Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1186/s12891-025-09014-y

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Language：Japanese   Publisher：日本股関節学会  

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Language：Japanese   Publisher：日本股関節学会  

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Language：Japanese   Publisher：日本股関節学会  

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Language：Japanese   Publisher：日本股関節学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Kinematic alignment (KA) in total knee arthroplasty (TKA) has been extensively studied in osteoarthritis (OA) knees but remains unexplored in rheumatoid arthritis (RA) knees. We compared the coronal and rotational alignments in knees with RA and OA. METHODS: In total, 433 patients (69 with RA and 364 with OA) who underwent TKA were included. The hip-knee-ankle angle HKA), lateral distal femoral angle LDFA), medial proximal tibia angle (MPTA), and coronal plane alignment of the knee (CPAK) classification were measured using full length anteroposterior radiographs. The difference between the posterior condylar axis (PCA) and surgical epicondylar axis (SEA) angle was measured with computed tomography. RESULTS: Patients with RA exhibited different CPAK classifications compared to those with OA. The mean PCA-SEA was significantly different between the RA and OA groups. Furthermore, the RA group had significantly larger HKA, smaller LDFA, and larger MPTA compared to the OA group. CONCLUSIONS: CPAK classification distribution between patients with RA and OA were different. The average PCA-SEA for RA is larger than that for OA, warranting caution of the complications associated with internal rotation placement. Understanding these differences allows for the consideration of RA knee characteristics and informs future evaluations of KA techniques.

DOI： 10.1093/mr/roaf056

PubMed

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Background: The shelf acetabuloplasty has received renewed attention as a minimally invasive, joint preservation surgery for developmental dysplasia of the hip joint. However, there has been little scientific validation of the optimal location of the shelf in terms of stress reduction.

Clinical Questions:

(1) Where is the optimal shelf location for successful stress reduction to the acetabulum?

(2) Are there any patient characteristics that indicate limitations of shelf acetabuloplasty that make it difficult to obtain load distribution?

Patients and Methods: Preoperative computed tomography of fifteen patients scheduled for shelf acetabuloplasty was used for finite element analysis to create various simulated shelf models. The following four parameters were set as the shelf-placement conditions: shelf height, shelf tilting, shelf extrusion, and shelf anterior–lateral position. Three different conditions were set for each parameter, creating a total of 81 shelf models for each case. Using finite element analysis, the mean equivalent stress in the loading area of the acetabulum was analyzed, and the stress reduction ratio was calculated based on the preoperative values.

Results: Among the 1,215 shelf models across 15 cases, 284 demonstrated a stress reduction exceeding 10%. Multiple regression analysis showed that the center-edge angle was the only significant factor associated with stress reductio n (p<0.001). The center-edge angles at which the acetabular stress reduction exceeded 10% were limited to approximately 13°–19°. Multivariate analysis using a mixed linear model, while avoiding the influence of the dysplasia grade, revealed that the equivalent stress values on the acetabulum were significantly lower for lateral shelf placement than the anterior position (p<0.05). Moreover, the stress on the inner shelf, the part implanted in the pelvis, was significantly greater in the lateral position than the anterior position (p<0.001) and increased with increase in the tilting angle (p<0.001). The reduction rate of acetabular stress exhibited a significant correlation with the equivalent stress on the inner shelf (p<0.0001).

Conclusions: Considering load dispersion, cases with the center-edge angle between 13° and 19° may benefit from shelf acetabuloplasty. Moreover, lateral installation is advantageous for effective load dispersion. Additionally, stress changes in the acetabulum are influenced by the stresses applied to the inner shelf.

DOI： 10.1093/jhps/hnaf011.220

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.eats.2024.103193

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.eats.2024.103064

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Language：Japanese   Publisher：日本股関節学会  

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Language：Japanese   Publisher：日本股関節学会  

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Language：Japanese   Publisher：日本股関節学会  

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Language：English   Publishing type：Research paper (scientific journal)  

It is well known that increased posterior tilt of the pelvis is an effective strategy for avoiding impingement of the femur with the pelvis during movement. Daily repetitive collisions become mechanical loads, and the more frequently they occur, the more tissue damage and pain they cause. Therefore, reducing the rate of occurrence of impingement is important to avoid aggravation of symptoms. This study aimed to evaluate the effects of changes in posterior pelvic tilt on the risk of impingement between the femur and the anterior inferior iliac spine (AIIS)/subspine in various functional postures. Patients with femoroacetabular impingement syndrome (FAIS) who were candidates for hip arthroscopic osteochondroplasty between October 2013 and June 2020 were included. A three-dimensional reconstructed model was used to simulate the incidence of impingement at 12 hip positions required for activities of daily living. We predicted value of the spatial incidence of impingement assumed that hip motion should exceed 130/30 degrees without impingement. Impingement was measured at three pelvic positions: an anterior tilt of 10°, in the functional pelvic plane and a posterior tilt of 10°. Multivariate linear-mixed models were used to assess the effect of covariate-adjusted posterior pelvic tilt on the impingement incidence in the AIIS region. AIIS type, center-edge angle, acetabular version and femoral version were used as covariates. The impingement rates and locations of the three pelvic tilt postures were assessed. Seventy-eight patients (60 males and 18 females; average age, 46 ± 15.1 years) with FAIS were analyzed. A multivariate linear-mixed model revealed a coefficient of -0.8% (95% confidence interval -0.9 to -0.7%; P < 0.001) for posterior pelvic tilt. Thus, posterior pelvic tilt affects AIIS impingement incidence. After adjusting for anatomical effects, the posterior pelvic tilt should be addressed to avoid impingement.

DOI： 10.1093/jhps/hnae003

PubMed

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.7759/cureus.57953

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Language：English   Publishing type：Research paper (scientific journal)  

Background The aim of this study was to determine the incidence of deep tissue injury (DTI) and potential risk factors after surgery in the lithotomy position. Methods All patients who underwent surgery in the lithotomy position under general anesthesia at a single center between January 2017 and December 2021 were retrospectively evaluated. The medical records of these patients were reviewed, and patient demographic and clinical characteristics, surgical data, and occurrence of DTI were recorded. Results During the study period, 5146 patients, 2055 (39.9%) males and 3091 (60.1%) females, with a mean age of 57.3 ± 17.4 years, underwent surgery in the lithotomy position. Seven (0.14%) patients developed DTI on their calf following surgery. All presented with severe pain and swelling, requiring prolonged hospital stay. Multivariate analysis showed that male sex (odds ratio (OR): 11.43; 95% confidence interval (CI): 1.15-113.34, p = 0.037), higher BMI (OR: 1.32; 95% CI: 1.17-1.50, p = 0.0001), and longer operation time (OR: 1.01; 95% CI: 1.004-1.014, p = 0.0002) were independent risk factors for postoperative DTI. Optimal cut-off values for BMI and operation time were 23.5 kg/m2 (sensitivity = 100%; specificity = 64%) and 285 minutes (sensitivity = 100%; specificity = 90%), respectively. Conclusion Factors significantly associated with DTI include male sex, higher BMI, and prolonged operation time.

DOI： 10.7759/cureus.57413

PubMed

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Antibiotic susceptibility is very important for the successful treatment of orthopedic infections, particularly for implant-related infections. While the minimum inhibitory concentrations (MICs) of Staphylococcus species were well investigated for the isolates from the respiratory tract, investigations for orthopedic pathogens are very limited. We investigated the antibiotic MIC values of Staphylococcus species isolated from orthopedic infections and compared them with those of respiratory medicine isolates used as a control. METHODS: The MICs of vancomycin (VCM), arbekacin (ABK), teicoplanin (TEIC), linezolid (LZD), and rifampicin (RFP) of a total of consecutive 259 (89 orthopedic and 170 respiratory) Staphylococcus speciesisolated in our laboratory from January 2013 to July 2016 were retrospectively reviewed. Differences between the MICs of each antibiotic in orthopedic and respiratory samples were determined. RESULTS: The number of methicillin-sensitive Staphylococcus aureus (MSSA) with a VCM MIC of <0.5 μg/mL among respiratory isolates was significantly higher than that among orthopedic isolates, while those with a MIC of 2 μg/mL were significantly lower (P = 0.0078). The proportion of methicillin-resistant coagulase-negative staphylococci (MRCNS) isolates with a VCM MIC of 2 μg/mL was significantly higher in orthopedic samples than that of methicillin-resistant Staphylococcus aureus (MRSA) (P < 0.001) in respiratory isolates. The proportion of MRCNS orthopedic isolates with an RFP MIC of >2 μg/mL was significantly higher (P = 0.0058) than that of other orthopedic staphylococci. CONCLUSIONS: The VCM MICs of Staphylococcus species from orthopedic infections were higher than those of respiratory samples, particularly MRCNS from implant-related samples.

