著者

藤村 謙次郎 山下 彰久 白澤 建藏 城戸 秀彦 原田 岳 林 哲生 牛島 貴宏

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.58, no.1, pp.27-31, 2009

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【目的】当院で2000年以降に経験した化膿性膝関節炎を検討し,今後の治療方針決定に役立てる.【対象および方法】2000年から2008年2月までに当科で化膿性膝関節炎と診断されたのは21例21膝.うち合併症のために最終的に下肢切断術を余儀なくされた2例とACL術後感染1例,真菌性膝関節炎1例を除外して検討を加えた.平均年齢69.5(32~89)歳,男性8例,女性9例であった.手術方法は関節鏡下滑膜切除+持続灌流を基本とし,症例に応じて適宜変更した.【結果・考察】退院時のBallard評価基準はgood 2,fair 13,poor 1,死亡1であった.起炎菌の同定,早急な外科的治療および抗生剤投与が重要であり,また,MRSAは治療遷延化および変形性膝関節症(OA)の進行を招き機能予後を低下させる原因であった.さらに2006年以降の4例中3例はMRSA感染であり,近年のMRSA感染増加が示唆された.

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 The gluteus medius muscle was retracted anteriorly, and the piriformis muscle posteriorly, to exposure the hip capsule.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.