著者

河原 郁生 大根田 豊 田中 康仁

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.461-465, 2017 (Released:2018-12-15)

参考文献数

18

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Introduction: Although posterior soft tissue repair reduces the incidence of dislocation after posterior-approach total hip arthroplasty (THA), little is known about the importance of tendon repair of the obturator externus muscle. This study makes a comparison for dislocation rates after the posterior-approach THA in two different procedures for short external rotators fixation.Methods: We retrospectively reviewed 725 patients who underwent primary THAs via the posterior approach. In 541 patients we detached the piriformis muscle and the conjoined tendon from the greater trochanter backed with the capsule, and repaired to the posterior margin of the gluteus medius muscle (Group A). In this series the obturator externus muscle was cut with capsule incision far from the insertion at the greater trochanter, so we were unable to repair it effectively. In another 184 patients we released all external rotators (including the obturator externus muscle) from the insertion backed with the capsule in an L-shaped incision along the superior part of femoral neck and the trochanteric crest. The L-shaped flap was repaired back to the superior capsule and the posterior margin of the gluteus medius muscle (Group B). In each group we used two different head size (28 mm and 36 mm) according to the operation period and the cup size. We compared the dislocation rate between two groups at least one year after the operation. We also made a comparison for the dislocation rate in different head size within the two groups.Results: The overall dislocation rate was 5.7% in Group A and 1.1% in Group B, respectively. The dislocation rate with the 28 mm head size was 6.9% and 3.1%, and with the 36 mm head size was 1.7% and 0%, for Groups A and B respectively.Conclusions: The obturator externus muscle plays an important role in preventing posterior dislocation after THA. Anatomically it runs from the obturator foramen to the greater trochanter passing the posteroinferior part of the capsule like a sling. It gives dynamic pressure on the femoral head especially in flexion and during internal rotation in the natural hip. This function can be now be reproduced after THA as we have demonstrated, which gives low rates of dislocation.

著者

小林 哲夫

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.2, pp.97-101, 2017 (Released:2018-07-31)

参考文献数

29

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Bacteremia occurs through the translocation of oral bacteria from subgingival biofilms into the systemic circulation following daily oral hygiene activities and dental procedures. Bacteremia is caused more frequently in the treatment of periodontal disease than in other dental procedures. Periodontal treatment involves mechanical debridement, which consists of plaque control, scaling and root planing, and periodontal surgery. The debridement of bacterial biofilms in close proximity to the ulcerated epithelium of the gingival sulcus or periodontal pocket may lead to bacteremia. Therefore, it is essential to maintain oral hygiene and periodontal health in order to decrease the risk of bacteremia. It has long been debated by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA) whether or not the risk of prosthetic joint infection (PJI) is related to bacteremia after professional dental treatments. Currently, there is strong evidence of such an association. In addition, the indirect evidence obtained from multiple moderate-strength studies suggests that the use of prophylactic antibiotics reduces the incidence of post-dental procedure bacteremia. However, there have been no studies regarding the relationship between bacteremia and PJI. In summary, it is necessary to consider the risk of dental procedure-induced bacteremia and patient characteristics when prescribing prophylactic antibiotics for patients with prosthetic joints who are undergoing dental procedures. It may be particularly beneficial for these patients to maintain good oral hygiene.

著者

大石 正信 中島 康晴 岡崎 賢 福士 純一 久保 祐介 播广谷 勝三 松本 嘉寛 林田 光正 岡田 誠司 小山田 亜希子 岩本 幸英

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.35, no.4, pp.475-480, 2016 (Released:2017-12-15)

参考文献数

12

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Ankylosing spondylitis (AS) is a chronic inflammatory disorder characterized by bone formation, syndesmophytes, and ankylosis of the sacroiliac joints and spine. Recently, tumor necrosis factor inhibitors such as infliximab and adalimumab have been shown to be efficacious for AS. However, patients with AS often suffer from arthralgia and problems related to ankylosis of the spine due to the delay in the diagnosis of AS. Those patients often benefit from surgical treatments. We have treated total of 72 patients with AS in our hospital. Among them 32 operations were performed on total of 19 patients. Total hip arthroplasties were the most performed surgical procedure. Surgeries for spinal fractures and spinal deformity have also been performed.