DOI： 10.7759/cureus.49535

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Language：English   Publishing type：Research paper (scientific journal)  

Shelf acetabuloplasty has been performed in patients with developmental dysplasia of the hip (DDH); however, the appropriate position of the shelf has not been determined, particularly with respect to avoiding range of motion (ROM) loss. The aim of this study was to investigate the frequency of ROM inhibition and the influence of 3D position of the shelf following actual shelf acetabuloplasty and virtual surgery using computer simulation analysis. Computed tomography data from 15 patients with DDH who underwent shelf acetabuloplasty were collected between August 2019 and February 2022. The three-dimensional models of a hip joint were constructed using Zed Hip®. Maximal internal rotation (MIR) at 45° and 90° flexion was measured in each patient. The frequency and position of ROM inhibition was determined in a real postoperative model virtually. In addition, a second analysis using virtual acetabuloplasty was performed. Upon placing the shelf, three patterns were provided for the following four parameters: height, coronal inclination, center-edge angle (CEA), and anteroposterior position. The predictors for ROM inhibition were analyzed using a logistic regression model. In the actual postoperative model, a limitation of MIR at 90° and 45° of flexion occurred in 60% and 66.7% of patients, respectively. A higher CEA and anterior position are major factors limiting MIR. The analysis of the virtual shelf acetabuloplasty model revealed that anterior position and CEA were significant factors causing ROM inhibition. As for clinical significance, the results of the current study indicated the optimal location of the shelf to avoid iatrogenic impingement after shelf acetabuloplasty.

DOI： 10.1002/jor.25710

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Language：Japanese   Publisher：日本股関節学会  

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Publisher：株式会社医学書院  

DOI： 10.11477/mf.1408202727

CiNii Research

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: To identify factors associated with insufficient range of motion (ROM) improvement after the posterior pelvic tilt change in cam-type femoroacetabular impingement syndrome (FAIS). METHODS: Preoperative computed tomography (CT) images from 71 consecutive patients with FAIS treated with arthroscopic cam resection were evaluated. Using a dynamic computer simulation program, 3-dimensional models with a 10° posterior pelvic tilt from the supine functional pelvic plane (baseline) were created by CT models. Patients were divided into two groups: those who experienced >10° (effective group) and ≤10° (ineffective group) improvements in internal rotation at 90° flexion after a 10° posterior pelvic tilt. Demographic characteristics; preoperative range of internal rotation at 90° flexion; and radiographic parameters, including Tonnis grade, lateral center-edge angle, acetabular roof obliquity angle, central acetabular anteversion, cranial acetabular anteversion, femoral anteversion, and α angle, were compared in the two groups. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with insufficient ROM improvement following a 10° posterior pelvic tilt. RESULTS: The 71 patients included 58 men and 13 women, of mean age 41.4 ± 14.6 years. Posterior pelvic tilt was effective in 13 hips and ineffective in 58. Univariate analysis showed that preoperative range of internal rotation at 90°flexion, femoral anteversion, and α angle differed significantly in the two groups. Multivariable analysis showed that femoral anteversion <16° (odds ratio [OR], 7.4; 95% confidence interval [CI], 1.6-35; P = 0.012) and α angle >65° (OR, 6.7; 95% CI, 1.2-37; P = 0.027) were significant factors associated with insufficient ROM improvement after posterior pelvic tilt. CONCLUSION: Physical therapy may not be successful for patients with cam-type femoroacetabular impingement syndrome and may result in insufficient hip range-of-motion when femoral anteversion is less than 16° and α-angle is greater than 65°.

DOI： 10.1016/j.arthro.2023.07.012

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Language：Japanese   Publisher：(株)医学書院  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01554&link_issn=&doc_id=20230706040011&doc_link_id=10.11477%2Fmf.1408202727&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408202727&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00402-023-04914-x

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Other Link： https://link.springer.com/article/10.1007/s00402-023-04914-x/fulltext.html

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Publisher：金原出版  

DOI： 10.18888/se.0000002452

CiNii Research

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Language：Japanese   Publisher：金原出版(株)  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The indications for hip arthroscopy have been increasing, as have been the number of patients undergoing total hip arthroplasty (THA) after hip arthroscopy. Several matched cohort studies have assessed the impact of prior hip arthroscopy on THA, but conflicting results have been observed. The purpose of this study was to evaluate the influence of prior arthroscopy on subsequent THA. METHODS: This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched to identify relevant studies. Dichotomous variables were summarized qualitatively as a meta-analysis of pooled odds ratios (ORs) and 95% confidence intervals (CIs), and continuous variables were summarized as standardized mean differences and 95% CIs. P-values <0.05 were considered statistically significant. The risk of bias was evaluated for each study, as was publication bias. RESULTS: In patients who underwent hip arthroscopy prior to THA, the ORs for dislocation, reoperation, and revision were 2.02 (P = 0.01), 1.66 (P = 0.01), and 2.15 (P = 0.001), respectively. There were no significant between-group differences in the Harris Hip Score (HHS; P = 0.40), WOMAC (P = 0.069), FJS-12 (P = 0.77), estimated blood loss (P = 0.48), and surgical time (P = 0.16). CONCLUSIONS: Prior hip arthroscopy is a risk for postoperative dislocation, reoperation, or revision after conversion THA. However, prior hip arthroscopy has no effect on patient-reported outcomes, or operative factors such as surgical time and blood loss.

DOI： 10.1016/j.jos.2022.12.016

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Subspine impingement, or anterior inferior iliac spine (AIIS) impingement, is a type of extra-articular pathology associated with femoroacetabular impingement syndrome and often requires subsequent arthroscopic surgery. Purpose: To examine the diagnostic accuracy, prevalence, and clinical outcomes of arthroscopic treatment for AIIS impingement. Study Design: Systematic review; Level of evidence, 4. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was applied. We searched for studies on the prevalence, diagnostic accuracy, and results of surgical treatment for AIIS impingement. For each included study, data synthesis and statistical analysis were performed to identify pooled prevalence, calculate clinical outcome scores, and estimate adverse events. The QUADAS (a quality assessment tool for diagnostic accuracy studies) was used to assess the quality of the diagnostic accuracy studies, and the Risk of Bias Assessment tool for Nonrandomized Studies was used to assess the quality of the studies on arthroscopic treatment efficacy. Results: Out of an initial 791 studies, 23 were included. AIIS impingement was diagnosed by plain radiography with 76% to 86% sensitivity, 3-dimensional computed tomography with 80% to 81.8% sensitivity, magnetic resonance imaging with 80% sensitivity, and ultrasound with 92.5% sensitivity. For patients who underwent hip arthroscopy, the pooled prevalence of AIIS impingement was 18%. Significant improvement between pre- and postoperative clinical outcomes was observed: 25.75 points for the modified Harris hip score (mHHS), 46.88 points for the Hip Outcome Score-Sport subscale, 20.85 points for the Nonarthritic Hip Score, and -2.92 points for the pain visual analog scale. The minimal clinically important difference on the mHHS was exceeded by 94% of patients. The pooled incidence of surgical complications was 1%. Of 6 included studies on diagnostic accuracy, 2 were identified as having a low risk of bias, and 4 included >2 factors with a high risk of bias. All 9 included studies on treatment outcomes had at least 1 factor with a high risk of bias. Conclusion: Several imaging modalities assist in the diagnosis of AIIS impingement. The overall prevalence of AIIS impingement in patients that underwent hip arthroscopy was 18%. Clinical outcomes after arthroscopic AIIS decompression were generally favorable, with a relatively low rate of surgical complications.

