整形外科と災害外科
Online ISSN : 1349-4333
Print ISSN : 0037-1033
ISSN-L : 0037-1033
42 巻, 2 号
選択された号の論文の115件中101~115を表示しています
  • 坂田 浩章, 前川 清継, 岡嶋 啓一郎, 家入 浩一, 佐々木 彰, 高野 晴夫
    1993 年 42 巻 2 号 p. 839-841
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    Two cases of joint tuberculosis are reported.
    A 65-year-old woman with rheumatoid arthritis for the past twenty years presented with right wrist pain and pneumonitis. Smears of pus and sputum were negative for acid-fast bacilli, but cultures were reported positive for tubercle bacilli after three weeks. This patient died of respiratory and renal failure nineteen days after admission.
    A 64-year-old man with chronic renal failure presented with right shoulder pain and mild swelling. Microscopical examination of pus smears revealed acid-fast bacilli of Gaffky III. This case was treated by curettage and medication of INH, RFP and EB. He was discharged with a shoulder brace, and his general condition had improved when seen three months later.
    The importances of early diagnosis and management of patients with joint tuberculosis is stressed.
  • 福本 巧, 相良 孝昭, 堀川 広通
    1993 年 42 巻 2 号 p. 842-848
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    Hematogenous osteomyelitis of the calcaneus is uncommon. We describe a rare case of hematogenous osteomyelitis localized in the growth plate of the calcaneus and review the literature.
    The patient was a 10-year-old boy who complained of right heel pain. He had fallen from a height of 6 feet 6 inches two days before, but had no wound. When admitted to our hospital, his temparature rose to 39°C. Examination of his right heel demonstrated moderate swelling and local tenderness over the medial side of the calcaneus. Laboratory tests showed WBC count 5, 500/mm3, CRP 0.86mg/dl and ESR 46mm/hr. Initial radiographs showed no evidence of bony abnormality. Computed tomography revealed a slight expansion in the medial growth plate of the calcaneus.
    We aspirated pus from his heel, which on culture grew Staphylococcus aureus. Surgical curettage was performed, and the pus was proved to be localized in the growth plate of the calcaneus.
    Seven months after treatment, he was clinically and radiologically well.
  • 大西 敏之, 中村 宏志, 松田 剛正, 吉國 長利, 酒匂 崇
    1993 年 42 巻 2 号 p. 849-851
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    We reported 5 cases of stress fracture in RA patients during 1989-1991, in which 3 cases of femoral neck fracture were treated surgically and 2 cases of pubic fracture conservatively. They were all female and evaluated for their state of osteoporosis. We consider that osteoporosis, increased activity of daily living after arthroplasty and muscle imbalance are possible causes of stress fractures. Because pain arising from stress fractures is easily mistaken for rheumatoid synovitis, clinical suspicion and close follow-up are nessesary for RA patients with persistent hip pain.
  • 前田 剛, 近藤 正一, 篠原 典夫, 横山 庫一郎, 南島 広治, 中 敬彦, 星野 秀士
    1993 年 42 巻 2 号 p. 852-856
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    Eighty-three patients with Rheumatoid Arthritis who had 96 uncemented acetabular components were followed postoperatively for 4 months to 5 years and 2 months. Thirty-eight of these hips had protrusio acetabuli and needed bone grafting to the medial acetabular wall. Hydroxyapatite ceramics were used in 7 of 38 hips. Clinical results and roentgenographical analysis were evaluated. All grafts appeared to have united roentgenographically and protrusion did not progress. Radiolucent line around acetabular cup was seen in some cases, but loosening of acetabular cop was not seen. The results of this study suggest that the acetabular cup fixed onto the grafted bone for a press-fit.
  • 黒木 隆則, 鳥巣 岳彦, 丸井 俊一
    1993 年 42 巻 2 号 p. 857-860
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    Total knee replacement for osseous ankylosed knees has been reported in the literature. We describe the technical difficulty in exposing the joint in such an operation.
    We performed TKR for a case of rheumatoid arthritis with bilateral osseous ankylosed knee. Review of the surgical technique was reported in this paper.
  • 税所 幸一郎, 津曲 孝康, 尾田 朋樹, 木村 千仭, 桑原 茂, 伊勢 紘平, 田島 直也
    1993 年 42 巻 2 号 p. 861-865
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    The results of fourteen press-fit (uncemented) Kinemax total knee arthroplasties (TKAs) were analyzed and compared to twelve cemented Kinemax TKAs. Uncemented TKAs were used for rheumatoid patients with or without diabetes who had rather good bone quality. The mean post-oprative JOA-RA knee scores at an average of 8.4 months after operation were 65.4 for uncemented knees compared to 62.4 for cemented knees. The difference was not statistically significant. There were a few complications: two tibial component subsidences in uncemented knees and a patellar fracture in a cemented knee. Cement fixation of Kinemax appears to provide satisfactory results in some osteoporotic cases.
  • 星野 秀士, 近藤 正一, 前田 剛, 篠原 典夫, 横山 庫一郎, 南島 広治, 中 敬彦, 名西 史夫
    1993 年 42 巻 2 号 p. 866-872
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    We reported three patients with rheumatoid arthritis (RA) who died from secondary amyloidosis.
    Case 1 was a 65-year-old woman with RA who complained of diarrhea. Amyloidosis was diagnosed by colonic biopsy. The patient died from diarrhea and paralytic ileus.
    Case 2 was a 55-year-old woman with RA who also had complications of amyloidosis. She received a weekly intravenous injection of 5mg methotrexate, four times. Following this she developed pancytopenia and a high fever. After recovering from this she developed diarrhea and paralytic ileus and died from renal failure.
