The experience of Sugioka's rotational osteotomy in three cases, four joints of avascular necrosis, and one case, one joint of slipped epiphysis of the femoral head was reported. Good results were obtained in two cases of idiopathic avascular necrosis and one case of slipped capital femoral epiphysis. In conclusion, we consider the indication of the rotational osteotomy as follows. 1) In idiopathic avascular necrosis, when the lesion is less than two thirds of the femoral head, the rotational osteotomy is indicated, but when the lesion is more than two thirds, the rotational osteotomy with vascular bundle transplantation or vascularized bone graft, is indicated. 2) Vascularized bone graft is performed for the femoral head with no collapse of avascular necrosis caused by caisson disease. Rotational osteotomy with vascularized bone graft is recommended for collapsed head. 3) Three dimensional osteotomy is designed for the moderate degree slipping (30°-60°) of capital femoral epiphysis, and the rotational osteotomy is recommended for severe slipping (>60°).

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骨粗鬆症に関して最も重要なことは, この疾患をできるだけ早い時期に見い出し, 骨折の発症を防止することである. 骨折と骨塩量との関連を見ると, 最大骨塩量を示す時点では骨折が殆ど見られないが, 骨塩量が減るにつれて, 骨折の発生頻度が高くなり, 骨塩量が骨折を規定する重要な危険因子であることがわかる.
予防及び早期治療の基本的な考え方は, もともと骨塩量の低い人を早い時期に見出し, 骨折闘値以上に骨塩量を保つようにすることである. 骨塩量が正常でも fast loser を検出し, 骨塩量の減少を予防して normal loser の範囲に保つようにする. そのためには, まず骨塩量を測定し, 骨塩量が低い場合には, 骨塩量を増加させる或いは減少を予防する措置を講じる. 一方, 骨塩量が正常な群については骨代謝異常を評価し fast loser を検出する.

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For several weeks, a hip joint is usually kept in a slightly flexed position after transtrochanteric anterior rotational osteotomy of the femoral head because of possible necessity of relaxation of a stretched nutritional artery of the femoral head; a branch of the medial femoral circumflex artery. We measured the blood flow of the nutritional artery by using Doppler ultrasound sonography at various hip flexion positions intraoperatively to analyze the necessity of postoperative hip flexion. Between July 1998 and July 1999, 16 hips underwent transtrochanteric rotational osteotomy for the treatment of 15 osteonecrosis of the femoral head and 1 osteochondritis dissecans. There were 14 male and 2 femalepatients with the mean age of 39 years (age range, 17-54 years). After rotating femoral head, the nutritional artery was checked by using ultrasound sonography in fibrofatty tissue beneath divided quadratus femoris muscles and the blood flow was continuously measured while decreasing the angle of hip flexion. In 14 hips (88%), the nutritional artery blood flow was able to measured at the 30-degree flexed position, but not in other two hips (12%). This study provides further evidence of the importance of postoperative flexed hip positions.

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From 1965 to 1987, 17 2 patients with steroid-induced osteonecrosis of the femoral head in 296 joints have visited our university hospital clinic. This osteonecrosis has occured frequently in young patients. There has been a high incidence of involvement of both sides of the femoral head.
We have treated 176 of these joints with osteotomy or replacement with artificial joints. Transtrochanteric rotational osteotomy (TRO) was performed on 120 joints, with a success rate of 77.6 %. As this is equal to that in cases of idiopathic osteonecrosis, showing that TRO is useful for treating steroid- induced osteonecrosis. For making the decision to perfom a osteotomy, it is important to investigate the position and extent of the intact area in the femoral head. Tomography, CT scan, and MRI are useful methods for doing this.