DOI： 10.1177/23259671221131341

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1097/bto.0000000000000609

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: To compare plain radiographs with 3-dimensional (3D) computed tomography (CT) data for preoperative planning of arthroscopic lateral acromioplasty (ALA) for patients in whom ALA was performed along with arthroscopic rotator cuff repair (ARCR). Methods: Patients older than 25 years old who underwent ALA along with ARCR in our institution between October 2019 and February 2021 were included in this study. Preoperative ALA simulations were performed on plain radiographs and 3D models based on CT data. The critical shoulder angle (CSA) was compared between simulations based on radiographs and those based on 3D models. The ALA procedure was performed using the 3D model simulation, along with ARCR. The CSA after surgery was investigated using radiographs. Results: We evaluated 11 shoulders in 10 patients. There was no significant difference between the mean preoperative CSA on radiographs and 3D models (38.0° ± 2.6° vs 38.6° ± 1.8°, respectively; P = .55). The mean CSA after 4-mm ALA simulation using radiographs was not significantly different to that using 3D models (34.1° ± 2.6° vs 34.3° ± 2.5°, respectively; P = .84). Four cases (36.4%) required 8-mm ALA to reduce the CSA to <35° on radiographic analysis, and 2 (18.2%) required 8-mm ALA on 3D model analysis. The mean CSA on postoperative radiographs was significantly smaller than that on preoperative radiographs (32.1° ± 2.7° vs 38.0° ± 2.6°, respectively; P < .01). Conclusions: There was no significant difference between the mean CSA after a 4-mm ALA simulation using radiographs and that using 3D models based on preoperative CT data, which suggests that radiographs are comparable with 3D CT data models as a reliable modality for the preoperative simulation of ALA. Level of Evidence: III, retrospective comparative study.

DOI： 10.1016/j.asmr.2022.07.008

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Femoroacetabular impingement (FAI) is primarily caused by bony impingement between the acetabulum and femoral neck during hip motion. Increasing posterior pelvic tilt improves hip range of motion in patients with FAI. Purpose: To use computer simulation analysis to compare the effects of 3-dimensional (3D) changes in pelvic tilt (sagittal tilt [St], axial rotation, and coronal tilt) with changes in a single plane (St), with the aim of improving range of motion in patients with FAI. Study Design: Controlled laboratory study. Methods: We evaluated 43 patients with FAI treated by arthroscopic cam resection. A 3D simulation was used to construct the following pelvic models: a 5° and 10° increase posteriorly in St (St5° and St10°) and a combined 5° change in St, axial rotation, and coronal tilt (Complex5°) from the baseline of the anterior pelvic plane. Improvements in maximum internal rotation (MIR) at 45°, 70°, and 90° of hip flexion and improvements in maximum flexion with no internal rotation were compared among the St5°, St10°, and Complex5° models. The pelvic models of each single-plane change of 5° and 10° were evaluated in the same simulation. Results: At 90° and 70°, there was a significant difference between the Complex5° and St10° models with respect to improvement in MIR (P = .004 at 90° of flexion; P = .017 at 70° of flexion). There was no significant difference in MIR at 45° of flexion (P = .71) or in maximum flexion (P = .42). Conclusion: At 70° and 90° of hip flexion, a combined change in 3D pelvic alignment of 5° (ie, St, axial rotation, and coronal tilt) was more effective in improving hip MIR than a 10° change in St only. Clinical Relevance: Effective physical therapy for FAI should address pelvic motion in all 3 planes rather than in a single plane.

DOI： 10.1177/23259671221123604

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Language：Japanese   Publisher：日本股関節学会  

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Language：Japanese   Publisher：日本股関節学会  

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s00402-022-04444-y

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Other Link： https://link.springer.com/article/10.1007/s00402-022-04444-y/fulltext.html

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
Rehabilitation is an effective procedure for promoting functional recovery after simultaneous bilateral total knee arthroplasty (TKA); however, it has been cited as a significant economic burden of medical care. We hypothesized that preoperative factors, including age, sex, body mass index, living alone, the knee society function score (KSS), the American society of anesthesiologists (ASA) class, hemoglobin (Hb), albumin level, mean range of motion, and the Kellgren–Lawrence grade, would predict prolonged rehabilitation utilization.


</sec><sec>
<title>Methods</title>
In total, 191 patients undergoing simultaneous bilateral TKA in a single hospital were enrolled. The successful compliance group included patients who completed their rehabilitation program and could return to their residence within 3 weeks after surgery (<italic>n</italic> = 132), whereas the delayed group included the remaining patients (<italic>n</italic> = 59). Logistic regression analysis was performed using preoperative factors. A prediction scoring system was created using the regression coefficients from the logistic regression model.


</sec><sec>
<title>Results</title>
Logistic regression analysis revealed that age (β = − 0.0870; <italic>P</italic> &lt;  0.01) and Hb (β = 0.34; <italic>P</italic> &lt;  0.05) were significantly associated with prolonged rehabilitation programs, whereas body mass index, living alone, KSS score, and ASA class were not significantly associated with successful completion of rehabilitation programs; however, these factors contributed to the prediction scoring formula, which was defined as follows:
<disp-formula><alternatives><tex-math>$$ {\displaystyle \begin{array}{l}\mathrm{Score}=10-\left(0.09\times \mathrm{age}\right)-\left(0.09\times \mathrm{body}\ \mathrm{mass}\ \mathrm{index}\right)-\left(0.56\times \mathrm{living}\ \mathrm{alone}\ \right[\mathrm{alone}:1,\\ {}\mathrm{others}:0\left]\right)+\left(0.03\times \mathrm{KSS}\ \mathrm{stairs}\right)+\left(0.34\times \mathrm{Hb}\right)-\left(1.1\times \mathrm{ASA}\ \mathrm{class}\right).\end{array } } $$</tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML">
<mml:mtable>
<mml:mtr>
<mml:mtd>
<mml:mtext>Score</mml:mtext>
<mml:mo>=</mml:mo>
<mml:mn>10</mml:mn>
<mml:mo>-</mml:mo>
<mml:mfenced>
<mml:mrow>
<mml:mn>0.09</mml:mn>
<mml:mo>×</mml:mo>
<mml:mi>age</mml:mi>
</mml:mrow>
</mml:mfenced>
<mml:mo>-</mml:mo>
<mml:mfenced>
<mml:mrow>
<mml:mn>0.09</mml:mn>
<mml:mo>×</mml:mo>
<mml:mtext>body mass index</mml:mtext>
</mml:mrow>
</mml:mfenced>
<mml:mo>-</mml:mo>
<mml:mo>(</mml:mo>
<mml:mn>0.56</mml:mn>
<mml:mo>×</mml:mo>
<mml:mtext>living alone</mml:mtext>
<mml:mspace />
<mml:mo>[</mml:mo>
<mml:mtext>alone</mml:mtext>
<mml:mo>:</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>,</mml:mo>
</mml:mtd>
</mml:mtr>
<mml:mtr>
<mml:mtd>
<mml:mtext>others</mml:mtext>
<mml:mo>:</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>]</mml:mo>
<mml:mo>)</mml:mo>
<mml:mo>+</mml:mo>
<mml:mfenced>
<mml:mrow>
<mml:mn>0.03</mml:mn>
<mml:mo>×</mml:mo>
<mml:mi>KSS</mml:mi>
<mml:mspace />
<mml:mtext>stairs</mml:mtext>
</mml:mrow>
</mml:mfenced>
<mml:mo>+</mml:mo>
<mml:mfenced>
<mml:mrow>
<mml:mn>0.34</mml:mn>
<mml:mo>×</mml:mo>
<mml:mi>Hb</mml:mi>
</mml:mrow>
</mml:mfenced>
<mml:mo>-</mml:mo>
<mml:mfenced>
<mml:mrow>
<mml:mn>1.1</mml:mn>
<mml:mo>×</mml:mo>
<mml:mi>ASA</mml:mi>
<mml:mspace />
<mml:mtext>class</mml:mtext>
</mml:mrow>
</mml:mfenced>
<mml:mo>.</mml:mo>
</mml:mtd>
</mml:mtr>
</mml:mtable>
</mml:math></alternatives></disp-formula>


The C-statistic for the scoring system was 0.748 (95% confidence interval, 0.672–0.824). The positive and negative likelihood ratios were 2.228 (95% CI, 1.256–3.950) and 0.386 (95% CI, 0.263–0.566), respectively. These results showed an increase of 15–20% and a decrease of 20–25% in the risk of prolonged rehabilitation. The optimal cutoff point for balancing sensitivity and specificity was 3.5, with 66.6% sensitivity and 78.0% specificity.


</sec><sec>
<title>Conclusions</title>
Older age and lower preoperative Hb were significantly associated with prolonged rehabilitation programs. We defined a new scoring formula using preoperative patient factors to predict prolonged rehabilitation utilization in patients undergoing simultaneous bilateral TKA.