著者

小関 弘展 尾﨑 誠

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.37, no.2, pp.105-109, 2018 (Released:2019-07-31)

参考文献数

17

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Objective: The present study aimed to determine the generation and behavior of airborne particles that could carry microorganisms around the area of the feet while walking in a bio-clean operating room.Methods: Four surgical staff members performed four walking patterns comprising combinations of the following: independently or as a group, and entering or exiting the operating room.Results: Fine particle visualization and laser particle counts revealed large numbers of airborne particles on shoes, the hems of gowns, and the floor regardless of the walking pattern. Numerous airborne particles were generated by followers who walked in groups and even more particles were brought to the level of the operating table by groups compared to solitary walkers.Conclusion: Surgical staff should be aware of transferring airborne particles from non-sterile areas to reduce the incidence of contamination by airborne bacteria in bio-clean rooms.

著者

川島 史義 髙木 博 古屋 貴之 加藤 慎 佐藤 敦 前川 勝彦 浅井 聡司 中田 規之

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.1, pp.15-19, 2017 (Released:2018-03-31)

参考文献数

10

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Introduction: Several methods have been proposed to determine proper femoral component rotation alignment in total knee arthroplasty (TKA). Usually the epicondylar axis, the posterior condylar axis and Whiteside’s line are used for landmarks. However, sometimes recognition of these landmarks is difficult intraoperatively. We decide on the rotation angle of the femoral component using the epicondylar view via a preoperative radiograph. The angle consists of the clinical epicondylar axis (CEA) and the posterior condyle line minus two degrees. We think the influence of the residual cartilage of the posterior lateral femoral condyle is about two degrees in varus osteoarthritis (OA).Objective: The objective of this study was to evaluate the rotation alignment of the femoral component after TKA, and the usefulness of our method for the decision of femoral component rotation alignment.Methods: There were 43 patients (7 males, 36 females) with varus OA who underwent primary TKA. The average age was 78.1 years (range, 64-87 years). The rotation angle of the femoral component was decided by the above-mentioned method. We evaluated the angle between the posterior border of the femoral component and the CEA, and the surgical epicondular axis (SEA) using postoperative computed tomography. These angles were expressed as∠CEA and∠SEA. External rotation was expressed as plus.Results: The mean∠CEA was−1.1 (−5-1)°. The mean∠SEA was 0.48 (−3-3)°. The mean angle of∠SEA−∠CEA was 1.5 (0-3)°. The femoral component was placed in internal rotation to CEA and parallel to SEA.Conclusion: Internal placement of the femoral component was considered to be caused abnormal patella tracking and dislocation and low value of Knee Society Knee scoring. We think that it can be difficult to recognize some landmarks intraoperatively. We decide on the rotation angle of the femoral component using the epicondylar view of preoperative radiographs. From the results of this study, the femoral component was placed in internal rotation to CEA and parallel to SEA. We conclude that our method for the decision of the femoral component rotation alignment is useful for TKA of varus OA of the knee.

著者

小浦 卓 高木 徹 横山 裕介 小西池 泰三

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.38, no.2, pp.155-158, 2019 (Released:2020-04-28)

