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伊達 武利, 常岡 武久, 大久保 喬志, 西村 行政, 村田 雅和
1996 年 45 巻 2 号 p.
533-536
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
We reviewed 13 cases of complete dislocation of the acromioclavicular joint treated by Dewar's procedure. Post-operative results were assessed according to Kawabe's evaluation. Almost all cases achieved satisfactory results although some cases with dislocation in the anatomical position tended to have limitation of their ROM. Therefore, it is necessary to reduce this dislocation sufficiently during operation to achieve optimun results.
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中野 哲雄, 阿部 靖之, 鶴田 敬郎, 菊池 太朗, 大山 哲寛, 谷 彰文, 古賀 俊光
1996 年 45 巻 2 号 p.
537-542
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
The indications for surgical treatment of complete acromioclavicular luxations are controversial. Surgical treatments using Wolter's hook plates provide satisfactory results in five cases of acromioclavicular luxations and four cases with distal clavicular fractures. All patients with acromioclavicular luxations had Tossy type III lesions, and Neer type II lesions were present in three patients with distal clavicular fractures. This device allowed early functional exercise after surgery.
According to the evaluation method proposed by Kawabe, in patients with acromioclavicular luxations, there were two excellent results and two good results. All patients with distal clavicular fractures had excellent results.
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畑中 均, 猪原 史敏
1996 年 45 巻 2 号 p.
543-545
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
We surgically treated 24 consecutive unstable fractures of the distal third of the clavicle. 23 were treated by open or closed reduction and internal fixation using transacromial K-wires. A patient with a comminuted fracture was treated by tension band fixation using transacromial K-wires and a circular wire. Healing occurred uneventfully and shoulder function was restored to the pre-injury level except in one single case. The K-wires were removed under local anesthesia after healing of the fracture and there were very few complications.
Internal fixation using transacromial K-wires appears to be a valuable alternative for the treatment of type II fractures of the distal third of the clavicle.
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廣瀬 方志, 伊達 伸也, 榎田 誠, 古瀬 清夫
1996 年 45 巻 2 号 p.
546-549
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report a case of epiphyseal separation of the right coracoid process with acromioclavicular dislocation in a 14 year old male.
Stryker view roentgenogram and plain CT were useful for diagnosis. Conservative treatment was given using a sling for four weeks. At the last investigation, the separated lesion had been united, and the patient had returned to full sports activity.
The traction force of the coracoclavicular ligaments associated with acromioclavicular dislocation appeared to be the cause of the separation.
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生田 拓也
1996 年 45 巻 2 号 p.
550-552
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Ten cases with humeral greater tuberosity fractures were treated using tension band wiring. According to Neer's classification there were 3 cases of type IV and seven type VI cases. All cases achieved bony union. The postoperative JOA shoulder scores averaged 90.6 points (range: 73-100).
We concluded that this method is reasonable and useful for treatment of humeral greater tuberosity fractures.
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鳥越 雄史, 伊藤 信之, 衛藤 正雄, 朝長 匡, 原田 真一, 岩崎 勝郎, 鳥越 雄喜, 朝永 郁夫, 大久保 喬志, 山本 尚幸
1996 年 45 巻 2 号 p.
553-557
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report seven cases of scapular fractures treated by plate fixation. Subjects consisted of five males and two females with a mean age of 46.1 years (range: 22-59 years). The follow-up period ranged from six to eighty-two months with an average of 35.1 months. The fractures were classified into two tyes; 1) fracture of the glenoid (2 cases) and 2) fractures of the body, neck or acromion (5 cases). Associated injuries were present in three cases. The results of the treatment were evaluated by the range of movement, pain and muscle power.
Cases with fractures of the glenoid or those with associates injuries, showed poorer results especially with regard to restriction of movement. The time of onset of rehabilitation also influenced the results.
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渡部 正一, 戸田 勝, 黒木 龍二, 末永 治, 田島 直也
1996 年 45 巻 2 号 p.
558-561
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Seven patients (five men and two women) diagnosed with pseudoarthrosis of the upper extremity long bones were treated by external fixation. The mean age of patients was 38.3 years (range, 20-55 years). Wagner's fixation was used in five cases, and Mono-Tube in two cases. Bone graft was carried out in 5 cases. As a result, 6 patients acquired bone union, and only 1 patient was not able to achieve union due to bone atrophy and deterioration of bone formation ability. External fixation was effective especially for treating those patients with infectious pseudoarthrosis.
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有永 誠, 中村 宏, 城戸 正喜, 松崎 昭夫
1996 年 45 巻 2 号 p.
562-565
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Osteoarthritis of the basal joint of the thumb causes disabling pain and swelling often associated with deformity, instability, crepitus and loss of motion.