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DOI： 10.1186/s12891-021-04211-x

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Other Link： https://link.springer.com/article/10.1186/s12891-021-04211-x/fulltext.html

Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Of the several methods used to prevent surgical site infection (SSI), diluted povidone-iodine (PI) lavage is used widely. However, the clinical utility of PI for preventing periprosthetic joint infection (PJI) remains controversial. The aim of this study was to perform a systematic review and meta-analysis of the utility of dilute PI lavage for preventing PJI in primary and revision surgery. METHODS: This study was conducted in accordance with the PRISMA checklist for systematic reviews and meta-analyses. A comprehensive literature search of PubMed, CINAHL, ClinicalTrials.gov , and Cochrane Library databases was performed. The results are summarized qualitatively and as a meta-analysis of pooled odds ratios with 95% confidence intervals (95% CIs). Heterogeneity of treatment effects among studies was classified as low, moderate, or high, corresponding to I2 values of < 25%, 25-50%, and > 50%. A random effects model was applied in cases of high heterogeneity; otherwise, the fixed effects model was applied. Subgroup analyses were conducted to identify potential sources of heterogeneity. RESULTS: After the screening and eligibility assessment process, eight studies were finally extracted for analysis. Overall, the results showed that PI had no significant effect on PJI with ununified control group. However, subgroup analysis of studies with a saline control group revealed an odds ratio of 0.33 (95% CI, 0.16-0.71) for the PI group, suggesting a significant effect for preventing PJI. CONCLUSION: The systematic review and meta-analysis of the current literature demonstrates that diluted PI lavage is significantly better than saline solution lavage for preventing PJI. LEVEL OF EVIDENCE: Level I, Systematic review and meta-analysis.

DOI： 10.1186/s13018-021-02703-z

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：English   Publishing type：Research paper (scientific journal)  

Background: The influence of pelvic tilt mobility, which can be reproduced in computer-simulation models, is an important subject to be addressed in the understanding of femoroacetabular impingement (FAI) pathophysiology. Purpose: To use computer-simulation models of FAI cases to evaluate the optimum improvement in hip range of motion (ROM) achieved by decreasing the anterior pelvic tilt and compare the results with the improvement in ROM achieved after cam resection surgery. Study Design: Controlled laboratory study. Methods: The pre- and postoperative computed tomography (CT) images from 28 patients with FAI treated with arthroscopic cam resection were evaluated. Using a dynamic computer-simulation program, 3-dimensional models with a 5° and a 10° decrease in anterior pelvic tilt from the supine functional pelvic plane (baseline) were created from the preoperative CT scans. Similar models were constructed for hips before (at baseline) and after cam resection. Improvements from baseline in maximum internal rotation at 45°, 70°, and 90° of flexion were assessed for the 5° change in pelvic tilt, 10° change in pelvic tilt, and cam resection models, and the results were compared for all conditions. Results: The combination of a 10° change in pelvic tilt and cam resection showed the largest ROM improvement from baseline (P < .001). Improvement in internal rotation in the cam resection model was significantly higher compared with the 5° pelvic tilt change model (P < .001), while there was no significant difference between the cam resection model and the 10° pelvic tilt change model. Conclusion: Decreasing anterior pelvic tilt by 10° in the preoperative computer simulation model resulted in an equivalent effect to cam resection, while a 5° change in pelvic tilt was inferior to cam resection in terms of ROM improvement. Clinical Relevance: Enough of a decrease in anterior pelvic tilt may contribute to ROM improvement that is as effective as that of cam resection surgery.

DOI： 10.1177/2325967121999464

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

当院で2014〜2018年に変股症に対して両側同時TKAを施行した191例を対象とし、術後入院期間が21日以内であった群(132例)と22日以上群(59例)に分け、術前諸因子の群間比較および多重ロジスティック回帰分析を行った。調査項目は「年齢」「性別」「BMI」「独居か否か」「KSS functional score」「ASA class」「Hb値」「Alb値」「膝可動域」「K-L grade」とした。多重ロジスティック回帰分析の結果、入院期間に有意な影響を与える因子として「年齢」と「Hb値」が抽出された。調査項目のうち下記6項目を用いて入院期間を予測するスコアリングシステムを構築したので提示した。1)年齢。2)BMI。3)独居か否か。4)KSS functional score。5)ASA class。6)Hb値。

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Publishing type：Research paper (scientific journal)   Publisher：SLACK, Inc.  

DOI： 10.3928/01477447-20200619-03

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Oxford University Press (OUP)  

Abstract

Sports medicine surgeons sometimes encounter morbidly obese athletes with femoroacetabular impingement, such as Sumo wrestlers. In such cases, traditional arthroscopic equipment will not reach the joint. This case report describes the use of a cystoscope to perform arthroscopy to treat borderline developmental dysplasia of the hip combined with cam impingement in a morbidly obese athlete. The cystoscope enables hip arthroscopy to be performed when traditional instruments are not of sufficient length to access the hip and/or an extra-long arthroscope is not available. The use of the cystoscope provides a practical, feasible and minimally invasive option to treat non-arthritic intraarticular hip pathology in the morbidly obese or extremely muscular athletes.

DOI： 10.1093/jhps/hnaa029

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Language：English   Publishing type：Research paper (scientific journal)  

Background: The alpha angle used to evaluate cam morphology can be determined on different imaging views; however, 2-dimensional (2D) imaging can present limitations in terms of the reproducibility of the radial alpha angle. Recent developments in 3-dimensional (3D) high-resolution magnetic resonance imaging (MRI) have allowed detailed evaluations of the radial alpha angle. Purpose: To determine whether there are any correlations or discrepancies between the 2D alpha angle on plain radiography and the maximum radial alpha angle on 3D MRI. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 42 hips from 39 patients (19 males, 20 females) were analyzed, including 22 hips with femoroacetabular impingement (FAI; mean age, 41 years) and 20 hips with borderline developmental dysplasia of the hip (BDDH; mean age, 43 years). Radial images were reconstructed from 3D multiple echo recombined gradient echo (MERGE) MRI. Differences in the maximum radial alpha angle on MRI between hips with FAI and BDDH were evaluated. Correlations and discrepancies between the maximum radial alpha angle on MRI and alpha angles on the anteroposterior, cross-table lateral, and 45° Dunn views of radiography were also evaluated. Results: The maximum radial alpha angle was significantly higher for hips with FAI than for hips with BDDH. On average, the greatest alpha angle on radial MRI was higher than the alpha angle on each of the 3 radiographic views for both FAI and BDDH. The 45° Dunn view revealed the smallest discrepancy for both FAI (P = .005) and BDDH (P = .002). The cross-table lateral view had the highest correlation with the maximum radial alpha angle for BDDH (P < .001). Conclusion: We reconfirmed the utility of the 45° Dunn view, with it presenting the best reproducibility for the maximum radial alpha angle in the evaluation of cam morphology, while the cross-table lateral view revealed the best correlation with the maximum radial alpha angle, particularly for hips with BDDH.

DOI： 10.1177/2325967120932922

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Language：English   Publishing type：Research paper (scientific journal)  

Objectives: This retrospective, single-center study aimed to compare leg morphology between patients with rheumatoid arthritis (RA) and those with osteoarthritis (OA) undergoing total knee arthroplasty (TKA).Methods: We enrolled 70 RA and 327 OA female patients undergoing TKA. Hip-knee-ankle angle (HKA), femorotibial angle (FTA), valgus correction angle (VCA), and femoral/tibial bowing were measured using full-length radiographs. Femoral bowing of more than 3° or tibial bowing more than 2°, either laterally or medially, was considered substantial. Distribution of these results and the incidence of substantial bowing in RA and OA were compared.Results: HKA, FTA, and VCA were significantly smaller in RA than those in OA. Femoral bowing was significantly smaller in RA (mean angle: 0.04° ± 3.1°) than that in OA (mean angle: 2.1° ± 3.6°) (p < .05). In almost half of the patients with RA (48.6%), femoral bowing occurred medially, whereas femoral bowing occurred laterally in approximately three quarters of OA patients (73.1%). Tibial bowing did not differ. The incidence of substantial femoral bowing was significantly lower in RA (27.1%) than that in OA (43.0%) (p < .05).Conclusion: RA patients undergoing TKA had different leg morphology than OA patients. These findings have implications for surgical planning.