    Case 3 was a 56-year-old woman with RA who complained of quadriplegia. She developed gangrene and was diagnosed as having malignant rheumatoid arthritis. She developed paralytic ileus and died from perforation of the alimentary tract.
  • 笠井 時雄, 青山 茂樹, 野並 誠二, 梶浦 清司, 神村 盛裕
    1993 年 42 巻 2 号 p. 873-876
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    We examined the wrist by magnetic resonance imaging (MRI) in 22 patients(3 males and 19 females) with rheumatoid arthritis. Coronal wrist section in T1-weighted spinecho sequences showed destruction and synovial hypertrophy as grey masses. T2-weighted spin-echo MRI showed tissue with high liquid content and inflamed synovial membrane as a bright signal.
    MRI was useful in diagnosis of rheumatoid arthritis (RA) lesions like synovial infiltration, local inflammation and exudation. Both T1 and T2 weighted sequences were necessary for evaluating RA lesions.
  • 高山 健吾, 鳥巣 岳彦, 中村 雅彦, 多田 勝弘, 藤原 亨, 針 秀太, 真角 昭吾
    1993 年 42 巻 2 号 p. 877-880
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    We reported a case of femoral shaft erosion with the patella wrapped around the femur associated with calcium pyrophosphate crystal deposition disease. There was little synovial proliferation on the femoral erosion site. Histologically there were no inflammatory changes in the synovium and bone cortex in the area of the femoral erosion. Acceleration of osteoclastic bone resorption on the bone cortex in the erosion was obsened. We concluded that the upper end of the patella contacted chronically with the femur, so that bone resorption was accelerated in that part of the femur, leading to femoral erosion.
  • 徳田 光章, 山本 吉藏, 豊島 良太, 萩野 浩, 高須 宣行
    1993 年 42 巻 2 号 p. 881-883
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    Although some reports suggest that osteoporosis occurs with increasing incidence among rheumatoid arthritic (RA) patients compared with the normal population, there are few reports concerning the incidence of fractures in RA patients. We studied the records of 1059 adult RA patients who visited at our department in the 27-year period, from 1965 to 1991. There were 822 females and 237 males with the age at first visit ranging from 20 to 86 years (average, 48.9 years). Eleven patients sustained seventeen extremity fractures from minor trauma. Patients were all females and three of them were using steroids. At the time of fracture, most patients were aged between fifty and seventy years and the disease duration exceeded ten years. Six fractures occurred in the upper extremity and eleven in the lower extremity, including six hip fractures. Fracture incidence was 1.34% in female patients and 0% in male patients. Six patients were in stage 4 and class 3 at the time of first fracture. Four patients were analyzed for bone mass of left distal radius and the mean value of this was lower than that for age-matched controls. Fracture incidence in patients taking steroids was higher (2.91%) than in those without steroids (1.31%). Concerning the fractured patients, mean age was younger in the steroid group than in non-steroid group.
  • 星野 秀士, 近藤 正一, 前田 剛, 篠原 典夫, 横山 庫一郎, 南島 広治, 中 敬彦, 松田 秀一, 隅田 幸男
    1993 年 42 巻 2 号 p. 884-887
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    We performed 54 implant arthroplasties for patients with rheumatoid arthritis using predeposit autologous transfusion, postoperative autologous transfusion or both. Though patients with rheumatoid arthritis often were anemic, autologous blood predeposit could be performed with recombinant human erythropoietin. Postoperative autologous transfusion was effective in implant arthroplasties with postoperative bleeding. We can avoid homologous trasfusion more effectively with both methods.
  • 中島 康晴, 小山 正信, 黒瀬 眞之輔, 池田 正一, 小沢 慶一
    1993 年 42 巻 2 号 p. 888-890
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    When surgically removing spinal neurinoma, especially if a large tumor, sacrifice of nerve tissue is often required to achive total tumor removal. To avoid postoperative neurological deficits, we tried to preserve nerve tissue as much as possible under the microscope while totally removing the tumor. Ten patients who were treated for spinal neurinoma were evaluated. Postoperatively eight patients were neurologically intact and only two showed some deficit. However their deficits were minor with only partial loss of strength and sensation.
    There is no recurrence in these ten patients.
  • 真島 靖, 原口 和史, 橘 寛, 吉田 光男, 池川 征吾, 西尾 潔
    1993 年 42 巻 2 号 p. 891-895
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
    Injuries to the lumbar region such as lumbar disc herniation (LDH) are relatively common occurrences in athletic activities.
    Fortunately many patients suffering from LDH, whose symptoms consist of low back and radicular pain, improve with careful conservative treatment. However those cases which exhibit severe clinical signs and symptoms in spite of conservative management ultimately undergo surgery.
    Over a 10 year period, 50 patients have been treated operatively. The surgical procedure consists of fenestration and discectomy. We examined the prognosis of 27 patients who were younger than 32 years and have often participated in athletic activities.
    Thirteen were athletes and the other 14 performed less stressful activities. After surgery, all 13 athletes were treated with a trunk muscle strengthening program, while 7 (53.8%) were able to return to their former level of play and 4 (30.8%) remain asymptomatic in less stressful activities.
    It appears that careful fenestration and discectomy followed by therapeutic exercise are successful for treatment of severe disc herniations in athletes occuring at the L4-5 space or lower, at least for a fixed period of time.
  • 1993 年 42 巻 2 号 p. 896-902
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
  • 1993 年 42 巻 2 号 p. 903-906
    発行日: 1993/03/25
    公開日: 2010/02/25
    ジャーナル フリー
feedback
Top