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病態と手術的治療
冨永 積生
1988 年 36 巻 4 号 p.
1278-1284
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Seventy patients who had been followed for more than 3 years after operation were neurologically and radiologically analyzed. The clinical features were made clear and the results of operation were assessed. Ten patients of them had the degenerative changes in the single intervertebral level and the remaining 60 patients in the multiple levels. Twenty-six patients had symptoms due to compression of the single root and 44 patients the multiple roots or the cauda equina. The characteristic symptoms were continuous low back and leg pain increasing by standing and walking, intermittent claudication, cold sensation in the paralyzed area and dysuria. For these patients, decompressive-wide laminectomy was performed to sufficiently release the neural compression. In the results, 43 patients had acceptable improvement without any problems of pain, paralysis and activities of daily living and working. The remaining 27 patients were unchanged or deteriorated.
As the factors influencing on the results, structural changes after operation, i. e. relapsed canal stenosis due to hypertrophy from the remained laminae and intervertebral instability, and progressive prolonged symptoms due to the neural dysfunction are listed. A new laminectomy method to preserve the posterior lumbar elements, the spinous process and the interspinous ligament, was indicated.
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楢原 知啓, 今里 博司, 遠藤 俊哉, 野口 蒸治, 山中 健輔, 井上 博, 早川 潤太郎, 松田 弘彦
1988 年 36 巻 4 号 p.
1285-1288
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Cubital tunnel syndrome in 3 fishermen were reported in this paper. The 3 men had been working on their boat as a bird watching using binoculars to get a fishing point for about 16-30 years.
They took an extremely flexed position of the bilateral elbows on a table for 12 hours a day. Paresthesia of the ring and little fingers was caused. Regional hypesthesia and atrophy of the intrinsic muscles on the affected hands were observed at the first examination.
Two of them were operated on by the method of king, and their postoperative courses were good.
Another one was treated conservatively. It is possible that mechanisms of these cases can be the results from an external compression force and physiological pressure by an arcuate ligament and tension of the ulnar nerve in an extremely flexed position of their elbows.
We suggest that soft pad under elbows at work may help to prevent the development of this disease. Additionally, it is better to have a free time from work, a few minutes an hour.
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術後早期のMCVの有用性について
白石 元, 表 寛治郎, 山崎 博信, 河合 伸也, 中田 和男, 佐々部 富士男, 山縣 茂樹, 伊藤 孝
1988 年 36 巻 4 号 p.
1289-1292
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Thirty patients of cubital tunnel syndrome were examined clinically and electrophysiologically. The preoperative and postoperative conditions over 1 year were evaluated by means of our special scales. This is the pre-and postoperative grading system which consists of individual four graded sensibility and motor score so that postoperative results could be easily understood.
According to the MCV values between above-elbow and wrist (AE-MCV) and between belowelbow and wrist (BE-MCV), clinical stages were divided into three. In the first stage, AE-MCV is slow, but BE-MCV is within normal limit. In the second stage, both MCV values are slow and in the third stage, both MCV could not be found. All cases in the first stage showed full clinical recovery, but all cases in the third stage showed no objective clinical recovery. In the second stage, most of cases obtained some clinical restoration of the score though some of them did not show any clinical recovery. In the last group, all cases with good improvement of the immediate postoperative AE-MCV values showed their further good postoperative results. We emphasize the significance of the immediate postoperative AE-MCV values.
In the second stage we think that the cases with no improvement of the immediate postoperative AE-MCV values should be re-examined about its cause, for instance, double crush syndrome or a wrong selection of operative method.
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中村 巧, 畑田 和男, 井口 竹彦, 森本 聡, 増田 頼昭, 宗広 秀史
1988 年 36 巻 4 号 p.
1293-1298
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Thirty-four cases with supracondylar fractures of the humerus in children were treated during five years period from 1982 to 1987.
Out of them twenty-three subjects were medically examined. Thirteen cases were treated surgically and ten by percutaneous pinning. These were compared to each other. We measured three factors, that is, coronal tilting (varus), anterior angulation (hyperextension) and horizontal rotation (internal rotation), which are thought to be connected with cubitus varus. We calculated coefficient of correlation between cubitus varus and three factors. There was a significant correlation between cubitus varus and coronal tilting (r=0.93, p<0.01), and a relatively high correlation between cubitus varus and anterior angulation (r=0.57, p<0.01). But the correlation between cubitus varus and horizontal rotation was not so significant (r=0.39, p<0.10).
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喜名 政浩, 奥江 章, 石崎 知樹, 松口 信行, 真島 靖, 時任 毅, 副島 修
1988 年 36 巻 4 号 p.
