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PGE1軟膏を用いたアルミホイル被覆療法
久保 学, 宮崎 憲一郎, 多田隈 元, 平岡 弘二, 佐藤 公昭
1998 年 47 巻 2 号 p.
577-580
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We have treated 20 cases of finger tip injury using PGE
1 ointment and occlusive dressing, during the period from Jan 1996 to Apr 1997. Their mean age was 45 years (ranging from 2 to 64 years). The level of injury was classified according to Sasaki's classification. Four cases were in level 1, 7 cases were in level 2, 4 cases were in level 3, 1 case was in level 4, and 4 cases were in level 7. At first, we performed sufficient irrigation, debridement, hemostasis, and resection of protruded bone. At several days later, we applied gentamicin ointment mixed with PGE
1 and covered this by sterilized aluminium foil as occlusive dressing. Then once a week as required, we re-irrigated the wound with osvan and changed the sterilized aluminium foil. The duration until regeneration of new skin in cases of a finger tip injury involving bone injury (level 2-4) was 22.6±7.7 days. Compared with previous reports, this term was shorter. We concluded that the teatment of finger tip injury using PGE
1 ointment and occlusive dressing was able to reduce the term of treatment.
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上田 淳, 小峯 光徳, 加藤 利樹, 芦原 愛, 渡辺 英夫
1998 年 47 巻 2 号 p.
581-584
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We treated 6 fingertips and 1 palm necrosis (3 cases) with an occlusive dressing using aluminium foil. Necrotomy was performed to flatten the surface until bleeding. We painted povidine iodine gel on to the raw surface and covered the fingertip and palm with aluminium foil over 1-2cm from the tip. We washed the surface with water every 2-5 days when the dressing was changed.
All cases healed. The raw surface changed to a good round fingertip, and 2-3mm of thick soft tissue was shown on X-ray. The period of treatment was 21-41 days (average 30 days).
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中島 英親, 寺本 憲市郎, 平野 哲也, 原田 香苗, 米満 弘之
1998 年 47 巻 2 号 p.
585-587
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
In Kumamoto Kinoh Hospital, between June 1981 and December 1996, we had 77 cases of multiple finger amputations involving more than three fingers. 10 of 77 cases received stumplasty in our hospital, 10 of 77 cases were treated by stumplasty in other hospitals, 17 of 77 cases were covered with a groin flap and 40 of 77 cases had replantation. After the stumplasty. We used the wrap around flap procedure in three cases of the thumb amputation and toe to finger transfer procedure in 6 cases of finger amputation. The degree of sensory restoration in the toe to finger transfer as determined by 2PD is as shown in Fig. III. 2PD of the toe to finger transfer cases was 7mm, 8mm, 9mm, 10mm and, 12mm. The degree of motor function was determind by TAM of the toe to finger transfer was 50°, 65°, 80°, 81°, 88° and 90°. Restoration of the motor function was necessarily good but the opposition to the thumb was very good.
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平野 哲也, 寺本 憲市郎, 武田 浩志, 中島 英親, 米満 弘之
1998 年 47 巻 2 号 p.
588-590
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We have performed wrist arthroscopic treatment in 35 patients for ulnar wrist pain associated with Triangular Fibrocartilage Complex tears, since 1994.
An arthroscopic partial resection was performed in 20 cases.
The age at surgery ranged from 16 to 52 years (average 32.7 years).
Follow-up averaged 9.8 months.
Post-Arthoscopy diagnoses were Palmer I-A; 6 cases, I-D; 3 cases, II-C; 11 cases.
In all cases with ulnar variant <+3mm, the results were evaluated as excellent and good, but in all cases with ulnar variant >+3mm, we were not able to achieve satisfactory results.
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中島 三郎, 沼田 亨, 山内 達朗, 外間 裕人
1998 年 47 巻 2 号 p.
591-593
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Between 1991 and 1996, one hundred and ten hands of eighty-six patients with carpal tunnel syndrome were treated surgically and followed (mean, twenty months; range, three to sixty months). Sixteen hands were treated with open carpal tunnel release using a conventional incision from palm to forearm, and ninety-four hands using a palm alone incision.
All patients were symptomatically improved following surgery. There was no neurovascular complications. Two of sixteen hands (12.5 per cent) with the conventional incision had hypertrophic scars. In contrast, all with palm alone incision had no complaints of excess scar.
Carpal tunnel release using palm alone incision is a safe and simple procedure, which is not associated with any significant neurovascular complications nor discomfort in the operative scar.
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衛藤 正雄, 伊藤 信之, 朝長 匡, 井上 博文, Mohammad Ehsanur Rabbi
1998 年 47 巻 2 号 p.
594-597
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Surgical procedures for the elbow flexor restoration in brachial plexus palsy depend on the paralytic status of the patient. 30 elbows of 29 patients were evaluated functionally following flexorplasty. The average age at surgery was 28.2 years (8 to 53 years) with an average follow-up period of 6 years. The procedures included intercostal nerve transfer (18 elbows), Steindler's method (6 elbows), latissimus dorsi transplantation (4 elbows) and pectoralis major transplantation (2 elbows). Bateman's operation in 9 cases and shoulder arthrodesis in 3 cases were carried out to stabilize the shoulder.
