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高須 宣行, 福島 明, 丹生 譲治, 福嶋 寛子, 上山 高尚
1998 年 47 巻 4 号 p.
1308-1311
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We performed rotational acetabular ostetomy (RAO) on 14 patients. All subjects were women, their ages at surgery ranged from 25 to 52 years, and the follow-up period averaged 4 years. We compared the CE angle and AC angle before and after surgery.
All patients showed improvement of both the CE angle and AC angle. The mean CE angle improved from 4.4 degrees to 24.6 degrees (p<0.01), and the mean AC angle from 23.8 degrees to 8.3 degrees (p<0.01). The range of motion (flexion and abduction) did not decrease alter surgery. 1 patient showed progression of the degenerative change by the necrosis of the rotated bone.
The clinical results for RAO were not significant compared to early stage OA (11 hips) and advanced OA (4 hips).
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蒲原 光義, 内藤 正俊, 金宮 毅, 緒方 公介
1998 年 47 巻 4 号 p.
1312-1313
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We performed curved periacetabular osteotomy on 20 hips in 20 patients with osteoarthrosis in the dysplastic hip since 1995. Anteroposterior radiograph in abduction is useful for simulating the postoperative relationships of the femoral head and acetabulum in the frontal plane. Since, however, there exists no method for simulating the same relationships in the sagittal plane, false profile radiograph of the flexion, which is a dynamic false profile view, was taken for the evaluation of the anterior coverage and congruency in the sagittal plane prior to curved periacetabular osteotomy.
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橋口 隆, 高橋 克郎, 榎本 寛, 白石 公太郎, 進藤 裕幸
1998 年 47 巻 4 号 p.
1314-1317
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We experienced 2 cases of bilateral THA with ankylosing spondylitis. In this study, the benefit of bilateral THA for ankylosing spondylitis was evaluated. The cases were 38 years old and 72. They complained of bilateral coxalgia and stooped posture due to flexion contructure of the hip and kyphosis deformity of the spine. Radiological findings of the hip joints showed screlosis, cystic formation, and absense of joint space.
The duration of follow-up was 2 years and 4 years, after which relief of coxalgia and improvement of stooped posture was seen. From the lateral view of the spinal radiographs, kyphosis index had not changed but the sacro-femoral angle improved. This suggests that bilateral THA for ankylosing spondylitis improves stooped posture due to the removal of the flexion constructure of the hip.
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山藤 良史, 河野 龍之助, 倉信 耕爾, 星野 弘太郎, 嘉本 慎也
1998 年 47 巻 4 号 p.
1318-1321
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
Total hip arthroplasty using a hybrid prosthesis (consisting of a cemented femoral component and an uncemented acetabular component) was performed on 14 hips. The subjects included 2 men and 12 women who age at operation ranged from 47 to 77 years (mean 65.4 years). The mean duration of follow-up was 6 years 11 months, ranging from 5 years to 8 years 3 months.
The clincal results were evaluated using the Japanese Orthopaedic Association (JOA) scoring system as well as evaluation of radiological findings. The preoperative JOA score was 48.7 increasing to 84.8 after 5 years. Radiopaque lesions were seen on the acetabular side in several cases but there was no evidence of loosening in any of the cups. Clear zones were seen on the femoral side in 11 cases within 1 year and there was evidence of loosening in 1 case.
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綾 宣恵, 島内 卓, 本松 伸一, 星野 秀士, 江口 正雄
1998 年 47 巻 4 号 p.
