整形外科と災害外科
Online ISSN : 1349-4333
Print ISSN : 0037-1033
ISSN-L : 0037-1033
54 巻 , 1 号
選択された号の論文の42件中1~42を表示しています
  • 川畑 英之, 吉野 伸司, 鶴 亜里紗, 横内 雅博, 今村 勝行, 有島 善也, 長嶺 智徳, 小宮 節郎
    2005 年 54 巻 1 号 p. 1-5
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We reviewed the clinical findings of Chiari pelvic osteotomy with arthroscopic debridement for hip osteoarthritis.
    Ten patients were available for evaluation. They were all females whose ages ranged from 35 to 55 years at surgery. Five showed progress and another showed end stage on rentgenogram before surgery. JOA score and arthroscopic findings were evaluated after surgery, compared with preoperative state.
    Arthroscopic findings were evaluated by Taneda's classification in our study.
    The JOA score improved 12.7 points on average, especially in the pain score. Arthroscopic findings showed high-grade defects of the cartilage and tear of the labrum in most cases before surgery.
    Two cases which underwent arthroscopy two years after osteotomy showed formation of fibrous cartilage pathologically.
    The results suggest that secondary cartilage formation and arthroscopic debridement are effective for reducing pain after Chiari pelvic osteotomy. In our study, as only two cases underwent arthroscopic evaluation after surgery, but not preoparative evaluation, no conclusion could be reached on the effectiveness, and further studies are necessary.
  • 河野 俊介, 重松 正森, 藤林 功, 佛淵 孝夫
    2005 年 54 巻 1 号 p. 6-10
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    The purpose of present study was to evaluate the short-term results of revision total hip arthroplasty (revision THA) without cement. Thirty-two hips of 31 patients who underwent revision THA from September 1998 to June 2003 were enrolled. There were 6 men 7 hips and 25 female 25 hips, and the mean age at revision THA was 65.7 years. According to Endo-Klinik classification, four hips were grade 1, seventeen hips were grade 2, nine hips were grade 3, one hip was grade 4, and there was one fracture. The average full weight bearing time was nine days after operation. There was only one hip, which showed 3 mm subsidence of the stem. When initial fixation was obtained, early full weight bearing and early social rehabilitation were possible.
  • 山崎 康平, 吉野 伸司, 横内 雅博, 長嶺 智徳, 有島 善也, 川畑 英之, 井尻 幸成, 小宮 節郎
    2005 年 54 巻 1 号 p. 11-14
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Generally, we use long stem or interlocking long stem to fix femoral fractures after THA associated with loosening. We report the clinical results of treatment using interlocking nail in five cases of femoral fractures after THA. The subjects consisted of one male and four female, with a mean age of 64 years. Assesment was based on JOA score, estimation of bone union on X-ray, time taken for bone union, estimation of stem sinking and clear zone. Bone union was achieved in four cases and one case showed prolonged bone formation. There were no cases of stem sinking and two cases indicated a clear zone close to the femoral proximal side. Pain relief was anticipated but scores were poor for ADL and articular range of motion. The interlocking long stem state remains good for primary fixation and stability of rotation.
  • 田中 寿人, 大野 晴子, 渡辺 英夫
    2005 年 54 巻 1 号 p. 15-20
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    The effects of cross band thoraco-lumbo-sacral orthosis (TLSO) for osteoporotic vertebral fractures are discussed in this paper. The patients were divided into two groups: Our group treated by cross band TLSO and the other by other TLSO methods. The cross band TLSO made up by posterior blue steel strut and axillar strap crossed back at junction of thoraco-lumbal vertebra, and pull it out to hypogastric region. That aim at strong three point fixation. It was found that the cross band TLSO maintains corrected alignment and provides strong fixation. More over, cross band TLSO improved comfortable wearing, and prevent slide the orthosis, reduced complication like decubitus.
  • 豊田 耕一郎, 田口 敏彦, 金子 和生, 加藤 圭彦, 東 良和, 今城 靖明, 井上 裕文, 米村 浩
    2005 年 54 巻 1 号 p. 21-24
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We studied multiple clinical vertebral fractures in osteoporosis during a period of four years at the Mito Hospital. There were 41 cases (128 vertebras) whose average age was 78 years, and average follow up period was 22 months. The frequency of fractures was in the order of lumbar(L2-5) for the first time, lumbar for the second time, thoracic(T4-11) for the first time, thoracic for the second time. Prevalent vertebral fractures made up 80% of all patients, who suffered prevalent changes of posture in standing. Postural changes were seen in 30% of all patients with the increase in kyphotic angles and vertebral collapse ratio. There was a tendency for increased kyphotic angle and collpse of verteral height in the breakage of the posterior of the posterir vertebral wall. Early diagnoses decreased the intensity of the treatment of osteoporosis.