The elbow flexion strength were evaluated according to Daniel and Worthingham's muscle testing (M0 to M5). With intercostal nerve transfer, MMT improved to M4 in 5 elbows, M3 in 7 elbows and below M3 in 6 elbows at final follow-up.The average active flexion was 115°. 5 elbows had M4 and one M3 and the average active flexion was 104° with St.eindler's method. In patients with latissimus dorsi transplantation, 2 obtained M4 and rest 2 had M3 and M2 each. The average active flexion was 95°. In patients with pectoralis major transplantation, both the cases had M2.
From this study it can be suggested that muscle transfer should be considered than intercostal nerve transfer. Our results showed Steindler's method can provide a stable and satisfactory outcome.
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渡慶次 学, 金谷 文則, 普天間 朝上, 茨木 邦夫
1998 年 47 巻 2 号 p.
598-602
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report a patient who developed proximal radio-ulnar synostosis after two attempts of open reduction for congenital subluxation of the radial head. The patient was a 5 year-old boy who sustained a supracondylar fracture to his right humerus after a fall.
Coincident congenital radial head subluxation was misdiagnosed as traumatic dislocation and he received open reduction of the radial head and pinning. But the radial head subluxated again. He then received a second open reduction with pinning and osteotomy of the ulna. Proximal radio-ulnar synostosis developed after these surgeries. On the first visit to our clinic, he showed ankylosis of forearm in 10° pronation. X-p films and CT revealed proximal radioulnar synostosis. The synostosis was separated and the space created by separation was filled with the anconeus and vascularized fascio-fat graft from the ipsilateral upper arm. Three years after surgery, X-p films showed no re-ankylosis and supination improved to 35° and pronation improved to 45°.
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前田 和彦, 外間 浩, 大城 亙, 上原 邦彦, 新垣 寛, 金谷 文則, 茨木 邦夫
1998 年 47 巻 2 号 p.
603-606
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Panner's disease is defined as avascular necrosis of the humeral capitellum and was first reported by Panner in 1927. It usually occurs in boys younger than 10 years of age. Residual deformity and loose bodies are not usually seen.
Osteochondritis dissecans, which sometimes results in residual deformity and loose bodies, need to be distinguished from Panner's disease.
We experienced an eight-year-old boy with Panner's disease who was successfully treated by immobilization for 20 weeks. Radiograph and MRI showed satisfactory revascularization of epiphysis of the humeral capitellum. Prolonged immobilization may enhance the rapid revascularization of the humeral capital epiphysis.
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鳥越 雄史, 野口 雅夫, 中西 秀二, 手島 鍛, 飯岡 隆, 村田 雅和
1998 年 47 巻 2 号 p.
607-610
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We treated 10 cases of bone and joint infections by continuous closed irrigation. Subjects comprised 4 with acute osteomyelitis, 1 with chronic osteomyelitis, 4 with pyogenic arthritis and 1 with late infection after femoral head prosthesis. We used Kawashima's double lumen tube in all cases. The organisms were Staphylococcus aureus, Staphylococcus epidermidis, methicillin resistant Staphylococcus aureus (MRSA), methicillin resistant Staphylococcus epidermidis (MRSE) and Escherichia coli. The average irrigation period was 13.9 days.
All cases was healed and there was no recurrence. We recommend this method for bone and joint infections.
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加藤 利樹, 忽那 龍雄, 重松 正森
1998 年 47 巻 2 号 p.
611-613
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We investigated 4 cases of MRSA osteomyelitis. All cases occurred after fracture, and the pathogen was MRSA in all cases.
For treatment, we performed curettage of the focus and closed continuous irrigation, followed by general and local infusion of antibiotics. All infection was successfully treated. There are no effective drugs for MRSA infection, therefore we consider that surgical treatment in the early stage is the best therapeutic method.
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富村 奈津子, 谷口 良康, 牧 信哉, 濱里 雄次郎, 福村 憲司, 吉野 光
1998 年 47 巻 2 号 p.
614-616
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report eight cases of gas gangrene experienced from 1988 to 1997 in Kagoshima city Hospital and allied hospitals. The injured sites were lower extremity in seven (four cases with popliteal artery injury) and the palm in one. The period from the injury to onset was 2 to 7 days (average; 4.5 days). Our criteria for diagnosis of gas gangrene are as follows; fever, secretion with foul odor, crepitation, serious inflammatory reaction and roentgenogrophic gas. Six patients were treated by amputation of the affected limbs and two cases received a surgical limb salvage procedure. All patients were also treated by hyperbaric oxygen and antibiotics. The hyperbaric oxygen therapy seemed to be effective for borth clostridium and non-clostridium gas gangrene. The prophylactic hyperbaric oxygen therapy for gas gangrene seemed to be effective for cases with diabetes mellitus or poplitial artery injury.
