整形外科と災害外科
Online ISSN : 1349-4333
Print ISSN : 0037-1033
ISSN-L : 0037-1033
35 巻, 1 号
選択された号の論文の83件中1~50を表示しています
  • 諫山 智洋, 鈴木 勝己, 永田 善之, 坂井 一夫
    1986 年 35 巻 1 号 p. 1-4
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Ossifying fibroma is one of a group of fibro-osseous lesions which are rarely seen in the long bones.
    The patient reported here is a 15-year-old female whose tibia and fibulla is affected.
    Seventy-four cases have been reported from 1966 to 1984 throughout the world (Japan: 25, Other countries: 49).
    We compared these two groups, and found that there were some differences in the age and sex between them.
    This report describes clinical features of ossifying fibroma, and its distinction from fibrous displasia.
  • 有村 一盛, 高良 健, 福山 紘, 松岡 正敏, 栄 輝己
    1986 年 35 巻 1 号 p. 5-8
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    The case of a 54-year-old man with vertebral artery invaded in C4 vertebral body is reported. The patient had cervical spondylotic myelopathy due to C3-4 soft disc herniation. We ruptured it by anterior decompression surgery. Fortunately good relief was obtained without palsy after blood vessel suture and fusion. Retrospectively, we severely thought the necessity of preoperative
  • 菊地 哲次郎, 佐々木 邦雄, 芝 啓一郎, 植田 尊善, 溝口 知行, 前山 叙之, 村尾 哲, 吉村 豊暢, 角田 信昭
    1986 年 35 巻 1 号 p. 9-14
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We have experienced eight cases of multiple noncontiguous cervical spine injuries for six years, from 1979 to 1985.
    They consist of five cases of a combination in upper and lower, a case of combination in middle and lower cervical spine and two cases of multiple noncontiguous disc injuries.
    We had two patients who failed to be diagnosed secondary injuries of cervical spine, therefore we believed that we should take careful check regarding radiological and neurological examinations.
    In the multiple noncontiguous disc injuries, we could not determine the main lesion before the operations.
  • 脱臼骨折・椎体骨折例における
    佐々木 邦雄, 芝 啓一郎, 植田 尊善, 溝口 知行, 前山 叙之, 菊池 哲次郎, 村尾 哲, 吉村 豊暢, 角田 信昭
    1986 年 35 巻 1 号 p. 15-18
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We have treated patients with spinal injuries surgically to obtain neurological recovery, rigid stabilization and to allow for early rehabilitation. 119 patients with fractures or fracture-dislocations of the cervical spine underwent surgical treatment. In fracture-dislocations and flexion-tear drop fractures, we employed a surgical method called one-staged anterior-posterior reduction, decompression and stabilization. In burst fractures, we employed anterior decompression and fusion. 48% of the patients operated on within 48 hours after the injuries gained neurological recovery but only 30% of the patients operated within 2 weeks after the injuries recovered. Among patients treated surgically within 48 hours after the injuries, those suffered from fracture-dislocations showed better neurological recovery than those with fractures.
    Our method of surgical treatment seemed to be benefit for neurologocal recovery and early rehabilitation.
  • 保存症例の追跡調査
    森園 良幸, 川井田 秀文, 前原 尉, 松元 光生, 小櫻 秀一郎, 山内 常人, 川越 勝秀, 酒匂 崇
    1986 年 35 巻 1 号 p. 19-23
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Twenty-seven cases of RA who had had atlantoaxial dislocation were followed up for five years and seven months in average to examine the sequence of the dislocation. The dislocation progressed in five, but none of them developed myelopathy. Superior migration of C2 occurred in eight and spontaneous fusion of Cl-2 in eight. Those of spontaneous fusion were all in stage IV. 1 It is concluded that the X-ray examination should be performed periodically to check the subluxation. And fusion surgery should be given before the dislocation progresses severe.
  • 前川 清継, 森田 直, 水野 秀夫, 甲斐 功一, 岡嶋 啓一郎, 津留 隆行
    1986 年 35 巻 1 号 p. 24-26
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We have operated 72 cases for cervical lesions since 1978. In them we have operated 51 cases with myelopathy. The follow-up results of 51 cases were classified as excellent in 23 cases, good in 16 cases, fair in 5 cases and no change in 7 cases. We have studied about poor (fair and no change).
  • 荒武 郁朗, 富村 吉十郎, 森本 典夫, 森園 良幸, 吉国 長利, 浜畑 和人, 簗瀬 光宏, 森 輝男, 新門 裕三, 酒匂 崇
    1986 年 35 巻 1 号 p. 27-29
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We carried out the postoperative evaluation in 66 cases of cervical Spondylotic myelopathy treated by anterior fusion and examined influencing factors on postoperative recovery of myelopathy. Poor results were found in the older patients more than 60 years of age and those who developed other diseases such as lumbar canal stenosis and OYL postoperatively. The presence of developmental canal stenosis had no effect on their results.