DOI： 10.1080/14397595.2019.1621420

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Total knee arthroplasty (TKA) is an established procedure for knee osteoarthritis. Multimodal analgesia is reportedly more effective for postoperative analgesia. We investigated the efficacy of 2 patches after TKA. METHODS: Seventy-nine knees that underwent unilateral TKA for osteoarthritis were included. Oral administration, local periarticular analgesic injection, and patches were adopted for pain management. The knees were randomly assigned to the flurbiprofen patch (FPP), S-flurbiprofen patch (SFPP), and control (no patch) groups. Patch treatment was continued for 14 days. Pain according to the visual analog scale, knee flexion angle, renal dysfunction, gastrointestinal injury, duration of hospitalization, dermatitis, and the rate of using additional oral nonsteroidal anti-inflammatory drugs were compared (from preoperative to postoperative day 14). RESULTS: The FPP, SFPP, and control groups included 29, 27, and 23 knees, respectively. Visual analog scale was lower in the FPP and SFPP groups than in the control group on days 1 and 3 (day 1: 24.4, 25.0, and 39.4, respectively; day 3: 25.5, 23.3, and 39.3, respectively). Knee flexion angle was larger in the SFPP group than in the control group on days 7 and 14 (day 7: 89.8° and 76.6°, respectively; day 14: 98.3° and 84.2°, respectively). Neither renal dysfunction nor gastrointestinal injury was confirmed. The duration of hospitalization did not differ among the groups. Dermatitis occurred only in the SFPP group. The rate of using additional oral nonsteroidal anti-inflammatory drugs was higher in the control group. CONCLUSION: Both patches were effective and safe as part of multimodal analgesia for postoperative TKA.

DOI： 10.1016/j.arth.2020.04.006

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：神奈川県医師会  

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PURPOSE: This study aimed to assess the effect of soft tissue correction due to knee joint laxity, which induces alignment error after hybrid closed-wedge high tibial osteotomy (CWHTO). In addition, to verify whether postoperative soft tissue correction can be predicted from preoperative radiographic parameters. METHODS: A retrospective evaluation of data from patients treated by CWHTO in 2016-2019 was performed. Standing full-length anteroposterior radiograph measurement was performed pre- and post-surgery, and short anteroposterior radiographs of the knee under maximal manual varus and valgus stress were taken preoperatively. The weight-bearing line, hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) were measured, in addition to JLCA under varus or valgus conditions. Soft tissue correction was defined as ΔHKA minus ΔMPTA. Multiple regression analysis was performed to evaluate preoperative factors that could influence soft tissue correction. RESULTS: Data from 49 knees were included in the analysis. The mean soft tissue correction was 3.2°, which indicates an over-correction. Multiple regression analysis revealed that JLCA (β = 0.642; p < 0.001) and valgus JLCA (β = - 0.422; p = 0.001) were significantly associated with postoperative soft tissue correction. The final model of the regression formula was described by the following equation: postoperative soft tissue correction = 0.691 × JLCA - 0.411 × valgus JLCA - 0.399. CONCLUSION: Preoperative values for JLCA and JLCA under valgus stress are associated with soft tissue correction. Surgeons should, therefore, consider these measurements to achieve postoperative limb alignment.

DOI： 10.1007/s00167-019-05762-2

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本肩関節学会  

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Objective: A history of venous thromboembolism (VTE) is a risk factor for newly formed VTE after total hip arthroplasty (THA). However, its morbidity and association with postoperative VTE are not clear and, therefore, were investigated in this study. Methods: Four-hundred and nineteen patients scheduled for primary THA were included. We preoperatively identified any VTE factors such as obesity, age, and history of VTE by interviewing and duplex ultrasonography for all patients, and the patients were assigned into 'high-' or 'low-risk' groups, that were the indication whether chemoprophylaxis was administered after surgery. Postoperative VTE was also examined on the day 7 by enhanced computed tomography (CT) for all patients. Results: Preoperative VTE were detected in 48 patients (11.4%), and postoperative VTE were found in 44 (10.5%). Linear and multivariate logistic regression analysis revealed osteonecrosis and preoperative VTE were the independent factors associated with postoperative VTE (Odds ratio (OR) 1.0 e-7 and 5.00, respectively). In the survey of each risk group, only preoperative VTE was recognized as a risk factor for high-risk group, and longer operation time for low-risk group. Conclusion: The present study confirmed high frequency of preoperative VTE which was still the strongest risk factor for postoperative asymptomatic VTE.

DOI： 10.1080/14397595.2018.1524959

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier B.V.  

DOI： 10.1016/j.eats.2018.01.007

Scopus

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Language：Japanese   Publisher：(一社)日本静脈学会  

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DOI： 10.1097/JSM.0000000000000479

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.arth.2017.02.036

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier B.V.  

DOI： 10.1016/j.eats.2016.09.016

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PURPOSE: To identify the distribution of the impingement region in cam-type femoroacetabular impingement (FAI) or patients with borderline developmental dysplasia of the hip (DDH) using computer simulation analysis. METHODS: A total of 51 painful hip joints from 42 consecutive cases diagnosed as cam-type FAI (center edge [CE] angle ≥ 25°, alpha angle ≥ 55°) or borderline DDH (CE angle ≥ 20° and < 25°) with or without a cam deformity (alpha angle ≥ 55° or < 55°) were enrolled. ZedHip (Lexi, Tokyo, Japan) 3-dimensional computer simulation was used to identify impingement points. Computed tomography data were used for 3-dimensional modeling and impingement simulation. The maximum flexion angle and maximum internal rotation angle at 90° were evaluated. The impingement point was identified at a position of maximum internal rotation and 90° of flexion. Six impingement regions were defined. Differences in the distribution of the impingement region were evaluated between groups. RESULTS: There were significant differences in range of motion at maximum flexion and internal rotation among the 3 groups (P < .0001). There was no significant difference in the distribution of the impingement point in the cam-type FAI group (P = .71); similarly, there was no significant difference in the borderline DDH with a cam deformity group (P = .071). On the other hand, in terms of proximal or distal sites, there was a significant difference between the borderline DDH with and without a cam deformity group (P < .001). CONCLUSIONS: The impingement region in cases of cam-type FAI was variable. The coexistence of a cam deformity affected the distribution of the impingement region in cases of borderline DDH; the region tended to be distributed across proximal rather than distal regions. The site of cam osteochondroplasty should be based on the identified impingement point, particularly in cases of cam-type FAI and borderline DDH with a cam deformity. LEVEL OF EVIDENCE: Level IV, case control study.

DOI： 10.1016/j.arthro.2016.08.018

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Language：Japanese   Publisher：(一社)日本人工関節学会  

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Language：Japanese   Publisher：日本股関節学会  

当院でCam-type femoroacetabular impingement(FAI)に対し関節鏡視下骨軟骨形成術を行った10例を対象に、CTデータより有限要素モデルを作成し、有限要素解析法を用いて骨切除部の位置や切削形状と術後大腿骨強度との関連について検討した。その結果、術後有限要素モデルの強度低下と有意な相関を示したのは、head-neck junction部に近い、より遠位部での切削深度および頸部断面における骨切除部面積であった。骨頭中心に近い部位ではそれらのパラメーターと強度低下との関連性が低く、また骨切除部全体の体積は術後骨モデルの強度とは相関を認めなかった。以上より、骨切除部の位置、すなわち頸部のより遠位部で骨切除量が多くなると術後大腿骨頸部骨折リスクが高くなることが示唆された。

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨・関節感染症学会  

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Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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DOI： 10.1016/j.arth.2015.07.023

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Language：Japanese   Publisher：(一社)日本関節病学会  

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DOI： 10.1080/10255842.2013.869320

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DOI： 10.1007/s00774-014-0610-x

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DOI： 10.1302/0301-620X.97B4.33736

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DOI： 10.3109/14397595.2014.931505

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DOI： 10.1002/jor.22717

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DOI： 10.1007/s00774-013-0526-x

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DOI： 10.3109/14397595.2013.868781

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DOI： 10.4137/CCRep.S16159

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DOI： 10.3109/17453674.2013.862460

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DOI： 10.1007/s11239-012-0773-z

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DOI： 10.3109/17453674.2011.652886

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DOI： 10.1007/s00776-011-0153-0

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DOI： 10.1016/j.arth.2011.04.002

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DOI： 10.3109/17453674.2011.594232

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DOI： 10.2106/JBJS.I.01714

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DOI： 10.2106/JBJS.I.00119

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DOI： 10.1016/j.diagmicrobio.2009.01.033

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Language：Japanese   Publisher：東京 : 金原出版  

CiNii Books

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Other Link： https://ndlsearch.ndl.go.jp/books/R000000004-I032684412

J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：西日本整形・災害外科学会  

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66歳女。15年前に左大腿骨頸部骨折に対する人工骨頭置換術を行っていた。4ヵ月前より徐々に歩行困難となった。初診時身体所見、両股関節X線、臥位骨盤CT各所見より、高度骨盤後傾斜を伴う人工骨頭前方脱臼と診断した。骨盤傾斜の計測は立位では困難で、臥位での骨盤傾斜を基にCT-basedナビゲーションを用いて再置換術を行った。本症例は脱臼リスクが高いため、dual mobility systemを用いたTHAを行った。CT-basedナビゲーションは正確なインプラント設置計画・設置を行うことができ、骨盤後傾を伴う症例に対して有用であると思われた。