  • 松野下 幸弘, 川内 義久, 永吉 隆作, 鮫島 浩司, 小宮 節郎
    2005 年 54 巻 1 号 p. 25-27
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Usually, osteoporotic spine fracture is treated conservatively. But there are cases which resist conservative treatment.
    We performed vertebroplasty using β- tricalcium phosphate (β- TCP) on such cases.
    After the operation, some cases should collapse of the vertebral body and escape of the instrument into the vertebral body, due to failure of the β- TCP to bear load with porosity, and insufficient healing β- TCP was found to be unsuitable as a vertebral body filler.
  • 河村 一郎, 松永 俊二, 今村 勝行, 川畑 直也, 長友 淑美, 山元 拓哉, 林 協司, 米 和徳, 小宮 節郎, 大園 義久
    2005 年 54 巻 1 号 p. 28-30
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We report two cases of calcification of the ligamentum flavum of the cervical spine.
    Case1: A 68-year-old woman presented a history of numbness of the limbs and gait disturbance. Computerized tomograph showed calcification of the ligamentum flavum from C3 to C6.
    Case2: A 68-year-old woman presented a history of numbness and pain of the bilateral hands. She had calcification from C5 to C7 and suffered from diabetes mellitus.
    We treated both cases with open-door laminoplasty and removed the mass. We analyzed the mass of case 2 with X-ray microanalyzer and found that it consisted of hydroxyapatite.
    Calcification of the ligamentum flavum of the cervical spine is a serious disease with severe myelopathy.
  • 大長 省博, 鈴木 裕彦, 川畑 亜矢人, 濱崎 将弘, 馬渡 玲子, 古川 雄樹, 植田 大樹, 吉野 興一郎
    2005 年 54 巻 1 号 p. 31-34
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We present an operated case of spontaneous epidural hematoma of the cervical spine. Laminoplasty together with evacuation of the hematomas were performed. The patient followed a satisfactory postoperative course and made recovered quickly. Critical factors for the recovery of spinal epidural hematoma are preoperative neurological deficits and operative interval.
  • 前田 純一郎, 馬場 秀夫, 衛藤 正雄, 森口 昇, 小関 弘展, 西村 誠介, 進藤 裕幸
    2005 年 54 巻 1 号 p. 35-39
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We report three cases of atlanto-axial rotatory fixation (AARF). Two of the cases were secondary to plastic surgeries of microtia, and the third case took a month to be diagnosed as AARF and was difficult to cure. In all cases, we selected conservative therapy including manipulative reduction under general anesthesia. First, we attempted to treat AARF with fixation by neck braces. If remarkable recovery from neck pain or in range of motion of the neck was not achieved, continuous traction (Glisson's traction) was started. If symptoms still continued for about two weeks, manipulative reduction under general anesthesia followed by skeletal traction was chosen. The first two cases were cured in this way. In case 3, recurrence was observed after manipulative reduction, so we repeated manipulation. All the cases finally achieved sufficient recovery from AARF only by conservative therapy.
  • 岡本 健太郎, 寺田 和正, 小原 伸夫, 宮崎 清, 仲西 知憲, 木村 岳広, 宮原 寿明, 和田 研
    2005 年 54 巻 1 号 p. 40-45
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Pseudotumor of the preodontoid soft tissue seen on magnetic resonance imaging (MRI) is a well known manifestation of atlantoaxial subluxation with rheumatoid arthritis (RA). We report a case of atlantoaxial dislocation pseudotumor with RA reduced remarkably three weeks after posterior fixation. The patient was a 55-year-old male with RA for 10 years. Onset of numbness in the arms and legs dated back to three months before. He was referred from a private M.D. for gradual gait disturbance. His RA stage was classified as stage 3 and class 3. Lateral flexion radiographs showed ADI 14 mm, SAC 12 mm. extension led to reduction. Compression of the medulla and upper cervical spine, due to periodontoid pannus (pseudotumor) extending into the spinal canal, was seen in MRI. Bone resorption most likely caused by geodes was found at the base of odontoid by computed tomography. We performed posterior atlantoaxial fixation. Neck pain and cervical myelopathy improved. His Ranawat neurological score also improved to 2 from 3A. Post three weeks operative MRI showed a significant decrease of the pseudotumor.