1299-1305
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Fractures of the distal humerus in adults have unusual and difficult problems. Recently, we experienced three cases of distal humeral fractures in the adult treated by internal fixation. Two were males and one was a female. The average age was 37.3 years and the average duration of follow-up was 11.6 months. All cases were sustained in motor vehicle accidents. We employed the posterior approach using osteotomy of the olecranon and anterior transposition of the ulnar nerve, and fractures were fixed with two AO reconstruction plates on each epicondyle. Rigid fixation was achieved enough to allow early exercise by this method. Though one patient had varus deformity, the average elbow extension was -10.6° and flexion was 131.3°.
We concluded that the anatomical reduction with rigid fixation gave best results.
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内田 芳雄, 小島 哲夫, 緒方 公介, 杉岡 洋一
1988 年 36 巻 4 号 p.
1306-1308
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
We proposed new osteotomy for cubitus varus deformity after supracondylar fracture of the humerus. This osteotomy which is named as interlocking wedge osteotomy has following advantages.
1. This osteotomy can correct three dimentional deformity easily.
2. Bone contact area is wide and bone fusion is rapid.
3. Fixation after osteotomy is easy and solid compared to the standard wedge osteotomy.
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内田 芳雄, 小島 哲夫, 杉岡 洋一
1988 年 36 巻 4 号 p.
1309-1312
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
We analysed possible pathophysiology of cubitus varus deformity after supracondylar fracture of the humerus using clinical materials and experimental models. In addition to varus, distal portion of the humerus usually rotates internaly and extends posteriorly. As a result, pronation of the forearm, external rotation of the shoulder and elbow flexion are limited in the patients with cubitus varus deformity.
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笹重 善朗, 萩山 吉孝, 嶋村 正俊, 朝尾 和彦, 今川 俊一郎
1988 年 36 巻 4 号 p.
1313-1318
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
From 1983 to 1986, we treated six cases of Barton's fracture, and reported five cases over a half-year after their treatment. There were 3 males and 2 females: 4 were volar Barton's fractures and 1 was dorsal Barton's fracture. The mean age was 41.2 years with a range from 23 to 61 years. The most frequent mechanism of injury was a motorcycle accident, and others were a fall from the roof and a tumble in the steps. One was treated by closed manipulation and plaster cast immobilization and three by open reduction and internal fixation and one by percutaneous pinning. According to the Sarmiento system of evaluation, two were rated excellent, two good, and one fair. Some patients complained of occasional stiffness, slight pain, or weakness, but none reported major impairment. The successful recovery parallels the accuracy of reduction.
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牧 信哉, 吉留 鶴久, 別府 徹己, 貴島 稔, 谷口 良康, 小倉 雅, 酒匂 崇
1988 年 36 巻 4 号 p.
1319-1322
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Sixteen cases of comminuted Colles' fractures were treated by pins and plaster method (10 cases) and Hoffmann-C type external fixation (six cases). Radial length and radial tilt were reduced to some extent. But external fixation method was superior as regards volar tilt. “Die punch fragment” was reduced by the combined method of external fixation and percutaneous pinning, but step-off of the radial articular surface was not always reduced by both methods. Functional results were almost good to excellent in spite of X-P evaluation. Our method of excessive traction and external fixation was usefull in early ROM acquirement.
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太田 剛, 上田 恵亮, 野村 茂治
1988 年 36 巻 4 号 p.
1323-1325
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-six cases of the comminuted fractures of the distal end of the radius were reviewed. All cases were evaluated according to Gartland's assessment. 18 cases had good or excellent results. In the conservative treatment, the reposition of palmar-tilt angle and shortening of the radius was important, and we were impressed with the preventive treatment of shortening.
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井上 敏生, 徳永 純一, 小林 晶, 福元 敬二郎, 王 享弘, 吉本 隆昌, 後藤 元徳, 井上 善博, 泊 一秀
1988 年 36 巻 4 号 p.
1326-1329
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Thirty-five patients with 37 articular fractures of the distal radius were evaluated as to the results of treatment radiologically and subjectively by questionnaire. Three patients complained of discomfort and were graded as poor. Two of them were initially treated by manual reduction and plaster fixation. Re-dislocation of the fragment, however, occurred in the plaster and consequently loss of integrity of the distal radio-ulnar joint remained, presenting ulnar plus variant on radiological antero-posterior view. Ulnar plus variant resulted from either re-dislocation of the fragment or shortening of the radius. To estimate the reduction rate of the fracture and its maintenance, calculation of the dorsal tilting angle and ulnar variance is useful in treatment of the fracture.
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渡邉 精一郎, 吉良 秀秋, 新村 哲也, 本川 哲, 山口 善久
1988 年 36 巻 4 号 p.