While milder forms of the disorder can be treated conservatively, the severe form requires surgical treatment.
Numerous surgical procedures have been advocated for the treatment of this disease, including simple resection of the trapezium; resection of the trapezium combined with interposition; ligament reconstruction, and partial or total joint replacement.
We present a case of this disease and describe the method of tendon suspension sling arthroplasty (Modified Epping Method).
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下村 義文, 田嶋 光
1996 年 45 巻 2 号 p.
566-571
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
From 1988 to 1994, we treated eleven cases of Kienböck's disease surgically.
Five cases were treated with radial shortening, one with radial and ulnar shortening, four with radial shortening associated with vascular bundle transplantation, and one with resection of a fragment.
Clinical results of all cases were almost good, but radiographical findings of each procedure showed little improvement.
In the cases with radial shortening and vascular bundle transplantation, investigation using magnetic resonance imaging (MRI) showed improvement of circulation of the lunate.
Therefore, we suggest the significance of performing revascularization with radial shortening.
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大宮 伸二, 枝光 淳, 興津 貴則, 阿部 靖之
1996 年 45 巻 2 号 p.
572-576
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Although avascular necrosis after fracture of the scaphoid is common, it rarely develops without apparent trauma. However avascular necrosis of the triangular bone is extremely rare. It is there fore extremely rare to find the former condition on one side with the latter on the other, and this has not been reported previously in any literature.
This paper presents one case of idiopathic avascular necrosis of the triangular and of the scaphoid.
A 42-year-old female cook complained of motion pain in her right wrist since her restaurant opened. One year later motion pain in her left wrist was added. Radiographs showed ulnar plus variant; 5mm at right and 4mm at left, and showed cysts in the triangular bone and scaphoid. She was treated conservatively, and her complaints decreased. MRI was taken three times over six months, and it was shown that the triangular developed a tendency to heal but the scaphoid tended to become worse. In following conservative treatment MRI examination is useful.
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安部 幸雄, 土井 一輝, 酒井 和裕, 小田 竜徳, 椎木 栄一, 河合 伸也, 桑田 憲幸
1996 年 45 巻 2 号 p.
577-580
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Scapholunate advanced collapse (SLAG wrist) is a relatively rare pattern of wrist degeneration in Japan that has been attributed to posttraumatic or spontaneous osteoarthritis of the wrist.
Nine patients were retrospectively evaluated for up to 10 years (average, 4 years) after surgical treatment of SLAC wrist. The operative procedures comprised 4 limited wrist arthrodesis (LWA), 2 proximal row carpectomy (PRC), 2 luno-capitate fusion (LCF) with scaphoid excision or with fascial implant arthroplasty, and 1 silicone implant arthroplasty. PRC were performed in the absence of luno-capitate arthrosis. LCF were performed to the patients that had luno-capitate arthrosis.
Postoperative extension/flexion of the wrist averaged 36° in LWA, 63° in PRC and 71° in LCF. Grip strength averaged 84% of a normal opposite wrist in LWA, 75% in both PRC and LCF. All of the patients were able to return to their original jobs. At follow up X-ray, radiocapitate joint space were preserved in PRC, and radial translation of the carpal bones was recognised in LCF with scaphoid excision.
A stage-dependent surgical approach to the SLAC wrist is advocated. LWA is not recommended for treating laborers or younger patients because of significant decrease of wrist motion. PRC is recommended for the wrist without luno-capitate arthrosis (stage II), and LCF is advocated for the wrist with luno-capitate arthrosis (stage III) for adequate pain relief and the restoration of maximum function.
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寺本 憲市郎, 中島 英親, 平野 哲也, 武田 浩志, 木村 展生, 米満 弘之
1996 年 45 巻 2 号 p.
581-584
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Procedures for lengthening the upper extremities, especially the fingers and forearms, have recently been reported. Various instruments have been used for performing these procedures. Some investigators reported a case in which correction of deformation was carried out simultaneously with bone lengthening. We have performed radius lengthening in 5 patients, using an Orthofix external fixation device. Of the 5 patients, 4 were male and 1 female. Their ages were 10, 3, 14, 14 and 17 years respectively (mean; 14 years). In all these cases, radial lengthening was needed because of shortening of the radius due to disturbed growth following a forearm fracture. After assessing radial dislocation of the carpal bones, pain caused by movement of the ulna and presence or absence of pain during the movement of the wrist joint, we obtained informed consent from each patient and his/her guardian after careful discussion, and we usually carried out this surgical procedure during the summer holidays. The hospital stay was 7-21 days. After discharge, the patients were managed at our outpatient clinic. Advice was given to their family members on how to help the children with the program for lengthening the bones. Their postoperative course was assessed every week on X-rays. As a rule, bone lengthening started one week after the osteotomy. The average length extension was 21.2mm.