  • 濱田 裕美, 武富 栄二, 石堂 康弘, 砂原 伸彦, 中村 憲一, 松永 俊二, 小宮 節郎
    2005 年 54 巻 1 号 p. 46-49
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Atlantoaxial subluxation occurs in patients with bone dysplasia as spondyloepiphyseal dysplasia or Down disease. There has been no reports of atlantoaxial subluxation in patients with resistant rickets. A 16-year-old boy with resistant rickets complained of neck pain and numbness of the upper right extremity. Deformity of the cervical spine and atlantoaxial subluxation were seen on radiographs. We present the features of cervical spine in a patient with resistant rickets.
  • 有島 善也, 林 協司, 山元 拓哉, 松永 俊二, 米 和徳, 宮口 文宏, 河村 一郎, 小宮 節郎
    2005 年 54 巻 1 号 p. 50-51
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We studied 22 patients (seven men and fifteen women) with ossification of the posterior longitudinal ligament (OPLL) of the thoracic spine.
    Posterior approach was performed on all patients, laminoplasty on nine patients, and laminectomy on thirteen patients. The mean JOA score of all patients improved from 3.6 points to 6.3 points. The improvement rate (Hirabayashimethod) was 35.4%.
    In four patients, paralysis of the lower extremities progressed temporarily, but at the end of the study it had improved. In conclusion, satisfactory results were observed by posterior surgical procedure for thoracic OPLL.
  • 田邊 史, 川畑 了大, 古賀 公明, 宮口 文宏, 林 協司, 松永 俊二, 米 和徳, 小宮 節郎
    2005 年 54 巻 1 号 p. 52-55
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Intraspinal cysts of the lumbar spine were named "discal cysts" by Toyama in 1997. We report a case of lumbar discal cyst treated by percutaneous CT-guided puncture through transdural approach.
    The patient was a 55-year-old man. He suffered from low back pain and right lower extremity pain. Neurological examination suggested right L4 radiculopathy. MRI indicated iso intensity mass with T1-weighted imaging and high with T2 in the lumbar spinal canal behind the L4 vertebral body. L3/4 discography showed the cyst connecting with the disc, and severe radiating pain was reproduced. Right L4 radiculopathy was diagnosed due to the discal cyst.
    Percutaneous CT-guided puncture through transdural approach was performed. After puncture and steroid injection, low back pain and right lower extremity pain disappeared. Four months after the procedure, no recurrence was found in MRI.
    Percutaneous CT-guided puncture is a teatment available for lumbar discal cysts. However, the causes of cysts are unknown and careful long-term observation is necessary.
  • 増田 寛, 久保 紳一郎, 黒木 浩史, 濱中 秀昭, 後藤 英一, 小島 岳史, 帖佐 悦男
    2005 年 54 巻 1 号 p. 56-59
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Many authors report that discal cysts are likely to occur at the upper lumbar level, such as L2/3 or L3/4, compared with typical disc herniation.
    We present a case of discal cyst raised from L5-S1 disc. A 27-year-old male was admitted to our hospital suffering from low back pain and right sciatica. An intra-spinal cyst was detected at L5-S1 with MR imaging. Right S1 root was compressed with a mass, which connected to L5/S1 disc. In MR imaging, it showed low intensity in T1 weighted image, and high-iso intensity in T2 weighted image. L5/S1 discogram revealed that the intradiscal space communicated to the cystic mass. The cyst was excised surgically under microscopic vision. Histological findings showed that the cystic wall was composed of fibrous connective tissues including hemosiderin deposits and synovial tissue.
  • 林 哲生, 有薗 剛, 藤本 俊博, 諸岡 孝明, 福元 真一, 時任 毅, 志田 純一, 増田 祥男, 小橋 芳浩
    2005 年 54 巻 1 号 p. 60-62
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Lumbar posterior fusion is an established method of treating spondylosis, however there have been controversial views with regard to the degenerative change of adjacent segments to the fusion site.
    Thirty patients who underwent lumbar posterior fusion with about five years postoperative observation were included in this study. Intervertebral disc height, spondylolisthesis in adjacent segment to the fusion site and the Japanese Orthopedic Association (JOA) score were evaluated before and after surgery. Fifteen cases showed degenerative changes including decreased intervertebral disc height or spondylolisthesis to adjacent segments. However, no significant correlation was seen between the clinical status and degeneration adjacent to the fusion. As a result of estimating ages, sex, disc angle, % slip, lumbosacral joint angle, and lumbar lordosis, no significant difference was found between cases affecting degeneration adjacent to the fusion or those not.
