整形外科と災害外科
Online ISSN : 1349-4333
Print ISSN : 0037-1033
ISSN-L : 0037-1033
46 巻, 4 号
選択された号の論文の79件中51~79を表示しています
  • 葉 山泉, 緒方 公介, 諌山 照刀, 安部 龍暢, 神戸 太一
    1997 年 46 巻 4 号 p. 1130-1133
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We report on three patients with a benign cystic lesion of the femoral neck or trochanter. All patients were women between the ages of 19 and 34 years (median, 20 years). The diagnosis was based on X-ray imaging, which showed a solitary bone cyst with a central osteolytic lesion, thinning and inflating the cortex. However the pathological diagnosis was aneurysmal bone cyst. All patients were treated by curettage and an autogenous bone graft with or without hydroxyapatite, in conjunction with a dynamic hip screw, dynamic condylar screw, or a γ nail. At a median follow-up 33 months, all patients had achieved good bony union and incorporation of the implanted graft and packing of the hydroxyapatite. There were no complications and no recurrences. Internal fixation promotes union of the graft to the host bone. A γ nail is useful, because the nail occupies the bony space, making only a small amount of graft bone needed.
  • 山口 鉄生, 真島 隆三, 弦本 敏行, 楢林 葉子, 岩永 斉, 有馬 信之, 平野 徹
    1997 年 46 巻 4 号 p. 1134-1139
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    A 62 year-woman was admitted with pain in the chest, lower back and both lower extremities in January 1995. Clinical findings revealed osteolytic lesions and hypercalcemia. She sustained a subtrochanteric fracture of the left femur after a fall. We treated the fracture with an intramedullary nail. Biopsy of the osteolytic lesions around the fracture demonstrated osteitis fibrosa cystica with no surrounding tumor cells. After the operation, we demonstrated positive HTLV-1 antisera and a high level of CD4, CD4/CD8 and CD25. In June, a subcutaneous tumor appeared in the left thigh. The biopsy demonstrated a T-cell lymphoma, and we confirmed a diagnosis of ATL. Serum PTHrP was high and serum intact PTH low, suggesting that the cause of the osteolytic lesions was PTHrP originating from the ATL tumor cells.
  • 西村 誠介, 橋口 隆, 宮田 倫明, 宮本 力, 弓削 七重, 平野 徹
    1997 年 46 巻 4 号 p. 1140-1144
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We reviewed the clinical significance of our surgical procedure for 10 patients with metastatic femoral cancers. Patient's ages ranged from 43 to 75 years with an average of 58 years, and their primary cancers included renal cell carcinoma, mammary carcinoma and others in 4, 3 and 3 patients, respectively. During the procedure, the intraosseous lesions were curetted thoroughly and packed with bone cement. Subsequently, the femurs were reinforced with long plates to prevent pathological fractures.
    The majority of the 10 patients could walk within three weeks after surgery. Seven patients had no discomfort in the affected limbs for the mean follow-up term of 16 months. However, local recurrence appeared radiologically in 3 patients 7, 10 and 24 months after surgery, respectively. The present study disclosed that our procedure was useful for patients whose metastatic lesions extended minimally into the soft tissues.
  • 伊藤 博史, 児玉 太郎, 酒匂 崇, 森本 典夫
    1997 年 46 巻 4 号 p. 1145-1147
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    大腿骨遠位, 脛骨近位の悪性骨腫瘍で患肢温存手術をされた10例のうち, 術後感染, 血行障害のために3例が二次的に切断に至り, 2例に追加手術を要した. 患肢温存されている7例の機能評価は全体で70%であり, 大腿骨遠位74%, 脛骨近位は60%であった. 大腿切断は初回切断71%に対し, 二次的切断は59%と低かった.
  • 枝光 淳, 興津 貴則, 塩川 徳, 大宮 伸二
    1997 年 46 巻 4 号 p. 1148-1152
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We report the clinical results of 51 peritrochanteric fractures treated with the Gamma nail. There were 6 stable and 45 unstable fractures according to Evans classification. The distal locking screw was used for only 9 of the 51 fractures. The mean duration of surgery was 52 minutes with minimal operative blood loss. Gait recovery for 18 patients followed for over 2 months was satisfactory.
    Intraoperative complications included jamming of nail (one case), fracture of lateral cortex (one case) and displacement of peritrochanteric fracture (two cases). Postoperative complications included cut out (one case) and migration of lag screw (three cases), nail movement in medullary cavity (two cases), femoral shaft fracture (one case), breakage of distal locking screw (one case) and bone atrophy of femoral shaft (one case). We suggest that these complications might be caused by incorrect intramedullary nail placement, incorrect lag screw placement, distal locking screw problems and osteoporosis.
