled neurons were counted. FG-labeled neurons were distributed from C2 to C7. The glenohumeral joint was mainly innervated by C4 and C5 dorsal root ganglion neurons. DiI-labeled neurons were distributed from C2 to C7. Although subacromial bursa was innervated from C2 to C7 dorsal root ganglion neurons, there was no main innervation level for subacromial bursa. Dorsal root ganglion neurons which double-labeled with FG and DiI were 19.0 ± 6.4% of FG-labeled neurons and 20.3 ± 6.2% of DiI-labeled neurons. Dichotomizing axons projecting to the glenohumeral joint and subacromial bursa were approximately 20% of dorsal root ganglion neurons. The glenohumeral joint was innervated from C2 to C7 and subacromial bursa was innervated from C2 to C7 dorsal root ganglion neurons. Obscurity of shoulder pain might be caused by which dichotomizing axons projecting to the glenohumeral joint and subacromial bursa approximately 20% of both sides. Injection into either the glenohumeral joint or subacromial bursa would be somewhat effective with the existence of dichotomizing axons.
  • 吉村 英哉, 秋田 恵一, 加藤 敦夫, 山口 久美子, 望月 智之, 浜田 純一郎
    2009 年 33 巻 3 号 p. 595-597
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The sternoclavicular joint has a critical role in the function of the shoulder, because it is a medial fulcrum of clavicular movement. However, the involvement of this joint has not been well documented. The purpose of this study was to examine the structures in the sternoclavicular joint and surrounding ligaments. 60 specimen shoulders from 30 cadavers (20 females and 10 males) were examined. In performing resections of the sternoclavicular joints, the muscles and soft tissues were removed carefully, and the ligaments were identified. The anterior and posterior sternoclavicular ligaments were present in all specimens. These configurations did not differ from specimens to others. In 17 cadavers, the interclavicular ligament connected the clavicles in the superior and posterior aspects, and covered the superior portion of the articular discus. Some fibers are attached to the superior manubrial margin. In 7 cases, the interclavicular ligament was located at the base of the sternal notch, and the ligament could not be found in 6 cases. In these joints, the upper part of the posterior sternoclavicular ligament was attached to the jugular notch of the manubrium. The stability of the sternoclavicular joint depends primarily on surrounding ligaments. It has been thought that the interclavicular ligament prevented the upward displacement of the clavicle during forceful depression of the shoulder. Our results suggest that the interclavicular ligaments are very variable in different individuals, and it is possible that disorder of this ligament potentially cause restriction of movements of the sternoclavicular joint and shoulder.
機能
  • 尼子 雅敏, 有野 浩司, 津田 悦史, 金子 正利, 渡邉 樹一, 根本 孝一
    2009 年 33 巻 3 号 p. 599-601
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The Japanese Society for Surgery of the hand version of the disability of the arm, shoulder, and hand (DASH) questionnaire is an evaluation measure of quality of life (QOL) for patients with upper extremity disorders. The purpose of this study was to evaluate the reliability, validity, and responsiveness of the DASH for patients with shoulder disorder. 54 patients with shoulder disorders were assessed their shoulder function with the DASH, Japanese Orthopaedic Association (JOA) score, and the Japan Shoulder Society Shoulder Sports Score (JSS-SSS). The shoulder rotational muscle strength was also measured using a Biodex dynamometer. The isokinetic peak torque ratio was calculated under both 60 and 180 deg/sec conditions. The DASH was compared with the JOA score, the JSS-SSS, or the peak torque ratios. Correlation coefficients between the DASH and the JOA score or the JSS-SSS were -0.73 and -0.35. There was a high negative correlation between the DASH and the peak torque ratio of the shoulder rotational muscle strength (r=-0.43 ∼ -0.59, p<0.01). The DASH has been widely used in the area of hand surgery in Japan, however, there have been few reports in shoulder disorders. The strong correlation between the DASH and the JOA score supported that the validity and reliability in shoulder function. The DASH also reflected the shoulder muscle strength, and should be widely used in evaluating QOL in shoulder disorders.
  • 橋本 俊彦, 福林 徹, 井上 和彦
    2009 年 33 巻 3 号 p. 603-605
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    To measure and evaluate changes of the scapular muscles by MRI at the shoulder internal rotation in shoulder abduction quantatively. The subjects were 8 overhead varsity athletes. Before and after performing shoulder internal rotation exercise of 30 deg / sec in 90 degree-abduction in Biodex, MRI was taken and T2 relaxation time of the rotator cuff (infraspinatus muscles (ISP)) and scapular muscles (trapezius muscle upper (TU), trapezius muscle middle (TM), trapezius muscle lower (TL), rhomboid muscle major (RMJ) pectoralis major (PEC)) were calculated. TM and RMJ revealed significant elongation of T2 relaxation time after internal rotation exercise, which meant not only rotator muscles but also scapula stabilizer muscles functioned during internal rotation motion of shoulder at 90 degree-abduction position. The scapular stabilizer, especially trapezius muscle middle and rhomboid muscle major could play important roles for shoulder rotation at abduction position in the overhead athletes.
検査
  • 山中 芳, 濱田 一壽
    2009 年 33 巻 3 号 p. 607-610
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The aim of this study was to evaluate the usefulness of the 3 dimensional ultrasonography (3D ) of the supraspinatus (SSp) tendon and the low echoic area of the tendon. 2 and 3 dimensional ultrasonographies were performed on the SSp tendons of 97 patients. The right shoulders were involved in 54, left in 28 and both in 15 patients. Ultrasonograms were divided into 2 groups with or without complaint and were compared. In 2 dimentional ultrasonographies (2D), the configurations of the sagittal section of SSp tendons classified into 4 types and the echogenesity classified into 4 types were studied. In 3D, configurations of the serial sagittal sections were classified into 3 grades by its clearness and the echogenesity in the tendons were into 4 types respectively. In 2D, 72 concave, 9 flat, 2 irregular types were found in sound shoulders, and 82 concave, 17 flat, 8 irregular and 5 defect were found in involved shoulders. In 2D, moderate or large low echoic area were found in 9 sound shoulders (9.6 %) and 20 involved shoulders(19%). In 3D, the configurations demonstrated good and moderately were found in 72 sound shoulders (72/83 86.7%) and in 97 involved shoulders (97/112 86.6%). In 3D, moderate or large hypoechoic area were found in 40 (58.0%) and 57(64.9%) SSps respectively. In this preliminary study, the rate of manifestation of 3D utrasonography as good or moderately was not satisfied but the better results were expected by technical improvements. Implication of low echogenesity in the SSp tendon was still controversial but the contribution of tendon degeneration might be suspected. 3D ultrasonography could be a useful tool to evaluate the cuff pathology.
  • 木島 泰明, 皆川 洋至, 冨岡 立, 島田 洋一
    2009 年 33 巻 3 号 p. 611-613
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We clarified the relations between the material properties of the coracoacromial ligament and rotator cuff tears. The material properties are affected by the length and the cross section of the ligament. The purpose of this study was to clarify the relations between the length and thickness of the coracoacromial ligament and the rotator cuff tears in live shoulders with ultrasonography as the medical examination and treatment indexes. Twenty-two persons (40 shoulders, mean age 52 years old) were studied. We investigated the presence of rotator cuff tear and measured the length and thickness of the coracoacromial ligament with ultrasound machine (EUB-7500, HITACHI, Japan). The longitudinal images of the ligaments were depicted with the acromion and coracoid process, and the lengths of the ligaments were measured by using acoustic shadows as the landmark. On the same screens, the thicknesses of the ligaments were measured at the central points of the ligaments. The length of the ligaments with rotator cuff tear (26.1±2.6 mm, 17 shoulders) was shorter than that of the ligaments without rotator cuff tear (28.9±1.6 mm, 23 shoulders) (P=0.0001). There was no significant difference in the thickness of the ligaments. The length of the coracoacromial ligaments with rotator cuff tears, which were measured with ultrasonography in live shoulders, was significantly short. These results were provided for the first time in live shoulders. The risk of outbreak and progress of rotator cuff tears may be evaluated by measuring the length of the coracoacromial ligament clinically.
  • 堀籠 圭子
    2009 年 33 巻 3 号 p. 615-618
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    To determine postoperative early MR findings of the repaired rotator cuffs, which predict future re-tear, we evaluated MRI taken 1 month after arthroscopic rotator cuff repair (ARCR). From February 2005 to February 2008, 29 patients with 29 cuff tears underwent ARCR using dual-row fixation. There were 21 men and 8 women with the average age of 62 years old. The tear size was medium in 7 patients, large in 19, and massive in 3. Postoperatively MRI was taken twice, first at 1 month and second at 3 months or later (average 5.1 months). None of the 29 patients showed re-tear of the cuff in the first postoperative MRI, whereas 7 patients exhibited re-tear in the second postoperative MRI. These 7 patients were referred to as the re-tear group. The remaining 22 patients were referred to as the repair group. Between 2 groups, MR findings at 1 month postoperatively were compared with respect to cuff integrity, cuff thickness at the top of the humeral head and the greater tuberosity, difference of the cuff thickness between at the top of the humeral head and the greater tuberosity, fatty degeneration of rotator muscles, atrophy of the supraspinatus muscle, and effusion of the gleno-humeral joint, the subacromial bursa, and the bicepital groove. Based on the Mann-Whitney's U test and the Fisher's exact probability test, data with p-values of less than 0.5 were regarded as statistically significant differences. Among several parameters examined in 2 groups, significant differences were found in the cuff thickness at the greater tuberosity, and the difference of the cuff thickness between at the top of humeral head and greater tuberosity. These 2 parameters likely reflect retraction of the repaired cuff medially. Such medial retraction of the repaired cuff at 1 month postoperatively may serve as a predictive MR feature for future re-tear.
