著者

中村 洋

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.28, no.2, pp.183-188, 2009 (Released:2011-09-01)

参考文献数

31

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Glucosamine is an aminosaccharide with a molecular weight of 179.2 and the source of various aminosugars that make up the extracelluar matrix and glycoproteins. It also has biological effects on chondrocytes and other cells; for example, glucosamine is known to suppress the production of PGE 2 and MMPs from chondrocytes. Glucosamine has been used to treat osteoarthritis (OA) since the 1960s, however, clinical trials have reported inconsistent results. According to a recent meta-analysis, effect size of glucosamine was decreased to 0.35. The study showed the following two points; 1) only products of a specific company are effective and 2) glucosamine hydrochloride was ineffective. Regarding industry bias, controversy exists as to whether well-designed clinical studies supported by pharmaceutical companies thus show robust results on efficacy. Both glucosamine hydrochloride and its sulfate dissociate are absorbed as glucosamine in the oral mucosa. Careful analysis of clinical trials using glucosamine hydrochloride do not inevitably show that it is ineffective. Chondroitin sulfate is a high molecular weight compound composed of galactosamine and glucuronic acid. The meta-analysis showed negative results, partly because the quality of products is heterogeneous. To elucidate the efficacy of these products, investigation into the diagnosis and evaluation of OA is important.

著者

松本 淳

出版者

Japanese Society for Joint Diseases

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.7, no.4, pp.509-510, 1989-03-05 (Released:2010-10-07)

参考文献数

2

著者

藤巻 洋 稲葉 裕 小林 直実 雪澤 洋平 鈴木 宙 池 裕之 手塚 太郎 平田 康英 齋藤 知行

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.32, no.1, pp.17-22, 2013 (Released:2014-06-26)

参考文献数

12

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Objective: The aims of the present study were first to investigate the frequency and location of bone cysts in the acetabulum of hip osteoarthritis (OA) patients and second to examine the influence of pelvic tilt on the location of bone cysts in the acetabulum.Methods: A total of 80 patients (65 women and 15 men) with hip OA who underwent primary total hip arthroplasty were included in this study. The mean age at surgery was 65 years (range, 43-83 years). The bilateral hips of these 80 patients were examined; however, 9 contralateral hips that had previously been implanted with prostheses were excluded. We evaluated the minimal joint space width (MJS) on preoperative antero-posterior radiographs of the pelvis in the standing position. We also obtained the digital imaging and communication in medicine (DICOM) data from the preoperative pelvic computed tomography (CT) images, and then three-dimensionally reconstructed the DICOM data using OrthoMap 3D software with reference to the anterior pelvic plane. We divided the acetabulum into six areas and examined the presence of bone cysts in each area. We also examined the degree of pelvic tilt with three-dimensionally reconstructed CT images.Results: The frequency of bone cysts on CT images increased when the MJS of the hip joint on radiographs of the pelvis was less than 2 mm (p < 0.05). In the total of 151 hips, the antero-lateral area of the acetabulum (88 hips, 58%) exhibited the highest frequency of bone cysts. Patients who had bone cysts in the anterior part of the acetabulum tended to have a larger value of pelvic retroversion than those who did not have cysts in the anterior part of the acetabulum; however, the difference was not significant.Conclusion: The antero-lateral area of the acetabulum, which exhibited the highest frequency of bone cysts, is thought to be susceptible to loading stress. We hypothesized that patients who have bone cysts in the anterior part of the acetabulum have larger retroversion of the pelvis than others; however, the difference was not significant. We need to investigate further to reveal the influence of pelvic tilt on the location of bone cysts.

著者

岩田 久

出版者

Japanese Society for Joint Diseases

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.13, no.1, pp.1-3, 1994-06-30 (Released:2010-10-07)

参考文献数

13

著者

村田 英明 村上 恒二 宗重 博 浜田 宣和 天野 幹三 山本 健之 生田 義和

出版者

Japanese Society for Joint Diseases

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.12, no.3, pp.273-282, 1993-12-20 (Released:2010-10-07)