参考文献数

6

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Background: Popliteal cysts are often observed in patients with rheumatoid arthritis (RA) . Complications of these cysts are rupture, dissection, pseudothrombophlebitis, leg ischemia, nerve entrapment, and compartment syndrome. We describe a patient suffering from RA with a ruptured popliteal cyst that was treated by surgery.Case: A 74-year-old patient with RA presented with sudden-onset pain and tense swelling in his right calf. Prior to hospital admission, a deep vein thrombosis (DVT) was suspected, and he was referred for evaluation and treatment. His C-reactive protein level was 3.78 mg/dL, and his D-dimer level was 3.7 μg/mL (normal level, <1.0 μg/mL) . During his evaluation for DVT, the diagnosis of a ruptured popliteal cyst (RPC) was made on enhanced computed tomography and magnetic resonance imaging. He resisted conservative management and was treated surgically. Postoperatively, the cyst disappeared completely and has not recurred.Conclusion: A popliteal cyst is a benign lesion that results from degenerative or inflammatory disease of the knee joint. This cyst may rupture causing severe pain in the calf, with warmth, erythema, and tenderness. This may be confused with other causes of swelling and pain in the calf including deep vein thrombosis. Hence it is also described as pseudothrombophlebitis. After surgical resection of such cysts, general as well as local signs of inflammation improved. In difficult cases, surgery is considered to be very effective for the treatment of RPCs. In the case of failure of conservative management, surgical treatment is a good option for the treatment of RPCs.

著者

川口 航平 山神 良太 河野 賢一 鹿毛 智文 村上 亮 武冨 修治 田中 栄 乾 洋

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.42, no.2, pp.54-60, 2023 (Released:2023-07-31)

参考文献数

27

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はじめに:人工膝関節手術に対しての術後患者立脚型評価が標準化しているが,術後患者立脚型評価には術前の心理的因子が影響すると報告されている。しかしTKA,UKAにおいての術前の心理的因子の違いや術後患者立脚型評価に与える影響の違いなどは明らかではない。本研究の目的はTKAとUKAにおける術前の心理的因子の違いとその心理的因子が術後臨床成績に与える影響の違いを明らかにすることである。方法:2018年10月から2021年3月に当科にて人工膝関節手術を行った症例で,術後1年以上の臨床成績の評価が可能であったTKA192膝とUKA43膝を対象とした。術前心理的因子は痛みに対する中枢性感作の評価スコアであるCSIと破局的思考の評価スコアであるPCSにて評価した。術後患者立脚型評価として術後1年でのKOOS,New Knee Society Scoreを使用した。TKAとUKAでの術前心理的因子の違いと術前心理的因子と術後患者立脚型評価の関連の違いを評価し2群で比較した。結果:術前心理的因子であるCSIはTKA群23.5,UKA群21.5,PCSはTKA群27.3,UKA群26.1とともに両群で有意差はなかった。CSIと術後患者立脚型評価の関係は,TKA群では術後患者立脚型評価のすべての項目で負の相関を示したが,UKA群ではすべての項目と相関がなかった。PCSと術後患者立脚型評価の関係では,TKA群では立脚型評価のすべての項目で負の相関を示したが,UKA群ではKOOSのADLとNew Knee Society Scoreの満足度の項目のみ負の相関を示した。結論:TKAとUKAにおいては術前心理的因子(中枢性感作,破局的思考)には差がなかった。しかしTKAとUKAにおける術前心理的因子(中枢性感作,破局的思考)が術後患者立脚型評価に与える影響の程度は異なっていた。

著者

藤巻 洋 中澤 明尋 竹内 剛 門脇 絢弘 草山 喜洋 井出 学 金井 研三 金 由梨 松原 譲二 稲葉 裕

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.40, no.1, pp.14-21, 2021 (Released:2021-03-31)