  • 島内 卓, 小山 正信, 黒瀬 真之輔, 中村 博
    1986 年 35 巻 1 号 p. 30-37
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Presentation is made in this report on 22 cases of cervical lesion and concomitant lumbar lesion. All patients required either or both surgery. Thirteen were treated with cervical decompression or fusion alone. Three patients underwent lumbar operation alone. Seven patients underwent both cervical and lumbar operations. Cervical operation often resulted in improvement in lumbar symptoms with resolution of pain and sensory deficts of myelopathic origin. In the patients with coexisting cervical and lumbar lesion, we suggested that cervical operation preceedes lumbar one.
  • 橋本 伸朗, 今井 健, 角南 義文, 喜友名 修, 小西 明
    1986 年 35 巻 1 号 p. 38-41
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    A case of ankylosing hyperostosis of the cervical spine is reported because of the rarity of the condition. A man aged 59 years was first seen on April 15, 1981 with the chief complaint of neck pain. Rentogenograms showed ankylosing hyperostoses of the cervical spine at the level of C-2 to C-7. On January 12, 1985, he complained of hard dysphagia and hoarseness. Rentgenograms showed the development of hyperostosis at the level of C-2 to C-4. The disturbance of passage of contrast medium was also observed at the level of C-3 to C-4 in esophagogram. On January 18, 1985, anterior surgery was porformed in which the central bony mass was removed. The lateral bone mass was left in place so that the stability of cervical spine remained too. This procedure will disturb reossification. Complete relief was obtained immediately after surgery and he has been asymptomatic 9 months postoperatively.
  • 浅川 康司, 舌間 憲士, 権藤 英資, 高嶋 研介, 高岸 直人
    1986 年 35 巻 1 号 p. 42-44
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    A case of acute cervical pain associated with soft tissue calcium deposit anterior to the cervical vertebrae was reported.
    A thirty years old lady complained of acute pain and rigidity of the neck accompanied by pain on swallowing, plane X-ray films of her cervical spine were obtained, and deposit of calcium in the soft tissue anterior to the interspace of the sixth and seventh cervical vertebrae were found. Rest by cervical collar and antiinflammatory drugs were given. Few days after. clinical symptoms disappeared. Two months later, plane X-ray films were obtained aganin and the deposit of calcium in the soft tissue disappeared.
  • 海永 泰男, 河合 伸也, 小田 裕胤, 松岡 彰, 斉鹿 稔, 浜田 純夫
    1986 年 35 巻 1 号 p. 45-49
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    The etiology of ossification of the spinal ligaments remains obsure. We selected the ossification of the supraspinous ligament (OSSL) as a method to clarify the etiology of ossification.
    We perform to calculate the stress on the supraspinous ligament and to discuss causative factors of ossification of the spinal ligaments from the view point of the local mechanical factors.
    OSSL can be divided into three types (type I, type II and type III) according to the shape and the size.
    The subject of our study are 30 cases with type I, 20 cases with type II, 20 cases with type III and 30 normal persons as a contrpl.
    The following results are obtained:
    1) stress on the supraspinous ligament mainly depends on the body weight and the distance from the center of gravity to the center of the intervertebral disc,
    2) in type II and type III of the ossification, the apex of thoracic kyphosis is chiefly seen at the Th7 and Th8, but biggest ossification is almost always found at Th11 and Th12,
    3) in type III, thoracolumbar kyphosis (T10-L2) is increased and lumbar lordosis (L1-L5) is decreased, and
    4) OSSL has more relation to general factors than local factors.
  • 園田 勉, 伊藤 博史, 脇丸 一孝, 前原 尉, 大迫 浩文, 酒匂 崇, 坂上 譲二
    1986 年 35 巻 1 号 p. 50-53
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Spinal epidural abscess is an uncommon disease and difficult in the early diagnosis. Delay of the diagnosis often leads to increase of the morbidity and mortality. In this paper we reported four cases of epidural abscess following epidural or satellite ganglion block. Decompressive laminectomy was carried out in all the cases. Two of them recovered from complete paralysis but the other two failed in the recovery of myelopathy and died from renal and respiratory failures. One of these was subjected to autopsy and the findings were described.
  • 岸川 陽一, 柴田 堅一郎, 大賀 正義, 牛島 正博, 白沢 建蔵, 杉岡 洋一, 泰 立比古, 坪田 順昭, 鴨井 逸馬
    1986 年 35 巻 1 号 p. 54-58
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Ependymoma is a kind of gliomas that is originated from ependymal cells of the cerebellar ventricles and the central canal of the spinal cord.