  • 井上 貴雄, 木下 篤, 山名 圭哉, 佐藤 徹, 井上 一
    1997 年 46 巻 4 号 p. 1153-1156
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    85才以上の大腿骨転子部骨折に対する髄内釘式ヒップスクリュー (Intramedullary hip screw; IMHS) 法の有用性を検討するため, IMHS法を施行した85才以上の症例23例を対象とし, 手術侵襲, レントゲン評価, 局所合併症の有無, および機能評価を調査した. 手術時間は48.2±12.3分, 出血量は69±40g, テレスコープは1.5±0.6mmで, 骨癒合は全例2ヵ月以内で完了し, 内反変形やラグスクリュー先端のカットアウト等は認めなかった. また, 調査時に死亡していた5例を除いた18例のうち, ADLレベルが2段階以上低下した症例 (可, 不可) は4例 (22.2%) であった. 本法は, 手術侵襲が少なく, 強固な初期固定性を得られるため, 機能訓練が早期より開始でき85才以上の高齢者の本骨折に特に有用と考えた.
  • 坂田 浩章, 高野 晴夫, 川添 泰弘, 池邉 顕嗣朗, 梅村 武寛, 岡嶋 啓一郎
    1997 年 46 巻 4 号 p. 1157-1159
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    A retrospective analysis of the outcomes in 20 patients aged over 90 years with femoral neck fractures showed a return to the preinjury ambulatory status in 50 per cent. Twelve patients had died a mean of 17 months after surgery. For the 14 patients with senile dementia, 64% were non-ambulatory and 64% had died. The presence of senile dementia is an important prognostic factor for regaining ambulation or survival.
  • 田辺 龍樹, 小牧 一麿, 川越 正一, 帖佐 悦男, 柏木 輝行, 園田 典生, 田島 直也
    1997 年 46 巻 4 号 p. 1160-1163
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    Surgical treatment of 55 femoral neck fractures in 53 patients aged over 90 years treated during the past 4 years was evaluated. All patients had some complications and abnornality of blood examination before surgery. Surgical treatments included se ven prosthetic replacements and 48 osteosyntheses.
    Postoperative complications were urinary tract infection in 12 patients, dementia in 8 and pulmonary tract infection in 7. Three the 7 patients with pulmonary infections died during admission. The patients with cardiovascular and pulmonary complications preoperatively tended to develop worse complications after surgery.
    Particularly, a preoperative understanding of the patients general condition and perioperative general control are needed to prevent postoperative complications from occuring and worsening.
  • 斉藤 修, 亀川 陸雄, 下河辺 仁, 川上 義史, 黒木 良克, 森 雄二郎, 森下 益太郎, 小原 周
    1997 年 46 巻 4 号 p. 1164-1167
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    The outcome of fracture of the femoral neck in elderly patients is greatly affected by the timing and the method of treatment, and when treatment is inadequate, the prognosis can be very poor.
    This disease has been observed frequently in routine diagnosis and treatment, and problematic cases occur on occation. Among the patients who suffered fracture of the femoral neck and were treated surgically during the 6-year betweenfrom April 1990 and April 1996, 62 patients (62 joints) aged 85 years of age orolder were selected and examined in this study. The subjects included 5 men and 57 women, who were divided into two groups by age for comparison: Group A consisted of 32 patients aged 85-89 years old, and Group B consisted of 30 patientsaged 90-99 years old. Patients in both groups underwent early surgical treatment, left their sickbeds early, and began postoperative treatment early as well. At the time of discharge from the hospital, most of the patients in both groups could leave their sickbed and walk. The mean survival time after discharge was 592 days in Group A and 521.4 days in Group B, and thus differed little between the groups. In conclusion, early surgical treatment appeared to be useful for extremely elderly.
  • 佐藤 理, 花川 志郎, 梶谷 充, 宮地 健, 宮越 浩一
    1997 年 46 巻 4 号 p. 1168-1171
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    The combined femoral fracture according to the Aoyagi definition is a rather rare type of fracture defined as occurring in two or more parts simultaneouslyin the cervical, diaphysial, or condylar part of the femur. Its treatment is often very difficult. We reviewed results of six patients with femoral combined fractures in the past eight years.
    All six cases were males with average age of 38.7 years old (range, 22-58 years) at the time of injury. Based on the Aoyagi classification, five of the fractures were Gla and the other one was G2b. Among the Gla patients, two patients received a reconstruction nail, two patients had both a Grosse & Kemph nailand a Knowles pin, and a nother had both CHS and AO broad plates. In the G2b patient, we inserted a Grosse & Kemph nail. For two cases of nonunion, we addeda bone graft.