参考文献数

13

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To study the effectiveness of bone peg graft from the ulna for osteochondritis dissecans of the elbow joint, we analyzed 16 patients with bone peg graft who had various types of preoperative and postoperative findings. All the cases were baseball players except for one volleyball player. The onset ages ranged from 10 to 16 years (mean 11.2), and the periods from then to the operation from 5 to 72 months (mean 2.6 years) . The follow-up periods were from 12 to 29 months (mean 20 months) . Based on Minami's X-P classification, 8 cases were categorized into the stage of fragmentation and 8 into the stage of isolation. Patients were also classified with respect to the osteochondral lesion found during operation; 9 were without abrasion of the lesion or, if with it, without invasion of fibrocartilage into the lesion and were classified into Type 1. The 7 in which the osteochondral lesion was unstable due to the invasion of fibrocartilage were classified as Type 2. The results with regard to postoperative X-P were classified as excellent when the osteochondral lesion was repaired anatomically, as ‘good’ when the lesion was under repair and the osteosclerotic halo of the capitulum had disappeared, and as ‘poor’ when the halo remained. As a result, 7 Type 1 cases (78%) were excellent and 2 cases (22%) good, while one Type 2 case (14%) was excellent, 4 (57%) were good and 2 (29%) were poor. All patients were clinically not symptomatic and were satisfied with the surgery. We emphasized that bone peg graft could be indicated in all cases of osteochondral dissecans of the elbow joint and that there were difficulties in repairing osteochondral lesion in Type 2 (unstable) cases.

著者

岩本 幸英

出版者

Japanese Society for Joint Diseases

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.17, no.2, pp.89-98, 1998-10-31 (Released:2010-10-07)

参考文献数

32

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The process of bone metastasis consists of several distinct but essential events: escape from the original site, dissemination through blood vessels, and growth at a bone. Tumor cells cross basement membranes as they initially invade vascular beds during the dissemination. The inva sion of tumor cells through basement membranes involves three distinct events: attachment of the tumor cells to the basement membrane, secretion of MMPs by tumor cells which causes degradation of the adjacent basement membrane, and migration of the cells into the target tissue. Bone metastases are frequently associated with osteolysis, which leads to pathologic frac tures and hypercalcemia, while metastasis from prostatic carcinoma usually shows osteosclerotic changes. Cancer cells promote osteolysis by activating osteoclasts through a variety of chemical mediators secreted by cancer cells themselves or by monocytes. The risk of pathological frac ture is high if lytic metastasis involves cortical destruction.When skeletal metastasis is suspected following a roentgenogram, we suggest that a bone scintigram be performed primarily in order to identify whether the lesion is single or multiple. Patients with multiple skeletal metastases usually do not undergo surgery. Instead, radiation or chemotherapy is indicated. Surgery for skeletal metastasis does not necessarily affect the life expectancies of patients. However, if dramatic improvement in the quality of patients' lives can be expected, surgery for long bone metastasis or spinal metastasis is indicated.For patients with long bone metastasis, we prefer to carry out resection with a wide margin before a pathological fracture occurs, since the fracture carries the risk of disseminating tumor cells. Reconstruction after the resection of long bone involving metastasis may be best achieved by prosthetic replacement. The spine is the most common site of skeletal metastasis, irrespective of the primary tumor. When patients with spinal metastasis are expected to survive longer than six months, and neurological deficits become evident in addition to back pain, decompression followed by posterior stabilization is indicated.

著者

土屋 弘行 加畑 多文 北野 慎治 上原 健治 森永 敏生 富田 勝郎

出版者

Japanese Society for Joint Diseases

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.17, no.4, pp.237-248, 1999-06-10 (Released:2010-10-07)

参考文献数

11

---

Introduction of the Ilizarov external fixator has bought about a treatment revolution to resolve such orthopaedic problems as fracture fixation, limb lengthening, deformity correction, joint mobilization, and reconstruction of bone and soft tissue defects. One of the advantages of the Ilizarov method is its versatility, that is, different orthopaedic problems can be simultaneously treated with the Ilizarov method. In this study, we introduce a method of deformity correction of the lower extremities and reconstruction of skeletal defects using the Ilizarov external fixator. Deformity correction with the Ilizarov hinge system is very useful to realign the mechanical axis of the lower extremities. We also introduce a new concept of high tibial osteotomy called“mechanical axis lateralization”for genu varum resulting from unicompartmental medial osteoarthrosis, Blount's disease and so on. In addition, the Ilizarov method made it possible to successfully reconstruct extensive bone defects combined with or without intramedullary nailing. The Ilizarov method will become more widely used and advantageous if the treatment period is shortened.