参考文献数

12

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目的 : 人工膝関節全置換術 (TKA) 前後の立位下肢アライメント左右差が脚長差に及ぼす影響を調査すること。方法 : 調査対象は初回片側TKAを施行した74例で手術時年齢は平均73歳。TKA術前および術後3週に両側の下肢全長立位2方向単純X線像を撮影し, 正面像で下肢機能軸 (大腿骨頭中心と足関節中心を結ぶ線) の長さ (MA長) および下肢機能軸の膝関節面通過点の膝関節中央からの偏移 (MAD) を, 側面像でknee flexion angle (KFA) を計測した。術前後での各計測値の左右差を調査し, さらに術前後それぞれでMADおよびKFA左右差がMA長左右差に及ぼす影響を単変量および多変量で解析した。結果 : 術前にMA長左右差と有意に関連したのは単回帰分析でMAD左右差 (R=−0.31, P=0.003) およびKFA左右差 (R=−0.51, P<0.001), 重回帰分析でもMAD左右差 (P<0.001) およびKFA左右差 (P<0.001) であった (修正R2=0.43)。術後にMA長左右差と有意に関連したのは単回帰分析でMAD左右差 (R=−0.39, P<0.001) およびKFA左右差 (R=−0.58, P<0.001) で, 重回帰分析でもMAD左右差 (P<0.001) およびKFA左右差 (P<0.001) であった (修正R2=0.50)。考察 : TKA前後で冠状面および矢状面の立位下肢アライメントが脚長差に影響しており, 片側TKA後には脚長差が生じる可能性を認識する必要がある。

著者

海野 宏至 長谷川 正裕 鈴木 慶亮 松井 佑梨世 湏藤 啓広 今中(吉田) 恭子 吉田 利通

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.35, no.2, pp.131-136, 2016 (Released:2017-07-31)

参考文献数

16

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Objective: Tenascin-C (TNC) is an extracellular matrix glycoprotein. In this study, we examined the effects of full-length TNC on joint cartilage protection in murine osteoarthritis (OA) models and on synovial inflammation in OA joints. In addition, we performed an in vitro study to reveal the mechanism of repairing cartilage using full-length TNC.Methods: In this in vivo study, fourteen male BALB/c strain mice (8-weeks-old) were used. Both knee joints were exposed and the anterior cruciate ligament and medial collateral ligament were transected. 10 μg/mL of TNC were injected into the knee joint (group Ⅰ). The control group had injection of phosphate buffered saline (PBS) (group Ⅱ). Mice were sacrificed at 4 days, 2 weeks, and 4 weeks postoperatively. Cartilage was evaluated using the Mankin score, and synovitis was evaluated using the Synovitis score. An in vitro study was also performed on human cartilage specimens, which were obtained from patients who underwent total knee arthroplasty for the treatment of OA. Chondrocytes were isolated and cultured, and they were treated with 0, 1, or 10 μg/mL of TNC. We also compared the expression of many kinds of messenger RNA after exposure at each dose by real-time polymerase chain reaction. We evaluated the expression of TNC, inflammatory cytokines [TNF-α, IL-1β, NFκB], anabolic factors [TGFβ, TIMP3, bFGF], and catabolic factors [ADAMTS-4, -5, and MMP-3, -13].Results: With the in vivo study, the average Mankin scores were significantly better in group Ⅰ than group Ⅱ at 4 weeks (group Ⅰ; 1.1, group Ⅱ; 3.2 (P<0.05)). At 4 days and 2 weeks, no development of OA was found in either of the two groups. Low-grade synovitis occurred in both groups at 4 days, 2 weeks, and 4 weeks. There were no significant differences in average synovitis scores between two groups at 4 days, 2 weeks, and 4 weeks. The in vitro study revealed that TNC upregulated the expression of endogenous TNC, TNFα, IL-1β, NFκB, TGFβ, TIMP3 and ADAMTS-4, MMP-3, and MMP-13. But 10 μg/mL of TNC downregulated the expression of ADAMTS-5.Conclusion: This study has demonstrated that 10 μg/mL of full-length TNC can prevent articular cartilage degeneration for 4 weeks without promoting synovitis. The in vitro study demonstrated that TNC upregulates itself and anabolic factors. However, TNC also downregulated the expression of ADAMTS-5 which contributed to cartilage degradation.