    It rarely metastatizes to some organs and destructs the vertebral bodies, though most of the Ependymoma are histologically benign.
    We experienced one case of Myxopapillary Ependymoma double-located in Cauda Equina with destruction of Sacrum. We performed wide laminectomy of lumber spine and Sacrum, and removed the tumor. C. U. S. A. (Cavitron Ultrasonic Surgical Aspirator) helped us to remove the tumor macroscopically almost perfectly from inside of the capsule.
  • 脊髄血行障害の見地より
    樋笠 靖, 山岡 賢兒, 松本 周一, 森本 聡
    1986 年 35 巻 1 号 p. 59-61
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    An autopsy was performed in one case of metastatic spinal tumor with complete paralysis. Histopathological findings in the case were examined with a view to confirm the venous circulatoy disturbance in the spinal cord. The findings of the degenerative change to sponge and enlarged vein in the spinal cord showed circulatory disturbance in venous system. In addition to those findings, multicystic softening evidenced that the degenerative change of spinal cord was due to circulatory disturbance in venous system. Another finding of this case, diffuse infiltration of tumor cell was observed in the whole vertebral body (Th. IO-L. 3), so that we can't find normal vein in vertebral body. This finding suggests that the circulatory disturbance in venous system was caused by diffuse block of the flow from internal vertebral venous plexus to external vertebral venous plexus in vertebral body.
  • 黒瀬 眞之輔, 小山 正信, 島内 卓
    1986 年 35 巻 1 号 p. 62-65
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Using the method of turbidometric immunoassay, CSF immunoglobulins (IgG, IgA and IgM) were analyzed in 15 samples from normal control subjects and patients with orthopedic neurological diseases, including cervical myelopaty (25), thoracic myelopathy (4) and lumbar radiculopathy.
    Mean values of IgG and IgG% (IgG/CSF-total protein x 100) in cases with myelographically proven cervical myelopathy and lumbar radiculopathy were significantly larger than those in control group.
    In cervical myelopathy IgG% was significantly elevated with neurological severity, but IgG was not correlated.
    Elevated IgG, IgG%, IgM and IgM% were shown in 3 cases of cervical myelopathy. These findings were similiar to those obtained for demyelinating disease. As the origin of the increase, the influence of local immunoglobulin synthesis was suspected.
    Thus, for the diagnosis of orthopedic neurological disease which shows unknown etiology and severe neurological status, it is suggested that the quantitation of CSF immunoglobulins is useful.
  • 飯島 卓夫, 伊地知 正光, 伊藤 謙三, 片岡 康文, 岡部 聡, 鶴野 寿一
    1986 年 35 巻 1 号 p. 66-69
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Seven patients with spinal canal stenosis who underwent simultaneous operations on the cervical and lumbar parts of the spine are reported. Indication of combined cervical and lumbar decompression, risk of combined operation compared with two stage operation are also discussed.
  • CT像による椎間関節の変化を中心に
    城戸 研二, 河合 伸也, 小田 裕胤, 土井 一輝, 砂金 光蔵
    1986 年 35 巻 1 号 p. 70-73
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    It is considered that the degenerative changes of the facet joints cause the lumbar canal stenosis of degenerative type. CT of the facet joints shows the relation of the degenerative changes of the facet joints to the lumbar canal. Considerable measurements of the facet joints by CT were made on fifteen cases of lumbar canal stenosis (LCS) and forty-five cases of degenerative spondylosis (OA). There were significant differences between LCS and OA in facet angle, sectional area of the dural sac and A-P diameter of the lateral recess. Especially sagittal orientation and tropism of the facet joints were reffered to the LCS. We suggested that the sagittal orientation of the facet joints accelerated the degenerative changes of them.
  • 栄 輝己, 水岡 二郎, 野村 一俊, 田嶋 光
    1986 年 35 巻 1 号 p. 74-77
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Since 1970, in Japan, there have been many reports regarding to the results of conservative and operative treatments of spinal canal stenosis. But there are very few reports describing lateral nerve root entrapment (lateral stenosis) in which nerve root is constricted in the lateral recess.
    From August, 1981 to July, 1985, we experienced 13 cases of lateral nerve root entrapment including 6 males and 7 females. An average age at the time of operation was 58 years old. Neurologic abnormalities were diagnosed by myelography, discography and nerve root block. Method of operation were partial laminectomy for 7 cases, hemilaminectomy for 5 cases. Postoperative results were good.
  • 成尾 政圀, 小柳 英一, 浦門 操
    1986 年 35 巻 1 号 p. 78-86
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Eighty-three cases of lumbar disc herniation in the teenager were clinically investigated, classifying into 8 cases under 15 years of age (A) and 75 cases over 16 years of age (B). Results were as follows:
    1) Induced factors were more commonly encountered in A (50%) than in B (22.6%).