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Other Link： http://search.jamas.or.jp/link/ui/2016322097

Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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J-GLOBAL

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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DOI： 10.3109/14397595.2015.1045257

Scopus

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本股関節学会  

CT画像を用いた変形性股関節症患者の中臀筋体積計測について検討した。片側人工股関節全置換術を施行した進行期または末期変形性股関節症患者40例を対象とした。中臀筋体積は健側と比較して患側で小さく、対健側比は平均80%であった。股関節外転筋力は38例で患側が小さく、対健側比は平均72%であった。中臀筋体積と股関節回転筋力との間に強い正の相関を認めた。脚長は全例で健側と比較し患側の脚短縮を認め、脚長差は平均11mmであった。脚長差が大きいほど患側中臀筋体積は小さくなる傾向にあった。大腿骨オフセットは、28例で患側が健側と比較して小さく、対健側比は平均93%であった。大腿骨オフセット比と中臀筋体積との間には明らかな相関を認めなかった。中臀筋体積は罹病期間と相関し、罹病期間が長いほど中臀筋体積は小さくなる傾向にあった。JOAスコアは総合点数および各項目点数で中臀筋体積との明らかな相関は認めなかった。

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Language：Japanese   Publisher：日本股関節学会  

両側性の大腿骨頭壊死症34例56関節を対象に、DEXAを用いて骨頭圧潰と大腿骨近位部骨密度(BMD)の関連について検討した。骨頭圧潰群は38関節、非圧潰群は18関節で、骨頭圧潰群は非圧潰群と比べ転子部および転子間部BMD、T-scoreが有意に低値を示した。

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Language：Japanese   Publisher：日本股関節学会  

人工股関節全置換術(THA)における術後ADLと疼痛の関連について検討した。初回THAを施行した55例55関節を対象とした。術後3日目までに歩行器歩行獲得となったものを早期歩行器群、4日目以降で獲得となったものを遅延歩行器群、術後7日目までに1本杖歩行獲得となったものを単期杖歩行群、術後8日目以降に獲得できたものを遅延杖歩行群、術後10日以内に退院したものを早期退院群、術後11日目以降に退院となったものを遅延退院群とした。術後疼痛は、歩行器歩行の早期群と遅延群の間でVASに有意差は認めなかったが、杖歩行では術後6、7日目の安静時VAS、術後2〜6日目の運動時VASが早期群のほうが遅延群より低値であった。退院では術後1〜7日目の安静時VAS、術後1、3〜7日目の運動時VASが早期群のほうが遅延群より低値であった。

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

66歳女。発熱、左膝関節の疼痛と腫脹を主訴とした。細菌培養検査にて関節液よりリステリア菌が検出され、抗菌薬はアンピシリンとベンジルペニシリンに感受性が認められた。関節エコー検査では、関節内の著明な液体貯留と滑膜内の血流信号が認められた。入院時、左人工膝関(TKA)周囲感染による敗血症とプレショック状態であると判断し、MTXを中止し、抗菌薬の静脈内投与とショックに対する全身管理を施行した。アンピシリンを投与したところ、全身状態は速やかに改善し、入院15日目にインブラント抜去、洗浄デブリドマン、抗菌薬含有セメントスペーサー挿入術を施行した。術後もアンピシリンの静脈内投与を4週間継続し、その後アモキシシリンとST合剤の内服へ変更した。術後3週頃より関節リウマチ(RA)による多関節炎が再燃したため、術後4週よりMTXを再開した。その後、CRPは陰性化した。TKA抜去術から3ヵ月経過した時点で再置換術を施行し、非蝶番型拘束性人工関節を選択した。再置換術後もアモキシシリンの内服を6ヵ月間継続し、術後12ヵ月の時点では感染の再燃は認めていない。

DOI： 10.11551/jsjd.33.85

CiNii Books

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Other Link： https://jlc.jst.go.jp/DN/JALC/10035061372?from=CiNii

Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本関節病学会  

コンピュータナビゲーションを用い、骨盤傾斜を考慮した術前計画に基づいて人工股関節全置換術(THA)を行った54股を対象として、術後のインプラント設置角に関する成績について検討した。その結果、術後1年での臥位および立位のインプラント設置角度は、術前の骨盤傾斜にかかわらず良好なインプラント設置が得られ、目標としたCA 37.3°は、術後1年で臥位と立位のほぼ中間にあり、臥位から立位へ、もしくは立位から臥位へ骨盤傾斜が変化しても理想的な37.3°を中心に変化するため、これらの姿勢変化によっても37.3°から大きく逸脱することが少なく、安全で良好なインプラント設置が行われていたと考えられた。なお、術前計画と術後設置角との誤差はCAで約6°であった。

DOI： 10.11551/jsjd.32.433

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Language：Japanese   Publisher：(一社)日本人工関節学会  

人工股関節全置換術(THA)を施行した185例203股(女性137例150股、男性48例53股、平均年齢61.4歳)を対象として、術後撮影した骨盤CTより再構築した三次元モデルを用い、THA後の骨盤傾斜の変化を計測して、術前の脊椎アライメントとの関係を調査した。骨盤単純X線正面像において骨盤腔の縦径(A)、横径(B)を測定し、骨盤腔縦横比(A/B)と三次元CTモデルの骨盤腔縦横比(A&#039;/B&#039;)が等しくなるように、水平軸に沿って両上前腸骨棘と恥骨結合で規定されるanterior pelvic plane(APP)の鉛直面に対する傾きを前傾を正の値として記録した。術前の立位骨盤傾斜角をもとにAPPの傾斜角が10°より前傾しているものをA群、前傾0〜10°をB群、後傾0〜10°をC群、後傾10°以上をD群とした結果、術前に立位で骨盤が前傾していたものはA群22股、B群63股、後傾していたものがD群48股であった。A群は有意に若年であり、D群は有意に高齢であった。A群、B群それぞれの立位骨盤傾斜は術後3ヵ月、12ヵ月で有意に後傾斜していた。

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Language：Japanese   Publisher：(一社)日本人工関節学会  

初回人工股関全節置換術(THA)を施行し、術後1年以上経過観察可能であった49例(女性38例、男性11例、手術時平均年齢64歳)を対象に、THA後の機能的な脚長差が骨盤側方傾斜角や脊椎冠状面アライメントに及ぼす影響について調査した。その結果、骨盤側方傾斜角と小転子脚長差、機能軸脚長差はいずれも負の相関を認め、患側の脚長が短いほど骨盤は患側に傾いた。骨盤側方傾斜角は小転子脚長差よりも機能軸脚長差とより強い相関を認めた。腰椎Cobb角は機能軸脚長差のみ負の相関を認め、患側の脚長が短いほど腰椎は患側凸となった。胸椎Cobb角は相関が弱くなるものの機能軸脚長差とのみ正の相関を認め、患側の脚長が短いほど胸椎は健側凸となった。また、小転子脚長差よりも機能軸脚長差の方が骨盤・脊椎冠状面アライメントとの相関が強い結果となった。

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Language：Japanese   Publisher：日本生体電気・物理刺激研究会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：日本股関節学会  

股関節痛や臼蓋形成不完全が認められた57関節(男性8名、女性49、平均50.8歳)を対象に、18F-fluoride PETによる集積が変形性関節症(OA)の進行予測因子となるか検討した。疼痛悪化群では非悪化群に比べPET集積の定量評価のmaximum standardized uptake value(SUVmax)、Kellgren and Lawrence(K/L) Gradeが有意に高かった。疼痛悪化に関する多変量ロジスティック回帰分析ではSUVmaxのみで有意差が認められた。最小関節裂隙幅(MJS)狭小化群では非狭小化群に比べ初回疼痛ありが有意に少なく、SUVmax、K/L Gradeが有意に高かった。MJS狭小化に関する多変量ロジスティック回帰分析ではSUVmaxのみで有意差が認められた。SUVmaxのcut-off値は、疼痛:7.2(感度1.00、特異度0.84、area under the curve(AUC):0.90)、MJS狭小化:6.4(感度0.92、特異度0.83、AUC:0.93)であった。18F-fluoride PETはOA進行と疼痛悪化の予測因子として有用と考えられた。