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佐々木 誠人, 田村 裕昭, 井原 秀俊, 野呂 純敬, 永芳 郁文, 川嶌 眞人
1998 年 47 巻 2 号 p.
617-620
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We treated 26 patients of painful rotator cuff tear by arthroscopic subacromial decompression (ASD) without repair. These patients were over 70 years of age. In these patients 23 shoulders were full thickness and 3 were partial thickness rotator cuff tears. Patients were evaluated pre and postoperatively with the Shoulder Assessment Scoring System of Japanese Orthopaedic Society.
The average score increased significantly from more than 1 month after operation. Particularly, pain was relieved promptly and significantly. We have demonstrated that ASD is an effective form of treatment rather than other more invasive methods for patients of painful rotator cuff tear over 70 years of age.
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喜多村 泰輔, 柴田 陽三, 緑川 孝二, 緒方 公介
1998 年 47 巻 2 号 p.
621-623
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We assessed the acromio-humeral interval of 84 cases (86 shoulders) having rotator cuff tears. Their average age was 56.5 years. The acromio-humeral interval was measured in a neutral rotated position of the shoulder using antero-postero views. Second measurement was performed in which the acromio-humeral interval was divided by the radius of the humeral head. Average distance of the acromio-humeral interval was 8.6mm. The coefficient of correlation was 0.263 between the length of the cuff tear and the AHI, and was 0.438 between the width of it and the AHI. In the ratio of AHI/radius of the humeral head, the coefficient of correlation was 0.246 in the length of the cuff tear, and was 0.457 in the width of the cuff tear. There was not significant difference in coefficient of correlation between the AHI and the AHI/radius of the humeral head.
We can postulate the width of the cuff tear by measuring the AHI or the AHI/radius of the humeral head.
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弓削 七重, 伊藤 信之, 衛藤 正雄, 朝長 匡, 原 寛徳, 井上 博文, 白濱 克彦, M. E. Rabbi
1998 年 47 巻 2 号 p.
624-628
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Three dimensional motion of the scapula during arm elevation in the scapular plane was measured and analyzed in patients with rotator cuff tears using a fluoroscope. Patients were asked to elevate both arms to a maximum abduction position in the scapular plane slowly from a resting position over a time span of ten seconds. During this movement several recordings were taken and then analyzed in a micro-computer. There was a great deal of variation in the elevation angle of the arm with rotator cuff tears. However, there were no significant differences in the upward rotation angles, both in the resting position and in the maximum elevated position between the affected side and contralateral side. Downward tilting angle in the maximum elevated position of the affected side was significantly greater than that of the normal side.
The present study suggests that rotation of the scapula is not only maintained by the rotator cuff muscles but other shoulder girdle muscles are also responsible.
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平野 真子, 野村 一俊, 橋本 伸朗, 福元 哲也, 大島 卓
1998 年 47 巻 2 号 p.
629-633
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We compared the findings of ultrasonography and MRI of the rotator cuff. Yokokawa LOGIQ500 (7.5MHz) and Philips GYROSCAN T5II 0.5T were used. Twenty-four shoulders (24 patients) were examined. The average age of the patients was 62.0 years. All shoulders were examined by shoulder arthrography which showed 13 complete cuff tears, 2 in complete tears and 9 intact cuffs. The rate of co-incidence of finding of ultrasonography and MRI was 85.7%. Both methods were useful for cuff tear diagnosis. The diagnostic rate of ultrasonography was a little less than that of MRI. This was almost due to technical error. Ultrasonography is a very useful examination, it is convenient and costs less than many other diagnostic methods, so improved techniques will make this a reliable method. However MRI remains inevitable for surgical cases.
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西村 誠介, 伊藤 信之, 衛藤 正雄, 朝長 匡, 原 寛徳, 小田 純爾
1998 年 47 巻 2 号 p.
634-640
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Dislocation of the shoulder is difficult to reduce when it has been a long time since the initial dislocation.
We reviewed the results of surgical treatment in 4 patients with 4 right shoulders that hadn't been reduced. Their ages ranged from 30 to 70 years with an average of 51 years. The duration of the dislocation was between 6 weeks and 56 weeks, with a mean of 22 weeks.
Glenoplasty was attempted in 3 cases, and Total Shoulder Replacement in one case. The case with TSR was dislocated a few days after surgery and it was removed because of infection.
Assessment based on function or JOA score did not demonstrate such a good result. However, their ADL did improve.
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坂梨 謙一, 根本 理, 平良 肇
1998 年 47 巻 2 号 p.
641-647
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Coraco-acromial ligament transfer for 5 male patients with antero-inferior instability of the shoulder was reviewed. Averaged age was 19.8 years, ranging from 18 to 23 years. The follow up period ranged from one year and 5 months to 14 years, with a mean of 7 years and 3 months. In 3 patients without general Joint laxity, the rate of inferior instability was reduced from 72.1% to 18.3%, but the reduction was not satisfactory in 2 cases with general joint laxity. In 4 cases with voluntary subluxation, all had good reduction postoperatively. The average JOA score was improved from 66.4 points preoperatively to 91.2 points postoperatively. These results indicate that coraco-acromial ligament transfer seems to be effective for patients with antero-inferior instability of the shoulder, especially for patients with voluntary subluxation.