    2) Low back pain as a chief complaint was more commonly found in B (98.7%) thann in A (62.5%). On the other hand, leg pain was more commonly seen in A (100%) than in B (89.3%).
    3) As a whole, physical signs were more prominently encountered in A.
    4) As a matter of course, disc degeneration and disc narrowiing progressed with aging.
    5) Postoperative course was mostly satisfactory and accounted for “excellent” (77.7%), “good” (5.6%), “fair” (11.2%) and “poor” (5.6%). Particularly in A, all cases were excellent.
  • 甲斐 功一, 前川 清継, 森田 直, 水野 秀夫, 岡嶋 啓一郎, 津留 隆行
    1986 年 35 巻 1 号 p. 87-91
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Thirty-one patients with lumbar disc herniatiorn were treated by the Love's method at our hospital from November 1976 to February, 1965. Twenty-six of thirty-one patients were reviewed. We evaluated these cases by the assesment of treatment of low back pain proposed by the Japanease Orthopaedic Association Committee. The mean age of the patients was 30. 5 years and the mean duration of follow-up was 2 years and 6 months.
  • 江川 正, 朝長 圀夫, 近藤 司, 平松 隆, 西村 行政, 神戸 太郎
    1986 年 35 巻 1 号 p. 92-95
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Five hundred fifty-three patients underwent discectomy by Love's procedure between 1969 and 1985. of 553 patients, eight patients had recurrent disc protrusions. The rate of recurrent disc protrusions in our series was 1.4%. In the present series recurrence was found to be more frequent at a previously operated level. The recurrences at a new level occurred in three cases at ten intervertebral discs.
  • 武富 栄二, 森本 典夫, 増田 明敏, 前原 尉, 酒匂 崇
    1986 年 35 巻 1 号 p. 96-98
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We analysed the causes of multiply operated back (MOB) in 26 cases treated with salvage operation in our clinic and evaluated the postoperative results. The initial diagnoses before the first surgery were lumber disc herniation in 17, lumber canal stenosis in 4 and spondylosis and spondylolytic spondylolisthesis in 5. The main caure was incomplete excision of herniated disc and hard disc. Sixty-nine percents of the patients showed good results after the salvage operation in which postero-lateral fusion was combined with in most of them for the stabilization of the lumbar spine.
  • 出口 義宏, 田島 直也, 川野 桂一郎, 川越 正一, 黒木 俊政
    1986 年 35 巻 1 号 p. 99-103
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Ten patients from 11 to 19 years of age having idiopathic Scoliosis underwent electromyography of the paraspinal muscles using surface electrodes. The study was conducted with the patients both standing and hanging. In the standing position most of the patients had electrical silence on both the concave and convex side of the curvature. In the hanging position, 7 patients had asymmetrical activity on EMG and their Cobb angles improved much more than that of the patients who had electrical silence. An asymmetrical activity at thoracic curvature was observed with a preponderance of activity on the convex side. The electromyographic evaluation in hanging position for idiopathic scoliosis was more valuable.
  • 前山 叙之, 佐々木 邦雄, 芝 啓一郎, 植田 尊善, 溝口 知行, 村尾 哲, 菊地 哲次郎, 吉村 豊暢, 角田 信昭
    1986 年 35 巻 1 号 p. 104-107
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    This report describes the treatment of the lumbosacral spondylolisthesis associated with scoliosis. Scoliosis was treated by posterior spinal fusion with Harrington instrumentation, and 27 days later, spondylolisthesis was treated by anterior spinal fusion. Good reduction and fixation was obtained by the treatment.
  • 角田 信昭, 浅川 康司, 権藤 英資, 吉本 隆昌, 金梅 光夫, 足立 裕, 佐々木 邦夫, 芝 啓一郎
    1986 年 35 巻 1 号 p. 108-111
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    To obtain rapid and solid fusion, and to diminish the non-union rate, circumferential motor-segment fusion technique was employed for unstable lumbar disc degeneration.
    This techniques contains; (1) posterior interverbral body fusion after bilateral discectomy, (2) spinous processes fusion with strut bone grafts at the bibilateral and interlaminal space reinforced by wire fixation, and (3) posterolateral fusion. We operated on 19 patients which contained 4 spondylolisthesis, 3 degenerative spondylolisthesis, 3 multiple operated back, and 9 unstable disc lesions. In all of them, Symptoms were greatly diminished in early periods after surgery. There was no pseudarthrosis (no rabid-lucent area and no collapse of grafted bone) at follow-up examinations.