1330-1337
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Ninety-four cases with fractures of the distal radius, attended our hospital between 1982 and 1986, were reviewed. Their ages ranged from 5 to 83 years with the average of 31.8 years Adult's franctures were seen in 48 cases, and children's in 46 cases. Distal fractures were classified by kawashima's classification and Colles's fractures were divided into 3 groups by Gartland's classification. They were treated by fixation with plaster cast after manipulation as a general rule, but some of them were treated by direct traction, external fixation device, percutaneous pinning, or open reduction.
This paper presents three interesting cases of comminuted type fractures in adult and the results of prognostic investigation of 14 children's fractures. Clinical results at the last examination were evaluated by the modified Saito's method. In children, the results of all were excellent. Radiologically, in 6 cases, followed up over one year, both dorsal deviation and radial deviation were corrected satisfactorily in comparison with normal side.
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中野 哲雄, 川口 宗義, 池田 天史, 加藤 悌二
1988 年 36 巻 4 号 p.
1338-1341
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
In cases with fracture of the distal end of the radius, intraarticular comminuted fractures and unstable fractures were treated by employing pins and plaster method or cast fixation method. The results were evaluated between the two methods. There were 22 cases of cast fixation and 15 pins and plaster method.
Pins and plaster method was superior in regard to roentgenographic evaluation and subjective symptoms.
This method is a first-choice treatment regimen because of the technical ease, few complications, and the stability of the results.
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西田 民夫, 上崎 典雄, 松永 大助, 村上 陽太郎, 西崎 博巳, 松本 直之, 緑川 孝二, 池田 正一, 井上 尚美
1988 年 36 巻 4 号 p.
1342-1345
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-one patients with fractures of the lower end of the radius were investigated.
The results were as follows:
1) The cases with good anatomical results showed good functional results, whereas the clinical results were not so poor as the X-ray findings.
2) Percutaneus Kirschner wire fixation was considered to be desirable for the unstable fractures.
3) The best position for maintaining normal alignment and minimizing deforming forces is supination.
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長嶺 功一, 親川 勝, 上原 敏則, 粟国 敦男, 安里 隆, 宮城 能久
1988 年 36 巻 4 号 p.
1346-1350
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
In total of 726 patients with Colles' fracture from July 1981 through June 1986, there were 87 epiphyseal injury of the distal radius; 73 men and 14 women. Ages ranged from 5 to 17 years. There were also 78 elderly cases, 7 men and 71 women. Their ages ranged from 65 to 102 years.
Subjective functional results were excellent or good in 67 patients with epiphyseal injury, fair in 3 and 17 cases were lost of follow up. Anatomical end results of the patients with epiphyseal injury were excellent in 58, good in 22, fair in 1, poor in 2 and unavailable in 4 cases. There was one early epiphyseal closure, one remarkable deformity of the epiphysis and one partial physeal growth disturbance.
In 78 elderly cases, subjective functional results were excellent or good in 56, fair in 2, poor in one and unknown in 19 cases. Their anatomical end results were excellent or good in 47, fair in 13, poor in 10 and 8 were lost. There was no significant correlation between anatomical end results and subjective functional assessment.
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野村 茂治, 中井 諒一, 岡部 聡, 猪原 史敏, 帖佐 博文, 上田 恵良, 佐々木 賀一
1988 年 36 巻 4 号 p.
1351-1354
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Between 1975 and 1986, sixty-two Colles' fractures in sixty old-aged patients were treated in our clinic. The patient' ages ranged from 65 to 87 years with an average being 71 years. Twenty-five patients who had twenty-six fractures were fresh cases, and thirty-five patients who had thirty-six fractures were old cases.
All fresh cases were treated with manual reduction and fixed with plaster cast, but only one case was treated with neurolysis and resection of the bone fragment for the median nerve palsy. In fresh cases, we found that loss of reduction had happened to 46% of the cases especially in unstable cases.
We studied 24 fractures clinically and compared that with radiological result. Satisfactorily functional results were obtained in spite of less satisfactorily anatomic results in old-aged patients.
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鳥越 雄喜, 高須賀 良一, 桑原 弘治, 実松 義昭, 小西 宏昭, 高橋 克郎, 小林 秀樹, 熊谷 謙治, 小田 純爾, 原 真一郎, ...
1988 年 36 巻 4 号 p.
1355-1360
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Among 82 patients treated in the last 16 years, 39 cases of the Colles' fracture over 65 years old were followed and the types of fractures were classified according to the Frykman's classification. The results were as follows: 20 cases were excellent, 9 were good, 9 were fair and 1 was poor. The influencing factors on the results were shortening of the radius, radial tilt and dorsal angulation.