  • 後藤 久貴, 河野 昌文, 末広 昌嗣, 前田 和成, 川原 俊夫, 和氣 聡
    2005 年 54 巻 1 号 p. 63-67
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    From 1991 through 2003, we performed 15 isolated tibial insert exchanges on 12 patients (four men and eight women, average age was 72.6 years, three patients had bilateral revision) without loosening of any of the components and a history of infection. The duration of follow-up averaged one year and eleven months (range: two months to six years and nine months). The implants had been in situ for an average of five years and eleven months (range: one month to ten years and eleven months (range: one month to ten years and ten months) at the time of the insert exchange. The indications for insert exchange were wear of insert (11 patients) and mismatch of femoral component (one patient). Seven patients had problems (such as instability or malalignment, mainly due to surgical technique) just after primary operation. Surgical technique and careful planning before operation are recommended for achieving good clinical reslts.
  • 大宮 博史, 木屋 博昭, 弓削 孝雄, 藤本 徹, 西里 徳重, 山田 正寿, 桐谷 力
    2005 年 54 巻 1 号 p. 68-71
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Pulmonary embolism(PE) is frequently caused by deep vein thrombosis, and its prevention is very important. We report three patients with a history of PE inserted with an inferior vena cave filter (IVC) before alloarthroplasty. There were no signs of PE after operation. Preoperative insertion of an IVC filter is a useful method for the prevention of PE in patients with a history.
  • 河野 正典, 坂口 満, 平川 敬, 矢渡 健一, 岩永 貴行, 久賀 太
    2005 年 54 巻 1 号 p. 72-76
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We treated eight patients with infected total knee arthroplasties for 17 years. We reviewed the onset time of infection, organism, and timing of reimplantation. Cultures grew methicillin sensitive Staphylococcus aureus in all cases. Two joints were cured by continuous drainage and retained prosthesis, and 2-stage reimplantation was performed on six joints. In comparing knees with successful salvage to those with persistent infection, the following factors strongly correlated with successful salvage : short duration of symptoms of infection ( <3 weeks) and no prosthetic loosening or roentgenographic evidence of infection. In TKA complicated by infection, implant salvage with aggressive surgicai debridement and antibiotic therapy should be strongly considered, provided that these strict criteria for attempted salvage are observed.
  • 永島 由紀子, 井手 衆哉, 重松 正森
    2005 年 54 巻 1 号 p. 77-80
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We report a rare case of disseminated carcinomatosis of the bone marrow from colon cancer.
    A 74-year-old woman was admitted for low back pain. It was diagnosed as metastatic carcinomatosis from well differentiated adenocarcinoma of colon. Diagnosis by radiographs was difficult. However, bone scintigraphy showed extensive accumulation in the vertebral bone, pelvis, and femur.
    Her general condition deteriorated rapidly due to disseminated intravascular coagulation (DIC), and she died on the 50th day of admission.
    Diagnosis in an early stage is important.
  • 高木 基行, 熊谷 謙治, 江頭 昌幸, 岡崎 成弘, 進藤 裕幸, 峰 雅宣
    2005 年 54 巻 1 号 p. 81-85
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Previous epidemiological studies have shown an increased rate of cancer in people with dermatomyositis. However, there are few report of malignant bone tumors and malignant soft tissue tumors. We report two rare cases of dermatomyositis with malignant bone and soft tissue tumor.
    Case1. A patient with dermatomyositis developed inflammatory myofibroblastic tumor. This patient had dermatomyositis at the age of nine and was treated by steroid. Four years later, the patient developed an inflammatory myofibroblastic tumor of her right humerus.
    Case2. A patient with dermatomyositis developed liposarcoma. This patient had dermatomyositis at the age of 57 and was treated by steroid. Twelve years later, the patient developed liposarcoma within her right gluteus maximus muscle.
  • 中村 俊介, 宮口 文宏, 川畑 英之, 吉野 伸司, 小宮 節郎
    2005 年 54 巻 1 号 p. 86-88
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    This is a case report of a ganglion due to medial meniscus tear. A 79-year-old female presented a painfull swelling of the right knee. A soft tumor was found in the medial side. The soft tumor manifested a cystic image connected to the medial meniscus on MRI. We performed arthroscopy and found a medial meniscus horizontal tear that was connected to the cystic lesion. We performed partial menisectomy plus open tumor resection. Surgical outcome was good. Six months after resection, there was no recurrence.