  • 吉村 豊暢, 佐々木 邦雄, 芝 啓一郎, 植田 尊善, 溝口 知行, 前山 叙之, 菊地 哲次郎, 村尾 哲, 角田 信昭
    1986 年 35 巻 1 号 p. 112-118
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We treated surgically two patients with paraparesis after fracture of vertebral body with osteoporosis. We employed postero-lateral decompression (modified Erickson's technique) and Luque instrumentation among vertebral body fracture.
    There were rarely some patients with paralysis because of angular deformity, bony encroachment and instability. It seemed to be important to study the bony damage by computerized tomography. Fractures with posterior cortex of the body seemed to be hazardous to neurological involvement. In operative treatment, instrumentation for osteoporotic vertebra was difficult because of its mechanical weakness. We preferred Luque instrumentation for such cases because of its advantage. Our two cases showed good neurological recovery after operaton.
  • 後藤 健志, 柴田 堅一郎, 大賀 正義, 牛島 正博, 林 和夫, 古賀 雅之, 杉岡 洋一, 奥江 章, 松口 信行
    1986 年 35 巻 1 号 p. 119-122
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    A 57-year-old man who had a bursting fracture of the fourth lumbar vertebra with thyroid metastatic cancer was reported. The patient fell down from 4 meters height in July 1984, and sustained a fracture of the fourth lumbar vertebra which had been treateated conservatively for eleven months. In June 1985 he was admitted to our hospital because of lumbago and pain of the legs. He had hypesthesia and muscle weakness below a level of the fourth lumbar root segment. Radiographs showed a bursting fracture of the fourth lumbar vertebra, but no osteolytic change.
    To obtain the recovery of the paresis, anterior decompression and fusion with Zielke instrumentation was performed. At the time of operation we unexpectedly found the brown soft tissue around the fourth lumbar vertebra with massive hemorrhage. This tissue was a follicular thyroid cancer histologically. He had the history of thyroidectomy for follicular adenoma in 1983,
    Finally we made a diagonosis of the thyroid metastatic cancer of the fourth lumbar vertebra.
  • 三隅 弘三, 田中 忠良, 森重 一郎, 友澤 尚文, 桜田 和之, 桑田 憲幸, 田丸 幸一, 篠田 陽健
    1986 年 35 巻 1 号 p. 123-125
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    A 37-year-old man was admitted with multiple fractures and on the 5th day after his admission, complained of increasing dyspnea.
    Upon auscultation, decreasing breath sound and bowel sound were recognised in the greater part of the left chest.
    A chest X-P film revealed that the left lung had collapsed and that there were intestinal gases.
    A left side thoracotomy was performed under the diagnosis of traumatic diaphragmatic hernia. The colon, small intestine and spleen were seen in the left thoracic cavity. The left diaphragm was lacerated about 20cm from the central tendon to the antero-lateral end and a 10cm rupture of the pericardium was seen. These two lacerations were not continuous. The spleen also had a small laceration, but the bleeding had stopped.
    The rupture of the pericardium was repaired with continuous over and over suture and the diaphragm was repaired with continuous horizontal mattress suture. The postoperative course was uneventful.
  • 今里 博司, 永田 見生, 高松 徹, 高木 久雄, 大橋 輝明, 南野 盛二, 佐藤 直人, 遠藤 俊哉, Inoue Akio
    1986 年 35 巻 1 号 p. 126-129
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    The bone scintigram and the X-ray findings of metastatic bone tumors of the spine (31 cases) were compared with those of other diseases of the spine which have to be differentiated from them; such as compression fracture (20 cases), spondylosis deformans (14 cases), pyogenic spondylitis (10 cases), tuberculous spondylitis (10 cases), and following results were obtained;
    1. The characteristic pattern of the scintigram of the metastatic bone tumors of the spine is asymmetric abnormal concentration with multiple lesions and multilevel distribution.
    2. Compression fracture of the spine showed symmetric concentration, and not continuously when the lesions are multiple.
    3. Spondylosis deformans included some asymmetric cases, so diagnostication should be careful.
    4. Pyogenic spondylitis and tuberculous spondylitis tend to concentrate symmetrically on adjoining two vertebral bodies.
  • 小住 和徳, 大村 勇二, 陣内 卓雄, 門脇 哲郎
    1986 年 35 巻 1 号 p. 130-135
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We experienced ten cases of blowout fracture in the period of twenty-two months, from December 1983 to September 1985, at St. Mary's Hospital. Seven cases were pure type blowout fracture, and others were impure type.
    In all cases surgical treatments were performed within two weeks after the trauma, and in eight of them we inserted silicone implants.
    Six cases showed complete disappearance of diplopia, and four cases showed remarkable improvement of eye movement and diplopia.
    We consider that after careful clinical and radiological assessment of blowout fracture, surgical treatment should be done as early as possible after injury.