    After treatment all six cases successfully achieved complete union. Their function a evaluation at the final examination was as follows; three cases rated excellent, and three good, based on Karlstrom's criteria.
    From these outcomes, we conclude that the reconstruction nail is a useful method for internal fixation in treating combined femoral fractures with the method able to be applied to patients with more communited fractures.
  • 村田 雅和, 野口 雅夫, 中西 秀二, 手島 鍛, 飯岡 隆, 鳥越 雄史
    1997 年 46 巻 4 号 p. 1172-1176
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We reviewed seven cases of ipsilateral fractures of the femoral neck and shaft treated at our hospital since 1989. There were four males and three females. Their ages ranged from 19 to 69 years (average, 44.9 years). All injuries resulted from high energy trauma.
    There were two intracapsular femoral neck fractures and five extracapsular fractures (three were trochanteric and two were subtrochanteric fractures). There were no open fractures.
    Two patients were treated with plate fixation for the shaft and compression hip screw fixation for the femoral neck, two were treated with an intramedullary nail for the shaft (Ender nail or Russell-Taylor nail) and pinning for the neck, and three were treated with Russell-Taylor reconstruction nail. One case had non-union and nail failure (Ender nail), so reoperation with plate fixation and an autobone graft was performed. The average follow-up was 19 months.
    At follow-up, all patients had achieved a good result and all fractures were followed to union. There was no case of avascular necrosis of the femoral head.
    Ipsilateral fractures of the femoral neck and shaft should be stabilized by internal fixation as early as possible. Russell-Taylor reconstruction nail is useful providing superior stabilization with a single implant.
  • 鳥越 雄史, 野口 雅夫, 中西 秀二, 手島 鍛, 飯岡 隆, 村田 雅和
    1997 年 46 巻 4 号 p. 1177-1180
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We treated 7 cases with fractures of the distal end of the femur. Subjects comprised 2 males and 5 females with a mean age of 63.3 years (range: 55-75 years). Fractures were classified using the AO system as follows: type A2 (3 cases), type A3 (1 case), type B1 (1 case), type C2 (2 cases). We treated s cases with Russell-Taylor interlocking nails, 5 cases with intramedullary supracondylar nails.
    Bone union was achieved in 6 of 7 cases. The mean healing time was 158.8 days.
  • 福嶋 寛子, 福島 明, 丹生 譲治, 高須 宣行, 楠城 誉朗
    1997 年 46 巻 4 号 p. 1181-1184
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We studied eighteen patients who had surgical treatment for tibial condylar fractures with a mean follow-up of 40.3 months (5-77).
    We evaluated the clinical results according to Hohl and Luck's criteria. There was no agreement between joint function and good anatomical grade. By using multiple regression analysis, we examined factors which affect the functional results. Our study results suggests that anatomical reduction and early active motion were the most important factors for obtaining optimal result for this fracture.
  • 西岡 英次, 百田 耕, 山内 豊明, 吉田 健治
    1997 年 46 巻 4 号 p. 1185-1188
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We used ultrasound to examine 19 patients with muscle and tendon injuries of the lower extremity. Patients ranged in age from 14 to 50 years with a mean of 26.4 years. Injuries included rupture of Achilles tendon, M. C. L., M. triceps surae, M. rectus femoris, M. adductor longus, M. biceps femoris. We used a 7.5MHz convex type probe. Ultrasonography proved useful for evaluating muscle and tendon injuries and for determining the best treatment to use for.
  • 木村 一雄, 尾上 英俊, 野見山 宏, 秋吉 祐一郎, 松永 和剛
    1997 年 46 巻 4 号 p. 1189-1193
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We report a case of crush syndrome in a 26 year-old man who had fallen from a car. Physicians should be alerted to this syndrome because prompt replacement of the fluid deficit and careful management of those individuals in whom renal insufficiency develops will improve their survival. Early fasciotomy may allow preservation of function of the involved limb.
  • 時任 毅, 増田 祥男, 小橋 芳浩, 花田 能成, 中川 悟
    1997 年 46 巻 4 号 p. 1194-1199
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    To elucidate the clinical characteristics of patients with elderyly-onset rheumatoid arthritis (EORA), we compared the clinical features, laboratory data, and clinical course of 17 patients with elderly-onset (age at onset; over 60 years, average 63.0 years with) 19 patients with younger-onset (below 50 years, average 38.3 years). The group with EORA had an increased incidence of hypertension, diabetes mellitus, cardiovascular disease, ischemic heart disease. There was no significant difference in the levels of ESR, CRP, IgG-RF titer, serum IgG concentration at entry, and the clinical course during two years follow-up between the 2 groups. In spite of EORA patients having a higher prevalence of complications to drugs including disease-modifying anti rheumatic drugs (DMARDs) and steroids, we considered that DMARDs (especially GST) and steroids must be used to prevent rapid bone destruction. In addition, surgical procedures including joint replacement were recommended to maintain the EORA patients activity of daily living.