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藤井 康成, 小倉 雅, 奥脇 透, 酒匂 崇
1998 年 47 巻 2 号 p.
648-651
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We report one case who presented with suprascapular nerve paralysis caused by a ganglion.
The patient is a 20 year-old male, and a high-level athlete. He complained of pain and weakness of his right shoulder, and presented with marked atrophy of infraspinatus muscle. MRI and ultrasonography showed a cystic legion in supraspinatus fossa. We treated with a puncture of the ganglion safely under ultrasonography.
Eight months after puncture he has no signs of relapse and has returned to full sporting function.
In this study we show that ultrasonography is a useful method for diagnosis and treatment of suprascapular nerve paralysis caused by a ganglion.
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前田 芳郎, 井手 淳二, 山鹿 眞紀夫, 北村 歳男, 前田 智, 高木 克公
1998 年 47 巻 2 号 p.
652-654
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We operated on three patients with entrapment of the suprascapular nerve by a ganglion, but there was a recurrence in a first case after one year. We represent surgical techniques to allow neurolysis and complete removal of the ganglion in the spinoglenoid notch, reporting our surgical experience with the other two cases.
«A case report» Case 3. A 42-year-old worker gave a 7-month history of pain in his right (dominant) shoulder. He had difficulty in elevating his arm. On examination there was marked wasting of infraspinatus. EMG confirmed denervation of only infraspinatus. MRI showed a ganglion straddling the base of the spine of the scapula. At surgery, the spine of the scapula was cut to allow adequate exposure. Coloring matter was injected into the ganglion to find out its origin. It arose from the anterior superior capsule of the glenohumeral joint and its neck was ligated. We performed complete removal of the ganglion and neurolysis. SLAP lesion was found using arthroscopy of the shoulder. After the operation, pain was relieved. Fourteen months later the power of external rotation had improved and ultrasound examination confirmed no recurrence.
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松永 和剛, 城戸 正喜, 松崎 昭夫, 古賀 崇正, 佐藤 哲紀
1998 年 47 巻 2 号 p.
655-660
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Two cases of rheumatoid subacromial bursitis containing a large number of rice bodies are presented.
Case 1: A 51-year-old man visited our clinic with a chief complaint of swelling and motor pain in his right shoulder. Since December 1995, he had a swelling of the 2nd MP joint of his left foot. But RA-F, CRP, ESR showed no abnormality. He had been treated conservatively with NSAIDs, by an orthopedic surgeon. Since early September 1996, he noticed a swelling in the anterior aspect of his right shoulder and slight motor pain.
He visited our clinic on 27. 9. 1996. He had morning stiffness for 1 hour. A diffuse swelling on the antero-lateral aspect of the right shoulder was observed, showing local heat and fluctuation but no redness. Shoulder motion was not restricted. Swelling of the MP joint of the left 2nd toe was also recognized. Laboratory examination: ESR 19mm/46mm, CRP2+, RA-F 111iu/ml, Mantoux's Reaction (±). Plain radiograph showed no abnormality of his right shoulder, but bone erosion of the 2nd proximal phalanges. Subacromial bursography showed an enlargement of the bursa and a honeycomb shadow. The clinical symptoms, laboratory data, radiographs fulfilled the criteria for a diagnosis of definite RA. Surgical excision of the subacromial bursa and synovectomy of the left 2nd MP joint were performed on 16. 1. 1997. The subacromial bursa contained 111 rice bodies. Pathologic diagnosis was chronic rheumatoid arthritis. The postoperative course was uneventful.
Case 2: A 71-year-old woman, who was treated with NSAIDs, gold and steroids for RA by an orthopedic surgeon since 1964, visited our clinic on 1. 9. 1995, with a chief complaint of a swelling and pain in the anterior aspect of her left shoulder. Since August 1995 she had noticed swelling and pain in her left shoulder. The swelling increased gradually and ROM of the shoulder gradually decreased. The swelling was in the anterior aspect of the left shoulder, tenderness and local heat was recognized. Shoulder motion was slightly restricted. Plain radiographs showed no abnormality of the shoulder joint, but subacromial bursograph showed an enlargement of the bursa and a honeycomb shadow. Surgical excision of the subacromial bursa was performed on 9. 11. 1995.
The postoperative course was uneventful and she had no further problems with her shoulder.
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藤澤 基之, 緑川 孝二, 柴田 陽三, 山川 晃司, 緒方 公介
1998 年 47 巻 2 号 p.
661-666
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
A sixty-year-old man was seen complaining of discomfort and swelling without pain in his left shoulder. On examination slight restriction of motion was found, but the muscle strength of left upper extremity was within normal limits. The only positive result from the laboratory studies was elevation of the level of rheumatoid factor. Tuberculin test was found to be strongly positive. Thickening of the wall of subacromial bursa and a large number of rice bodies suspended in the fluid were observed by echo gram, MRI and bursography.