Especially, the shortening of the radius was most influential in the clinical end-results. It was found to be difficult to prevent another deformity after first treatment, however, only a few complaints were found regardless of the severe deformity. We have to pay much attention to preventing contractures of the fingers and shoulder joints in elderly patients.
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田崎 法昭, 永山 盛隆, 平 宏章, 新垣 晃, 上里 智美
1988 年 36 巻 4 号 p.
1361-1365
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
A follow-up study was performed on 264 patients of Colles' fracture (271 limbs) who were treated at Naha Prefectural Hospital from 1979 to 1985.
The results were as follows: most fractures occurred at 15 to 24 years in men and after the middle age in women. Statistically the fracture type of the patient was focused on Frykman type I and II. Dorsal tilt deformity had a relationship with the deterioration of symptom (pain, swelling, limitation of motion). It is suggested that, symptom may appear according to the level of daily activity in aged patient who had residual deformity of the fracture.
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井手 淳二, 森沢 佳三, 大平 卓, 生田 拓也, 石川 浩一郎, 北川 敏夫
1988 年 36 巻 4 号 p.
1366-1370
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Gout is commonly seen in men and recently chronic tophaceous gout of severe degree is rare. We report our experience of managing a 42-year-old woman with chronic tophaceous gout and aseptic necrosis of the left femoral head. Laboratory data showed hyperuricemia (serum uric level 10.7mg/dl) and renal insufficiency (BUN 45mg/dl, creatinine 4.6mg/dl). While being treated with allopurinol (300mg/day), the patient developed high fever, skin rush of the trunk and extremities, and agranulocytosis. Allopurinol was discontinued with apparent resolution of them. She is now treated with benzbromarone (100mg/day), but hyperuricemia is still observed. We consider that allopurinol desensitization may be necessary for this patient.
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小酒井 治, 松元 司, 粟国 順二, 中光 紳一, 橋本 卓
1988 年 36 巻 4 号 p.
1371-1375
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Sialic acids fluctuate sharply in disorders with acute inflammation and necrosis. In orthopedic cases of acute suppurative disorders and rheumatoid arthritis, sialic acids also fluctuate.
Sialic acids of serum and synovial fluid in seventy-two cases of rheumatoid arthritis were measured, and the classification of stage and class, correlation with ESR and CRP, and fluctuation by treatment were all discussed.
Serum sialic acids consentrations have a significantly high average in stages 2 and 3 of rheumatoid arthritis, and have a one to one correlation with ESR, and with treatment effects generally. Synovial fluid sialic acids were typically more present in rheumatoid arthritis than in osteoarthritis.
Sialic acids seem to be a most important index for inflammatory reaction.
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松下 和徳, 渡辺 英夫, 怱那 龍雄, 松下 いく子, 中尾 俊憲, 服巻 直也, 笠原 とし子, 陣内 卓雄
1988 年 36 巻 4 号 p.
1376-1380
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
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松田 和浩, 大石 年秀, 山口 司, 井原 和彦, 太田 剛, 松本 直之, 杉岡 洋一, 松元 信輔, 藤井 敏男
1988 年 36 巻 4 号 p.
1381-1385
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
The Results of Riemenbügel Treatment for Congenital Dislocation of the Hip.
An investigation was made on 56 cases in our clinic involving 61 hips reduced by Riemenbügel treatment during a period between the year 1969 and 1982. The average in terms of months when the treatment started was 4 months (range: 1 month to 1 year and 3 month). The average age when investigated was 9 years old (range: 6 years to 18 years old). The results consisted of 82% of satisfactory group and 18% of unsatisfactory group. Judging from the historical change of the hips after treatment for reduction, it was considered to have a high possibility of getting better prognosis in the cases with improvements up to α angle of 25°, OE angle of 10°, and ot value of 26mm, at the age of 6 years old.
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河村 誠一, 秦 立比古, 江口 正雄
1988 年 36 巻 4 号 p.
1386-1390
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
The cases of 40 patients (44 hips), who had been treated with Pavlik harness, were reviewed radiologically at a mean of 5.5 years (range, 3 to 11 years) after treatment. Good results were noted in 38 hips (86%) and poor results were noted in 6 hips (14%) in the dislocated side. Acetabular angle (α angle) and OE angle of both sides (dislocated side and contra-lateral side) were measured, and the distribution of the cases on the α-OE chart was studied periodically. Although the distribution of both sides became coincident with growth, a few cases showed the delay of improvement in α angle and OE angle even in cases with good results. The difference between good cases and poor cases had become obvious at the age of 3 to 5 years.