  • 井上 裕文, 河合 伸也, 田口 敏彦, 金子 和生, 森信 謙一, 大藤 晃, 山本 健志
    1997 年 46 巻 4 号 p. 1200-1203
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    Displacement of the atlanto-axial joint was first described by Corner. We report six children with atlanto-axial rotatory fixation (A. A. R. F.). Five cases who had a short interval between injury and diagnosis were treated by Short-tern Crisson traction and so, achieved reduction and ealy return of function. One case with a delay in trea tment required cervical fusion for instability.
    Eary diagnosis is important, so A. A. R. F. should be looked for in all cases of acute torticollis.
  • 三隅 秀樹, 河合 伸也, 城戸 研二, 田中 浩, 服部 泰典, 今村 竜治, 白倉 祥晴
    1997 年 46 巻 4 号 p. 1204-1207
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    In 1995, three cases of septic arthritis of the hip joint in infancy and childhood were admitted to our hospital. Arthrotomy was performed in all patients immediately after the diagnosis had been established. Two patients who were treated within five days of symptom onset had good results. One patient in whan the diagnosis was made after 33 days from the onset of symptoms, had a limp and limited movement of the hip joint, with radiological evidence of a pathological incomplete dislocation.
    We recommend immediate diagnostic arthrocentesis of the hip joint under image intensifier for all suspected cases of septic arthritis of the hip joint, emergency arthrotomy should be performed as soon as the diagnosis of sephc arthrifis is made.
  • 田原 尚直, 内藤 正俊, 有田 哲彦, 緒方 公介, 深堀 雄蔵, 石田 高康
    1997 年 46 巻 4 号 p. 1208-1210
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We performed trochanteric osteotmy with anterior transtrochanteric slide in seven cases; four cases of revision arthroplasty, two cases of Sugioka's transtrochanteric rotational osteotmy and one case of Sugioka's transtrochanteric valgus osteotmy. Alth ough one case showed nonunion after operation, none of the cases demonstrated proximal migration of the trochanteric fragment.
    This osteotomy method is performed without release of the attachment of the vastus lateralis; therefore, compared with standard osteotmy, it decreases the incidence of proximal migration of the trochanteric fragment which causes abductor muscle weakness.
  • 二之宮 謙一, 寺田 和正, 斎藤 太一, 河野 修, 杉岡 洋一, 清水 敦, 大賀 正義
    1997 年 46 巻 4 号 p. 1211-1213
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We reviewed roentgenograms of 17 patients who had been treated with CDI for idiopathic scoliosis, between 1988 and 1995. The correction of each type of scoliosis, using King's classification was good in about 50% of cases. Among the 17 patients, 4 were type II. and of these 4, 2 were unbalanced in the frontal plane after surgery. When we perform selective fusion of the thoracic curve for patients with type II scoliosis in whom the thoracic and lumbar curves are almost equal with a flexibility index less than 25, they tend to be unbalanced after surgery. We believe in these cases it is better to fix the scoliosis from the thoracic to the lumbar curve.
  • 佐伯番匠健康マラソン大会におけるアンケート調査より
    村上 秀孝, 野口 蒸治, 宮本 義明
    1997 年 46 巻 4 号 p. 1214-1216
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We investigated running injuries in entrants to the 7th Saiki Banjou marathon race using a questionnaire. There were 170 runners, 153 men and 17 women with a mean age of 48.7 years. On average subjects had a running history of 12 years, and a mean monthly mileage of 156km.
    54 runners had experience of running injuries and many had knee injuries. There were no statistical differences in training distances, age, running speed and number of years running between injured runners and non-injured runners. We concluded that the reason for this, was that most of the subjects was low level runners.
  • 横山 庫一郎, 篠原 典夫, 花村 聡, 久保田 晃志, 永津 治, 筒井 秀樹
    1997 年 46 巻 4 号 p. 1217-1219
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We report a case of malignant fibrous histiocytoma occuring in the thigh of an 18 year-old female. At first, the tumor was too large to resect completely, and we therefore used preoperative adjuvant therapy comprising irradiation (Liniac; 60Gy) and multidrug chemotherapy (MAID; combination of Doxorubicin, Ifosphamide, Dacarbazine and uroprotection by MESNA). After treatment, the tumor markedly decreased in size, 60% by volume as measured by CT, and histologically 90% necrosis was confirmed. Hemipelvectomy was performed. However, the patient could not receive further adjuvant chemotherpy because of post-operative deep infection. Six months after surgery, retroperitoneal metastases wete detected, and she died of recurrent disease twelve months later.