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酒井 和裕, 土井 一輝, 伊原 公一郎, 安部 幸雄, 河合 伸也
1996 年 45 巻 2 号 p.
585-590
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Four children with congenital malformation of the hand were treated successfully using microsurgical reconstructive procedures. Two children had hypoplastic thumbs (Blauth grade III), which were treated by dorso-volarly reversed vascularized second toe MP joint transfers for reconstruction of the missing first CM joints. They also had secondary tendon transfers for thumb opposition, extension and abduction. The results were cosmetically superior with five digits and favorable thumb growth. Function was also satisfactory.
One child with radial club hand (total aplasia of the radius) was treated using a vascularized second metatarsal head transfer as the bifurcation procedure with excellent results achieved. The wrist was supported by the grafted bone to repair the adduction instability, while maintaining the flexion-extension range of motion.
The last child with syndactyly of the middle and ring fingers had a vascularized dorsalis pedis flap at the site of the separation. The skin was durable enabling two correction osteotomies. However recently, a tissue expander is available for pure skin defect reconstruction. We concluded that microsurgical reconstruction is advantageous for repairing congenital malformation of the hand, especially hypoplastic thumb and radial club hand.
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浅見 昭彦, 森澤 佳三, 峯 博子, 渡辺 英夫, 鶴田 敏幸
1996 年 45 巻 2 号 p.
591-596
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
特発性手根管症候群の原因は従来より腱滑膜炎であるといわれているが, 明らかな腱滑膜炎はさほど多くない. そこで, 本疾患と狭窄性腱鞘炎との因果関係, および滑膜の病理組織学的所見について検討を加えた.
特発性手根管症候群の患者45例, 66手 (男性8例, 女性37例, 手術時年齢15～68歳, 平均52.8歳) について狭窄性腱鞘炎の有無を, また手術時, 手関節滑膜が採取された22例, 25手について病理組織所見を検討した.
弾発指, de Quervain 病などのいわゆる狭窄性腱鞘炎を合併していたものは45例中11例, 16手 (24.2%) であった. 組織所見の内訳は, 炎症32%, 浮腫88%, 線維化84%, 硝子質化8%, 小血管の硬化あるいは閉塞40%であった. 中等度以上の炎症は8%のみであった.
本症の組織所見では浮腫, 線維化を示すものが大部分であったことより, 発症要因は腱滑膜炎のみならず様々なファクターが複雑に絡み合って発症するものと推察された.
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会田 勝広, 浅見 昭彦, 中尾 俊憲, 渡辺 英夫, 鶴田 敏幸, 高井 宏明, 加藤 善之
1996 年 45 巻 2 号 p.
597-601
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
肘部管症候群術後の第一背側骨間筋のエネルギー代謝を
31P-MRS法にて測定し, 筋肉機能の評価を行なった.
片側罹患の肘部管症候群術後7症例 (男性5例, 女性2例, 平均年齢62.1歳, 平均術後観察期間5.8年) において, (1) 尺骨神経の伝導速度 (MCV) および終末潜時の測定 (2) 超音波断層による第一背側骨間筋の筋断面積の測定 (3) 第一背側骨間筋の最大随意収縮力 (MVC) の測定 (4)
31P-MRS法による安静時および運動中, 運動終了時の第一背側骨間筋のエネルギー代謝の測定等を行なった.
《結果・考察》患側での肘部MCVの低下や, 第一背側骨間筋MVCの低下が認められたが, 単位面積当たりの静的収縮力, 筋細胞内pH, 安静時のPi/PCrには有意差はなかった.
肘部管症候群においては, 筋の量的回復より質的回復が先行すると考えられる. 患側の運動終了時のPi/PCrの高値は, 筋疲労を起こしやすい状態の残存と考えられる.
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楢林 葉子, 藤田 雅章, 本川 哲, 角光 宏, 藤本 勝也
1996 年 45 巻 2 号 p.
602-604
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
We experienced a case of ulnar nerve neuropathy caused by an itraneural ganglion of the ulnar nerve.
A 57 year-old man, who is a carpenter, felt numbness of his left ring and little finger. He had sensory disturbance in the ulnar nerve area and decrease of hand grip strength. At surgery, a ganglion was located under the epineurium and we were only able to remove the epineurium. After one and half years, has no symptoms.
Electromyography and magnetic resonance imaging were most useful for the preoperative diagosis.
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谷口 良康, 牧信 哉, 濱里 雄次郎, 岡村 一幸, 馬場口 康宏, 村山 隆, 吉野 伸司
1996 年 45 巻 2 号 p.