  • 中村 祐二, 井上 博, 猿渡 勝義, 大橋 輝明
    1986 年 35 巻 1 号 p. 136-138
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We experienced a rare case with fracture of the outer clavicle displaced backward to the glenoid cavity of the scapula in a five-year-old boy.
    He was injured by traffic accident and had multiple injuries. Operation was carried out ten days after injury. it was revealed that the acromioclavicular ligament was intact and that the proximal fragment displaced backward to the glenoid cavity of the scapula leaving the periosteal sleeve. Open reduction and internal fixation with K-wire was done.
    Clinical result was favourable. The fracture mechanism was suggested.
  • 相良 耕三, 井上 喜博, 河合 尚志, 平野 英二, 平塚 弘幸, 中西 秀二, 真子 安二, 千綿 国彦
    1986 年 35 巻 1 号 p. 139-143
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Clinical literature has indicated that non-operative treatment is the treatment of choice for clavicular fracture except such example as non-union. Since 1981, 17 patients with a clavicular fracture have been treated by internal fixation with one or two modified threaded Kirschner wire. The patients' age ranges from 14 to 73 years, The operative indication was adapted to the patients with largely displaced fragments in spite of conservative therapy, neurovascular impingement of upper extremity, delayed unions, and with the inability to tolerate prolonged immobilization. Threaded Kirschner wire was modified with minor change which consists of more shortened part of thread so as not to break easily in it, and of bipointed end.
    On technical procedure threaded part is anchored on the cortex of distal end after penetrating the proximal fragment backward through medullary canal.
    All fractures healed with complete union. None of migration of wires but one which was found to be technical failure, and no bursitis were seen. The merits of this method are presumed to be easy utility and flexibility similar to original Kirschner wire, and to be immobility due to threaded part.
  • 高村 和幸, 芳賀 敏, 久能 保則, 小西 淳二
    1986 年 35 巻 1 号 p. 144-147
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Thirty-nine fractures and one pseudoarthrosis of the middle third of the clavicle were treated by K-U C-plate. None of them showed limited range of motion of the shoulder but one of them re-fractured at 10 weeks after removal of the plate and screws.
    Our indications for internal fixation are:
    1) marked displacement and angulation of bone ends which cannot be reduced by closed methods,
    2) marked angulation of bone ends which may perforate the skin,
    3) neurovascular complication,
    4) symptomatic pseudoarthrosis, and
    5) open fracture.
    We advocate that internal fixation by K-U C-plate is one of the best procedures for such fractures.
  • 上原 信生, 鱸 俊朗, 根津 勝
    1986 年 35 巻 1 号 p. 148-150
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We reported an extremely rare case of intermittent subclavian vein occlusion following a fracture of the middle third of the left clavicle.
    The patient is a 56-year-old female, who was initially treated conservatively by figureof-8 cast, but immediately cyanotic appearance, prominent edema and pain of the entire left upper extremity appeared only when the left upper extremity was dropped. The radial pulse was full and bounding. There was no neurological deficit at the left upper extremity.
    An impingement on the subclavian vein between the fractured clavicle and the first rib was suspected and confirmed by a phlebogram.
    A satisfactory result followed treatment by open reduction and immobilization.
  • 山本 良輔, 大屋 國益, 宮本 龍彦, 多原 哲治, 香月 正昭, 宮原 寿明, 高野 信一
    1986 年 35 巻 1 号 p. 151-153
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We treated two cases with non-union of the humerus using a spiral pin. In one case, a woman aged 73 with non-union of the hemeral shaft, solid union was obtained 6 months after operation. In the other case, a woman aged 74 with non-union of the surgical neck, her symptoms have subsided 15 weeks after operation, although good callus formation is obscure. The humerus was atrophic and weakened in both cases. In such cases, no methods seem to provide rigid fixation. Intramedullary fixation with a spiral pin provides more stable fixation rather than a smooth pin such as a Rush pin does, and it's not bulky unlike a Küntscher nail, so it facilitates bone grafting with or without an additional fixation. We consider that intramedullary fixation with a spiral pin is not the best but a good method for treatment of non-union of the humerus which is atrophic and weakened.
  • 田副 司郎, 羽座 利昭, 熊谷 謙治, 高木 信吾, 長岡 徳三, 伊藤 信之, 鈴木 良平
    1986 年 35 巻 1 号 p. 154-160
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Eighty-two cases of supracondylar fracture of the humerus in children were followed-up from 1 to 13 years with an average length of 4 years and 5 months. Supracondylar fractures were classified by Holmberg's classification. They were treated by fixation with plaster cast, plaster cast after manipulation, traction, percutaneous pinning or open reduction. We studied about the range of motion (R. O. M.) and varus or valgus deformity of the elbow after the treatment. There were no relation between the R. O. M. and deformity of the elbow and the degree of displacement of distal fragment after the treatment. The deformity and abnormal R. O. M. of the elbow were essentially caused by incomplete reduction. Decrease of the tilting angle led to the limitation of flexion of the elbow. If the conservative treatment is not acceptable to get the good augment, open reduction must be considered.