1322-1327
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
Autologous blood is generally considered the safest blood transfusion method. Perioperative homologous blood transfusion is associated with numerous problems such as transmission of certain diseases, such as GVHD (graft-versus-host disease), or AIDS (transfus ion-transmitted acquried immune deficiency syndrome). To defermine whether the administration of recombinant human erythropoietin (rh-EPO) increases the amount of autologous blood that can be collected prior to surgery, we studied 210 adults scheduled for elective orthopedic procedures. 183 of these patients were administered rh-EPO [group EPO (+)], and 27 patients were not [group EPO (-)]. All patients received iron sulfate. The mean autologous blood volume collected was significantly greater in the group EPO (+) than in the group EPO (-) (890vs. 677ml; p<0.0001). The preoperative group EPO (+) showed a greater increase in the mean haemoglobin concentration than the group EPO (-). (2.095vs. 0.915g/dl; p<0.0001). Postoperative haemoglobin recovered significantly more rapidly in the group EPO (+). We conclude that recombinant human erythropoietin increases the ability of patients about to undergo elective surgery to donate autologous blood.
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橋本 幸枝, 佐藤 直人, 斎藤 吉由, 樋口 富士男, 井上 明生
1998 年 47 巻 4 号 p.
1328-1333
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We retrospectively studied autologous blood transfusion in 65 cases of hip and knee arthroplasty. The cases consisted of 10 males and 45 females whose age ranged from 34 to 81, with an average age of 61.3 years.
Autologous blood was preserved by liquid, and in 35 cases, Erythropoietin (EPO) was intravenously administrated 3 times a week.
We have been performing autologous blood transfusion on patients treated with hip and knee arthroplasty since 1990, and the method allows us to avoid homologous transfusion in 88.9% of our patients.
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生田 拓也, 喜多村 泰輔, 田北 親寛
1998 年 47 巻 4 号 p.
1334-1337
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
Seven cases with osteoarthritis of the hip joint were treated by total hip arthroplasty together with bone graft using bioabsorbable screws.
The averase JOA score improved from 57.3 to 89.3. The Bone union was achieved in the bone grafts of all cases. Only one case showed problems associated with bioabsorbable screws, where the screw head is absorbed by the surrounding bone.
Bioabsorbable screws are safe and useful for bone graft in total hip arthroplasty in place of metal or sapphire screws.
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渡辺 伸彦, 池田 実, 西野 一郎, 有水 淳
1998 年 47 巻 4 号 p.
1338-1341
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We experienced one case of dislocation of the inner head in biporal hip prosthesis caused by the wear of the HDP liner. The case, a 82 year-old woman with left femoral neck fracture was treated with biporal hip prosthesis, without self-centering mechanism, approximately 11 years ago. She had severe pain in her left hip while sitting down on her heels, and was unable to walk. Roentogenogram of the hip revealed extreme varus position of the outer head and dislocation of the inner head in bipolar hip prosthesis. Surgical exploration revealed the outer head that was fixed in the varus position, hyperplastic granulation in acetabulum, and manifest wearing of all inner HDP liners. This suggested that the wear occurred due to impingement between the stem neck and outer head fixed in the varus position. In conclusion, we should follow-up carefully after operation for a long period of time, and help the patient resume proper daily activities.
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坂田 浩章, 堤 隆治, 高野 晴夫, 西 芳徳, 成尾 政一郎, 岡嶋 啓一郎
1998 年 47 巻 4 号 p.
1342-1343
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
A case with failure of the liner-locking mechanism as well as disassociation of the polyethylene liner from the titanium-alloy shell is described.
In January 1995, left total hip arthroplasty was performed on a 69-year-old woman for the treatment of osteoarthritis. 24 months postoperatively, the patient expenenced immediate mild pain in the hip when she turned around. Acetabular revision revealed complete disengagement of the Harris-Galante acetabular component (Zimmer), and that three peripheral tines of the liner-locking mechanism had broken.
Careful observation is further required for patients implanted with the same prostheses as the one we reported.
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有岡 美佐, 野口 蒸治, 志波 直人, 中島 義博, 柳 東次郎, 久保 学, 樋口 富士男, 井上 明生, 田川 善彦
1998 年 47 巻 4 号 p.