  • 本多 宏明, 森原 徹, 木田 圭重, 高取 良太, 岩田 圭生, 久保 俊一, 井上 望
    2009 年 33 巻 3 号 p. 619-622
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We reported the method of the accurate 3D kinematics of the normal shoulder which includes the sternoclavicular (SC) joint. We also thought this method can be applied clinically. The subjects of this study were 3 patients of clavicular non-union. Computer tomographies of the shoulder (including sternum, clavicle, scapula and humeral) were obtained in the neutral position and head touching position. 3D models of each bone were created from CTs and the movement of each bone was calculated by Volume Merge (custom computer program). The movements of the bone were seen by the Euler angle, which used 3 rotational parameters and 3 quantities of movement. We measured the rotation and quantity of movement of each bone from the neutral to head touching positions. We calculated the SC joint movement as the difference of movement of the clavicle from the sternum, AC joint movement as the difference of the scapula from the clavicle. In X axis rotation, cases 2 and 3 were similar to normal pattern and the rotation in clavicular non-union was little. But in case 1, the rotation in clavicular non-union was large and the SC and AC joint rotation were less than normal. The X axis rotation was similar to the clavicle posterior rotation. In case 1, clavicular non-union rotated instead of the SC and AC joint. This method can be useful to clinically.
  • 西本 竜史, 永澤 雷太
    2009 年 33 巻 3 号 p. 623-626
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to investigate the value of 3DCT for arthroscopic subacromial decompression and the relationship between subacromial spur and rotator cuff tears. 96 shoulders with rotator cuff tears, 59 men 37 women, were evaluated by computed tomography pre and post arthroscopic rotator cuff repairs. The average age at operation was 64.8 years old (range 41-83). Subacromial spur was classified into 5 grades according to their size. Preoperative CTs showed that all of subacromial spur was located along coracoacromial ligament, and bottom aspect of acromion was like double floor. There were 0 grade 0, 48 grade 1, 24 grade 2, 24 grade 3, 0 grade 4 in preoperative CTs. 3 dimension computed tomography enabled us to evaluate more accurately than X-rays. There were 28 partial tears, 12 small tears, 21 medium, 14 large, 21 massive in size of tears. Higher grade of CT classification was larger tear and elder patient significantly, and in grade 3, 58% was large or massive tears. Otherwise, there was no relationship between subacromial spur and sex, duration of symptom, trauma. Preoperative 3DCT was useful for understanding range of decompression. Subacromial spur correlated with tear size and age significantly.
  • 石谷 栄一
    2009 年 33 巻 3 号 p. 627-630
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    It is thought that the difference between affected and un-affected side of scapula-spine distance (SSD) is the evidence to have a shoulder's injury in inspection. However, it is not cleared which disorder appears for the difference of SSD. The purpose of this study was to investigate the characteristic of the differences of SSD for each disorder and made an index of differential diagnosis by inspection. We examined 215 cases that had shoulder complaints. We measured SSD of both sides at the upper distances between the medial border of spine of scapula and spinous process of the same height and at the lower distances between inferior angle of scapula and that. We diagnosed from the findings of XP and MRI and clinical examinations. The differences of SSD of each disorder: the upper, the lower. Small size (under 1cm) of rotator cuff tear were 30cases: +2.5mm, +3.0mm. Medium size (1-3cm) of it were 48cases: +4.0mm, +3.3mm. Large size (over 3cm) of it were 40cases: +7.1mm, +9.9mm. Throwing shoulder were 32cases: +7.3mm, +6.7mm. Thoracic outlet syndrome were 15cases: +10.6mm, +7.1mm. Calcific tendonitis of rotator cuff were 17cases: +1.4mm, +1.6mm. Recurrent dislocation of the shoulder were 7cases: -1.7mm, +0.9mm. Frozen shoulder were 26cases: -0.7mm, +1.1mm. The differences of SSD in large size of RCT and throwing shoulder and thoracic outlet syndrome were more than +7mm. As tear sizes were increased, We found that scapula's position of affected side became to abduction and upper rotation. The differences of SSD in calcific tendonitis of rotator cuff and recurrent dislocation and frozen shoulder were less than ±2mm. The differences of SSD becomes an important index of differential diagnosis by inspection.
  • 木田 圭重, 森原 徹, 佐々木 健太朗, 小椋 明子, 久保 俊一, 堀井 基行, 黒川 正夫
    2009 年 33 巻 3 号 p. 631-635
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to analyze the compensatory movement of the scapula on shoulder abduction by using surface electromyography(EMG). We evaluated the upper trapezius muscle, middle deltoid muscle, and infraspinatus activity using surface EMG during shoulder abduction of 10 cases 20 shoulders who had undergone rotator cuff repairment. We used Telemyo System 2400(Noraxon USA Inc) and analyzed it by MyoVideo and MyoResearch. The relative activity of the upper tarapezius muscle was significantly increased after an operation and gradually lowered while rehabilitation program proceeded. Relative activity of the middle deltoid and infraspinatus muscle approached normal EMG pattern. Upper trapezius muscle activity contributed to scapular substitution movement in compensation for impaired glenohumeral motion in patients with rotator cuff insufficiency. Sufficient rotator cuff functions stabilized the glenohumeral joint and increased the output power of the deltoid muscle, and decreased the trapezius muscle activity. EMG analysis of scapula substitution movement can be one of the indicators for rehabilitation program.
脱臼
  • 西原 淳, 長谷川 智彦
    2009 年 33 巻 3 号 p. 637-639
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to evaluate the background and intraarticular lesion of traumatic anterior glenohumeral instability, such as Bankart lesions, capsular tear, and HAGL lesions, based on dislocation frequency.
    33 shoulders with anterior glenohumeral instability underwent arthroscopic examination from 2003 to 2008. Excluded 2 shoulders with massive rotater cuff tear due to old age. We divided them into 2 groups based on dislocation, subdislocation frequency; 1 group with 9 or less dislocations: less than 9 times, and another group for more than 10 dislocations: more than 10 times. Then, we investigated the anterior mechanism failure by background, physical and arthroscopic examinations. Shoulder instability and Carter's sign are not significant between the 2 groups. There are not a lot of dislocation frequencies for joint instability and laxity. The group with less than 9 times : there were 12 Type1, 6 Type2, 1 Type3, 1 Type7. And another group of more than 10 times: there were 4 Type1, 2 Type2, 2 Type4, 1 Type6, 2 Type7. When dividing into Bankart lesion of Type1, 2 and 3 and non-Bankart lesion of Type4, 5, 6 and 7, there were intensionally a lot of non-Bankart lesion in the group of more than 10 times of dislocation. However, intraarticular lesion are not possibly related to dislocation frequency, but the period from 1st time injury to operation, because the group of more than 10 times is longer than the groups less than 9 times about period from 1st time injury to operation.
  • 大関 信武, 山崎 哲也, 明田 真樹, 齋藤 知行
    2009 年 33 巻 3 号 p. 641-644
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to investigate background, arthroscopic findings and clinical results of traumatic anterior shoulder instability for rugby players. This study included 49 rugby players (54 shoulders) who underwent surgery for traumatic anterior shoulder instability. All patients were men, and the mean age at the surgery was 20.1 years old. The mean follow-up period was 21.4 months. In all patients, arthroscopy was performed first to evaluate and treat intraarticular pathology. After arthroscopy, Modified Bristow procedure was undertaken. Backgrounds were evaluated concerning the position of players and cause of injury. Arthorscopic findings were evaluated concerning the pathology of glenohumeral instability and the presence of superior labrum injury. Clinical results were evaluated concerning JSS Shoulder Instability Score(JSS SIS), JSS Shoulder Sports Score(JSS SSS), the recurrence of dislocation(subluxation), return to game after surgery, the range of motion and complications. 59% of players were backs players and 70% of causes of injury were tackling. Arthroscopic findings revealed Bankart lesion in 48 patinets (89%), humeral avulsion of the glenohumeral ligament in 4, capsular tear in 2. Superior labrum injury was seen in 19 (35%). The mean JSS SIS was 93.9 points, and the mean JSS SSS was 90.3 points at the final follow-up. Recurrence of dislocation did not occur in any patients. The range of motion particularly for external rotation was decreased by 5.7 degree with the dropped arm position, 4.4 degree at 90 degree of abduction. In 1 patient, the screw displaced just after the surgery. Modified Bristow procedure provided satisfactory results for traumatic anterior shoulder instability for rugby players regardless of the intraarticular lesions on arthroscopic evaluations.
  • 岩噌 弘志
    2009 年 33 巻 3 号 p. 645-648
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    There have been studies on the application of DAFF as a fixation method to replace conventional fixation techniques. DAFF strengthens the initial fixation of the Bankart region, and this method is also useful for its anatomical repair. Theoretically, better outcomes can be expected by DAFF compared to conventional methods, but it has been reported that the DAFF procedures are more complicated, and require skilled techniques. In this study, we modified the DAFF procedures, and propose knotless relayless DAFF (Easy-DAFF). The subjects were 24 males (26 shoulders) with injury related to sports.