The subacromial bursa was resected surgically. After the operation, medical treatment for tuberculosis was started. Symptoms and abnormal data recovered to normal six months after operation. Pathological study of the tissue showed granuloma with caseous necrosis and multi-uncleated giant cells. Tuberculous bacteria was detected from the cultivation of the tissue. The diagnosis of tuberculosis of the subacromial bursa was thus confiremed.
We suggest that early surgical treatment is necessary to avoid invasion of the infected lesion to surrounding tissues.
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原 寛徳, 伊藤 信之, 衛藤 正雄, 朝長 匡, 宮本 力, M. E. Rabbi
1998 年 47 巻 2 号 p.
667-670
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We investigated the relationship between the slope and shape of the acromion and the spur at the antero-inferior surface of the acromion to clarify the cause of subacromial impingement. This investigation was performed with 394 scapular dry bone specimens. The specimens of 107 males were used. Their ages ranged from 20 to 83 years with an average age of 56.6 years. The specimens of 101 females were used and their ages ranged 24 to 92 years with an average age of 69.3 years. The acromial spurs of the acromion were identified. All acromions were classified visually at type I (flat), type II (curved) or type III (hooked) as described by Bigliani et al. The slope of the acromion was measured in all specimens.
A spur at the antero-inferior surface was seen in 180 acromions (45.6%). Almost all the spurs were located in the anterior one third of the acromion. In all specimens, 137 acromions (34.8%) were type I, 198 acromions (50.3%)were type II and 59 acromions (15.0%) were type III. The type of acromion was not related to the presence or absence of a spur. The average slope of all acromions was 47±8°, that of acromions with spur was 43±7° and that of acromions without spur was 50±8°. There was a significant difference between the slope of the acromion with spur and the acromion without spur. From this study it can be concluded that the type of acromion had no relationship to subacromial impingement and the flattened slope of the acromion might be one cause of subacromial impingement.
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安藤 徹, 市原 正彬, 田島 直也, 帖佐 悦男, 川越 正一, 園田 典生, 樋口 潤一, 小牧 一麿, 田辺 龍樹
1998 年 47 巻 2 号 p.
671-674
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We evaluated MRI findings of shoulder joint before and after pitching. Subjects comprised 14 males ranging from 19 to 27 years. All had a long history of baseball activities ranging from 12 to 20 years. Magnetic resonance imaging was performed before and after throwing 100 balls with full energy. As a result in T2 weighted image after pitching, theintensity of subacromion in m. supraspinatus, glenoid cavity and m. subscapuralis was significantly higher than that before pitching. In the short T1 inversion recovery images 4 males had retention of synovial joint fluid in their shoulder joint, inferior pouch and m. subscapularis bursa. We concluded that their findings showed water ambulation, increase in local blood circulation, inflammation and edema in their tissues and the efficiency of magnetic resonance imaging of the shoulder joint for pitching was confirmed in these findings.
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宮本 力, 伊藤 信之, 衛藤 正雄, 朝長 匡, 原 寛徳, 安達 耕一
1998 年 47 巻 2 号 p.
675-678
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We investigated osteophytes in the greater and lesser humeral tubercle. 331 shoulders of 192 patients were used for the study. The ages of the patients ranged from twenty to ninty-two years and averaged 61.9 years. 193 shoulders were men and 138 shoulders were women. We observed the osteophytes in the greater and lesser tubercle, and measured the humeral angle.
Osteophytes in the greater and lesser tubercle were found around the bicipital groove. The incidence for osteophytes was 29.6% (98 shoulders) in the greater tubercle, 36.3% (120 shoulders) in the lesser tubercle, and 45.6% (151 shoulders) in the acromion. There was a relationship between osteophytes of the greater tubercle and osteophytes of the acromion in shoulders where the bicipital groove was in a position of external rotation.
We considered that osteophytes were mainly caused by collision.
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後藤 英文, 比嘉 頴秀, 蒲原 光義, 原賀 勇壮
1998 年 47 巻 2 号 p.
679-684
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
It is possible to grow an artificial skin graft using skin originating from calf collagen and use this to treat deep wounds involving Bone, Muscle and Tendon.
We treated 6 patients with such an artificial skin graft. Four of these patients had Bone, 1 patient Joint and 1 patient Tendon wounds.
We were able to grow this artificial skin graft in 4 patients. However it did not grow in 2 patients, because of infection.
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豊原 一作, 金谷 文則, 普天間 朝上, 茨木 邦夫, 金澤 浩二, 新垣 晃, 北城 武司
1998 年 47 巻 2 号 p.