著者

宮本 浩次

出版者

日本関節病学会

雑誌

日本リウマチ・関節外科学会雑誌 (ISSN:02873214)

巻号頁・発行日

vol.11, no.1, pp.77-88, 1992

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Although many investigators had studied the innervation of the posterior longitudinal ligament (PLL) with regard to the pathogenesis of low back pain, the precise distribution of the nerve fibers had not been clarified before Kojima's acetylcholinesterase histochemical study. In my study here, innervation of the PLL of the rat lumber vertebral column was investigated by immunohistochemical staining of the calcitonin gene-related peptide (CGRP) and substance P (SP) .<BR>The PLL was found to contain dense nerve networks of numerous CGRP and SP-like Immunoreactive fibers which demonstrated nerve endings with marked varicosity. They were divided into two systems. One was a network which was distributed in the vertebral portion and in the superficial layer of the intervertebral portion of the PLL, and the other was the network existing in the profound layer in the intervertebral portion known as enthesis of the PLL. They were supplied by nerve fibers through the meningeal branches of the spinal nerves and the gray communicating branches.<BR>This study suggests that the CGRP and the SP-like immunoreactive fibers in the PLL are associated with not only the conduction of nociceptive stimuli but also the regulation of spinal motion and metabolism of the enthesis.

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

重野 陽一 福島 美歳 原田 憲正 石田 通暁 大西 純二 中川 滋人

出版者

日本関節病学会

雑誌

日本リウマチ・関節外科学会雑誌 (ISSN:02873214)

巻号頁・発行日

vol.9, no.4, pp.593-602, 1990

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The porous total knee replacement designed by Miller and Galante has been performed on 31 knees in 23 cases from November 1986 to June 1988 in the Kure National Hospital. We evaluated the postoperative results over an average follow-up period of 2.7 years (ranging from 2 to 3.6 years) on 6 knees in 4 men and 25 knees in 19 women, with ages ranging from 49 to 81 (average 69.0) . The original diseases were 5 cases of rheumatoid arthritis (7 knees) and 18 cases of osteoarthritis (24 knees) .<BR>Each knee was evaluated preoperatively and postoperatively by the functional evaluation score system proposed by the three universities. Preoperative and postoperative femoro-tibial angle, alignment of each component, degree of lateral displacement of the patella on the patellofemoral groove, occupancy ratio of the component to the tibial surface, amount of resection of the tibia, radiolucent line and sclerotic line adjacent to the component were investigated with roentgenograms.<BR>Postoperatively the clinical score improved from 36.9 to 80.3 points in rheumatoid knees and from 48.5 to 87.3 in osteoarthritic knees.<BR>In each case, the insertion angle of the components was close to ideal. The degree of lateral displacement of the patella was significantly decreased in cases with lateral retinacular release. The mean occupancy ratio of tibial component to tibial surface was 95.8% on A-P and lateral view X-rays, showing that the components used are small for the tibial surface. The mean resection of the tibia was 7mm from the surface of the lateral plateau in varus knees. Only 2 rheumatoid patients had radiolucent lines surrounding the tibial component. In 2 rheumatoid knees and 11 osteoarthritic knees there were sclerotic lines surrounding the pegs of the tibial components.<BR>In general, the short-term results of total knee replacement using this prosthesis were satisfactory. The long-term radiographic observation has shown that the choice of a tibial component of adequate size is mandatory to prevent the component from sinking.

著者

小橋 由紋子 尾尻 博也 山添 真治 馬場 亮 辻本 博瑛 青柳 裕

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.32, no.4, pp.409-415, 2013 (Released:2015-02-18)

参考文献数

3

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Objective: To evaluate availability of dual-source computed tomography (CT) for representative joint pathologies and to document the findings of each.Methods: We used dual-source CT to evaluate representative joint diseases. Dual-source CT has two X-ray tubes and can produce two different X-ray energies (80 KV and 140 KV) at the same time. We analyzed CT values of each structure obtained by dual-source CT, and distinguished one from the others using the three-material decomposition theory.Results: Dual-Energy Imaging produced virtual non-contrast (VNC) images, which detected several clinically important joint pathologies such as articular cartilage defect of the knee joint, labral tear of the hip, and triangular ligament tear of the wrist.Conclusion: VNC imaging obtained by dual-source CT is considered to be valuable in the evaluation of joint pathologies.