    The events consisted of basketball in 8 patients, skiing in 7, soccer in 6, American football in 3, and wrestling in 2. 1) The reduced position of the articular labrum-IGHL complex was maintained by the modified TOTS method. 2) Medial anchor: A knotless anchor with 2 loops was penetrated through IGHL at the scapular neck on the medial side. 3) Lateral anchor: 2 loops were individually fixed to the edges of the scapular joint surface to form a V shape using the knotless anchor. 4) If necessary, procedures 2) and 3) were repeated. 5) A W shape was created by performing these procedures twice. There was no subluxation nor redislocation during follow-up observation periods of more than 10 months. The mean pre-and post operative JSS scores were 50 and 89, respectively, showing improvement. Pre operative Rowe score was 19.2 and post operative score was 84.8.
  • 山上 直樹, 菅谷 啓之, 高橋 憲正, 萩原 嘉廣, 小瀬 靖郎, 杉森 一仁, 河合 伸昭, 森石 丈二
    2009 年 33 巻 3 号 p. 649-653
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    PURPOSE: The purpose of this study was to reveal the outcome after arthroscopic stabilization for recurrent traumatic anterior instability occurred in the throwers' dominant arm.
    METHOD: Arthroscopic stabilization for thrower's dominant shoulder has been performed under the following principles: adequate IGHL tensioning using suture anchors loaded with high strength sutures, which is accomplished by mobilization of labroligamentous complex from 2:00 to 7:30 associated with cartilage resection with 2 to 5mm width at the edge of the glenoid surface from 3:00 to 7:30; repair of associated pathology including capsular and labrum lesions. Since January. 2004 through April. 2006, 31 overhead athletes underwent the index surgery for their dominant arm.
    7 patients were interviewed by telephone and the rest of 24 patients were examined at our office, which was 31.8 months (range, 24 to 48) after the index surgery on average.
    RESULTS: The average Rowe, UCLA, and JSS Sports scores improved significantly respectively. 20 (80%) had returned to their sports at the preinjury level, 3 (12.5%) to their sports with minimal restriction, and 6 had quit their sports for some specific reasons rather than the shoulder. 2 patients (6.5%) experienced redislocation. Every single patient, who could not return to their sports at their preinjury level, had evident functional problems including scapula or trunk.
    CONCLUSION: Arthroscopic stabilization with emphasis of IGHL tensioning for throwers' dominant arm worked very well. However, to achieve complete return to their sports, athletic rehabilitation in order to obtain proper throwing mechanics is necessary.
  • 松本 一伸, 伊藤 陽一, 間中 智哉, 仲 哲史, 坂口 公一, 月山 国明, 中尾 佳裕, 中村 信之, 鞆 浩康, 高岡 邦夫
    2009 年 33 巻 3 号 p. 655-658
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Purpose: The modified Bristow procedure is thought to be suitable surgical method for the treatment of recurrent dislocation in collision athletes. Abduction and external rotation (ABER) position is useful for the evaluation of Bankart lesion and 3D-CT image is useful for evaluating bony morphologies. The aim of this study was to evaluate middle term clinical results of the modified Bristow procedure in collision athletes with reference to ABER 3D-CT imaging. Methods: We evaluated 15 shoulders treated with the modified Bristow procedure. The average age at operation was 28.7 years old. The average follow-up was 62.4 months. Clinical results were evaluated with Rowe scoring system. Range of motions of external rotation at 90 degree of abduction in the affected shoulders were measured and compared with those in the non-affected shoulders. 3D-CT images were obtained in the ABER position. Bony state between the transferred coracoid and glenoid was evaluated by the glenoid cavity images; shoulder joint stability was analyzed by the anterior-posterior images. Result: Re-dislocation was observed in 0%. However, subluxation was observed in 6.7%. The average Rowe score was 94.0 points in total. Average range of motion of external rotation was 96.6 degrees in the affected shoulders and 107.6 degrees in non-affected shoulders. 3D-CT images in ABER position revealed humeral head subluxation and displaced coracoid non-union combined with screw breakage in a clinically failure case. Conclusion: Middle term clinical results of the modified Bristow procedure were relatively acceptable. 3D-CT images in ABER were useful for the evaluation of postoperative joint stability.
  • 松田 雅彦
    2009 年 33 巻 3 号 p. 659-661
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The aim of this study was to clarify the complications of Bankart and modified Bristow procedure using a cannulated cancellous screw for recurrent anterior dislocation of the shoulder.25 shoulders who had received a Bankart and modified Bristow procedure and were able to be observed for more than a year postoperatively were investigated. We used a few suture anchors for Bankart repair, and a cannulated cancellous screw with a washer to fix the coracoid tip to the glenoid neck. There were 19 men and 6 women, whose average age at surgery was 29.1 years old(16-60 years old). We evaluated the complications about non-union of the coracoid tip, breakage of the screw, loosening of the screw and the loss of external rotation more than 20 degrees postoperatively. There were no re-dislocations or subluxations postoperatively. The complications were non-union in 4 cases, breakage of the screw in 1 case, loosening of the screw in 4 cases, and the loss of external rotation in 3 cases. Some cases overlapped. Using a cannulated cancellous screw to fix the coracoid's tip to the glenoid neck is uncertain. It is desirable that a national research about the complications of Bankart and modified Bristow procedure be performed.
  • 佐々木 誠人, 川嶌 眞人
    2009 年 33 巻 3 号 p. 663-666
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    This study aimed to examine the characteristic findings on MRI of dislocation of the long tendon of biceps brachii (LHB). We retrospectively evaluated MRIs of 16 cases of intact, complete rupture and dislocation of the LHB tendon with rotator cuff tears. We performed surgery in all cases and surveyed the LHB tendons. We examined the position, the edematous findings and the size of LHB tendons on the MRIs. It was useful to check the position of the LHB tendon at a distal level of the bicipital groove to detect any dislocation of the LHB tendon. Edematous findings around LHB tendon were found more often at the distal level than at the bicipital groove. Tendon size was not a characteristic of cases of dislocation of the LHB tendon.
  • 永井 英, 西中 直也, 上原 大志, 鈴木 一秀, 牧内 大輔, 三原 研一, 筒井 廣明
    2009 年 33 巻 3 号 p. 667-670
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to analyze the results of arthroscopic revision Bankart repair after initial open surgeries. We retrospectively reviewed 9 shoulders in 9 patients with failed open reconstruction surgeries for traumatic recurrent anterior glenohumeral instability of the shoulder, who were treated by arthroscopic revision Bankart repair for the patients, from 2002 to 2008. The average age at initial surgery was 28(18-38) years old. The initial surgical procedures were, Putti Platt in 1, shoulder, Boytchev in 1, Modified Oudard-Iwahara-Yamamoto in 1, inferior capsular shift in 1, Bankart-Bristow in 1, Bristow in 1 and open Bankart repair in 3. The average follow-up period was 19.7 (12-36) months. We analyzed the arthroscopic findings and clinical results using Rowe's score and JSS shoulder instability score. The arthroscopic findings of revision Bankart repair were a detached anterior labrum in all 9 shoulders (100%). Arthroscopic revision Bankart repair was performed for all cases, using 3 or 4 absorbable suture anchors. 4 anchors were used in 7 shoulders, and 3 anchors were used in 2 shoulders. No patients had recurrence after revision surgeries. Postoperative average JSS shoulder instability score was 90.9 points and average Rowe score was 96.1 points. Rowe grading was excellent in all patients. The cases after the initial surgical procedure which was not invasive to the joint (modified Oudard-Iwahara-Yamamoto, modified Bristow, Boytchev procedure) could be repaired easily as well as initial arthroscopic Bankart repair. Another case after the initial surgical procedure which was invasive to the joint were required a variety of resources. Procedural considerations included limited mobility due to adhesion of the anterior articular capsule and interference with the previously inserted metal anchor. Arthroscopic Bankart repair is useful as a revision surgery for the failed reconstruction for the traumatic recurrent anterior glenohumeral instability of the shoulder.
  • 畠山 雄二, 小林 志
    2009 年 33 巻 3 号 p. 671-674
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study is to investigate the epidemiology of traumatic anterior dislocations of the shoulder and the short term outcome of operative treatment of rotator cuff tears associated with acute dislocation. We reviewed 58 traumatic anterior dislocations of the shoulder between April 2002 and December 2007 to clarify the age, cause of injury and rotator cuff tears. Magnetic resonance images were performed in patient whose pain, muscle weakness and loss of range of motion persisted over 3 weeks after injury. 5 patients with rotator cuff tears underwent surgical repair. The majority of dislocations were in their 20's (9 patients) and of over 60 years old (30 patients). The main mechanism of injury was sports activities (12 patients) in their 10' to 30's, whereas a fall (26 patients) of over 60 years old. Sports activities included ball games (6 patients), contact sports (2 patients) and others (4 patients). In 5 patients with rotator cuff tears, the average flexion was 60° preoperatively/162° postoperatively, abduction 54°/160°, external rotation 12°/43°,internal rotation T12/T8 and JOA score 42/81 points, respectively. Postoperative rotator cuff integrity was classified into type I in 1, type II in 2 according to Sugaya's classification. The majority of dislocations were in their 20's and over 60 years old. The main mechanisms of injury were sports activities and a fall. Early rotator cuff repair yields successful functional outcomes.