685-689
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
26 flaps were used for vulvovaginal reconstruction following radical or wide resection of malignant tumor in 15 patients. There were eleven vulvar carcinoma, two uterus carcinomas, and one vaginal carcinoma. The mean patient age was 65 years (33-85 year-old). 19 gracilis myocutaneous (M-C) flaps were used in ten patients, four posterior thigh fasciocutaneous (F-C) flaps in three patients and three local flaps in two patients. Six gracilis M-C flaps in three patients were used to supplement the dead space and vaginal reconstruction after pelvic exenteration. The other 20 flaps in twelve patients were used for vulvar reconstruction. All but one flap survived. A unilateral gracilis M-C flap in which the skin flap was 25cm in length showed partial necrosis. Two patients receiving gracilis M-C flaps complained of discomfort during gait because of their bulk. One patient receiving posterior thigh F-C flap developed bursitis and required bursectomy. The other patient receiving local flaps needed debridement and closure for wound dehiscence. Gracilis M-C flaps were best suited for reconstructing both the defect after pelvic exenteration and the vagina. Posterior thigh F-C flaps were indicated for large vulvar defect and local flaps were indicated for small defects.
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和田山 憲, 田中 宏道, 吉武 明人, 白木原 憲明, 吉岡 徹, 小林 靖幸
1998 年 47 巻 2 号 p.
690-692
発行日: 1998/03/25
公開日: 2010/02/25
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フリー
Eight patients who had treated with Poly L-Lactic acid osteosynthetic implants from January 1995 through January 1997 were evaluated. There were three rotational acetabular osteotomies, two tibia plateau fractures, two talus fractures, one osteochondritis dissecans. It is not neccesary to remove Poly L-Lactic acid osteosynthetic implants. We can evaluate bony and cartilage change of early period by MRI and CT scan. We conclude that Poly L-Lactic acid implants are safe and effective alternative to metallic osteosynthetic implants for fractures and osteotomy.
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池田 実, 井上 敏生, 石西 貴, 緒方 公介
1998 年 47 巻 2 号 p.
693-697
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We measured IgG-RF in the synovial fluid of 34 patients (39 joints) with rheumatoid arthritis (RA) by enzyme immunoassay. As a control group we measured IgG-RF in the synovial fluid of 20 patients (22 joints) with osteoarthrosis and hydroarthrosis. We measured IgG-RF in the synovial fluid of non RA patients consisting of one patient (one joint) with gout arthritis, one patient (one joint) with pseudo gout and 2 patients (2 joints) with monoarthritis. The IgG-RF titer in the synovial fluid from RA patients was significantly higher compared to the control group and non RA patients. There was a significant correlation in the IgG-RF in the synovial fluid, between stage 1 and 2, 1 and 3, in the X-ray staging of the joint that was aspirated. The IgG-RF titer was high, above 2.0, in almost all cases of stage 2 and 3 on X-ray and demonstrated high activity. These results suggest a correlation between IgG-RF in the synovial fluid of RA patients and radiologic progression.
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篠原 一郎, 清水 正人, 谷田 玲
1998 年 47 巻 2 号 p.
698-700
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Twenty cases (20 joints) of total knee arthroplasty which were performed between 1994 and 1996 at our hospital were reviewed interms of intraoperative hemorrhage, blood transfusion, postoperative chages in Hb and Ht, and complications. The cases were divided into two groups, i. e., those (8) in which intraoperative avascularization was released, and after bleeding poits in the soft tissue were ligated, avascularization was performed again in combination with suction drainage and those (12) without the release of intraoperative avascularization or suction drainage Difference in Hb and Ht between the day before and the second day after operation, mean intraoperative hemorrhage and mean total volume of blood transfused were significantly smaller or less in the latter cases than in the former cases although differences in Hb and Ht between the day before and the seventh day after operation were not significant. These results suggest that performance of neither intraoperative avascularization or suction drainage may decrease hemorrhage during total knee arthroplasty.
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脇岡 徹, 佐藤 直人, 田中 信博, 善明 美千久
1998 年 47 巻 2 号 p.
701-703
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
A rare case of giant cell tumor of the tendon sheath appearing in the wrist is reported. A 25-year-old female complained of painless tumor in her right wrist. MRI, CT and bone scan showed soft tissue tumor in the wrist. The tumor was extirpated and diagnosed pathologically as giant cell tumor of the tendon sheath. Six months after the treatment, there is no recurrence of the tumor.
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中村 英次郎, 井口 竹彦, 中村 太郎, 山田 秀大, 七森 和久, 酒井 祐一, 林 義裕, 畑田 和男
1998 年 47 巻 2 号 p.
704-707
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Five cases of the fracture of the sternum due to use of a seat belt were reported. According to the Fowler's classification, our cases were classified as TYPE: 1 case, Type IV: 3 cases and Type VIII: 1 case. With regard to four cases (type I and IV), the mechanism of the fracture was direct violence.
A case associated with the injuries of interspinal ligaments of the thoracic spine, the mechanism of the fracture was indirect violence as flexion-compression injury. All cases were treated with rest and immobilization. The importance of radiographic examination on the sternum in patient of seat belt injury.
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井原 成男, 畠山 英嗣, 永島 雅人, 酒井 昭典
1998 年 47 巻 2 号 p.