  • 樫原 稔
    2005 年 54 巻 1 号 p. 89-91
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Tumoral calcinosis (TC) is a rare condition named by Inclan in 1943 and is characterized by a large calcified mass occurring predominantly in the juxta-articular region of the extremity. This paper presents a 63-year-old man with TC of the gluteal region. Histopathological examination revealed deposits of amorphous calcified material surrounded by dense fibrous material. They were stained black with von Kossa stain. The diagnosis of TC was a source of confusion in the present research. Recently several reports reveal that the clinical and pathological features of the calcification of hemodialysis patients are quite typical of TC, but this is called calcification simulating tumoral calcinosis. We regard TC as a form of idiopathic calcification and should exclude the calcification of hemodialysis patients and small calcifications of the calcinosis cutis.
  • 廣瀬 隼, 野村 一俊, 橋本 伸朗, 福元 哲也, 井 賢治, 田中 あづさ
    2005 年 54 巻 1 号 p. 92-96
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    The estimation of physiologic ability and surgical stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) determined by both the PRS and SSS. E-PASS predicts postsurgical risks by quantification of the patient's reserve and surgical stress, and was previously reported in relation to postoperative complications and the costs of hospital stay in elective gastrointestinal operations.We evaluated the usefulness of this scoring system for 119 consecutive patients who underwent surgery with osteosynthesis for proximal femoral fractures. The postoperative morbidity rates linearly increased as the PRS and CRS increased, and correlated significantly with both the PRS (ρ=0.4, P<0.01)and CRS (ρ=0.4, P=0.02). The costs of hospital stay also related significantly to the PRS (r=0.2, P=0.01) and CRS (r=0.27, P=0.006). These results suggest that E-PASS may be useful for predicting postsurgical risk, estimating medical expenses, and comparing surgical quality for surgical cases of proximal femoral fractures.
  • 大倉 俊之, 塩月 康弘, 坂田 勝美
    2005 年 54 巻 1 号 p. 97-100
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We studied the fluoroscopy time per operation in seven patients with trochanteric fractures using the gamma nail from January 5, 2004 to February 23, 2004. They consisted of one male and six females with a mean (range) age of 83.4 (78-91) years. We fixed all of them with gamma nail. The average operation time was 34 (15-52) minutes and average fluoroscopy time was 0.5 (0.3-1.0) minutes. The long term effects of low-level radiation exposure are relatively unknown and it is difficult to estimate the risks of low-level radiation exposure. We should try to minimize the fluoroscopy time and reduce radiation exposure.
  • 田中 博史, 古市 格, 山本 尚幸, 青柳 孝彦, 江口 愛, 染矢 晋介, 田代 直輔
    2005 年 54 巻 1 号 p. 101-104
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Treatment of unstable intertrochanteric fractures is often difficult.We report the effectiveness of the trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) compared with CHS or CHS with brim supporter.There were no significant differences in operation time and blood loss across the three groups.
    In the Evans stage Type I Grade 3 unstable fracture,lag screw sliding was lower in the DHS-TSP group than the other two groups.
    TSP is effective for preventing excessive sliding in Grade 3 unstable fracture.Grade 4 unstable fracture is difficult to treat by using only TSP.There is a need to fix the medial fragment and fill with filling material.
  • 小松 奈美, 田邊 龍樹, 黒沢 治, 栗原 典近, 舩元 太郎
    2005 年 54 巻 1 号 p. 105-110
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Seven lower extremity fractures were treated by minimally invasive plate osteosynthesis (MIPO). The subjects were five males and two females. The average age was 57.0 years (range, 30 to 71 years) at the time of surgery. The follow-up period was an average of 10.7 months (range, 3 to 20 months). The subjects were two supracondylar femoral fractures, one distal tibia fracture, and four lateral malleolar fractures.
    The evaluation included operation time, blood loss, length of incision/length of plate, period of union, and clinical symptom.
    One case of supracondylar femoral fracture with diabetes mellitus achieved delayed union. Other cases achieved good results, and there were no infections.
    MIPO was found to be a successful for reducing invasion compared with traditional approaches.