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太田 剛, 大石 年秀, 山口 司, 杉岡 洋一, 藤井 敏男, 寺戸 一成, 松元 信輔
1988 年 36 巻 4 号 p.
1391-1394
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty-six cases (fifty-two hips) of congenital dislocation of the bilateral hips were reviewed. All cases were followed above five years old, and evaluated according to Severin's assessment. The results showed that the bilateral cases were later than the unilateral cases for the begining of the treatment and worse in the evaluation. In comparison with right hip and left hip, left hip was worse than right side in the evaluation.
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井原 和彦, 大石 年秀, 山口 司, 太田 剛, 松田 和浩, 杉岡 洋一, 松元 信輔, 藤井 敏男
1988 年 36 巻 4 号 p.
1395-1398
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Thirty cases (thirty-five hips) treated by manual reduction between 1974 and 1981 were reviewed. The results were classified by Severin's criteria. Twenty-six hips (74%) were in Groups I and II. The results were poor in children who had had manual reduction after one and half year old. We concluded that it was hard to predict the final results before six year old.
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岸川 陽一, 原 寛道, 河野 淳亮
1988 年 36 巻 4 号 p.
1399-1404
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Iatrogenic dorsal bunion in children is observed mostly after operation for talipes equinovarus or post-poliomyelitic paralysis. The dorsal bunion is the deformity of the foot characterized by plantar-flexion of the great toe and concomitant dorsi-flexion of the fist metatarsal, and is often associated with hallut valgus or varus deformity.
A 16 year old male with dorsal bunion with hallux varus deformity is presented. We have successfully achieved correction of the deformity by an operation developed by D. W. McKay in 1983, in which the tendons of the flexor brevis and the abductor and the adductor muscles of hallux are transferred to the neck of the first metatarsal.
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柴田 直之, 佐竹 孝之, 森永 政博, 高見 博昭
1988 年 36 巻 4 号 p.
1405-1409
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
The incidence and degree of patella alta were studied radiographically in 22 ambulatory CP, 16 nonambulatory CP and 14 normal children. The relationship between the degree of patella alta and other factors (“spasticity score”, popliteal angle and true knee contracture) were analysed.
The results were as follows:
1) The incidence of patella alta in CP group were higher than that in normal.
2) The degree of patella alta and “spasticity score” were correlated in non-ambulatory CP group (γ=0.37).
3) The presence of patella alta and that of true knee contracture were correlated in ambulatory CP and non-ambulatory CP groups.
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有田 親史, 高松 鶴吉, 佐伯 満, 樋口 喜友
1988 年 36 巻 4 号 p.
1410-1412
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Early recognition and appropriate orthotic treatment may decrease the severity of the tibia vara deformity and the resulting need for osteotomy.
We investigated serial radiographic measurements of the lower extremities of 138 children (4 months to 4 years and 10 months of age) who had been evaluated for bowleg deformities. With time, most of the bowing in the children with physiologic bowing (tibial proximal metaphyseal/diaphyseal angle of 11° or less) corrected spontaneously. Tibiae with proximal metaphyseal/diaphyseal angle of more than 11° were more likely to develop significant bowing requiring treatment. In two of the children with no initial abnormal findings nor measurements, bowleg deformity remained unchanged.
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山口 司, 柴田 堅一郎, 大賀 正義, 林 和生, 杉岡 洋一
1988 年 36 巻 4 号 p.
1413-1414
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Fifty-one curves of fourty-three patients were studied. They met the following criteria; (1) Female adolescent idiopathic scoliosis, (2) Starting the brace treatment before complete fusion of the iliac apophysis, (3) a minimum follow-up period of one year after completion of brace treatment. Only one curve showed an increase exceeding 5 degrees. Other fifty curves were unchanged or achieved correction of more than five degrees. The iliac apophysis maturation, the age and the magnitude of the curve when the patients start brace treatment and the kind of the brace were not significantly correlated with the result. The brace treatment appears effective for arresting the progress of the idiopathic scoliosis.
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藤本 勝也, 岩崎 勝廊
1988 年 36 巻 4 号 p.
1415-1418
発行日: 1988/04/25
公開日: 2010/02/25
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フリー
Body measurements were taken in 44 boys and 5 girls with Perthes disease. Children with Perthes disease showed a trend of short stature. In weight, patient showed normal distribution. Forty cases who underwent varus osteotomy were evaluated radiographically. Radiographical results were assessed by Mose's Method. Good results were obtained in the low height group and the low weight group.
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仲宗根 聡, 乗松 尋道, 上里 智美, 井上 治, 友利 昭夫, 知念 弘, 茨木 邦夫, 親泊 元信
1988 年 36 巻 4 号 p.