骨折
  • 菊川 和彦, 奥平 信義
    2009 年 33 巻 3 号 p. 675-677
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We have performed on arthroscopic reconstruction by reposition of bony fragment for acute anterior glenoid fracture. The purpose of this study was to evaluate the clinical results of this procedure and to compare them with open methods. We treated 10 acute anterior glenoid fractures by arthroscopic reconstruction. (males 9, female 1; mean age 23 years old). The mean follow up period was 20 months. Bony fragment was repositioned and fixed by suture anchor. Clinical results were evaluated according to the Japanese Orthopaedic Association's score (JOA score) and JSS Shoulder Instability Score (JSS-SIS). The translation of bony fragment was evaluated by CTs and 3DCT images. The average postoperative JOA score was 88 points, ranged from 76 to 100 points. The average postoperative JSS-SIS was 91 points, ranged from 82 to 100 points. There was no case that had apprehension, shoulder instability and severe limitation of range of motion in external rotation. The gap between the bony fragment and the glenoid surface was 1.9mm (from 1 to 6mm), but all cases gained a bone union. Clinical results of arthroscopic reconstruction of acute anterior glenoid fracture were satisfactory the same as the open method.
  • 山田 光子, 山路 哲生
    2009 年 33 巻 3 号 p. 679-683
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Bone structure and bone strength of the proximal humeral head affect the stability of the internal fixation material at the fracture operation. We evaluated the relationship between the trabecular structure and the bone strength in the proximal humeral head using cadaver humerus. 7 cadavers humerus ( mean age 79.6 ) was analyzed by micro CT. Bone volume/ tissue volume, trabecular number, trabecular thickness, trabecular separation, number of node and length of node strut were measured as trabecular parameters at 3 regions of interest ( region A : top of humeral head, B : middle of humeral head and C : neck ). On the coronal plane the osteotomy was performed on the middle of humeral head and sliced 1 cm thickness. The maximum load value was measured by the compression test using a universal material examination machine ( Instron 4505 )at region A and B. There were significant difference between region A and C, B and C concerning Bone volume/ tissue volume, trabecular number, trabecular separation node number, number of node and length of node strut ( p < 0.05 ). There were significant difference between region A and B( p < 0.05 ) concerning bonestrength. There were positive correlation between bone volume/ tissue volume and bone strength, trabecular number and bone strength, trabecular thickness and bone strength, node number and bone strength and node length and bone strength( p < 0.01). Our result shows the trabecular structure and bone strength at the superior region in the proximal humeral head had better than other regions. There were positive correlation between trabecular parameters and bone strength. Above results indicate that better stabilization is achieved by inserting the screw tip on the superior proximal humeral head at the fracture operation.
  • 畠山 雄二, 小林 志
    2009 年 33 巻 3 号 p. 685-688
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to evaluate the short term outcome of locked plate fixation in proximal humeral fracture. 6 patients (Group A) who underwent open reduction and locked plate fixation with proximal humeral fracture between June, 2007 and January, 2008 were used. There were 2 males and 4 females.
    All of group A involved surgical neck 2-part fracture. We compared group A with 8 patients (Group B) who underwent open reduction and conventional plate fixation. All of group B involved surgical neck 2-part fracture. The average age was 62 years old in group A and 70 years old in group B, the average follow-up periods were 11 months and 12 months respectively. There was no significant differences in the age and follow-up periods among the 2 groups. In group A the mean active flexion was 125°, abduction 117°, ER 53°, IR T12 and average JOA score was 86 points. In group B the mean active flexion was 125°, abduction 111°, ER 42°, IR T10 and the average JOA score was 89 points. The average humeral head inclination angle was 131°(mean humerus varus deformity 16°) in group A and 124°(18°) in group B. There was no significant differences in the range of motion, JOA score and humeral head inclination angle among the 2 groups. In both groups all patients showed bone union, however, 1 patient of group A had humeral head necrosis and needed hemiarthoplasty. There was no significant differences in clinical outcomes among the 2 groups, except for 1 patient of humeral head necrosis in the group of locked plate fixation.
筋腱疾患
  • 一ノ瀬 剛, 山本 敦史, 大沢 敏久, 小林 勉, 設楽 仁, 山口 蔵人, 高岸 憲二
    2009 年 33 巻 3 号 p. 689-692
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Intraarticular injection of sodium hyaluronate is known to be effective for osteoarthritis, frozen shoulder, but there are a few report which evaluate its effectiveness for a patient after rotator cuff repair. We investigated the effectiveness of intraarticular injection of sodium hyaluronate after rotator cuff repair. The study included 32 shoulders from 32 patients who underwent rotator cuff repair between October 2005 and May 2007(24 males and 8 females; average age at the time of study, 59.2 years old). Patients were divided into 2 groups, 1 group received intraarticular injection of 2.5ml sodium hyaluronate at the time of 1day, 8days, 15days after the surgery (HA group). Another group received intraarticular injection of 2.5ml natural saline (control group). A follow up study was done for 1 year after surgery, and postoperative result was investigated by visual analog scale(VAS) and JOA score. VAS was estimated in both groups at the time of 1day, 2days, 3days, 5days, 8days, 15days, 1month, 2months, 3months, 6months, 1year after the surgery. JOA score was estimated in both groups at the time of 1month, 2months, 3months, 6months, 1year after the surgery. There was no significant difference in VAS at all observation periods. At the time of 1month, the total JOA score and JOA function score were significantly high in HA group. At the time of 1year, only HA group revealed a significant improvement of JOA ROM score. Sodium hyaluronate has some pharmacologic effects, anti-inflammatory and analgesic effect, protection and restoration of joint cartilage, and prevention of adhesion by inhibiting granulation and fibrotic change. In the present study, postoperative intraarticular injection of sodium hyaluronate may be useful for improving function and range of motion in early postoperative period of rotator cuff repair.
  • 松木 圭介, 菅谷 啓之, 森石 丈二, 落合 信靖
    2009 年 33 巻 3 号 p. 693-696
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Fatty infiltration of rotator cuff muscles has been reported to affect the outcome of rotator cuff repair. Until now, quantitative evaluation of fatty infiltration of rotator cuff muscles has not been reported. T2 mapping is a quantitative magnetic resonance (MR) imaging technique that potentially evaluates the concentration of fat in muscles. The purpose of this study was to evaluate fatty infiltration of rotator cuff muscles using T2 mapping. Forty-seven shoulders of 46 patients with shoulder pain were studied. The subjects consisted of 27 males (27 shoulders) and 19 females (20 shoulders) with an average age of 58 years old (range, 16-84). Twenty-four shoulders had no rotator cuff tear (group A), and 23 shoulders had rotator cuff tear: 7 incomplete (group B), 10 small to medium (group C) and 6 large to massive tears (group D). T2 mapping was performed at a proximal muscular slice in oblique sagittal images with a 1.5-tesla imager. T2 of the supraspinatus (SSP) and infraspinatus (ISP) muscles were measured and compared among groups. The relationship between T2 and Goutallier's staging was also examined. The average T2 of SSP in groups A, B, C and D were 34.6 ± 3.0, 39.1 ± 2.8, 41.4 ± 7.2 and 49.0 ± 11.5 msec, respectively. The average T2 of ISP in groups A, B, C and D were 34.3 ± 3.4, 34.0 ± 2.6, 40.0 ± 11.3 and 44.5 ± 3.5 msec, respectively. Although no significant difference was observed in T2 of ISP between groups A and B, T2 increased with extension of tear in both muscles. However, T2 varied in larger tears. The higher stage in Goutallier's staging demonstrated a longer T2. However, the T2 varied in higher stage. T2 of rotator cuff muscles increased in accordance with extension of tear but varied in larger tears. T2 mapping was a useful quantitative evaluation method of fatty infiltration.
  • 舟崎 裕記, 吉田 衛, 菅 巌, 加藤 壮紀, 諸橋 正行, 笠間 憲太郎, 丸毛 啓史
    2009 年 33 巻 3 号 p. 697-700
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We studied the effectiveness of conservative treatment in non-operative patients with full-thickness tear of the rotator cuff. There were 28 patients (30 shoulders) with an average age of 65 years old. Non-operative treatment consisted of rehabilitation and injection of H.A or steroid to the subacromial bursa. The average follow-up period was 19 months. Relationships between tear size, pain score, range of motion, and muscle strength were evaluated retrospectively. 1) 2 shoulders after massive tears scored with less than 80 points of JOA score at final follow-ups. 2) The average pain score improved significantly from 11 to 25. 3) The average ROM for elevation and external rotation improved from 110 to 128 degrees and 42 to 52 degrees, respectively. 4) In 6 shoulders with global or massive tears, muscle strength did not exceed 4 degrees; in this group satisfactory improvement was not obtained. 5) The average number of injections was 4.3. Patients with initial ROM limitations showed significant improvements if 120 degrees of elevation were obtained and/or the H.A. or corticosteroid was injected at least 4 times. Conservative treatment in non-operative patients with full-thickness tear of rotator cuff produced satisfactory results especially in regard to relief of pain. Patients with global or massive tears and muscle weakness did not experience a full recovery. 4 injections and 120 degrees of elevation were thought to be useful end-point indices for deciding on the effectiveness of conservative therapy.