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Radiographs of 84 hips with advanced or terminal stage osteoarhritis were evaluated after transtrochanteric vaigus osteotomy (TVO). Improvement of radiographical changes after osteotomy usually correlate with the clinical conditions of each osteoarhritis hip. The average age at operation was 44 (17-60) years old. Radiographical changes including joint space narrowing, osteosclerosis and cystic change were evaluated at 2 and 5 years after operation. Additionally, at the last time after operation (average 8.3 years (7-11)), they were evaluated comparing with those just before operation. Two years after operation, most hips whose acetabular head index (AHI) was more than 60% showed better radiographical appearances than before operation. The higher was the AHI of operated hips, the better the radiographical appearances remained for a longer time after operation. The radiographs of the hips after TVO with acetabuloplasty improved similarly to those of the hips whose AHI was more than 60%. These data show that the improvement of the radiographical sign of the operated hips depends on AHI, suggesting that the acetabular coverage of the head is an important factor when selecting operation methods. When AHI is low, acetabuloplasty should be carried out with TVO.

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Many inveseigators have made efforts to produce a model arthritis, which is consistently reproducible in animals, with the aim at further investigation into the pathogenesis of osteoarthritis. We have challenged to produce the ostearthritic conditions by making unstable joints in rabbit knees with surgical procedure.
Degenerative changes were studied not only histochemically but also utilizing the cryoscanning E. M. and T. E. M. and were reported for the past two times.
On this occation, we have compared the findings of the experimental osteoarthritic cartilage, five to seven weeks postoperatively, with those of human osteoarthritic cartilage.
Some similarities; i. e, the characteristic features of osteoarthritis namely fibrillation, and fissuring of articular cartilage with loss of acid mucopolysaccharide stainning were observed in both of them.

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On seventeen hips, we performed the measurement of bone marrow pressure and the intramedullary venography in the proximal femur to study the haemodynamics of the medullary circulation. In case of bone necrosis, the baseline pressure was above 30mmHg, or the pressure elevation by stress test was more than 10mmHg above the baseline at five minutes after the injection of 5ml of normal saline.

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The authors investigated the muscle strength about the knee and hip joints in patients with unilateral femoral head necrosis, preoperatively and postoperatively. Results of preoperative (8 cases) and postoperative (7 cases) patients were also compared with those of normal and osteoarthritis groups using Cybex-II. The results were as follows;
1) Strength of all muscles except abductor and adductor both in the affected and the intact limbs of the two groups with femoral head necrosis was significantly less than that in normal group.
2) The muscle strength of lateral rotation in the affected limbs in the two groups was significantly less than that in the intact limbs. However, the distribution of the hip joint muscle strength was similar to that of the normal group, although the distribution-in the osteoarthritis group was poor.
3) It was suggested that muscle training for all joint muscles, especially extensor muscle strengthening in the prone position, both preoperatively and postoperatively is crucial to maintaining satisfactory joint function.

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難治性感染症の原因の1つに細菌のバイオフィルム形成による抗菌剤の菌体への透過障害が考えられている。そこで, 、in vitroにおいて緑膿菌バイオフィルムを作成し薬剤の透過性を測定する方法を考案した。すなわち, ブレインハートインフユジョン寒天平板培地上に底面にメンブランフィルターを張り付けた市販のインターセルを設置し. その中で緑膿菌を37℃, 3日間培養したものをバイオフィルム形成菌とした。これを走査型電子顕微鏡で観察したところ, 多量の網目構造をしたグリコカリックス層と菌体が厚さ約100μmの厚い層を形成していることが確認できた。また, 所々に膜状の物質や板状になったものが認められた。これを24穴マルチウェルプレートにセットし細菌用寒天で表面を保護し, インターセル内に薬剤溶液, 外層に燐酸緩衝液を内層と外層の液面をそろえるように注入し, 24時間後外層液に白然拡散した薬剤濃度をバイオアッセイ法にて測定し, 薬剤のバイオフィルム透過率を算出した。この方法で, ceftazidime (CAZ) とgentamicin (GM) のバイオフィルム透過性を測定したところ, CAZは透過障害を受けなかったがGMは明らかな透過障害を受けた。また, 緑膿菌から分離したスライムを薬液に添加しディスク法による阻止円形成におよぼす影響を検討した。その結果CAZの抗菌力はほとんど影響を受けなかったがGMは添加するスライム濃度に応じて抗菌力が低下した。同様の結果はスライム添加時における殺菌作用でも認められ, 薬剤のバイオフィルム透過率の結果を反映していた。