708-711
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Nine patients suffering from displaced fractures of the proximal humerus have been treated surgically with intramedullary curved Kirschner wires since 1996. All of these fractures were classified as group 3 according to Neer's sclassification. The number of Kirschner wires used for each patient were: three wires in seven cases, four in one case and two in one case. No patients had any wires slipping out distally. Eight patients had sound union of fractures and satisfactory results. This operative procedure, which gives less surgical stress and sufficient stability for fractures, is considered to be very useful for patients with either advanced age, severe osteoporosis or concomitant systemic disease.
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辻本 律, 弓削 大四郎, 三村 寛, 酒井 和祐, 中村 克巳, 貴船 雅夫, 伊達 武利, 白倉 祥晴
1998 年 47 巻 2 号 p.
712-715
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Two patients with a thumb defect had reconstructions with great toe transfer. One had the entire great toe transferred and the other a trimed great toe transfer.
Both great toes survived completely. Follow up periods were 8 months and one year vespectively.
Regarding the results, patients were satisfied with their cosmesis, especially its shape and nail appearance. In addition, the functional results were satisfactory. The reconstructed IP joints were mobile and stable, and made a powerful pinch and grasp possible.
In spite of losing all of their great toe, the patients didn't have any severe difficulty in walking, although they had a slight disturbance when making a quick turn.
At present, in Japan, great toe wrap around flap or second toe transfer is preferably selected for thumb reconstruction. However, great toe transfer could be a suitable choice for patients with thumb losses at the level of the metacarpal bones.
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松田 秀策, 藤井 敏男, 高嶋 明彦, 高村 和幸, 桶谷 寛
1998 年 47 巻 2 号 p.
716-721
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We reviewed the results of 15 knees in 11 patients who underwent semitendinosus transfer (Uezaki's procedure) at Fukuoka Chilyden's Hospital and Medical Center from 1983 to 1996. Five patellae were permanent dislocations, 2 were recurrent and 8 were habitual. The mean age at the time of the operation was 8.1 years, and we examined the results after an average follow-up period of 5.3 years.
According to our own clinical evaluation methods, the results were satisfactory in 12 knees and unsatisfactory in 3 knees.
We examined the sulcus angle, tilting angle, congruence angle and the lateral shift ratio on X-rays. Most angles and ratios decreased except in the 3 unsatisfactory cases.
In the 4 unilateral cases, we found that the earlier surgical reduction was performed on the patella, the better the improvement in the shape of the sulcus of the patellar groove.
For the purpose of earlier diagnosis, we examined patello-femoral congruity on MRI scans of 1 case with nail-patella syndrome whose patella was not able to be viewed on X-rays.
We concluded early diagnosis and operative reduction was extremely important for the treatment of dislocation of the patella in children.
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池田 慶裕, 城戸 研二, 田中 浩, 脇坂 敦彦, 峯 孝友, 河合 伸也
1998 年 47 巻 2 号 p.
722-724
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We reviewed 40 primary arthroplasties (in 36 patients) in which AML type hip prostheses were used and evaluated these cases clinically and radiographically.
The mean age of patients at surgery was 60 years (range 44 to 77 years) and they were followed up for an average of 39 months (range 24 to 72 months). All patients had osteoarthritis.
24 hips were hybrid type and the others were cementless type.
Clinical results using JOA score were excellent in all cases with marked relief of pain; preoperative total average score of 49 points was improved to 94 points postoperatively.
Radiographical evaluation was done of both the outer head and stem sites (initial gap, clear zone, osteolysis, pedestal formation, etc).
For acetabular dysplasia cases, massive bone grafting or high positioning of the socket during THA may be required.
In this study, 6 hips were settled in a position higher than the original acetabular position to obtain cup containment without acetabular bone-grafting. We achieved a comparatively good result in these cases: preoperative total average JOA score of 43 points was improved to 83 points postoperatively. Positioning of the socket higher may sometimes be recommended in such cases where a bone defect may arise if the socket is settled in the original acetabular position.
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藤井 謙三, 峯 孝友, 城戸 研二, 木戸 健司, 小川 清吾, 藤本 英明, 河合 伸也
1998 年 47 巻 2 号 p.
725-727
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We studied the results in six knees (five patients) -one male and four female who had patello-femoral unstable joint disorders and were treated by the modified Roux-Goldthwait procedure. Age of patients at surgery ranged from 14 to 22 years (mean; 18 years).
The results were analyzed after followups ranging from 3 months to 75 months (mean: 29 months). Clinical and radiographic evaluation demonstrated relatively satisfactory results.
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吉田 典弘, 高岸 宏, 松田 了聡, 高上 真一, 大島 英雄, 種村 一麿
1998 年 47 巻 2 号 p.
728-732
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We performed osteosynthesis for proximal humeral fractures using percutaneous threaded Kirschner wire. Cases comprised one male and six femals, with an average age of 44 years. Average follow-up period was four months.