  • 石谷 栄一
    2009 年 33 巻 3 号 p. 701-704
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    In a recent anatomic study, it was reported that the supraspinatus tendon inserted into the anteriormost area of the highest impression on the greater tuberosity, while the infraspinatus tendon extended to the anterolateral area of it. It was thought that the infraspinatus works as the abductor at the internal rotation (IR) position and the supraspinatus works as the abductor at the external rotation (ER) position in the previous study. We measured the shoulder abduction strength at IR and ER positions in rotator cuff tear to prove this hypothesis. We examined 69 cases of rotator cuff tear in MRI. Tears of 11 cases were located at the anterior part of the highest impression (HIa). Tears of 19 cases were located at the posterior part of the highest impression (HIp). Tears of 13 cases were located at the anterior part of the middle impression (MIa). Tears of 19 cases were located at the posterior part of the middle impression (MIp). We measured shoulder abduction strength at 40 and 90 degrees' scaption between IR and ER position. The device of measurement used was MicroFET. We compared the rate of affected / unaffected side in abduction strength at IR with ER. In HIa, 40 degrees test was IR: 81.3%, ER: 70.8% (NS), 90 degrees test was IR: 76.5%, ER: 65.5% (p<0.05). In HIp, 40 degrees test was IR: 71.6%, ER: 70.1% (NS), 90 degrees test was IR: 66.7%, ER: 64.1% (NS). In MIa, 40 degrees test was IR: 73.5%, ER: 72.0% (NS), 90 degrees test was IR: 68.3%, ER: 66.3% (NS). In MIp, 40 degrees test was IR: 55.7%, ER: 56.9% (NS), 90 degrees test was IR: 62.7%, ER: 67.4% (NS). When rotator cuff tear was located at HI-a, the abduction strength at ER was statistically less than at IR. We should think that the supraspinatus works as abductor at ER position and the infraspinatus works as abductor at IR position.
  • 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
    2009 年 33 巻 3 号 p. 705-708
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to compare the outcome of patients who underwent rotator cuff repair using all arthroscopic or mini-open repair techniques. The type of this study is a retrospective comparative study. We retrospectively reviewed 30 patients who underwent either arthroscopic or mini-open rotator cuff repair. 15 patients underwent mini-open repair and 15 patients had arthroscopic repair. All patients had medium size tears. The outcome of 2 groups was evaluated using range of motion (elevation, abduction, external rotation), Japanese Orthopaedic Association (JOA) score, abduction power and Visual Analogue Scale (VAS) with time (preoperative, 3 months, 6 months and 12 months after the operation). No significant difference between the 2 groups were found for any variable preoperatively. JOA score had improved in both groups postoperatively. Abduction power had improved in arthroscopic group. Arthroscopic group showed a significant improvement in abduction power at 3 and 6 months after the operation. Arthroscopic group showed a significant improvement in elevation and JOA score at 6 and 12 months after the operation. In both groups, the clinical outcome had improved postoperatively. In this short-term outcome, the elevation and JOA score of arthroscopic group were improved earlier than those of mini-open group.
  • 畑 幸彦, 石垣 範雄, 中村 恒一, 村上 成道, 小林 博一, 伊坪 敏郎, 内山 茂晴, 加藤 博之
    2009 年 33 巻 3 号 p. 709-712
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We conducted clinical evaluation and image assessment of the LHB patching procedure for examination of its clinical performance in rotator cuff tear cases including the subscapular tendon tear. Rotator cuff tear cases with more than a large tear and which were followed-up for more than 2 years after operation were divided into 2 groups: 75 cases in which LHB patching procedure was combined with the McLaughlin's procedure (LHB Group) and 82 cases in which only McLaughlin's procedure was used (Control Group). We compared the 2 groups in terms of joint range of motion (ROM), muscle strength, UCLA score, and image assessments of tendon attachment using MRI and US before operation and at 6 months, 1 year, and 2 years after. ROM and image assessments showed no significant difference. In terms of muscle strength, abduction 6 months after the operation and flection and abduction 1 year after the operation in the LHB Group were significantly smaller than those in the Control Group (p<0.05). In terms of the UCLA score, the total score 2 years after the operation did not show statistically significant between the LHB Group (32.6±2.6) and Control Group (33.1±2.2). However, satisfaction of the patient at 6 months, 1 year, and 2 years after the operation in the LHB Group was significantly lower than those in the Control Group (p<0.05). The LHB patch method demonstrated good clinical results and good recovery of the tendon attachment 2 years after the operation. However, the patient's satisfaction was significantly lower at all times after the operation, because of delayed improvement of muscle strength.
  • 坂口 公一, 伊藤 陽一, 中尾 佳裕, 間中 智哉, 仲 哲史, 月山 国明, 松本 一伸, 中村 信之, 鞆 浩康, 高岡 邦夫
    2009 年 33 巻 3 号 p. 713-716
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Many authors reported post operative good results of arthroscopic rotator cuff repair (ARCR) for small or medium size tears. However, high re-tear rate and poor functional outcomes of ARCR for massive tears were reported and those indications were obscure. The aim of this study was to determine the accurate operative indications of ARCR for massive tears according to the correlation between the preoperatively remained shoulder function and the postoperative outcome. We retrospectively evaluated 26 patients (18 males and 8 females), who had undergone ARCR for massive tears with a minimum 6 months follow-up. The average age at the surgery was 67.7 years old. Preoperative patients' factors: age, sex, longitudinal tear size, transverse tear size, involved torn tendon, ROM of active flexion, ROM of active abduction and evaluation by the Japanese Orthopaedic Association (JOA) shoulder scoring system were statistically analyzed about correlation with the postoperative evaluation by JOA scoring system at 6 months follow-up. Preoperative factors such as age, sex, longitudinal tear size, ROM of active abduction and preoperative evaluation by JOA scoring system did not significantly affect the postoperative evaluation by JOA scoring system. However, preoperative factors such as transverse tear size (over 40mm), involved torn tendon (torn subscapularis tendon), ROM of active flexion (below 90 degrees) did significantly affect the postoperative evaluation by JOA scoring system. Relative good surgical indications of ARCR for massive tears were as follows: below 40mm in transverse tear size, subscapularis tendon was not torn and a possible over 90 degrees of active flexion.
  • 安里 英樹, 照屋 均, 堀切 健士, 金谷 文則
    2009 年 33 巻 3 号 p. 717-721
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We had satisfactory results with infrasupinatus muscle transfer for massive rotator cuff tears with suprasupinatus muscle atrophy reported by Patte.
    12 patients received infrasupinatus muscle transfer. There were 8 males and 4 females with an average age of 70 years old (55 to 81 years old). The patients were affected on the right side (the dominant side) except 1 case. The etiology of rotator cuff tear was fell down in 6 and unknown in 6. All patients had rest and motion pain, contracture of shoulder was not observed and active-ROM (a-ROM) was under 90 degrees in 7 cases. The follow-up period averaged 15 months (range, 6 to 26 months). A brace with a 30-degree-abduction brace was applied in all patients after surgery, then they started passive ROM exercises from the day after surgery. Active ROM exercises without a brace was started from six to 8 weeks after surgery. All patients were evaluated with electromyograph ( EMG ) after surgery. Shoulder pain disappeared in 6 patients, and improved in 6 patients. The average active ROM improved from flexion 88°/ abduction 93° to 155°/161°, the suprasupinatus test became negative after surgery. The average JOA score improved from 52.3 preoperatively to 91.0 postoperatively. The amplitude and interference pattern in EMG still decreased in 10 patients slightly and were normal in 2 patients 24 four months after surgery. Infrasupinatus muscle transfer is an effective method for massive irreparable rotator cuff tears with suprasupinatus muscle atrophy and did not produce to suprascapular nerve palsy.
  • 立入 久和, 森原 徹, 岩田 圭生, 木田 圭重, 久保 俊一, 黒川 正夫
    2009 年 33 巻 3 号 p. 723-727
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to examine the characteristics of donor and host cells immunohistochemically in early remodeling process after transplantation of Achilles tendon with and without live cells for a rotator cuff defect. Sprague Dawley (SD) rats and Green fluorescent protein transgenic rats (GFP rats) were used in this study. Tendinous defects were made close to the supraspinatus tendon insertion. 3 models were made. Group A-1: Achilles tendons of GFP rats were transplanted into the defects of SD rats. Group A-2: SD rats Achilles were transplanted into GFP rats. Group B: SD rats frozen Achilles were transplanted into GFP rats. At 3 and 7 days after surgery, sections stained with antimacrophage antibody and antiHSP47 antibody (collagen production cell specific antibody) were assessed immunohistochemically, and localization of positive cells was also evaluated. The graft was surrounded by signal positive cells of macrophage at each day. There were no macrophage positive cells derived from the donor. Signal positive cells of HSP47 was infiltrated into the graft gradually. There were some co-expressions between HSP47 positive cells and donor cells. It was possible easily to distinguish a host or donor cell by using GFP rats. Both macrophage and HSP47 positive cells were important to play their parts of remodeling. This is the possibility for the live HSP47 positive donor cells to participate indirectly in the tendon remodeling.