605-609
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report the clinical and radiographic results of the Chiari pelvic osteotomy in 22 hips (22 patients) over eight years after surgery. The average follow up period was 11 years and one month. Subjects were divided into two groups, group A which did not show any advance in the patients osteoarthritis (OA) and group B which did. We utilized the Japanese Orthopaedic Association (JOA) score for clinical evaluation and CE angle, Sharp angle, AHI, lateral shift, medial shift and osteotomy level. Clinically excellent or good results according to the JOA score were obtained in 20 hips (90.9%). CE angle, AHI and lateral shift decreased significantly (p<0.05) in group B during follow up. A good correlation between the lower osteotomy level (below five millimeters) and lateral shift were noted. Important factors to prevent lateral shift were as follows; 1), To have adequate coverage by medialization of the femoral head, 2) The osteotomy should not be performed at less than five millimeters. These factors seem to be important for achieving good results.
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馬渡 太郎, 篠原 典夫, 横山 庫一郎, 近藤 正一, 真島 龍興, 山口 智太郎, 浦上 泰成
1996 年 45 巻 2 号 p.
610-614
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Foreign body retention is seldom reported in the medical literature, mainly due to legal implications. However, although the real incidence of foreign bodies is unknown, they may not be particularly rare.
We experienced three cases of pseudotumor caused by long-term surgical gauze retention. The periods of retention were 11, 16, and 1 year respectively.
The clinical and diagnostic aspects of retained surgical gauze have been discussed.
While such evidence is not present in every case, careful attention to the manifestations described here permit accurate diagnosis, and an even more important point is that foreign body granuloma should be taken into consideration in the differential diagnosis.
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馬渡 太郎, 加茂 洋志, 猪原 史敏, 前川 正幸, 徳久 銀一郎, 佐藤 実, 野村 茂治
1996 年 45 巻 2 号 p.
615-622
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Open fractures of the lower limb with massive skin defects are difficult to treat and a large number of studies have been made on application of free skin flap transfers and free vascularized bone transfers for salvage.
However such techniques cannot always be used because of problems of manpower and technical difficulty. In such cases we have to rely on conventional treatment.
Recently we conventionally treated two cases of type III-b fractures and a case of III-c fracture classified by Gustilo-Anderson with satisfactory results achieved. The importance of initial management cannot be overestimated.
The first important point is acute reduction and stabilization with good alignment. External fixators play an important role in immediate fixation, however internal fixation is necessary in many situations.
Even more important is wound management. When the wound is contaminated and extensive skin loss exists, we prefer to leave the wound open although the surface of the bone must be covered with skin or muscle.
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有水 淳, 内藤 正俊, 緒方 公介, 安永 雅克, 張 敬範, 西野 一郎, 浅川 康司
1996 年 45 巻 2 号 p.
623-625
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Exertional compartment syndrome is one cause of pain in the lower extremity, a common disability in athletes. The purpose of this study was to report on the technique of measuring the intracompartmental pressure and the results of subcutaneous fasciotomy as a treatment of exertional compartment syndrome. Subjects comprised seven adolescent athletes, five men and two women. The affected compartment was the anterior compartment of the leg in each athlete. Dynamic pressure measurement of the anterior compartment was performed in all athletes using a wick catheter or micro-tip transducer catheter. The pressure increased more than 30 millimeters of mercury in all cases during running and active dorsiflexion of their ankle. All patients underwent subcutaneous fasciotomy. The micro-tip transducer catheter was found to be more sensitive than the Wick catheter in measuring intracompartmental pressure. After surgery, symptoms were relieved in all patients and there were no recurrences in any athletes.
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清水 啓, 矢野 寛一, 福永 拙, 池辺 修二, 真角 昭吾
1996 年 45 巻 2 号 p.
626-629
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
The purpose of this study was to investigate the clinical results of bone grafts in our hospital.
Since 1982, a total of 339 bone grafts have been performed, of which there were 284 autografts, and 55 allografts. We investigated our cases according to radiographic findings, and found that most cases achieved good results.
Recently we have tended to use allografts, especially for arthroplasty.
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岩本 英明, 竹下 満, 平田 修, 尾上 敏博, 荒牧 健一
1996 年 45 巻 2 号 p.
630-633
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
Rupture of the subscapularis muscle-tendon is uncommon and difficult to diagnose clinically and graphically. Several features of this injury were illustrated by 4 cases treated in our hospital within the last year.
(1) Positive history of trauma
(2) Unreduced and intractable motion pain, especially throwing motion, associated with conservative treatment.
(3) Air CT is the best technique for showing accurate pathologic changes.
(4) Surgical treatment achieved pain relief and full recovery, allowing patents to resume sporting activites and employment in all cases.
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1996 年 45 巻 2 号 p.
634-644
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
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1996 年 45 巻 2 号 p.
645-649
発行日: 1996/03/25
公開日: 2010/02/25
ジャーナル
フリー