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

人工股関節全置換術を施行した股関節症患者80例151股関節(男15例、女65例、平均65歳)を対象に、X線で最小関節裂隙幅(MJS)を計測すると共に、骨盤CTデータを用いて三次元再構築モデルを作製し、骨嚢胞の発生頻度と部位について検討した。臼蓋の骨嚢胞は106股に認め、MJSが3mm以上の34股中9股、2〜3mmの23股中7股、1〜2mmの6股中6股、1mm未満の88股中84股と、2mm未満で有意に発生頻度が高かった。6区域の部位別にみると、外側前方(88股)、中間前方(68股)、外側後方(64股)で多かった。またX線像と三次元CTモデルにより計測した骨盤傾斜は、MJSが2mm以上では平均-3.9°、2mm未満は-0.6°と有意差が認められた。MJSが2mm以上で臼蓋前方に骨嚢胞が認められた群の骨盤傾斜は-0.6°、認めなかった群は-3.2°、2mm未満ではそれぞれ-0.8°、2.0°で、骨嚢胞が認められた群は骨盤が後傾する傾向を示したが、有意差はなかった。

DOI： 10.11551/jsjd.32.17

CiNii Books

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Language：Japanese   Publisher：関東リウマチ研究会  

症例は57歳女性で、高血圧症、糖尿病、脂質異常症の既往があった。9年前に関節リウマチ(RA)を発症し、近医にて治療を受けていたが、両膝関節破壊と屈曲拘縮の進行で歩行不能となり、手術目的に当科を受診した。RAはSteinblocker分類でStage IV、Class IV、両膝外反変形と腫脹があり、関節可動域は右:60〜80°、左:70〜80°、KISS Knee Scoreは右:-2.0点、左:-6.0点、Function scoreは両側0点であった。X線で両側とも高度関節破壊と骨変形を認め、Larsen grade Vであった。1週間の持続介達牽引後に両膝後方解離術を行い、術後は両側とも20°まで屈曲拘縮改善を認めた。3週間後に左人工膝関節置換術(TKA)、15週後に右TKAを行い、いずれも術翌日から膝伸展装具着用で全荷重・歩行訓練を開始し、退院時には杖歩行可能状態となった。関節可動域は両側とも0〜100°となり、JOAスコアは16点→88点、DAS28 CRPは5.18→1.88と改善し、歩容も杖使用下で安定した。

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本人工関節学会  

初回THA後1年間観察しえた146例を対象に、冠状面脊椎バランスを含む諸指標の経時的変化について調査し、脊椎バランスが臨床成績に及ぼす影響について検討した。調査項目は[coronal balance(以下CB)][骨盤側方傾斜角][腰椎Cobb角][胸椎Cobb角][脚長差][JOAスコア][WOMACスコア]などとした。術後1年時の[CB]が≦10mmの87例を&quot;バランス良好群&quot;、他の症例を&quot;バランス不良群&quot;とし、[CB]の経時的変化を群間比較したところ、バランス不良群では術前から[CB]が有意に不良であった。両群間で他の調査項目の経時的変化(術前・術後1年時値)を比較したところ、バランス不良群はWOMACのpainスコアが術前・術後1年時とも有意に低く、またWOMACのstiffnessスコアが術後1年時に有意に低かった。他の項目に有意な群間差は認められなかった。

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Language：Japanese   Publisher：(一社)日本人工関節学会  

表面置換型人工股関節置換術(HRA)患者における血清および尿中コバルトおよびクロム濃度について検討した。HRAを施行した26例を対象とした。血清中および尿中のコバルト濃度は術前と術後1週では有意差を認めず、術前および術後1週と比較して術後3〜6ヵ月および1年において有意な上昇を認めた。血清中コバルト濃度と血清中クロム濃度、血清中コバルト濃度と尿中コバルト濃度、血清中クロム濃度と尿中クロム濃度、尿中コバルト濃度と尿中クロム濃度はいずれも有意な相関を認めた。血清中コバルト濃度のみ臨床所見あり群において有意に高値であった。血清中コバルト濃度のみ画像所見あり群にて有意な高値を認めた。

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Language：Japanese   Publisher：全日本病院出版会  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2013009636

Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本股関節学会  

人工股関節全置換術(THA)後の小転子高位で計測した脚長差と下肢全長(下肢機能軸長)で計測した脚長差の違いを検討し、そしてそれぞれの脚長差が術後の臨床成績に及ぼす影饗について検討した。初回THAを施行した片側罹患の変形性股関節症で、術後1年以上の経過観察が可能であった54例を対象とした。術後1年での計測で、小転子脚長差では患側が0.7±7.0mmm短かったに対し、機能軸脚長差では患側が2.8±7.3mm短かった。小転子脚長差は54例中32例で5mm未満に補正されていたが、32例中14例では機能軸脚長差は5mm以上であった。小転子脚長差が5mm以上であった22例中8例では機能軸脚長差は5mm未満であった。

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：リウマチの外科研究会  

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Language：Japanese   Publisher：日本骨・関節感染症学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東リウマチ研究会  

70歳女。約18年前より関節リウマチ(Steinbrocker分類class IV、stage IV)のためプレドニゾロン、メトトレキサートの投与を開始された。その後コントロール不良のためインフリキシマブが投与され、効果不十分のため更に約1年半前よりトシリズマブへ変更されていた。今回、37°台の発熱、左臀部痛が出現し、血液検査でWBCの高値を認めた。単純X線でL1-3に陳旧性圧迫骨折を認めたが、以前からの所見と変化はなく、腰仙椎造影MRIではT2脂肪抑制画像でS1-2および左腸骨に高信号領域を認めた。化膿性脊椎炎と診断して抗菌薬の投与を開始したが、白血球数とCRPの高値、意識障害、血圧低下、頻脈が出現し、敗血症ショックを疑い緊急で仙椎腐骨摘出術および洗浄ドレナージを施行した。仙椎の病理組織像はplasma cellを主体とする炎症細胞の浸潤、組織の線維化、新生した骨梁を認め、慢性炎症の所見を呈していた。術後は抗菌薬MEPM+VCMを投与し、経過は良好で、臨床所見、検査所見、画像所見ともに改善して術後約1ヵ月で退院となった。

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本人工関節学会  

人工股関節全置換術(THA)が施行された54例(男性12例、女性42例、手術時平均年齢65.6歳)を対象に、術後の腰椎疾患の有無が臨床成績に及ぼす影響について検討した。立位腰椎X線検査を行ない、腰椎疾患なし群23例(A群)と腰椎疾患のあり群31例(B群)に分けた結果、JOAスコア、Harris HIp Score(HHS)、Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)の項目においては2群とも術後に改善が認められた。しかし、項目別ではJOAスコアは歩行能力と日常生活動作が、HHSはFunctionに関して、それぞれB群の方がA群に比べ術後の改善が乏しいことが示された。尚、WOMACにおいてはいずれの項目でも術後2群間に有意差が認められた。

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Language：Japanese   Publisher：(一社)日本関節病学会  

初回人工股関節全置換術(THA)を行い、術後1年以上経過観察し得た片側罹患の変形性股関節症43例(男9例、女34例、手術時平均年齢64.9歳)を対象として、下肢アライメントが脚長に及ぼす影響を検討した。両股関節立位正面および両下肢全長立位正面X線像を用いて術前後の脚長差と下肢アライメントを比較した結果、脚長差を有する変形性股関節症では術前に患側膝関節の外反変形を認めたが、THA術後に脚長差が補正されると患側膝関節は内反傾向を示し、下肢アライメントの左右差は減少した。また、小転子高位で計測した脚長差は必ずしも下肢機能軸で計測したそれと一致しなかった。変形性股関節症に対するTHAでは両下肢のアライメントに注意し、両側の膝関節アライメント差が大きい症例では、下肢全体を含めた脚長評価を行うことが重要であると思われた。

DOI： 10.11551/jsjd.30.483

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Language：Japanese   Publisher：(一社)日本人工関節学会  

初回人工股関節全置換術(THA)を施行後、1年以上経過観察可能であった90例中46例を対象に、小転子高位で計測した脚長差(小転移脚長差)と下肢機能軸長で計測した脚長差(機能軸脚長差)を比較し、術後の臨床成績に与える影響について検討した。その結果、1)小転移脚長差が5mm未満の症例は全体の58%であったが、このうち52%は機能軸では5mm以上の脚長差が認められた。2)小転移脚長差が5mm未満であった症例は、5mm以上であった症例と比べると、術後のHarris Hip Score(HHS)のgaitの点数が高値であった。3)小転移脚長差が5mm未満に補正された群の中でも機能軸脚長差が5mm以上の症例では、5mm未満の症例に比べJOAスコアの歩行能力、HHSのgaitの点数が低値であった。以上、これらのことからも、THA後の良好な成績には下肢機能軸としての脚長差の補正が必要であると示唆された。

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：神奈川整形災害外科研究会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：関東整形災害外科学会  