1419-1423
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
We analized the radiological results and the secondary changes of the acetabulum of 86 hips in 83 patients who were treated by weight-relieving abduction braces or by operative procedures. The average age at diagnosis was 7 years. The average follow-up period was 5.6 years, and all reached primary healing.
Good results were found much more in conservative group than in operative group, but in Catterall group 3 and 4, there was no difference in results between conservative and varus osteotomy groups.
Acetabular deformity was severe in poor result group and acetabular roof angle and acetabularhead index were not increased at follow-up.
In conclusion, containment therapy for Perthes' disease should be done at early stage because the containment therapy at late stage with severe deformity of the femoral head may lead to deformity of the lateral edge of the acetabulum.
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神代 敏之, 奥苑 直行, 林 広三郎, 鹿島 信之, 長谷 芳文, 藤原 亨
1988 年 36 巻 4 号 p.
1424-1427
発行日: 1988/04/25
公開日: 2010/02/25
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フリー
From January 1982 to December 1986, 36 patients with 37 mallet fingers were treated in our hospital, of which 19 mallet fingers of bony origin had been treated surgically. The mallet finger of bony origin due to an intra-articular fracture of the distal phalanx involving more than one third of the joint surface requires an anatomical reduction. Tension band wiring is a usefull method for mallet finger of bony origin.
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上妻 隆秀, 佐々木 邦雄, 田丸 卓弥, 桑畑 睦郎, 土屋 邦善, 林 烱晃, 福岡 善平
1988 年 36 巻 4 号 p.
1428-1430
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
A case of displaced fracture of the trapezium with multiple fractures of the extremities is reported. The treatment was open reduction and fixation with two Kirschner wires. Excellent results were achieved in terms of union, joint restoration and function.
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阿部 隆伸, 後藤 琢也, 高松 徹, 徳安 英世, 酒井 亮, 岡村 明
1988 年 36 巻 4 号 p.
1431-1434
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
The fracture-dislocation of the first carpometacarpal (CM) joint is a rare injury, but it has earned a reputation for being simple to reduce but difficult to maintain in position. We report our experience of treatment using the percutaneous pin fixation. Thirteen patients were treated by the percutaneous pin fixation, and three patients by conservative therapy. One of the conservative was unrecognized fracture, and others were little dislocation of the extra-articular type.
The clinical results of 7 cases were excellent in five, good in one and fair in one case.
We think that the exact anatomical reduction of the fracture-dislocation of the first CM joint is neccesary.
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松本 光司, 藤井 敏男, 寺戸 一成, 山本 裕之
1988 年 36 巻 4 号 p.
1435-1437
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Congenital ectopic nail formations are rare. We treated 3 years old girl who had had characteristic nail anomalies of both little fingers since her birth. The nail covered not only the dorsal but the palmar aspect of the distal phalanx. The motion of the PIP and DIP joints was restricted. X-ray showed abnormal short ungual phalanges. Analogous nail anomalies were also found in the toes.
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榎本 寛, 今村 宏太郎, 平野 英二, 前田 謙而
1988 年 36 巻 4 号 p.
1438-1444
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Since 1982, we have performed Ashworth type of silicone rubber interposition arthroplasty in ten cases and arthrodesis in six cases for arthritis in carpometacarpal joint of thumb. Seven cases of arthroplasty and five cases of arthrodesis were followed up for an average period of two years and eleven months. We examined relief of pain, range of motion, grip strength and pinch strength to determine the indications of each procedure. For relief of pain arthrodesis was superior to arthro-plasty, but arthroplasty gave better improvement in range of motion. There was no difference in grip and pinch strength between both procedures. It is better to choose arthroplasty when the patient wants good motion of thumb, whereas if he is a hard worker, arthrodesis should be choosed.
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別府 徹己, 今給黎 尚典, 牧 信哉, 吉留 鶴久
1988 年 36 巻 4 号 p.
1445-1448
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Four lower legs and feet with large soft tissue defect were resurfaced by free microvascular transfer of the latissimus dorsi muscle and overlying skin: one with a degloving injury of the foot with matatarsal fracture and exposure of the tarsal bone, two with large soft tissue defect of the middle third of the leg, and one with skin necrosis of the foot caused by a fall of stone. The procedure was successful in 2 patients whereas 2 patients sustained late superficial necrosis of the flap.
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嘉陽 宗俊, 茨木 邦夫, 乗松 尋道, 高良 宏明, 井上 治, 新垣 晃, 武内 正典, 小禄 尚, 外間 浩
1988 年 36 巻 4 号 p.