  • 乾 淳幸, 国分 毅, 藤岡 宏幸, 名倉 一成, 豊川 成和
    2009 年 33 巻 3 号 p. 729-732
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We hypothesized that a scaffold which is absorbable after the regeneration of damaged tissues and induce stem cells from surrounding tissues can repair massive rotor cuff tear without transplantation of stem cells. We prepared a bioabsorbable scaffold from synthetic poly(l-lactic acid) (PLLA) fibers and evaluated its use in the regeneration of rotator cuff tear in a rabbit model. The surface of the PLLA scaffold was kept smooth to prevent adhesion, and its inside was maintained rough to allow the surrounding cells to migrate and remain in the scaffold. It was transplanted under the back skin muscle of a rabbit, then histological examination was performed at 3weeks postoperatively. Scaffold was superimposed in double layers by keeping the smooth surface outside and the rough surface inside, and both edges of the double layered scaffolds were bonded by thermocompression. Double layered scaffolds were transplanted into infraspinatus defect models of rabbits. The implanted PLLA scaffolds were then evaluated mechanically and histologically at 2, 4, and 8 weeks postoperatively. In the back skin scaffold, fibrous tissue mainly existed in rough surface. In the shoulder scaffold, the PLLA scaffold persisted in the regenerated tissue, and the fibroblasts and macrophages were observed around the PLLA fibers. The scaffold did not absorb by 8weeks after the operation, and the enthesis of tendon was not regenerated by fibrocartilage, but fibrous tissue. The ultimate failure load of the PLLA scaffold was significantly increased and recovered to that of the normal tendon at 8 weeks. The stiffness was also increased, however there was no significant difference. The novel scaffold which has a smooth surface and rough inside can induce surrounding cells in its inside, and might regenerate the tendon tissue. Further study is required to improve the regeneration of the tendon tissue.
  • 松浦 恒明, 大江 健次郎
    2009 年 33 巻 3 号 p. 733-738
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We evaluated the natural history of partial rotator cuff tear using MRI. We examined 45 cases with partial rotator cuff tear (average age 71.0 years old) from May 2003 to October 2008 and who were performed on MRI and who underwent conservative treatment and were performed on MRI regularly. We classified the shapes of tears end into 4 groups(abnormal signal type, abnormal signal and swelling type, cut off end type, tapered end type) and evaluated atrophy and fat degeneration of rotator cuff muscle belly, using MRI, age, cause of pain, and the symptom change. The number of each type was abnormal signal type; 25 cases, abnormal signal and swelling type; 7 cases, cut off end type; 10 cases, tapered end type; 5 cases. The abnormal signal type almost showed a little change of the shape, and long term symptom. The 1/2 of the cut off end type changed into tapered end type. The tapered end type showed no change of the shape, and led to a little symptom. Regarding the shape of the torn end, 35 cases out of 47 cases(74.4%) showed no change, 12 cases(25.6%) got worse, 0 cases(0%) improved. Regarding to the shape and signal of the torn end, 25 cases out of 47 cases(53.2%) showed no change, 19 cases(40.4%) got worse, 3 cases(6.3%) improved. Atrophy of the muscle belly and fatty degeneration showed no significantly time-dependent change among the 4 types. We concluded that the tapered end type showed no change and the symptom was almost disappeared.
  • 菊川 和彦, 奥平 信義
    2009 年 33 巻 3 号 p. 739-742
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We have performed open rotator cuff repair (O method), arthroscopic repair with making complete tear (AC method) and arthroscopic repair with incomplete tear (AP method) for partial thickness rotator cuff tear. The purpose of this study was to evaluate the clinical results of 3 different operative methods. We treated 54 partial thickness rotator cuff tear. AP method group was 20 cases (males 12, females 8; mean age 46.4years old; 9 bursal side, 11 joint side tears).AC method group was 8 cases (males 5, females 3; mean age 49.2years old; 3 bursal side, 5 joint side tears). O method group was 26 cases (males 18, females 8; mean age 49.2years old; 9 bursal sides, 17 joint side tears). Clinical results were evaluated according to the Japanese Orthopaedic Association score (JOA score). The average postoperative JOA score was 92.3 points in AP method group, 94.3 points in AC method group and 91.3 points in O method group. In bursal side tear, the average postoperative JOA score was 94.2 points in AP method group, 93.3 points in AC method group and 92.1 points in O method group. In joint side tear, the average postoperative JOA score was 90.8 points in AP method group, 94.9 points in AC method group and 90.9 points in O method group. There was no significant correlation between postoperative JOA and 3 different operative methods tear side. The clinical results of arthroscopic and open rotator cuff repair for partial thickness rotator cuff tear are satisfactory.
  • 三好 直樹, 松野 丈夫, 末永 直樹, 大泉 尚美, 山口 浩
    2009 年 33 巻 3 号 p. 743-745
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Cryotherapy is performed in various situations, such as post operation, rehabilitation, and sports fields. Several studies about Cryotherapy after knee surgeries have been reported, but few reports have evaluated those after shoulder surgeries. The purpose of this study was to evaluate the effects of cryotherapy on hemorrhage and inflammation after Open Rotator Cuff Repair(ORCR). ORCRs were performed on 19 cases (average age 61.4 years old) from December 2007 to June 2008. Cryotherapy group: 9 cases(7 males/ 2 females) underwent cryotherapy with Icing System CF-3000(5 degrees, 48 hours). The average age was 58.7 years old (range 41 to 71 years old). Control group: 10 cases (8 males/ 2 females) were applied simple dressing to the wound. The average age was 63.8 years old (range 54 to 74 years old). In each group, we took blood samples on the operation day, the next day, and 1, 2, 3 weeks postoperatively, and evaluated hemoglobin(Hb), c-reactive protein(CRP), creatine phosphokinase(CK), and lactate dehydrogenase(LDH) levels. There were no significant differences between each group about Hb, CRP, LDH, CK levels. There was no complication, such as frostbite, nerve injury and infection by cryotherapy. There are several reports that cryothrapy has the effect to decrease hemorrhages after knee surgeries. Singh et al.6) reported the effect of cryotherapy after shoulder surgery, decreased the severity of pain and allowed return to normal sleep pattern. There were no differences between Cryotherapy group and Control group, but there was a tendency to decrease CK and CRP levels in the early phase of post operation. We suppose that it suggests the effect of cryotherapy on inflammation. We will investigate adequate measures, such as time and temperature of cryotherapy further.
  • 原田 幹生, 後藤 康夫, 村 成幸, 荻野 利彦
    2009 年 33 巻 3 号 p. 747-749
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to observe postoperative changes of MRI findings on a fascia lata patch graft for rotator cuff tear. Fascia lata patch graft for rotator cuff tear was performed on 16 patients. Their average age was 64 years old. Postoperative oblique coronal T2 weighted MRI findings on the graft was observed at 6 months and 1 year after the operation. We divided the graft into 3 sections: lateral part of the humeral head, top of the humeral head, and medial part of the humeral head, and investigated the intensity of the graft in each section. Intensity of the graft in each section at 6 months after the operation was the following: lateral part (low; 4, iso; 12, high; 0), top of the humeral head (low; 12, iso; 3, high; 1), medial part (low; 3, iso; 12, high; 1). The intensity at 1 year was the following: lateral part (low; 3, iso; 12, high; 1), top of the humeral head (low; 10, iso; 5, high; 1), medial part (low; 6, iso; 9, high; 1). In our study, at 6 months, patients with iso intensity of the graft in medial and lateral parts of the humeral head tended to be larger, and that those with low intensity of the graft in the top of the humeral head tended to be larger. These suggested that iso intensity of the graft may be the junction of the graft with greater tubercle and proximal end of rotator cuff tear. In our study, most patients with iso intensity of the junction at 6 months had the same intensity at 1 year.
  • 野中 伸介, 米田 稔, 山田 真一, 水野 直子, 井澤 一隆
    2009 年 33 巻 3 号 p. 751-755
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Although the conventional double row technique (DR) was a popular surgical technique for rotator cuff tears (RCTs), re-tear rate after an arthroscopic repair with medium to large tears have reported about 20% on MRI study. In 2005 we developed a new technique of arthroscopic rotator cuff repair: the double anchor footprint fixation (DAFF) technique, and then completed the current DAFF technique in 2006. It was characterized by briding-suture technique and no medial row knot, similar to transosseous fixation technique. The purpose of this study was to assess and compare the structural outcome of the DAFF with the DR for medium to large RCTs by MR imaging. We investigated 41 shoulders performed ARCR by two techniques, 18 by the DR and 23 by the DAFF. The average age at the operation was 63 years. In the DR, there were large RCTs in 4 shoulders and medium in 14.In the DAFF, large in 8 and medium in 15. The MRI assessment at 6 months postoperatively was performed on repair integrity using Sugaya's classifications. In the DR group, type I was detected in 2 shoulders, type II in 7, type III in 5, and type IV in 4. On the other hand, in the DAFF group, type I was in 6, type II in 14, type III in 2, type IV in 1 respectively. Type V was none in both. The rate of re-tear was 22% in the DR, 4% in the DAFF. Failure cases consisted of 2 medium-size RCTs treated by the DR, 2 large-size by the DR, and one large-size by the DAFF. Re-tear rate of the DAFF for medium to large RCTs is lower than that of the DR. In conclusion, the structural outcome of the DAFF technique that never needed medial-row knots was successful.