  • 徳安 英世, 上野 敦弘, 井上 博, 田中 秀武
    1986 年 35 巻 1 号 p. 161-163
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    It is uncommon that the fractured fragment is interposed into the ulno-humeral joint after closed reduction of dislocation of the elbow with medial humeral epicondyle in children, although interposition of medial humeral condyle which hinder the reduction is thought to be extremely rare. We experienced such a case.
    A boy aged thirteen was admitted to our hospital immediately after injury. He was diagnosed as traumatic dislocation of the elbow with fracture of the medial humeral epicondyle. Closed reduction was carried out unsatisfactorily, because of interposition of the fragment into the ulno-humeral joint. Open reduction was carried out and it was revealed that the fragment was not the humeral epicondyle, but the medial humeral condyle. Reduction and internal fixation was done. Three months after the operation functional recovery is still poor and X-ray showed marked changes of trochlear epiphysis. He is receiving the rehabilitation.
  • 山内 達朗, 平良 誠, 川島 重明, 錦戸 崇久, 桃崎 和彦, 高木 茂
    1986 年 35 巻 1 号 p. 164-166
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Twenty-nine hips in 27 patients of acetabular fractures were treated in our hospital. We reported the treatment and results of 27 hips in 25 patients which were followed for more than six months. Twenty hips had excellent or good results. Anatomical congruity of the acetabular fragments and stability of the hip joint are the goals of treatment.
  • 岩崎 勝郎, 中嶋 裕, 井上 喜博, 前田 謙而, 常岡 武久
    1986 年 35 巻 1 号 p. 167-172
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    In order to clarify the factors influencing the prognosis of the femoral neck fracture in young adults, 53 fractures in 52 patients were evaluated. All patients were between 13 and 49 years old.
    The incidence of non-union was 6 per cent of 49 fractures and of late segmental collapse (LSC), 24 per cent of 41 fractures. Non-union was seen in patients who had Garden Stage III and IV fractures, and in patients of more than 46years old at trauma. The LSC occurred in 6 of 9 Garden Stage IV fractures and in 2 of 8 transverse fractures in middleneck, as well as in 3 of 6 patients who had operation at 22 days or more after trauma.
    It is concluded that there is few problems on the bone union of the femoral neck fracture in young adults. The most important factor which influences the prognosis is LSC, and the occurrence of this complication i s related to the interval between trauma and operation, and to the type of fracture.
  • 山形 健治, 大森 俊一, 川口 徳久
    1986 年 35 巻 1 号 p. 173-177
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Between July 1982 and June 1985, 52 hip fractures have been treated with the sliding compression hip screw. The 52 of these reported include 4 subcapital femoral neck fractures, 46 intertrochanteric fractures and 2 subtrochanteric fractures.
    Patients' ages ranged from 59 to 98 years, with mean of 77.2. An average of weight bearing time was nine days. Twenty-nine patients with both stable and unstable fractures were allowed to bear weight within 7 days. Early weight-bearing did not exercise a bad influence upon the end result.
  • 宮近 信彦, 弓削 大四郎, 深沢 俊裕, 中村 泰, 三村 寛, 衛藤 正雄, 秋山 寛治
    1986 年 35 巻 1 号 p. 178-180
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Judet's screw-plate system is the best osteosynthesis material for fracture and pseudarthrosis of the proximal end of the femur. This screw-plate has been invented by R. Judet in 1969 and ameliorated by E. Letournel in 1980. We treated surgically 29 fresh fractures and 1 pseudarthrosis of the proximal end of the femur between 1982 and 1985, in 12 men and 18 women.
    The average, operation time, bleeding volume and consolidation were 68 years old, 136 minutes, 587g and 27 months respectively.
  • 宮城 成圭
    1986 年 35 巻 1 号 p. 181-187
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Seventy-nine cases of fracture of the proximal femur were successfully treated by multiple pinning with MK-pins for the last one and 8 months. The operation could be indicated for all types of fracture of the proximal femur, including intracapular and extracapsular fracture of the femoral neck.
    The operative procedure and the aftertreatment were presented with case illustrations.