1449-1455
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
For past 7 years, we have performed vascularized bone graft on 28 patients. Nineteen of them were vascularized free bone graft, 7 were vascularized pedicle bone graft and 2 were combined operation of both vascularized free bone and pedicle bone graft. As a donor bone, 25 fibulae, 4 iliac bones and a rib were used.
All of 10 cases except one of traumatic massive bone defect or pseudarthrosis, completed bone union. But in these cases, 2 needed conventional iliac bone grafting, because of delayed union due to unstable fixation of grafted bone. Four of 6 cases of avascular necrosis of the femoral head showed good X-ray appearance and clinical results. One case failed and another case is at a short time after operation to evaluate the result. In the cases of wide spinal lesions, spinal tuberculosis and neurofibromatosis, vascularized bone grafts were indicated. This procedure was used for limb salvage operations of malignant tumors of the tibia (adamantinoma), femur (osteosarcoma), and humerus (osteosarcoma, Ewing' sarcoma). Two cases of congenital pseudarthrosis of the tibia underwent free vascularized fibular graft. Both cases had additional operations: one required correction osteotomy and another patient needed Sofield procedure because of fatigue fracture. Vascularized bone graft was also used for arthrodesis, for example, of Charcot joint or infected joint in which the union of the bone was troublesome.
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角 光宏, 今村 宏太郎, 平野 英二
1988 年 36 巻 4 号 p.
1456-1460
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
This is a retrospective study of 14 patients with Kienböck's disease treated by radial shortening from 1981 to 1985. All patients were followed for a mininum of 1 year postoperatively (the averaged time of follow up was 32 months-range, 15 to 64 months-). In most patients pain essentially decreased the grip strength recovered to near normal, and the range of motion improved.
The radiographs at follow-up showed no change in the lunate bone in 12 patients, progressive change in 2 and reparative change in none. Accoording to Evans' evaluation, patients of preoperative stage III of Lichtman's classification showed better results than those of stage IV, and all patients of stage IV with radio-carpal osteoarthritis showed poor results.
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中西 俊郎, 鈴木 勝己, 三浦 直彦, 阿部 聖孝, 酒井 昭典
1988 年 36 巻 4 号 p.
1461-1464
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Eleven hands of Dupuytren's contracture in 9 male patients were surgically treated by limited fasciectomy with “open technique” over a period of 6 years. The average age from onset to operation was 2 years and 9 months. The lesions were evaluated according to Meyerding's classification; Grade 0 (2 hands); Grade 1 (2 hands); Grade 2 (6 hands), Grade 3 (1 hand) and Grade 4 (0 hand).
We followed up these 11 hands of 9 patients for an average of 3 years and 7 months (minimum period, 2 years; maximum period, 6 years and 1 month).
Postoperative results were classified according to Tubiana's method of evaluation: very good 5, good 5, fair 1 and poor 0. Six cases of good and fair results became recurrence and extension cases, but after surgical re-operation, became very good cases.
The wounds were closed on an average of 25 days (range, from 17 days to 38 days) after operation.
On follow-up, it was seen that the defective skin had become covered by soft skin with reproducted epidermal ridges.
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田中 宏道, 小林 靖幸, 嘉村 親芳, 阿部 聖孝, 成沢 研一郎
1988 年 36 巻 4 号 p.
1465-1468
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Lymphangioma of bone is rare. To our knowledge this is the 5th case reported in Japan. A 14-year-old female was admitted to our hospital complaining of pain in the right half of the pelvis and high temperature without apparent cause.
Radiologic examination showed deformity of the pelvic girdle and structural cystic changes in the 5th lumbar vertebra, iliac, ischial and pubic bones on the right. She was examined in detail. Open biopsy was performed. Histological diagnosis was developmental error of bone. After the biopsy, bilateral foot lymphangiography revealed numerous deformed varicose lymphatics. After 20h, contrast medium was accumulated in the pelvic bones. Six months later, open biopsy was repeated. We finally made a diagnosis of lymphangiomas of bones.
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森 修, 相良 孝昭, 森沢 佳三, 米村 憲輔, 高木 克公, 北川 敏夫
1988 年 36 巻 4 号 p.
1469-1471
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
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浅田 和英, 平野 徹, 鈴木 良平, 岩崎 勝郎, 矢次 登, 中村 智
1988 年 36 巻 4 号 p.
1472-1475
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
We have performed reconstruction of the pelvic ring with proximal tibia amputated in hemipelvectomy for the metastatic pelvic bone tumor. Comparing the value of this procedure between the case with this reconstruction and the other with hemipelvectomy alone, it was found that the former case had better ability of weight-bearing at the end of the stump and had less degree of the scoliosis.