著者

吉田 純 吉田 昌平 相馬 寛人 吉川 信人 橋尾 彩花 青島 早希 谷口 里奈 菅 寛之 毛利 尚史 辻原 隆是

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.33, no.1, pp.1-5, 2014 (Released:2015-06-10)

参考文献数

18

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Objective: We examined the relationship between isokinetic knee extensor strength and lower limb skeletal muscle mass measured by the impedance method. The objective of this study was to clarify the characteristics of knee extensor strength in patients with osteoarthritis of the knee.Methods: The osteoarthritis (OA) group was composed of thirty-six lower limbs of twenty females with OA of the knee, and the control group was composed of fifty lower limbs of twenty five healthy females, respectively. The mean age of the OA group was 68.1±4.9 years and that of the control group was 70.3±3.6 years, respectively. We measured lower limb skeletal muscle mass by the eight electrode body impedance analysis (BIA) method. In addition, we measured the peak torque of the knee extensor muscle strength in 60 deg/sec. Investigations were also carried on primary lower limb skeletal muscle mass and knee extensor strength obtained from the control group. We then predicted the knee extension strength of the OA group, which was obtained using a formula.Results: Lower limb skeletal muscle mass for the OA group was 6.2±0.6 kg, and for the control group was 6.3±0.5 kg (n.s.), respectively. Knee extensor torque for the OA group was 60.0±16.1 Nm, and for the control group was 77.7±13.7 Nm (p < 0.01), respectively. The primary regression equation in the control group was y = 11.016x + 8.63 (r = 0.428). Predictive value of knee extensor strength of the OA group obtained from the regression equation was 77.4±6.7 Nm.Conclusion: The ratio of muscle output for skeletal muscle mass decreases in the patients with OA. Therefore, we think instead of simply increasing the muscle mass in the rehabilitation of patients with OA, it is necessary to continue to improve the ratio of muscle to muscle mass output.

著者

腰野 富久

出版者

Japanese Society for Joint Diseases

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.6, no.2, pp.173-180, 1987-11-15 (Released:2010-10-07)

参考文献数

28

被引用文献数

1

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Patello-femoral disorders with anterior knee pain have become one of the most important subjects in orthopaedic surgery. The greater part of them are those with chondromalacia patella, patello-femoral compartment osteoarthritis, mal-tracking patella and painful shelf. The synovial impingement syndrome in the lateral patello-femoral facets, however, was rarely found and reported here as a new disease entity. Lateral shift and degree of lateral tilt of the patella shown on roentgenograms were found to be the most useful indications for deciding to perform medialization of the tibial tuberosity. Measurements were done in knees with surgical indication of patients with ages of less than 40 years. The former was 9.9 mm±4.8 mm in 13 knees. The latter was 24.6°±9.7°in 18 knees. Subluxation of the patella is, thus, defined by either more than 5 mm of the former or more than 15°of the latter.Clinical results of medialization or advancement of the tibial tuberosity revealed that improvements of symptoms were noted in 75-85% of the 26 knees operated on, except for those with retropatellar crepitation, improvement of which was found only in 20% of the cases. The position of the patella, however, was lowered after the above surgeries in 58.8% of 34 knees operated on, especially in the elderly. Fracture of the fragment was observed in 2 of 50 operated knees as a complication, but ended in there being satisfactory results. In 9 knees articular cartilages were observed at surgery and at the time of removal of internal fixation, usually one to two years after the initial surgery. All of the knees showed regeneration of degenerated cartilage postoperatively. The dege-neration grading and regeneration staging attempted were found to be satisfactory for evaluation of disorders.

著者

杉本 勝正 松井 宣夫 種田 陽一 大藪 直子 藤森 修

出版者

Japanese Society for Joint Diseases

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.71-76, 1992-06-05 (Released:2010-10-07)

参考文献数

6

被引用文献数

3

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Twenty-six coracohumeral ligaments (C-H hg) were studied by histochemical methods in order to investigate collagen structures and distribution of the nerves. The collagen structure of the C-H hg was different from that of the shoulder capsule in that tere was mainly Type III collagen in it. On the other hand, both Type I and III collagen were in the capsule of the shoulder joints. Regarding the distribution of the nerves, there were a lot of different types. Some C-H hg had many nerves and some had few nerves. Histologically the C-H hg was loose connective tissue which was connected with the periosteum of the coracoid process. We think such a characteristic of the C-H hg may be associated with the cause of frozen shoulder.