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Valgus intertrochanteric osteotomy is an effective treatment for osteoarthritis of the hip in younger patients. However, the disadvantage of this osteotomy is the difficult stem insertion at the time of subsequent total hip arthroplasty. Sugioka designed transtrochanteric valgus osteotomy to overcome this disadvantage. The purpose of the present study was to report the short-term results after operateion. The results of the first 10 hips in patients were prospectively studied with a minimum of 6-months follow-up. All patients had a long history of hip pain. The average age at the time of operation was 45.7 years. All patients had a flexion arc of at least 80 degrees and at least 20 degrees of passive adducion. Preoperative radiographs of the patients showed an elliptical deformity of the femoral head associated with a well-developed infermedial osteophyte and improved congruence of the articular surfaces was demonstrated in full adduction. Operatve corrections averaged 19 degrees of valgus and 6 degrees of extension. Bone union of both the femoral and trochanteric osteotomies was obtained in all hips. Hip pain was relieved in all except one hip.

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水中運動は, 浮力により関節への負担を軽くし, 全身の余分な緊張を和らげること, 水の抵抗のもとでからだを動かすことで, 安全にしかも確実に筋力を強化でき, 水圧が胸にかかる状態で努力呼吸を行うために呼吸・循環機能を高められ, 水による温熱効果あるいは寒冷効果が得られ, 骨・関節・筋肉などの血液の流れを改善し, 柔軟性を高めることができる. たとえば肉ばなれ・捻挫・骨折などの運動・スポーツで起きやすい傷害は, 水中運動ではほとんど起きる危険性がなく, 安全である. 温水プールでの水中運動の場合には, スポーツ感覚の明るく軽快な雰囲気の中でからだを動かすことを楽しみ, それが結果的にリハビリテーションの効果につながる. このように水中運動は, 優れた利点をいくつも有するために, 関節痛の運動療法としてきわめて優れている. 水中運動の主要な効果には, 次のようなものがある. (1) 関節の動きを改善する (2) 筋力を高める (3) 痛みを軽減する (4) リラクセーション (5) バランス感覚を磨く さらには, 関節痛のために, 自然に落ち込むことが少なくない中高年にとって, 水中運動は解放感を体験でき, 自身の上達・改善の様子を理解しやすく, 達成感を味わうことができるために, 生きる自身と希望をもたらす効果もある. 運動中や運動後に, 「疲れた!」と感じたり, 関節に痛みを感じたりするようならば, それは「やりすぎ!」とみられる. 普段地上では思うようにからだの動きができない分だけ, 水中で「こんなに動ける!」といううれしさのあまり, つい時間を長くしたり, 回数を多くしたりして家に帰ったらへとへとになってしまう例もある. しかし, こうした運動の仕方ではリハビリテーションの効果も得られないばかりか, かえって関節痛を悪化させたり, 他の病気・障害を招くことさえある. また, 関節痛の水中運動・水泳に適したからだの動きに留意することは, 傷害・事故の予防につながる.

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Transtrochanteric rotational osteotomy of the femoral head was carried out on three cases of posttraumatic osteonecrosis. Injuries of the hip joint were femoral neck fracture on two cases, and central dislocation with acetabular fracture on one case. The age of the each patient was 16, 20, 12 years old at the trauma, and 18, 22, 13 years old at the osteotomy. Findings of the osteonecrosis of the femoral head appeared at 12, 9, and 10 months after the trauma on each case.
Preoperative classification of femoral head necrosis according to Sugioka was grade II in every patients. Intact area of the femoral head on the lateral view of the preoperative roentgenogram was about one third or more on each case. Ratio of transposed intact articular surface of the femoral head after the osteotomy to the acetabular weight bearing area was 100% on each case.
Postoperative follow-up period is 51, 39, and 22 months on each case. Progressive collapse of the femoral head has not yet seen. The assessment score of hip joint function in Japanese Orthopaedic Association is 88, 88, and 90 on each case.

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