  • 高崎 実, 河村 誠一, 鬼塚 俊宏, 本荘 憲昭, 喜多 正孝
    2005 年 54 巻 1 号 p. 111-115
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We investigated the radiological results of surgical treatment with β-tricalcium phosphate (β-TCP) for periarticular fractures. Highly purified β-TCP was implanted in bone defects due to open reduction of the following periarticular fractures:one fracture of the distal humerus, four of the distal radius, three of the distal femur, four of the proximal tibia, and three of the distal tibia.
    Fifteen patients were followed up for an average of 10 months (range ; 6 to 19 months). Bone union was achieved in 13 patients, but not in two patients.
    In the 13 patients who achieved bone union, β-TCP was absorbed completely in ten patients and partially in three patients. This investigation suggests that β-TCP is a useful material in the surgical treatment of periarticular fracture.
  • 小柴 民子, 駿河 保彰, 行田 義仁, 重盛 廉, 土屋 恒篤
    2005 年 54 巻 1 号 p. 116-118
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Total dislocation of the talus is characterized by complete disruption of the ankle and subtalar joints. This injury without the concomitant fracture of the talus is very rare. We experienced a case of total dislocation of the right talus with malleolar fracture and fracture of the anterior process of the calcaneus. After 11 hours, the ankle and subtalar joints achieved reduction. The appearance of the subchondral atrophy of the talus called "Hawkins'sign" was useful for deciding the starting point of weight-bearing. After seven months, PTB brace was removed due to the appearance of this sign. After 22 months, the patient had little pain and showed more or less normal range of motion of the ankle and subtalar joints.
  • 高原 智洋, 牧野 佳朗, 宮原 健次, 鳥越 雄史, 白石 公太郎, 別府 綾子
    2005 年 54 巻 1 号 p. 119-124
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We successfully treated dislocation and fracture of the talo-calcanean joint by Ilizarov external fixator. The patient was a 63-year-old woman. She injured her left foot when she fell into a gutter on July 24, 2003. She suffered a fracture of the right fibular when she was 56 years old. She had diabetes mellitus (DM). On admission, plain X-ray films and computed tomography revealed a comminuted fracture of the anterior part of the calcaneus. The lateral part of the posterior talo-calcanean facet joint was fractured and dislocated in contact with lateral malleolus. It took two weeks to achieve good control of DM before operation. We performed open reduction using the Ilizarov external fixator. We were able to reduce the dislocation without skin incision, and the facet joint was also reduced completely. From the 4th week after the operation, weighing started. Ilizarov external fixator was removed on the 8th week. It is difficult to reduce dislocation without skin incision using ordinary methods for fractures with severe displacement or swelling. Half a year after the operation, she had no pain on walking and no limitation of range of motion.
  • 松下 康正, 竹下 満, 比嘉 頴秀, 尾上 敏博, 南川 博道, 岩本 英明
    2005 年 54 巻 1 号 p. 125-128
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Stress fracture of the proximal shaft of the fifth metatarsal is different in behavior from other stress fractures : it is slow to heal, predisposed to reinjury, and often requires delayed or non union.
    Nine patients presented stress fractures at our institution between 1999 and 2004. The age of patients ranged from 14 to 21 years.
    Eight patients were treated with surgical fixation. Cancellous screw was used in two patients and compression screw in the others. They were able to return to atheletic activities two to three months after surgery.
  • 北村 貴弘, 志田原 哲, 仙波 英之, 井上 三四郎, 美浦 辰彦
    2005 年 54 巻 1 号 p. 129-132
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We report a case of osteomyelitis of the cuboid bone following a puncture wound of the foot in childhood. A nine-year-old boy stepped on something while wearing rubber sandals. After two days a localized abscess formed on his foot. He was treated by surgical drainage of the abscess and antibiotics, but foot pain and swelling continued. Eight weeks after the initial injury, he was admitted to our hospital because of a lytic lesion in the cuboid bone on radiograph. A retained foreign body in the cuboid bone was suspected by computed tomography. Operation revealed several pieces of wood in the cuboid bone with abscess. He was treated successfully by surgical evacuation the abscess, removal of wood pieces, and antibiotics. He remained symptomless with no residual signs of infection three months postoperatively. Radiography is not useful for detecting radiolucent foreign bodies such as wood. Whenever infections due to foreign body are suspected, ultrasound, computed tomography or magnetic resonance imaging should be considered as a recommended examination method.