著者

町田 正文

出版者

Japanese Society for Joint Diseases

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.18, no.1-2, pp.13-18, 1999-08-31 (Released:2010-10-07)

参考文献数

19

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Idiopathic scoliosis is a common cause of spinal deformity in children and adolescents. Despite extensive studies, the etiology and pathogenesis remain unknown. Idiopathic scoliosis probably results from a multifactorial abnormality involving genetic, biochemical, and neuromuscular factors. Numerous experiments on various animal models and clinical studies have suggested possible anatomic or functional influences for the etiology, but many of them may be epiphenomena rather than etiologic causes. Recently, great emphasis has been placed on the role of the central nervous system. There is mounting evidence that a primary defect of central nervous system function - namely, a defect of posture, proprioception, or equilibrium control -is responsible for the development of scoliosis. More recently, results of studies indicate that calmodulin and/or melatonin are associated with the progression of idiopathic scoliosis. We have found that pinealectomy in chickens consistently produces scoliosis, which had similar anatomic characteristic of human idiopathic scoliosis. In addition, the intramuscular implantation of the pineal gland and interperitoneal injection of melatonin prevented the development of scoliosis. Furthermore, we demonstrated experimentally that induced scoliosis in pinealectomized rats occurs only in bipedal but not in quadrupedal rats.From our series of experimental studies we have proposed that a defect of melatonin synthesis may contribute to the etiology of experimental scoliosis model in chickens and rats, and bipedal condition may also be an important factor for the development of scoliosis.In a human study we found significantly decreased integrated concentration of melatonin over a 24-hour period and at night in adolescent idiopathic scolosis patients with progressive curves, while those with stable curves were similar to the control. We postulated that balanced muscle tone controlled by postural reflex is important to maintain normal posture with a straight spine in a bipedal condition. The disturbance of equilibrium and posture mechanism, secondary to a defect of melatonin synthesis, may promote development of rotational lordoscoliosis, especially in bipedal posture.

著者

川口 浩

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.35, no.1, pp.1-9, 2016 (Released:2017-03-31)

参考文献数

8

---

There are three representative international treatment guidelines for osteoarthritis (OA), each of which has different characteristics. These include the Osteoarthritis Research Society International (OARSI), the National Institute for Health and Clinical Excellence (NICE) from the National Health Service in the United Kingdom, and the American Academy for Orthopaedic Surgeons (AAOS). Among them, the OARSI guidelines are the most frequently revised with new evidence. Besides these international guidelines created by Western countries, there are Japanese OA treatment guidelines which were created by the Japanese Orthopaedic Association based on the OARSI guidelines (part Ⅱ). In some aspects, both guidelines are very similar. However, there are substantial differences, especially with respect to hyaluronic acid injection and supplements including glucosamine and chondroitin sulfate. In this paper, the newest 2014 OARSI treatment guidelines (part Ⅳ) are introduced in which the Author was a committee member as the Asian representative. There is also discussion about the present status of OA treatment in Western and Asian countries, especially when comparing between corticosteroid and hyaluronan intraarticular injections, and that between non-selective non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors, and the recent status of acetaminophen and topical NSAIDs.

著者

黒田 司 佐浦 隆一 廣畑 和志 石川 斉

出版者

Japanese Society for Joint Diseases

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.3, pp.503-506, 1990-12-15 (Released:2010-10-07)

参考文献数

8

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Although a number of cases of spontaneous medial dislocation of the long head of the biceps brachii muscle have been reported, lateral dislocation of this tendon has not. We describe a man with habitual lateral dislocation of the long head of the biceps tendon, and discuss the pathomechanics of this unusual condition. Enhanced computed tomography was useful for diagnosis in this case.

