著者

加茂 健太 城戸 秀彦 城戸 聡 清原 壮登 太田 昌成

出版者

日本関節病学会

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.36, no.4, pp.457-460, 2017 (Released:2018-12-15)

参考文献数

6

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Introduction: The superior approach (SA) in total hip arthroplasty (THA) is one of the muscle sparing posterior approaches. We describe this method and report the radiographic outcomes of the first 30 hip arthroplasties performed using a SA.Methods: The method for THA: The patient was placed in the lateral decubitus position with the operative leg in approximately 60° of flexion, 40° of adduction, and 20° of internal rotation. The gluteus medius muscle was retracted anteriorly, and the piriformis muscle posteriorly, to exposure the hip capsule. The femoral canal was entered at the trochanteric fossa with a round chisel. The femoral broaches were performed before the femoral neck osteotomy. The femoral head was removed after the osteotomy. The acetabular cup was impacted with anteversion of the transverse acetabular ligament. The method for hip hemi-arthroplasty (HA): First, the outer head was placed in the acetabular fossa; second, the femoral stem was placed and the inner head was impacted. The outer and inner head were set up in the acetabular fossa.Results: The SA group included 12 THAs and 18 HAs. In the THA group, the mean operative duration was 106±18 minutes, the mean varus angle of the stem was 0±1.5 degrees, the mean inclination of the cup was 45±8 degrees, the mean anteversion of the cup was 9±8 degrees and the mean limb length discrepancy was 6±4 mm. In the HA group, the mean duration was 60±17 minutes, the mean varus angle of the stem was 1±2 degrees and the mean limb length discrepancy was 0.5±4 mm. In four (33%) THAs, the piriformis muscles were resected and repaired. In all of the HAs, the piriformis and conjoint tendons were preserved.Conclusion: The piriformis muscles were resected in some THAs, but the short rotators muscles were preserved in the HA procedures.

著者

原口 和史 加茂 健太 谷口 秀将

出版者

西日本整形・災害外科学会

雑誌

整形外科と災害外科 (ISSN:00371033)

巻号頁・発行日

vol.66, no.1, pp.71-75, 2017-03-25 (Released:2017-05-01)

参考文献数

12

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近年,強直性脊椎炎(AS)に対して抗TNF-α製剤が使用され,臨床症状の著しい改善が期待できるようになった.しかし,抗TNF-α製剤は骨新生を抑制できず,臨床症状の改善とXP所見の進行には乖離があるとされている.今回,抗TNF-α製剤を投与し長期期間経過を見たASの2例を報告する.症例1(58歳男性,投与期間82カ月)29歳時ASの診断を受ける.50歳で両股関節痛のため初診.脊椎全体が強直,両仙腸関節は癒合,両股関節は高度に変形しており,MTX投与開始.両THA施行後,Infliximab 3mg/kg/8W開始,その後5mg強/kg/8Wまで増量する.症例2(42歳男性,投与期間60カ月)32歳頃より上顎洞炎,腰背部痛などあり,SAPHO症候群診断で治療を受ける.38歳時初診,MTX,Infliximab 5mg/kg/8W開始.効果減弱傾向あり,32か月後Adalimumab 10mg/2Wに変更.両例とも抗TNF-α製剤投与後,臨床症状は著しく改善したが,症例2では腰椎XP病変の進行を認めた.