  • 井上 三四郎, 志田原 哲, 仙波 英之, 北村 貴弘, 美浦 辰彦, 山口 美弘
    2005 年 54 巻 1 号 p. 133-137
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We report a 85-year-old man who presented a large calcification of the anterior tibial compartment, due to gunshot in war about 60 years ago. He noticed the mass in his left lower leg about 12 years ago, which grew slowly without pain. We diagnosed it as dystrophic calcification of the anterior tibial compartment. After conservative treatment for four months, we performed operation.
  • 田口 憲士, 和田 政浩, 崎村 幸一郎, 福島 達也
    2005 年 54 巻 1 号 p. 138-142
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Posterior dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna is referred to as terrible triad injury (TTI). We report three cases of TTI. The three patients were a 59-year-old female, a 43-year-old male, and 52-year-old male. All cases were treated by ostheosynthesis.
    We recognized posterolateral rotatory instability (PLRI) of the elbow in one case after operation. PLRI consists of the inadequate operation of a front bone factor (radial head and coronoid process) and the lateral collateral ligament. We think that PLRI is a poor prognosis factor of TTI and repair of the lateral collateral ligament is of great significance.
  • 田口 学, 中島 英親, 寺本 憲市郎, 原田 香苗, 長井 卓志, 星野 秀士, 田中 達朗
    2005 年 54 巻 1 号 p. 143-146
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    We reviewed 10 ruptures of the extensor pollicis longus (EPL) tendon after fracture of the distal radius, five of which were at first diagnosed without fracture. Eight were female and two were male. Their ages ranged from 14 to 73 years. All fractures showed minimal displacement around the Lister's tubercle. The mean interval between the fracture and EPL tendon rupture was 4.3 weeks, the mean interval of the cases treated with casting was 5.6 and without fixation was 3.2 weeks respectively. We think that mechanical friction contributes to the damage and inflammation to the tendon, resulting in rupture.
  • 井口 貴裕, 有馬 準一, 大賀 正義, 生田 光, 中野 壮一郎, 田中 孝幸, 佐々木 宏介, 楊 昌樹, 小宮 紀宏
    2005 年 54 巻 1 号 p. 147-150
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    Microgeodic disease was first described by Moroteaux in 1970.
    We report a 7-year-old girl, who had swelling and redness in her right index, ring and left small fingers. Radiographs showed osteolytic lesion in the middle phalanges. Pathological fracture of the middle pharanx occurred in the right index six weeks after onset. Clinical symptoms and radiographic findings subsided in sixteen weeks. One year later she showed the same symptoms in her right middle finger.
    Due to spontaneous healing, prognosis is excellent for this disease. However, careful follow-up is necessary because pathological fractures, mal-alignment of fingers, and recurrence have been reported.
  • 下小野田 一騎, 山元 拓哉, 古賀 公明, 今井 恒志郎, 前田 利雄, 鬼丸 高茂, 長野 芳幸, 今給黎 尚典, 小宮 節郎
    2005 年 54 巻 1 号 p. 151-154
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    In this study, we report a rare case of epidermoid cyst caused by trauma arising in the distal phalanx. A 40-year-old man complained of swelling and pain in the distal phalanx of the right thumb. We performed resection of the tumor, and found atheroma in the distal phalanx. The case was diagnosed as epidermoid cyst based on histological results. No recurrence was seen for five months after surgery.
  • 岩永 貴行, 坂口 満, 本田 五郎, 久賀 太, 矢渡 健一, 河野 正則
    2005 年 54 巻 1 号 p. 155-158
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    RDC was described as rapidly destructive arthropathy of the hip by Postel in 1970. Its characteristics are hip joint pain and gait disorder due to rapid destruction of the hip joint in less than a year in elderly women.
    In this paper, we report a case of RDC with severe periosteal reaction in radiographic findings. Periosteal reaction usually suggests malignant tumor. In this case, MRI, CT, and bone scintigram showed no findings of malignant tumor, rheumatoid arthritis, primary osteonecrosis, neuropathic osteoarthropathy or septic arthritis.
    It is considered that RDC with periosteal reaction is related to immunological inflammation.
  • 泉 俊彦, 中村 雅洋, 肥後 勝
    2005 年 54 巻 1 号 p. 159-161
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    This study was conducted on 386 patients (341 boys and 45 girls) with Perthes' disease to evaluate the characteristics of bilateral Perthes' disease. We experienced 34 bilateral cases (8.8%) among these patients them. There were no significant differences between boys (8.8%) and girls (8.9%). The average age at onset was significantly lower in bilateral cases (4.62 y. o.) than in unilateral cases (6.43 y. o.). The average interval period between earlier and later onsets in bilateral cases was 15.7 months. In 30 cases (88%), later onset occurred within 24 months. In four cases, Perthes' disease occurred at both sides at the same time. There were no significant differences in the severity of involvement between unilateral and bilateral cases, and between earlier and later onsets in bilateral cases.