著者

陳 隆明 井口 哲弘 三枝 康宏 松原 司 廣畑 和志

出版者

Japanese Society for Joint Diseases

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.10, no.1, pp.61-70, 1991-06-20 (Released:2010-10-07)

参考文献数

17

---

RA joints whose bone scan was positive are thought to have a subclinical abnormality even if there aren't any symptoms. Two hundred joints in 45 patients with positive 99m Tc -HMDP bone scan without clinical signs except in small joints in hands and feet were followed for 12 to 45 months (mean: 22 months) . The age of the patients ranged from 24 to 76 (average : 57) and they had suffered from RA from 4 to 30 years (mean: 14) .Clinical signs such as pain and/or swelling appeared in 88 out of the 200 joints during the follow-up time. The new symptoms appeared frequently in the knee joint. There was no significant difference in the occurrence of the symptoms, however, between loaded and non-loaded joints. Those new symptoms were observed within 18 months in 79 % out of 88 joints.It is therefore considered that bone scans are an useful means for prospective detection of inflammatory joints. Careful observation is necessary for at least 18 months for RA joints with positive scintigraphic findings.

著者

長岡 亜紀子 中澤 明尋 酒井 直隆 竹内 良平 高木 敏貴 斎藤 知行 岡本 連三 腰野 富久

出版者

Japanese Society for Joint Diseases

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.19, no.3-4, pp.197-202, 2001-02-25 (Released:2010-10-07)

参考文献数

10

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The purpose of this study was to describe the clinical course of steroid induced osteonecrosis of the humeral head, and to investigate the relationship between radiological stage, pain, and range of motion (ROM) .Nine patients (16 shoulders) were examined directly at our out-patient clinic, with an average follow-up period of 4.2 years. There were 2 men and 7 women, with an average age of 42 years at the first visit. Correlation between radiological stage and both pain and ROM of the shoulder was evaluated with Spearman's rank correlation coefficient.At the first examination, 9 of 16 shoulders were evaluated as radiological Stage III or IV, and only 7 as II. During follow-up, the stage advanced from Stage III to IV in 2 of 5 shoulders, but no advance-ment from Stage II to III was observed. Thus, the radiological stage did not progress in a time-dependent manner. A positive correlation was found between radiological stage and pain grade (p<0.0001), and between that and limitation of active movement (p=0.0064) .

著者

上西 蔵人 金山 竜沢 東 秀隆 吉居 啓幸 老沼 和弘 白土 英明

出版者

Japanese Society for Joint Diseases

雑誌

日本関節病学会誌 (ISSN:18832873)

巻号頁・発行日

vol.35, no.1, pp.37-43, 2016 (Released:2017-03-31)

参考文献数

17

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Objective: When the extension gap is smaller than the flexion gap during total knee arthroplasty (TKA), an additional osteotomy of the distal femur is needed, which results in joint line elevation. We hypothesized that the chief cause of a decrease in the extension gap is excessive tension of both the medial collateral ligament and posteromedial capsule during knee extension. Therefore, we introduced a new technique called the “posteromedial-longitudinal capsulotomy” (PMLC) in May 2013 that allowed the separation of the medial collateral ligament from the posteromedial capsule, making it possible to expand the extension gap selectively. Our objective in this study was to assess the relationship between PMLC and the joint line in total knee arthroplasty.Methods: We compared two groups: Group A (70 patients, 85 knees) who underwent TKA before May 2013 prior to the introduction of PMLC, and Group B (77 patients, 91 knees) who underwent TKA after its introduction after May 2013. The posterior cruciate ligament was preserved in all patients. We evaluated the joint line based on differences in thickness between the surgically removed femoral bone and femoral components. We adjusted the thickness of the bone saw accordingly.Results: Expansion of the extension gap was needed in 66 of the 85 Group A knees (78%) and in 75 of the 91 Group B knees (82%), respectively. The technique for expansion in Group A was additional distal femoral osteotomy in 20 cases and other soft tissue release in 46 cases. In Group B there was additional distal femoral osteotomy in 14 cases and PMLC in 61 cases. The amount of distal osteotomy was 2.9 mm in Group A and 1.1 mm in Group B, which was significantly smaller. The amount of differences in the joint line was 0.9±3.2 mm (medial) and 1.6±2.6 mm (lateral) in Group A and −0.4±2.2 mm (medial) and 0.6±1.9 mm (lateral) in Group B, respectively.Conclusion: PMLC significantly reduces the amount of osteotomy required in TKA, and makes it possible to control elevation of the joint line.

著者

大塚 隆信

出版者

Japanese Society for Joint Diseases

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.26, no.2, pp.77-78, 2007-08-25