1344-1349
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
There were 89 revision cases among 1315 total hip replacement (THR) until December 1996 at the Kurume University, and the rehabilitation of these revision cases was evaluated. The mean revision age was 65 years old, and the average period from the previous THR was 10 years and 6 months. Allobonegraft was used for significant osteolysis, and the Kerboull cross plate for such acetabulum. The Dall-Miles cable grip system was used for the re-attachment of the greater trochanter. The Sarmient brace was applied in the cases with weak femora, and hip abduction brace was also applied for easy dislocation cases. The details of rehabilitation should be decided according to the biomechanical characteristics of each operative device, technique, and individual bone condition.
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糸川 高史, 藤井 敏男, 高嶋 明彦, 高村 和幸, 柳田 晴久
1998 年 47 巻 4 号 p.
1350-1353
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We studied the results of external oblique muscle transfer for the lumbar spina bifida. We operated on 11 hips of 8 patients from 1994. The neurosegmental level of the patients were the first lumbar level with one patient, the third or fourth with five patients, and the fifth with five patients. Nine hips were subluxated and two hips were dislocated.
External oblique muscle transfer is easier than iliopsoas transfer and does not weaken the flexor muscle compared with iliopsoas transfer.
All the hips except two maintained concentric reduction after surgery in X-ray. Hip flexor power did not decrease and walking ability improved at the time of followup.
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粟国 敦男, 上原 敏則, 平 宏章, 長嶺 功一, 親川 勝, 譜久山 充, 中島 聡一, 仲地 聡
1998 年 47 巻 4 号 p.
1354-1359
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
Proximal femoral derotational osteotomy was performed bilaterally on 10 children who had spastic diplegia with internal rotation gait, in combination with simultaneous multiple operations for soft tissue contractures of the lower extremities.
The degree of derotation was determined intraoperatively and about 10° internal rotation at the hip was expected after surgery. Soft tissue release was followed about 4 weeks after osteotomy.
The mean age at operation was 6 (4-10) years.
The average follow-up was 1 year and 11 months (4 months-5 years).
The average femoral anteversion was preoperatively 62° (55-70°) and improved to 24° (0-50°) in the final examination.
The average derotation measured intraoperatively was 56° (45°-70°) and the average internal rotation at the hip reduced from 77° (55°-105°) to 32° (15°-50°) with a similar increase in external rotation after operation. All patients except one showed improvement of the internal rotation gait.
One showed a mild recurrence of the unilateral internal rotation gait.
The average time to regain preoperative ambulatory status was 5.3 (3.5-9) months. No children got worse in terms of walking ability.
We realized that derotational osteotomy is necessary for correcting internal rotation gait in addition to soft tissue release.
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井上 敏生, 緒方 公介, 城島 宏, 藤原 明, 吉村 一朗, 金澤 和貴, 菊田 朋朱
1998 年 47 巻 4 号 p.
1360-1362
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We performed ultrasonography on 12 cases of developmental dysplasia of the hip before treatment with the Pavlik harness and evaluated the relation between ultrasonography findings and the results of the treatment. All were unilateral cases and the average age at the initial treatment with the Pavlik harness was 3 months. Reduction was obtained by the initial application of the Pavlik harness in 8 cases, and by re-application in 2 cases. Reduction was not obtained in 2 cases. According to Graf's classification, 3 cases belonged to type II c, 6 cases to type D, and 3 cases to type III. All 3 cases of type II c and 5 cases of type D were successfully reduced by the initial application of the Pavlik harness, and 1 case of type D was successfully reduced by the reapplication of the Pavlik harness. On the contrary, 2 cases of type III were not reduced by the Pavlik harness, and in the 1 case of type III that was reduced by the re-application of the Pavlik harness, irregularity of the femoral epiphysis in the plain radiogram occurred later. It can therefore be concluded that treatment with the Pavlik harness may not be suitable for type III cases and above.
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牟田 實, 肥後 勝, 山元 拓哉
1998 年 47 巻 4 号 p.