  • 南村 武彦, 森原 徹, 田久保 興徳, 平田 正純, 岩田 圭生, 小椋 明子, 木田 圭重, 堀井 基行, 久保 俊一, 黒川 正夫
    2009 年 33 巻 3 号 p. 757-760
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The superior migration of the humeral head is often recognized on plain X-rays on rotator cuff tear. We evaluated the superior migration of the humeral head on X-rays in the supine position on massive rotator cuff tear. The aim of this study was to evaluate the relationship between superior migration of the humeral head on X-rays in the supine or standing position and the size of torn tendons on various rotator cuff tear. We studied 32 shoulders in 32 patients who underwent rotator cuff repair from January to December 2007 retrospectively. There were 23 men and 9 women, their mean age was 63.4 years old (range, 52-75 years old). We evaluated grading of superior migration of the humeral head by anteroposterior radiograph in external rotation in the supine and standing position reported by Oizumi. We measured torn tendon size on MRI and identified torn tendons on arthroscopy. Almost all cases on each torn size migrated superiorly by grade I in the standing position. The larger the size of torn tendons were, the more progressive grade of superior migration were in the supine position. Almost all cases in the small and medium tear were migrated by grade I. In large and massive tear, almost all cases were grade II or III. We cannot predict torn size by routine radiograph in the standing position, but can predict it in the supine position as an additional check. Examination of plain X-rays in the supine position may be useful to predict torn size of rotator cuff.
  • 上石 貴之, 高橋 晃, 松本 里沙, 江口 英人, 齋藤 知行
    2009 年 33 巻 3 号 p. 761-764
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    This study was designed to determine the correlation of a subacromial spur formation with instability of the shoulder to the frequency of impingement syndrome including degenerative rotator cuff tears. Fifty five shoulders with subacromial impingement syndrome including degenerative rotator cuff tears treated from 2006 to 2008 were evaluated. The patients' mean age was 65 years old (range, 40 to 80). The sizes of subacromial spur were measured using X-rays of 30 degrees caudal tilt view and classified into 3 groups: non-spur size (0 to 5mm), medium spur (5 to 10), large spur (over 10). The head of the humerus descending ratio was measured in X-rays of 5kg downward stressed view and classified into 3 groups: non-instability (0 to 10%), moderate instability (10 to 30), high instability (over 30). The results showed that 27% (8 shoulders) in non-spur group had instability, 80% (20 shoulders) in spur group had instability. In spur group, 7 shoulders (100%) of patients under 60 years old had instability, 9 shoulders (75%) of patients between 60 and 70years old had instability, and 4 shoulders (57%) of patients over 70 years old had instability. In shoulder impingement syndrome including degenerative rotator cuff tears, most patients in the medium and large spur group had shoulder instability. Patients under 60 years old with shoulder instability, tended to have a large subacromial spur. A large spur may cause rotator cuff tear at an early age.
  • 永澤 雷太, 西本 竜史
    2009 年 33 巻 3 号 p. 765-768
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to evaluate subscapularis tendon tears and to investigate the prevalence and treatment options according to our new classification. We classified the type and size of tendon tears using arthroscopy. From July, 2002 to October, 2008, we operated on 454 shoulders with rotator cuff tears. We classified subscapularis tendon tears into 4 types. Type 1: partial and longitudinal tear of articular side, pulley is intact, LHB is stable. Type 2: partial tear of superior tendon from lesser tuberosity, LHB is stable or unstable due to dysfunction of pulley. Type 3, 4: complete tear from lesser tuberosity, classified according to the location of “comma sign”, LHB is unstable and a state of partial or complete tear. We could investigate 274 shoulders (males 165, females 109, 155 right shoulders, 119 left shoulders) passed for 1 year at least after operation. Their mean age was 64 years old (33-87). More than 40% of rotator cuff tear patients had complications about subscapularis tendon (Type 1; 10.4%, Type 2; 14.7%, Type 3; 9.6%, Type 4; 9.6%). In Type 4 patients, they got better results than the other types. Subscapularis plays an important role in shoulder functions especially glenohumaral joint stability. We might overlook subscapularis tendon tears when we operate rotator cuff tears. Recently the number of arthrosopic rotator cuff repair is increasing. We can evaluate more in detail of the state of shoulder. Our classification is useful for treatment of subscapularis tendon tears because there is a direct relationship between the types and strategies of treatment. We had every confidence that to evaluate and treat subscapularis tendon tears brings good results after operation.
  • 江口 英人, 高橋 晃, 上石 貴之, 松本 里沙, 齋藤 知行
    2009 年 33 巻 3 号 p. 769-772
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Pathogenesis of deltoid muscle ruptures associated with rotator cuff tears in elderly patients is not clearly elucidated. The purpose of this study was to clarify the clinical features and image findings. 5 shoulders with deltoid muscle ruptures were included in this study. The patient's mean age at the onset was 80 years old and the mean period from onset to the 1st visits was 14 days. Mechanism of disease, history of steroid injections, clinical courses were assessed. The location and type of deltoid muscle ruptures were evaluated using MRIs. Superior migration of the humeral head and spur formations were assessed in X-rays. As causative factors, a fall, heavy labor, and shoulder elevation exercises was found in 1 shoulder. The other 2 had unknown mechanisms. 2 patients underwent injections of steroids. Motion pains, limitation of shoulder elevation, and subcutaneous hematoma at the lateral side of the upper arm were observed in all. All cases showed disability of elevation just after the onset, which had recovered to 40 degrees at the 1st visits. X-ray findings demonstrated superior migration of the humeral head in all, and spur formations at the subacromion in 4 and the greater tuberosity of the humerus in all. MRIs demonstrated detachment of the deltoid muscle origin in 2, and partial rupture of the deltoid muscle belly with nodal high intensity in T2 weighted MRI images in 3. Deltoid muscle ruptures associated with rotator cuff tears were classified into 2 types: detachment of the origin and partial rupture of the muscle belly. Detachment of the muscle origin showed no improvement with conservative therapies. However, the degree of elevation in cases with partial rupture of the muscle belly had returned to the original level in 1 month with conservative therapies. The clinical course and choice of treatment may be different between them.
  • 内山 善康, 繁田 明義, 新福 栄治, 大見 博子, 持田 讓治, 宮崎 誠司
    2009 年 33 巻 3 号 p. 773-776
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Rupture of the pectoralis major muscle (PMM) is a rare but incapacitating sports injury. This report introduced a novel technique for the repair of this injury using the Endobutton. 5 male patients (3 judo players, 1 martial arts player and 1 body-builder) underwent the primary repair of complete rupture of PMM at its humeral insertion within 2 weeks after injury. The average age at surgery was 28.4 years old (range 23-33), and the average follow-up was 26.8 months (range 18-36). A rectangular bone trough (4 x 1cm) was made at the PMM insertion and the tendon stump was introduced into this trough to be transfixed over the other side of the cortex using Endobuttons (Smith & Nephew Inc.) and fiber wires (Arthlex Inc.). The clinical assessment included rate of rerupture by MRI, range of motion (ROM) of the shoulder, JSS sports score and isometric power at final follow-up. No rerupture was detected clinically, and MRI findings also showed continuity of the PMM tendon in all cases at the final follow-up. Significant differences were present between average pre- (9.4, range 5-13) and postoperative (82.6, range 73-95) JSS sports scores (p<0.01) but not in ROM between affected and unaffected shoulders. Postoperative isometric power in horizontal flexion and extension of affected shoulders was as equal as that of unaffected shoulders. Satisfactory outcomes were obtained by early repair of complete rupture of the PMM within 2 weeks after injury using the Endobutton technique.
  • 今井 恒志郎
    2009 年 33 巻 3 号 p. 777-780
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Rotator cuffs possess 2 functions. They function as action-making muscles and also provide stabilization. At present, most diagnostic tests for rotator cuffs are designed to assess individual muscles as action- making muscles, and there are hardly any tests to evaluate stabilization. This time, we performed diagnostic tests focused on the stabilization function that maintains centripetal positions, and investigated sensitivity and specificity by comparing them with MRI-based diagnoses. Of the patients who visited our hospital complaining of shoulder pain, 177 shoulders for which cervical vertebralcauses had been clearly negated using MRI imagings were subjected to abduction tests of shoulder joints on the scapular axis (1st procedure), and flexion tests with horizontal flexion at 120 degrees: diagnostic tests performed at our hospital (2nd procedure). Comparisons were made between these tests for detection rates of rotator cuff tears (positive when MMT was 3 or less) and for muscular strength at positions for each test using power track II. Positive and negative results obtained in the second procedure were compared with MRI-based diagnosis, and the sensitivity and specificity of the 2nd procedure were studied. The positive rate for rotator cuff tears was higher in the 2nd procedure and muscular strength had also decreased in the position in the 2nd procedure according to the test using power track II in patients with rotator cuff tears. These sensitivity and specificity of the 2nd procedure were 71.4% and 90.8% respectively. Anterior parts of subscapularis muscle tendons seemed to be relaxed in the MRI images in the 2nd procedure, and scapular axes and rotation axes of humeri did not agree with images obtained in the 1st procedure either. It is thought that the 2nd procedure is an effective test method for diagnosing rotator cuff tears considering sensitivity and specificity as well as the concept force couple, suggesting that it is difficult to take the centripetal position in the 2nd procedure.
  • 福田 昇司, 西山 武, 大森 貴夫
    2009 年 33 巻 3 号 p. 781-784
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    We prospectively analyzed the time course changes in the signal intensity of repaired rotator cuff with serial MRI to investigate the healing process and retear rate after arthroscopic rotator cuff repair. 48 patients with full-thickness rotator cuff tear underwent arthroscopic rotator cuff repair. There were 7 small, 30 medium, and 11 large tears. MRI was performed at 6 and 12 months postoperatively for all the patients. Cuff integrity on MRI was classified into 5 categories according to Sugaya's classification. Type IV and type V were considered as postoperative retear.