  • 吉川 大輔, 帖佐 悦男, 坂本 武郎, 渡邊 信二, 関本 朝久, 濱田 浩朗, 前田 和徳
    2005 年 54 巻 1 号 p. 162-166
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    The purpose of this study was to evaluate the risk factors of preoperative Perthes' disease and to predict prognosis in the early stage using magnetic resonance imaging.
    We studied the MRI of seven patients (seven boys) with unilateral Perthes' disease. The average age at onset was 8.6 years; their ages at surgery was 9.3 years; and the length of follow-up was 4.4 years. All hips showed incongruity of the joints. They were classified by Catterall's classification as type 3 (four hips) and type 4 (three hips). Six hips had joint effusion.
    Risk factors at MRI may be useful in deciding operation in the early stage of Perthes' disease.
  • 久賀 太, 坂口 満, 岩永 貴行, 矢渡 健一, 河野 正典
    2005 年 54 巻 1 号 p. 167-172
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    This case involves an 81-year-old woman. The patient's medical history indicates radiation therapy for uterine cervical cancer 15 years ago. Subsequent metastasis to the lungs occurred ten years ago, and lobectomy was performed. Pyrexia in the right coxalgia was found about a half year ago during check up. She had been given antibiotics for the treatment of osteomyelitis at a previous hospital, but the condition in the right coxalgia lingered in greater and lesser degrees alternately. In the initial diagnosis, we observed that range-of-motion was restricted in the right hip joint, and X-ray examination showed Otto innominate bone deformation. Combined computed tomography and MRI examinations indicated giant cystic lesions extending to the lesser trochanter from the iliacus muscle of the iliac fossa. Bone scintigram examination showrd aberrant accumulation in the right acetabular roof, right femoral head, and trochanter. Tuberculin reaction was negative in two tests. There were no unusual findings in conventional chest X-ray examination. Articulatio simplex type rheumatoid arthritis, coxotuberculosis, osteomyelitis, and metastatic bone tumor were considered from the above observations. We performed puncture on the fourth day of hospitalization and diagnosed coxotuberculosis in a polymerase chain reaction. Treatment of the hip in which the joint space had been destroyed consisted of radical decompression, drainage of abscess, and removal of avascular tissues. This was followed by antituberculosis chemotherapy with multiple drugs until there was clinical and hematological evidence.
  • 植木 里紀, 重松 正森, 本岡 勉, 佛淵 孝夫
    2005 年 54 巻 1 号 p. 173-175
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    The purpose of this study was to identify temporal gait parameters in coxarthrosis.
    In this report, gait analysis was performed on 20 patients (all females; mean age 61.2 years) who had total hip arthroplasty from May to September 2004.
    All patients were tested during "free" walking along an 5-m walkway in which a ground reaction force plate (gait scan 8000; Nitta, Inc.) was installed. Normal average values reported by Murray et al.2 ) were used. As an index of pain, the Japanese Orthopaedic Association (JOA) pain score was used.
    Single support duration was compared with the involved and normal legs. Single support duration of the involved leg decreased in 19 patients. Moreover, compared with normal values, in the normal leg, those of most patients remained unchanged. In the involved leg, single support duration of all patients decreased from the normal value. Single support duration of the involved leg decreased as JOA pain score decreased. Double support duration of both legs increased as JOA pain score decreased.
    The results of gait analysis can be used as an objective index of hip pain.
  • 本岡 勉, 重松 正森, 植木 里紀, 佛淵 孝夫
    2005 年 54 巻 1 号 p. 176-178
    発行日: 2005年
    公開日: 2005/10/03
    ジャーナル フリー
    The gait of five patients with unilateral hip ankylosis was analyzed both before and after operation (total hip arthroplasty) in terms of distribution of stance phase rate (stance phase/gait cycle), step length, stride width, and foot angle. After operation, stride width and foot angle significantly improved. Step length was shortened with the decrease of gait speed. There was no significant change in the stance phase rate. Gait functions that do not depend on the knee, pelvis, and the ankle were achieved after total hip arthroplasty.
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