1363-1365
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We reviewed the radiographs of 76 patients (76 hips) with Perthes disease for the results of treatment with abduction brace in order to compare the predictive value of the Catterall classification and the lateral pillar classification. The average age at onset was 6.9 years, and the length of follow-up was 8.2 years. All hips were evaluated by the Catterall classification and lateral pillar classification at the fragmentation stage. Evaluation at the last follow-up was performed by the Stulberg classification. 59 hips (78%) were good results (Stulberg class I, II) and 17 hips (22%) were poor results (Stulberg class III, IV). There was no significant difference between both classifications in the last results. Lateral pillar classification serves as an easy method to group patients and is useful for the prediction of prognosis.
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榎本 寛, 松林 昌平, 橋口 隆, 高橋 克郎, 進藤 裕幸
1998 年 47 巻 4 号 p.
1366-1370
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
Seven cases of septic arthritis of the hip in children over one year old were examined at the average follow-up period of 3.4 years. Arthrotomy was performed on six patients after diagnosis had been established by joint aspiration. Five patients who were treated within 9 days from the onset of symptoms had excellent or good results. One patient with whom arthrotomy was performed 13 days from the onset, had fair results with radiological evidence of the osteonecrosis of the femoral head. One patient with whom neither arthrotomy nor aspiration had been performed, also had limited movement of the hip joint with the osteonecrosis of the femoral head.
We recommend immediate diagnostic joint aspiration for all cases with suspected septic arthritis of the hip joint, and emergency arthrotomy should be performed as soon as septic arthritis is diagnosed
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新しい撮影法によるX線計測
田代 宏一郎, 寺本 司, 穂積 晃, 鈴木 良平, 進藤 裕幸
1998 年 47 巻 4 号 p.
1371-1373
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
The purpose of this study was to evaluate the relationship between the transverse arch and hindfoot in normal foot by a new radiographic method. The subjects were 34 feet of 17 cases, consisting of 12 males and 5 females whose average age was 33 years (24-52 years). We used an original device which takes roentogenogram at 20 degrees of dorsiflexion of the MTP joints. In both leg standing position, the center of X-ray inserted from front to 2nd metatarsal axis and bottom level of device. We decided the bottom point of the 1st metatarsal head (A), 2nd metatarsal head (B), 5th metatarsal head (B), and axis line of the calcaneus on the roentogenogram. We measured the length of line AB and the distance from M to AB, and calculated the height of the 2nd metatarsal head as the transverse arch (H%). We measured the angle between the calcaneal axis and line AB too (θ°). The average of H was 4.54±1.69% (1.64-7.45%), and the average of θ was 96.5±4.48° (87.0-105.0°). Since we were able to evaluate the relationship between the transverse arch and hindfoot from one roentogenogram by our new method, it indicates that the technique is useful.
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山下 彰久, 野村 茂治, 福岡 真二, 首藤 敏秀
1998 年 47 巻 4 号 p.
1374-1378
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We experienced a rare case of the anomaly of the foot accompanied with congenital deficiency of the subcutaneous fat tissue. In this case, problems included the shortening of the leg, pes varus and talipes calcaneus with pain due to callus.
When the patient was six, we performed anterior release of the foot, osteotomy of the head of the talus, iliac bone graft, and free skin graft to fix the foot in the equinus position. Sixteen years old now, he is able to swim and play baseball, and is satisfied with the operational treatment.
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喜山 克彦, 金谷 文則, 渡慶次 学, 前原 博樹, 茨木 邦夫
1998 年 47 巻 4 号 p.