  • 若狭 雅彦, 岡田 雄二, 立川 昌宏, 村上 恒二
    1986 年 35 巻 1 号 p. 188-190
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We reported a case with epiphyseal separation of the distal ulna which could not be reduced by nonsurgical manipulation due to interposion of the extensor carpi ulnaris tendon. The case was a 14-year-old boy who was injured by falling down from a running bicycle. X-ray findings showed markedly separated distal epiphysis of the left ulna with fracture of the distal radius. In spite of manipulation under anesthesia. the epiphyseal separation was irreducible. Operative findings showed that the extensor carpi ulnaris tendon was interposed between the separated ulnar fragments. Each radius and ulna were fixed by Kirschner wires following surgical reduction.
  • 長谷 芳文, 平野 英二, 今村 宏太郎, 千綿 国彦
    1986 年 35 巻 1 号 p. 191-194
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Three cases including a dorsal fracture-dislocation, a vertical fracture associated with fracture of the second metacarpal and an old complete volar dislocation are presented. The mechanism of these fractures is usually a direct blowon the wrist or a fall with the hyperextended hand in radial deviation. Our all cases were seen after violent, direct trauma.
    Slightly displaced vertical fracture may respond well to closed reduction and casting. Although for the severe fracture-dislocation or complete dislocation, it is believed that anatomical reduction and internal fixation are indicated to provide the earliest possible restoration of motion of thumb with the least possibility of subsequent traumatic arthritis and avascular necrosis.
  • 住吉 和夫, 西野 輿史, 香月 一朗, 小島 哲夫, 内田 芳雄
    1986 年 35 巻 1 号 p. 195-198
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We reported a case of scaphoid non-union with carpal osteoarthritis. A non-union would most probably result in carpal osteoarthris and pain. The study suggested that the carpal instability led to osteoarthritis and the scaphoid union by bone-grafting would prevent development of ostdoarthritis.
  • 手術例の検討
    佐々木 賀一, 徳久 銀一郎, 野村 茂治
    1986 年 35 巻 1 号 p. 199-206
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We analyzed 68 cases of operative management of fractured and dislocated fingers in children, one to sixteen-year-old (average, 10-year-old), 43 boys and 25 girls, 14 cases of amputation, 16 open fractures, 9 fracture-dislocations, 9 mallet deformities, 13 distal end fractures of the middle phalanx, 6 closed diaphyseal fractures, 11 epiphyseal fractures. Indications for open reduction were open injury, distal end fracture of phalanx, irreducible or unstable fracture and dislocation, malrotation, malunion and Salter-Harris type III epiphyseal injury with volar subluxation of joint. Irreducible cases necessitate early open reduction with internal fixation, for early reliable treatment can result in a satisfactory outcome.
  • 副島 康, 花村 達夫, 桜木 孝二, 近藤 孝, 赤田 智男
    1986 年 35 巻 1 号 p. 207-209
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Four patients with chronic mallet finger were treated by tenodermodesis (Iselin 1977). The patients ranged in age from 27 to 41 (average 33). The average interval from the injury to operation was 37 months.
    The results were satisfactory in two cases but unsatisfactory in two. Cause of failure in the first case was delayed wound healing which probably due to to much resection of the tissues and in the second case, too early removal of splint.
    We prefer K-wire fixation of the DIP joint for 3 weeks and additional external splinting for 5 weeks after the operation.
  • 安藤 義博, 高田 晃平, 廣谷 速人
    1986 年 35 巻 1 号 p. 210-213
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    Carpal boss is a bony prominence involving the carpometacarpal (CM) joint of the index and long fingers.
    Two symptomatic cases of carpal boss were reported. These cases were successfully treated with excision of localized bony prominence, together with degenerated joint surface.
  • 田嶋 光, 水岡 二郎, 栄 輝巳, 野村 一俊
    1986 年 35 巻 1 号 p. 214-216
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    CUSA (Cavitron Ultrasonic Surgical Aspirator) has been mainly utilized for the hepatic surgery and neurological surgery. This equipment fragmentates and emulsifies soft tissues, then aspirates the chips protecting vessels and nerves from injury. We utilized CUSA for the operation of a 6-year-old boy with macrodactyly of the foot. Consequently this patient acquired a remarkable shortening and reducing of the toes.
    We consider CUSA is of great value to other hand surgery necessitating a strict protection of the nerve and vessels from injury.
  • 増田 頼昭, 加茂 洋志, 徳久 銀一郎, 上田 恵亮, 帖佐 博文, 佐々木 賀一, 野村 茂治
    1986 年 35 巻 1 号 p. 217-220
    発行日: 1986/10/25
    公開日: 2010/03/16
    ジャーナル フリー
    We experienced a case of congenital arterio-venous malformation in apalmar aspect of the wrist joint region. This case rarely had symptoms and the lesion was limited in extent by angiography. We could perform total excision of this lesion for the uncommon malformation of limited extent. Postoperatively this legion has improved without recurrence. Previously published literature about congenital A-V malformation is reviewed.
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