  • 横山 庫一郎, 篠原 典夫, 久保田 晃志, 花村 聡
    1997 年 46 巻 4 号 p. 1220-1221
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    We clinicopathologically analyzed 20 cases of soft tissue hemangioma, and found Magnetic Resonance Imaging to be useful for diagnosing painful lesions. Sixteen of 20 patients complained of pain, increasing after exercise. Difficulty of diagnosing hemangioma depends on disappearance of symptoms and the tumor itself when stopping exercise or resting. A particular hemangioma variant mainly occurring in the synovial tissue of the knee (synovial hemangioma), often causes severe pain and limitation in knee motion mimicking meniscal disorders, making it important to consider the possibility of hemangioma. Angiograms are useful for diagnosing synovial hemangiomas. Other diagnostic modalities, such as CT or MRI are of little help in the clinical diagnosis of this variant. Although MR images show discrete characteristic features of most hemangiomas, CT and MRI showed the synovial variant to be no more than non specific synovitis. Surgical extirpation is a treatment of choice, however, it is not always necessary to resect the lesion completely because of its unclear boundary.
  • 横山 庫一郎, 篠原 典夫, 前田 剛, 田坂 善彦, 斉藤 剛
    1997 年 46 巻 4 号 p. 1222-1224
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    Maligant pelvic tumors are difficult to manage because of a high incidence of recurrence and systemic spread. The long latency period between onset and diagnosis greatly increases the probability of metastasis. Patients are thus inevitably operated on after a considerable delay. Between 1975 and 1995, 33 patients had primary malignant tumors involving the pelvis. The ages of the patients (18 men and 15 women) ranged from 12 to 17 years, with an average of 41.8. Follow-up ranged form 7 months to 12 years, with an average of 28 months. There were 15 lesions in the ilium, eight in the ischio-pubic region, three in the sacrum, and seven soft tissue lesions invading pelvis. Of the 33 patients, 12 underwent wide resection including 7 hemipelvectomies, 7 marginal resections, and 6 patients an intralesional resection. In twelve patients, local recurrences had occurred. The main cause of local reccurrences was an inadequate surgical margin. In a patient aged 18 with malignant fibrous histiocytoma, after two courses of successful chemotherapy (VAC and MAID) and irradiation (30Gy of Liniac), a modified hemipelvectomy was intended. No further chemotherapy could be performed because of post-operative deep seated infection. The cause of the infection was thought to be radiation induced erosive dermatitis. The patient had distant metastases in the retroperitoneal cavity and left ilium 4 months after surgery.
  • 内側半月板断裂との関係
    石谷 栄一, 香月 一朗, 原口 和史, 田山 尚久, 藤田 秀一, 寺本 全男
    1997 年 46 巻 4 号 p. 1225-1226
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    The etiology of spontaneous osteonecrosis of the knee is still unknown. Severa authors have reported that medial meniscal tears are related to osteonecrosis. We report a case in which osteonecrosis occurred after sustaining a medial meniscal tear. A factor in the etiology of this disease is the stress concentration over the edge of the meniscal fragment.
  • 今村 寿宏, 大賀 正義, 田丸 卓弥, 有馬 準一, 生田 光, 江崎 幸雄, 吉兼 浩一, 冨重 守
    1997 年 46 巻 4 号 p. 1227-1232
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
    Panspinal canal stenosis is a well known complication of Achondroplasia. It can be difficult to decide which level is primarily responsible for this stenosis and the most suitable treatment. A 19-year-old woman who suffered from Achondroplasia with ossification of the yellow ligament is described. We performed laminectomy (Th8-L2) and PLF (L1-3) with instrumentation (Th12-L3). We found that 8 of 34. Achondropl astic patients had suffered from ossification of their yellow ligaments. We consider that there could be a relationship between Achondroplasia and ossification of the yellow ligament with reference to its static and dynamic factors in Achondro-plastic spinal stucture.
  • 1997 年 46 巻 4 号 p. 1233-1242
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
  • 1997 年 46 巻 4 号 p. 1243-1248
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
  • 1997 年 46 巻 4 号 p. 1249-1258
    発行日: 1997/09/25
    公開日: 2010/02/25
    ジャーナル フリー
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