It was therefore suggested that the hemipelvectomy with pelvic ring reconstruction had superiority to the hemipelvectomy alone in use of post surgical prosthesis.
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中馬 広一, 福間 久俊, 別府 保男
1988 年 36 巻 4 号 p.
1476-1479
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
We treated three cases of osteosarcoma with HD-MTX or CDDP preoperatively. All cases responded to this protocol clinically, roentgenologically and histologically. We put in order the changes of clinical, roentgenological and scintigraphical findings and ALPase after effective drugs. And we tried to make the new protocol for osteosarcoma combined with MTX, CDDP and ADR on the experience of three effective cases.
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平野 徹, 鈴木 良平, 岩崎 勝郎, 藤田 雅章, 松坂 誠應, 浅田 和英
1988 年 36 巻 4 号 p.
1480-1483
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Limb salvage procedure with alumina ceramic segmental replacement prosthesis was performed in 5 patients of osteosarcoma arising in distal femur. The functional results of those patients with an average follow-up of 18 months were evaluated according to Enneking's criteria and the overall rating showed one good result, 3 fair and one poor.
Radiographic data were observed in terms of stem/bone interface radiolucency and extracortical bone formation on the segmental part of the prosthesis. Stem radiolucent lines were common in this series, and in addition, resorption of cortical bone in stem rotation stopper was noticed remarkably during first one year. After that extracortical bone formation on the segmental part increased with time and it seemed to be useful for stabilizing the prosthesis. However, it is suggested that further improvement is needed in prosthetic design in order to gain better functional results by strengthening implant fixation.
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松浦 豪, 梅田 幸三郎, 山元 三郎, 川崎 正章, 溝上 健一郎, 安藤 季彦
1988 年 36 巻 4 号 p.
1484-1487
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
A rare case of paralysis of the deep branch of the radial nerve caused by extostosis of the radial head is reported. The patient was a girl aged twelve, who noticed disability in extention of the right thumb and fingers without sensory disturbance. A palpable lump at the radius head was present and was thought to be a cause of symptoms. Examination revealed no additional abnormality in other bones, but electromyographical changes. Ulnar part of the tumor of the radial head restricted supination of the forearm, and radio-dorsal part was thought to have compressed the deep branch of the radial nerve. The tumor was resected from the radial head. The tumor was histologically diagnosed as osteochondoroma. Function was completely restored clinically 8 weeks, and electromyographically 10 weeks after operation.
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松田 和浩, 牛島 正博, 増田 祥男, 杉岡 洋一
1988 年 36 巻 4 号 p.
1488-1490
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
A 13-year-old man with osteoid osteoma of the femoral neck associated with coxa magna was reported. Roentgenographic findings were compatible with those of osteoid osteoma, and the histologic feature confirmed its diagnosis. Postoperative clinical course was uneventful. The cause of occurrence of coxa magna following osteoid osteoma was unknown, but synovitis or increase of the blood flow seems to lead the femoral head to coxa magna.
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青柳 孝彦, 平野 徹, 岩崎 勝郎, 鈴木 良平
1988 年 36 巻 4 号 p.
1491-1495
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Giant-cell tumor of bone is rare in skeletally immature patients. Three cases of giant-cell tumor of bone were originated in the skelton with radiographically open epiphyseal plates in our series (33 cases). In two patients, a giant-cell tumor was found to be limited to the metaphyseal part of a long bone and in the other to predominantly metaphyseal involvement.
According to the relation between initial treatment and prognosis, a biological behavior of giant-cell tumor of bone in skeletally immature patients is similar to that in mature patients.
It is suggested that an initial origin of this tumor is the metaphysis and it invades the epiphysis later.
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井上 治, 茨木 邦夫, 乗松 尋道, 吉川 朝昭, 富山 聡, 仲間 健, 伊藤 悦男
1988 年 36 巻 4 号 p.
1496-1499
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
フリー
Three adult cases of femoral neck tumor with prominent sclerotic margin and central lytic lesion were presented. Histologically the case 1 (25-year-old male) showed plenty of foamy cells, the case 2 (59-year-old female) fibrous cicatric tissue, and the case 3 (66-year-old female) foamy cells and storiform pattern of spindle cells in femoral lesion or foamy cells under degeneration in acetabular lesion. All of the cases were diagnosed feasibly as long standing fibrous dysplasia for their heigher age, lack of clinical symptoms, bony sclerosis and histological degenerative appearance.
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森 修, 佐保 修二, 森沢 佳三, 米村 憲輔, 高木 克公, 北川 敏夫
1988 年 36 巻 4 号 p.
1500-1503
発行日: 1988/04/25
公開日: 2010/02/25
ジャーナル
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