Under general anesthesia, the fractures were reduced, and alignment of the fracture was checked using an image intensifier. A threaded Kirschner wire was inserted from the deltoid tubercle to the humeral head, along a medial portion of the humeral neck under the image intensifier control.
Involved arms were immobilezed with slings. Pendulum exercise was started two days after operation. Active assisted exercise was started at 8 days, and active motion at 15 days.
Theses patients were assessed using the Japanese Orthopaedic Association Shoulder Scoring System (JOA score).
(Results) All fractures united, and complications didn't occur except for slight irritation at the skin insertion. All Kirschner wires remained at the inserted position, except one case. Average JOA score was 92 points, except for one case who had inferior subluxation.
(Conclusion) Osteosynthesis for proximal humeral fractures using percutaneous threaded Kirschner is a conventional and non-invasive technique.
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真鍋 尚至, 西島 宗孝, 岩城 彰, 堤 義明, 藤原 将巳, 大石 聡, 浅山 勲, 森久 喜八郎, 熊本 芳彦
1998 年 47 巻 2 号 p.
733-735
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
We treated chronic osteomyelitis of the tibia with musculocutaneous flap transplantation from the latisimus dorsi.
The patient was a 79-year-old male. He developed osteomyelitis of his right tibia 76 years previously. Since then, he had been treated with skin flap transplantation at the age of 38 and with Papineau's method 29 years later.
This time, a large skin defect was observed on the anterior aspect of his lower leg. Pseudomonas aeruginosa was detected from the pus culture.
We performed curretage and irrigation for the lesion twice to lessen the activity of infection. We then transplanted latissimus dorsi musculocutaneous flap to cover the defect of lesion.
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麻生 邦一
1998 年 47 巻 2 号 p.
736-738
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Thirteen cases of EDC tendon dislocation at the MP joint were treated and studied clinically. Nine after were treated conservatively by splinting, while 4 cases were treated operatively using Wheeidon's method.
Six cases of subluxation of EDC healed rapidly after 2-3 weeks, but in 3 dislocation cases it was difficult to achieve optimal healing and the patients complained of disturbances in activity of daily living during treatment due to the splinting. On the other hand, 4 cases treated by surgery all healed.
I believe that operative treatment is the first choice for dislocation of EDC tendon at the MP joint.
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山田 徹, 後藤 琢也, 山下 寿, 森田 雅和, 安陪 淳, 坂井 健介, 橋本 彰二, 荘 念仁, 村上 秀孝
1998 年 47 巻 2 号 p.
739-741
発行日: 1998/03/25
公開日: 2010/07/01
ジャーナル
フリー
We report the realities of our emergency medical treatment, and define problems associated with being a regional hospital. The method of presentation, cause of injury, and the principal complaint were collected and examined. Targeted patients included 5, 992 in total examined mainly by the orthopaedics department. They accounted for 11.9% of 50, 273 patients cases who were sent to our hospital for emergencies.
According to our data, 12% of 5, 992 patients required admission to hospital. This number comprises 65% of the total yearly orthopaedics inpatients. We also found 33% of the patients come from the suburbs of Kurume city, reflecting the role of the hospital works well as the major regional hospital.
However these are times when the second or the third emergency patients are not treated adequately. This implies, the first (the most urgent) patients are treated urgently white less urgent patients are not treated as well. We suggest adjustment to our medical systems. In the near future we have to examine our hospital's function as well as the needs of the community.
After doing this, we may have to adjust our medical care systems.
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外間 裕人, 白石 稔, 水田 博志, 中村 英一, 大塚 豊, 水本 圭彦, 工藤 智志, 高木 克公
1998 年 47 巻 2 号 p.
742-746
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
Magnetic resonance (MR) imaging was performed in 28 patients with clinically stable knees after anterior cruciate ligament (ACL) reconstruction using rolled-iliotibial tract autograft. MR imaging evaluations were done with a O. S. T whoiebody system (Philips, Gyroscan). In the obliyue-sagittal plane, parallel to the ACL, proton density, T1-and T2-weighted images were obtained using a spin echo sequence. The interval from surgery to MR imaging was a mean of 27 months (range 12-48 months). MR image findings of each reconstructed-ACL were categorised depending on the shape (straight, curved), on the clarity (well-defined, ill-defined, and vague), and on the homogeneity (homogenceous, massive-inhomogeneous, and lincar-inhomogeneous).
None of the ACL grafts were indisceinible. All MR images were classified into 8 groups. The “Straight well-defined, Iincar-inhomogeneous” type of MR image (8 patients, 29%) was the most commonly reported, but in general MR imaging of the reconstructed-ACL demonstrated a variable appearance.
We believe that the signal intensity of MR imaging was of little value in detecting the quality of the reconstructed-ACL graft using the rolled-iliotibial tract.
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1998 年 47 巻 2 号 p.
747-754
発行日: 1998/03/25
公開日: 2010/02/25
ジャーナル
フリー
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1998 年 47 巻 2 号 p.
755-760
発行日: 1998/03/25
公開日: 2010/02/25
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