    Postoperative MRIs showed 9 type I, 24 type II, 3 type III, 8 type IV, 4 type V at 6 months, and 13 type I, 22 type II, 3 type III,4 type IV, and 6 type V at 12 months. From 6 months to 12 months, 4 type II changed to type 1, 2 type VI changed to type II, and other 2 type IV changed to type V. All type V at 6 months did not change at 12 months. Postoperative retear rate at 12 months was 20.8 %. Although type IV at 6 month does not always mean postoperative retear, most of the type V is already found at 6 months postoperatively. Type V retear might have occurred by 6 months, so that we have to modify the postoperative protocol for the patients with a high risk.
変性疾患
  • 山口 浩, 金谷 文則, 末永 直樹, 大泉 尚美, 久田 幸由, 松橋 智弥, 三好 直樹, 細川 吉博
    2009 年 33 巻 3 号 p. 785-788
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Though it has been reported that the humeral head migrates antero-superiorly when massive rotator cuff tear occurs, we sometimes find CTA cases which show postero-superior migration of the humeral head. CT osteoabsorptiometry (CTOAM) has been used to study the stress distribution changes of glenoid and coracoacromial arch in cuff tear shoulders. However, there is no study about the relationship between stress distribution and number or location of torn tendons and about CTA. The purpose of this study was to evaluate the stress distribution of the glenoid and undersurface of the acromion in shoulders with various degree of cuff tear including CTA using CTOAM. 100 shoulders of 91 patients, which underwent 3D-CT, were analyzed for this study. We divided the 100 shoulders into 4 groups as follows: 1) supraspinatus tear (SSP group); 41 shoulders, 2) massive tear without subscapularis tendon involvement (M-SSC(-) group); 14 shoulders, 3) massive tear with subscapularis tendon involvement (M-SSC(+) group); 11 shoulders, 4) CTA group; 34 shoulders. As results, 3 patterns of stress distribution (antero-superior, anterior-posterior, postero-superior) were observed for the glenoid and 2 patterns (anterior, central) for the acromion. In the SSP group, 100% of glenoid and 75% of acromion showed high stress in the anterior area. In the M-SSC(-) group, high stress of glenoid was located in the anterior area in 50% and posterior in 50%, while 100% of acromion showed high stress in the central area. In the M-SSC(+) group, 100% of both glenoid and acromion showed high stress in the anterior area. In the CTA group, however, all patterns were mixed. Our results suggested that cuff tear shoulders without arthropathy showed certain patterns of stress distribution according to the torn tendons; whereas various patterns were observed once they progress to CTA probably because of the gross instability. We believe the results of this study will provide useful information to understand the pathogenesis of CTA.
  • 白地 功, 光井 康博, 永田 見生, 後藤 昌史, 樋口 富士男
    2009 年 33 巻 3 号 p. 789-792
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    There is a growing body of evidence supporting the use of hyaluronan (HA) in patients with adehesive capsulitis of the shoulder, although the mechanisms of the effect have not been clarified as yet. This in vitro study examined the effects of HA in glenohumeral synovial/capsular fibroblast (GSCF) from patients with adhesive capsulitis of the shoulder. The study subjects were 7 patients with primary or secondary adhesive capusulitis of the shoulder, with an average age of 55 years old. Synovial/capsular specimens were obtained from the rotator interval in each patient during arthroscopy. The tissue was prepared for cell culture. Various concentrations of HA (1.0 ∼ 4.0 mg/ml) were added to the monolayer-cultured GSCF from these patients. CD44 expression on the GSCF was evaluated by confocal microscopy using fluorescein-conjugated anti-human CD44 antibody. Cell proliferation was evaluated by recording changes in the cell number. The mRNA expression level of adhesion-related collagen (procollagen α 1 (III)) and cytokines (TGF-β, PDGF A & B) were measured by real-time reverse transcriptase polymerase chain reaction. Immunoflurescence cytochemistry detected constitutive binding of CD44 expression on the GSCF. Treatment with various concentrations of HA significantly and dose-dependently inhibited cell proliferation and decreased the mRNA expression level of the adhesion-related procollagen and cytokines. These results suggest that exogenous HA may prevent the progression of the adhesion formation in patients with adhesive capusulitis of the shoulder.
  • 深谷 泰士
    2009 年 33 巻 3 号 p. 793-796
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    The purpose of this study was to evaluate shoulder magnetic resonance (MR) imaging in patients who have hemodialysis (HD)-related shoulder pain. Eight patients (5 men and 3 women, who suffered from HD-related shoulder pain underwent 1.5-T MR imaging to confirm their shoulder structure with conventional (T1WI, T2WI) and fat suppression techniques. The mean duration of HD was 23.1 years (range, 5-29 years). The measurements of thickness of rotator cuff were obtained 1 cm away from the site of insertion at humeral head, and vertically in the course of the tendons. If the measurement was greater than 6 mm of thickness, it was considered to be abnormal in accordance with previous reports. The group of patients who suffered from periarthritis of the shoulder was used as the control group. Not only subscapularis (n=5) and supraspinatus tendon (n=6), but also infraspinatus (n=5) tendon was considered to obtain thickness. The average thickness of each rotator cuff were as below; Subscapularis tendon was 7.87 mm (SD 1.84 mm), supraspinatus tendon was 8.08 mm (SD 2.58 mm), infraspinatus tendon was 7.19 mm (SD 1.46 mm), and teres minor tendon was 4.73 mm (SD 1.85 mm). Compared to the control group, the thickness was significantly increased in subscapularis tendon, supraspinatus tendon and infraspinatus tendon. Diameter of long head of biceps tendon was also greater in HD group than the control with significant difference (p=0.004). All cases of 8 subjects had a total of 18 intraosseous lesions at MR imaging. Effusion in subacromial space was observed in 7 (87.5%) of 8. Infraspinatus and teres minor tendon as well as subscapularis and supraspinatus tendon would become thickened in patients with HD-related shoulder pain. Bone cyst in humeral head was observed in all our cases. Assessment of MR imaging for this disease would be useful for further treatment.
  • 橋本 俊彦, 丸山 晴久, 伊藤 博元, 井上 和彦
    2009 年 33 巻 3 号 p. 797-799
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Patients with dialysis-related amyloid shoulder arthropathy (DASA) have hyperplasia of the feathery synovial membrane in the subacrominal bursa and glenohumeral joint. The progression of hyperplasia causes marked hydrarthrosis, resulting in rotator cuff tear. To explore treatment for it, we histopathologically compared the synovial membranes between long-term dialysis patients with DASA and those with rotator cuff tear. We studied 6 long-term dialysis patients who had undergone rotator cuff repair with synovectomy for shoulder hydrarthrosis that had not improved despite conservative treatment. We conducted HE staining, S-100 staining, α-SMA staining, and Congo-red staining of the synovial membranes collected during the surgery. In the control group consisting of 6 patients with rotator cuff tear who had undergone arthroscopic rotator cuff repair, staining of the synovial membranes was similarly conducted for comparison. Nerve staining with S-100 protein revealed less proliferation of nerve cells in the synovial membranes in patients with DASA, as compared to those with rotator cuff tear. Smooth muscle staining with α-SMA revealed less obvious neovascularization in patients with DASA, as compared to those with rotator cuff tear. The major histological finding of rotator cuff tear was inflammatory changes with marked vascular proliferation, fatty infiltration, and proliferation of nerve cells. On the other hand, the major finding of DASA was synovial hyperplasia that was caused by deposition of β2-microglobulin derived amyloid in the rotator cuff and synovial membrane. Dialysis therapy is used to prolong survival, and prophylaxis against lesions of dialysis-related amyloid deposition remains to be addressed to improve the quality of life. In treating patients with DASA, aggressive control of synovitis was effective. Given that β2-microglobulin takes a relatively long time to be deposited in the synovial bursa and glenohumeral joint, early synovectomy may be beneficial for DASA.
炎症疾患
  • 井澤 一隆
    2009 年 33 巻 3 号 p. 801-804
    発行日: 2009年
    公開日: 2010/01/29
    ジャーナル 認証あり
    Due to a drastic decrease of tuberculous disease, tuberculosis of the shoulder is rare in Japan recently. We retrospectively analyzed 12 patients with tuberculosis of the shoulder to assess its clinical problems. Before the patients were referred to our institution, 7 patients were misdiagnosed and treated. It took 18 months on average to make the final diagnosis. The delay of the diagnosis was often caused by a lack of severe symptom of the disease in its early stage. Consequently, prolonged duration of the disease caused an expansion of lesion, severe bony destruction and rotator cuff tear. We performed operations on 9 patients including curettage, curettage with bone grafting and resection arthroplasty. Wide curettage comprising of anterior and posterior approaches was often required for surgery, but complete curettage was sometimes difficult due to the location of lesion, such as the deep medial scapular region. Post-operative complications occurred in 2 cases including a death due to worsening of preexisting heart failure. Tuberculous lesions were successfully treated except for the deceased case. The mean forward elevation improved from 57.0 degrees at the 1st examination to 76.6 degrees at the latest follow-up. Patients with rotator cuff tear or severe bony destruction showed less favorable clinical results. Diagnosis and treatment of tuberculosis of the shoulder is still challenging for modern orthopaedic surgeons.
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