1379-1383
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We successfully treated intractable infected lateral malleolar bursitis with radical dèbridement and lateral supramalleolar flap in 4 patients. The lateral supramalleolar flap, described by Masquelet, is a fasciocutaneus flap supplied by the perforating branch of the peroneal artery. All 4 patients were male whose age at surgery ranged from 49 to 58 (mean 54 year-old). All patients showed some complications, such as hypesthesia in both legs with cervical myelopathy, akinesia with schizophrenia, anesthesia in both legs with meningocele and alcoholic polyneuritis. The preoperative period of the conservative treatment ranged from 6 weeks to 3 years 9 months (mean 2 years and 5 months). Skin defect after radical debridement of the bursitis including resection of the bony spur was covered with lateral supramalleolar flap (length 4-7cm, width 4-5cm). Skin graft was performed to cover the donor site. The length of follow-up ranged from 3 months to 5 years (mean 2 years and 5 months). All flaps survived completely and there has been no recurrence of the bursitis. We consider lateral supramalleolar flap the treatment of choice for the coverage of the lateral malleolus. The advantages of this flap included relatively large size, and stable blood flow by orthograde flow.
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和田 研
1998 年 47 巻 4 号 p.
1384-1387
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
729 females over 40 years old were studied for bone mineral density of the radius (DEXA method) and X-rays of the spine.
The incidence of vertebral fractures increases with age and as the bone mineral density (BMD) decreases.
The BMD average with vertebral fractures was significantly low.
While the BMD of the distal radius show correlation with vertebral fractures, it cannot serve as the single method for diagnosing osteoporosis.
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術後の生命予後
小川 清吾, 河合 伸也, 田口 敏彦, 岸本 哲朗, 村田 秀則, 森脇 透
1998 年 47 巻 4 号 p.
1388-1391
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
The purpose of this study was to investigate the prognosis of post operative cervical spondylotic myelopathy (CSM) patients in order to determine the treatment plan.
As of 1995, 365 cases were confirmed alive or dead. (life is 289 cases, death is 76 cases) The predictive number of CSM dying was calculated by age and sex to compare the mortality rate of CSM of the 365 cases with that of the normal Japanese population.
The average age at operation was 53.6 and the postoperative base-line period was 12.6 years. The 76 patients of the dead group were aged between 48 and 89, with an average age of 72 years. The predictive number dying of cervical CSM was 66.8, so the stamderd mortality ratio is 1.14.
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西田 公明, 米村 憲輔, 薬師寺 俊剛, 川谷 洋右, 高木 克公
1998 年 47 巻 4 号 p.
1392-1394
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We report a rare case of mixed tumor arising from the thigh. A 69 year-old man had a 7-year history of left thigh nodule. After open biopsy at another hospital, the tumor was suspected as extraskeletal myxoid chondrosarcoma. When he visited our hospital, the tumor was 5×4cm in size. Magnetic resonance imaging showed abnormal shadow, indicating low and high signal intensity in T1 and T2 weighted images, respectively. A wide surgical excision of the tumor was performed. Microscopic examination indicated a mixed tumor. It was however difficult to diagnose the mixed tumor in this case before surgical intervention.
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山下 彰久, 野村 茂治, 福岡 真二, 首藤 敏秀
1998 年 47 巻 4 号 p.
1395-1399
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
We present a rare case of pigmented villonodular synovitis (PVS) of a dislocated hip joint. A 70 year-old woman complained of left hip pain and was diagnosed with a tumor of the left buttock. She underwent conservative treatment for congenital dislocation of the bilateral hip of infants. Radiograph showed the disappearance of the bilateral femoral head, and cystic changes at the left ilium were recognized. On MRI the tumor showed low intensity on T1-weighted images and iso-high intensity with a portion of low intensity area on T2-weighted images. Synovectomy was performed as much as was allowed. Pathological findings of the synovia were corresponded with PVS. Five years after surgery, there has been no reccurence and PVS remaining on MRI.
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1998 年 47 巻 4 号 p.
1401-1407
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
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1998 年 47 巻 4 号 p.
1408-1415
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
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1998 年 47 巻 4 号 p.
1416-1421
発行日: 1998/09/25
公開日: 2010/03/16
ジャーナル
フリー
