著者

東 良和 土井 一輝 藤井 裕之 坂本 相哲

出版者

公益社団法人 日本リハビリテーション医学会

雑誌

The Japanese Journal of Rehabilitation Medicine (ISSN:18813526)

巻号頁・発行日

vol.51, no.4-5, pp.277-282, 2014 (Released:2014-05-10)

参考文献数

13

被引用文献数

2 1

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目的:高齢者大腿骨近位部骨折の術後リハビリテーション(以下,リハ)施行時間(単位数)とADL機能,医療費について比較検討し,適正リハ時間について検証する.方法:2010 年6 月1 日から2013 年6 月27 日の間に当院で手術,術後リハを施行した222 名に対してCONSORT 2010ガイドラインに基づいた無作為化比較試験(RCT)を6 単位(120 分)と1日2 単位(40 分)施行群間で行い,術後12 週までのADL機能,歩行と医療費について比較検討した.結果:最終的にRCTが完遂できた受傷前独歩患者は,6 単位群29 症例,2 単位群29 症例であった.FIM, Barthel Index,EQ-5D,歩行に関しては両群間で統計学的有意差はなかったが,医療費に関しては,6 単位群で約20 万円高額となった.結論:早期リハを行うことにより,術後2 単位リハで十分な機能回復が獲得でき,医療費の有効利用ができた.

著者

服部 泰典 土井 一輝 川上 不二夫 日浦 泰博

出版者

一般社団法人 日本農村医学会

雑誌

日本農村医学会雑誌 (ISSN:04682513)

巻号頁・発行日

vol.46, no.1, pp.23-26, 1997-05-30 (Released:2011-08-11)

参考文献数

3

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指末節部の切断指再接着術後のうっ血に対し, 医療用に開発されたヒルを使用し良好な結果を得ることができた。わずか数十分の使用で数時間にわたる出血が得られ, 従来行われていた医師もしくは看護婦によるミルキング等の処置を必要とせず, 医療サイドの負担を大きく軽減させることが可能となった。ヒルの使用による感染の危険もあるが, 第2, 3世代のセフェム系抗生剤に感受性があるため十分予防可能である。

著者

安部 幸雄 土井 一輝 酒井 和裕 深堀 勝之 藤井 裕之 河村 洋行 河合 伸也

出版者

West-Japanese Society of Orthopedics & Traumatology

雑誌

整形外科と災害外科 (ISSN:00371033)

巻号頁・発行日

vol.43, no.3, pp.1020-1022, 1994-09-25 (Released:2010-02-25)

参考文献数

9

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Peripheral nerve trunks are not rigidly fixed to surrounding tissues along their course. They slide longitudinally in their beds over several millimeters with movements of the extremity. This concept of peripheral nerve excurisions helps to explain the pathophysiological events occurring in entrapment neuropathy, chronic nerve irritation and nerve compression. Although this is an important physiological phenomenon, this has not been examined precisely.We examined excursion of the normal sciatic nerves of 10 adult rabbits. The following were investigated:1) Percentage elongation of the sciatic nerve under nomal lower limb motion.2) Excursion between epineurium and gliding floor.3) Excursion between the funiculus.4) Morphological changes of the sciatic nerves under nomal lower limb motion.5) Microanatomical features of the peripheral nerves adapting movements of the extremity.The results were as follows:1) Total percentage elongation of the sciatic nerve was 5.8% in 0° flexion of the knee and 90° flexion of the hip joint. But near the knee joint, the maximum percentage was 9.2%.2) Excursion was found between the epineurium and gliding floor, and between the funiculus.3) It was proven that in the funiculus the nerve fibres have an undulating spiral pattern, which is, after its discoverer, called Fontana's bands. When the nerve was stretched in the course of movement, the undulation straightened out until it disappeared. Microanatomical view represents the wave-like alignment of the nerve fibres.By these features, peripheral nerves can accommodate limb motion.

著者

林 洸太 服部 泰典 土井 一輝 坂本 相哲

出版者

日本マイクロサージャリー学会

雑誌

日本マイクロサージャリー学会会誌 (ISSN:09164936)

巻号頁・発行日

vol.31, no.2, pp.62-67, 2018 (Released:2018-06-25)

参考文献数

9

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In fingertip amputations, surgeons may encounter technical difficulties in vein grafting for anastomosis of small and fragile vessels.In this retrospective study, we evaluated the survival rate, complications, and surgical techniques for fingertip replantation with vein grafting.One hundred and twenty-five fingertip replantation procedures were performed in 116 patients between 1996 and 2017 at our hospital. There were 74 amputations in zone I and 51 in zone II. Twenty-five amputated fingertips in zone I were replanted with vein grafting for arterial or venous repairs. Among the 25 procedures with vein grafts, there were 11 with arterial repairs, 6 with venous repairs, and 8 with both arterial and venous repairs.In the procedures with vein grafting, vascular thrombosis was found in 6, of which there were 4 arterial and 2 venous thromboses. In 4 cases of arterial thrombosis, the circulation gradually deteriorated within 2 or 3 days and subsequent necrosis of the replanted fingertip occurred, presumably because of severe damage to the soft tissue.The overall survival rate of replantation with vein grafting was 84%.Although skillful microsurgical techniques and longer operation times are in high demand, our results using vein grafts for successful fingertip replantation are encouraging.