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Language：Japanese   Publisher：リウマチの外科研究会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本人工関節学会  

人工股関節全置換術後のフォンダパリヌクス(FPX)の血中濃度が示す静脈血栓塞栓症(VTE)予防効果と副作用について検討した。初回人工股関節全置換術(THA)のうち術後にFPXが投与された64例を対象とした。FPX投与下でVTE発生率は8例で、VTEの有無でのFPX濃度には有意差は認めなかった。術後7日目および14日目において腎機能障害例でFPX濃度は有意に高かった。術後7日目のヘモグロビン値から3日目のヘモグロビン値を引いた値の差が0未満である貧血進行例と0以上である非進行例のFPX濃度を比較したところ、両群間での有意差は認めなかった。また、術後においてmajor bleedingの発生は2例であったが、これら症例のFPX濃度は全体の平均値を超える値ではなかった。また、この2例においてFPXは途中で中止されたが、その後のFPX濃度は速やかに低下し、遷延化することはなかった。

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Language：Japanese   Publisher：(一社)日本人工関節学会  

人工股関節全置換術を施行した106例(男23例・女83例・平均64.0歳)を対象に、術前腰椎可撓性が術後の脊椎アライメントに及ぼす影響について検討した。立位X線正面像で最大側屈時の腰椎Cobb角の矯正率が100%以上をFlexible群、100%未満をRigid群とし、それぞれを腰椎患側凸と健側凸に分けて検討を行った。Flexible群は100例で患側凸が55例、健側凸が45例、Rigid群は6例で患側凸、健側凸が各3例であった。術後に患側の脚長は延長され、いずれの群においても脚長差は平均3mm以内に補正された。立位での骨盤側方傾斜角は改善し、各群とも術後1年以内に±1°以内に収束した。1年後のcoronal balanceは、Flexible群の患側凸で平均-0.77mm、健側凸で0.50mmと収束したが、Rigid群は患側凸で-12.55mm、健側凸で-3.15mmと改善を認めなかった。Flexible群に比べRigid群は腰椎側彎が強く、特に患側凸では術前後を通して腰椎Cobb角は大きかった。

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Language：Japanese   Publisher：(一社)日本人工関節学会  

初回人工股関節全置換術(THA)後の静脈血栓塞栓症(VTE)早期診断について検討するため、可溶性フィブリン(SF)とプラスミノーゲン活性化酵素阻害蛋白(PAI-1)の有効性について調査した。初回THAで、術後に抗凝固療法を施行しなかった65例を対象とした。VTEは17例に認め、DVTが12例、PEが2例、両方認めたものが3例であったが、全て無症候性であった。SFおよびPAI-1はいずれも術後1日目でVTE発生群が非発生群と比較して有意に高かった。SFのカットオフ値を設定すると19.8μg/mlとなり、その感度は88.2%、特異度は62.1%であった。PAI-1のカットオフ値は53.5ng/mlと設定され、その感度は78.3%、特異度は72.4%であった。SFとPAI-1の両方のカットオフ値を用いてVTEを判別し、得られた感度は100%、特異度は67.0%、陽性的中率は48.6%であった。

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Language：Japanese   Publisher：日本股関節学会  

診断を確定した変形性股関節症(OA)27例40股(男性3股、女性37股・平均38.9歳)と大腿骨頭壊死(ON)11例16股(男性11股、女性5股・平均46.7歳)を対象に、18F-fluoride PETによる画像評価について検討した。OAでは、X線上のKellgren &amp; Lawrence grade別の平均SUVmaxはgrade 1:6.8、2:6.7、3:11.6、4:13.7であり、grade 3、4で1、2に比し有意に高値を示し、病期別では前:6.2、初期:7.2、進行期:9.3、末期:13.7と病気の進行につれ高値となり、疼痛レベル別では疼痛なし:5.4、軽度:6.0、中等度:8.5、重度:12.1と重度で有意に高値であった。最小関節裂隙幅(MIS)とSUVmaxは負の相関を示した。ONでは、stage分類別の平均SUVmaxはstage 1:2.2、2:7.6、3:12.5、4:14.6であり、stage 3、4で1、2に比し有意に高値を示し、疼痛レベル別では疼痛なし:5.5、軽度:6.1、中等度:14.6、重度:12.2と中等度、重度で有意に高値を示した。

CiNii Books

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Language：Japanese   Publisher：日本股関節学会  

Propidium monoazide(PMA)処理後リアルタイムPCR法を用いた化膿性股関節炎における感染鎮静化の術中診断2例を経験した。症例1は52歳男性で、交通事故で多発外傷治療後、近医に左化膿性股関節炎(MRSA感染)と診断され抗菌薬で軽快したが、再燃を繰り返し歩行困難となり受診。X線で左大腿骨頭の大部分消失、MRIで股関節周囲と大腿骨頭内にT1で低信号、T2で高信号域を認めた。症例2は70歳女性で、右股関節痛で近医に臼蓋形成不全と診断され、歩行困難となり紹介受診。X線で右臼蓋形成不全と関節裂隙狭小化、MRIで股関節周囲と臼蓋、大腿骨頭内にT1で低信号、T2で高信号を認め、股関節穿刺液培養でMSSAが同定された。2例とも感染の診断で股関節洗浄・デブリドマンを行い、大腿骨頭切除後にバンコマイシン含有ハイドロキシアパタイトブロック挿入、抗菌薬全身投与後に二期的人工股関節全置換術を行った。術中リアルタイムPCRで陽性が、PMA処理で陰性となった。

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Language：Japanese   Publisher：日本股関節学会  

セメントレス人工股関節全置換術(THA)を行った62例62股(男性13例、女性49例)を対象とし、アルファカルシドール併用投与の抑制効果について検討した。アレンドロネート単独投与群(20例)、アレンドロネート+アルファカルシドール併用投与群(20例)、非投与群(22例)に無作為に分け、設定したインプラント周囲の関心領域(ROI)1〜7の骨密度(BMD)を術後1、12、24、48週に測定した。各群で最も低値を示したROI 7での術後1週時に対するBMDの割合は、非投与群では術後12週83.1%、24週79.7%、48週73.9%と低下し続け、アレンドロネート単独投与群ではそれぞれ95.4%、92.1%、92.3%、アルファカルシドール併用投与群では97.9%、91.6%、91.2%とBMDは維持され、各測定時で非投与群と他2群間に有意差を認めた。骨吸収マーカーのNTxと骨形成マーカーの骨アルカリフォスファターゼ(BAP)は非投与群では術後12週〜48週まで高値を示したが、他2群では非投与群に比し有意に低下した。

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：日本股関節学会  

当科ではMIS-THAでの手術進入法として、前側方アプローチ法のうち、中臀筋と大腿筋膜張筋の筋間から進入するOCM anterolateral法(以下OCM法)と、中臀筋の前方1/3を切離するMini-one anterolateral法(以下Mini-one法)のいずれかを施行している。今回、OCM法を施行した41例とMini-one法を施行した36例二無作為に分けて成績を群間比較することにより、中臀筋部分切離が術後成績に及ぼす影響について検討した。その結果、中臀筋の部分切離を行うMini-one法を施行した群ではOCM法群に比べて術後6週時の股関節外転筋力が有意に低かったが、術後6週・3ヵ月・6ヵ月・1年時のJOAスコアやSF-36スコアには有意な群間差は認めず、両群とも成績良好であった。

CiNii Books

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：東日本整形災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本臨床検査医学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

人工股関節全置換術(THA)59例61股を対象として、術前および術後3ヵ月・6ヵ月・1年のX線写真より立位骨盤傾斜と脊椎矢状面アライメントの変化を調査した。X線学的評価は骨盤X線側面像、腰椎X線側面像および全脊椎X線側面像を用い、両手を肩につけた状態での自然立位姿勢で撮影した。骨盤立位X線側面像よりDiGioiaらによるanterior pelvic plane(APP)を、腰椎立位X線側面像よりlumbo-sacral angle(LSA)、lumbo-lordotic angle(LLA)を、全脊椎立位X線側面像よりthoraco-kyphotic angle(TKA)を計測した。その結果、APPは術後1年で有意に減少し、LSAは減少傾向を示した。LLAとTKAは術前後で減少傾向を示したが、有意差はなかった。以上より、股関節疾患を有する患者にTHAを施行すると、骨盤は徐々に後傾するが、腰椎前彎と胸椎後彎の減少は有意ではないことが示唆された。

DOI： 10.11551/jsjd.28.527

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Language：Japanese   Publisher：(一社)日本人工関節学会  

18F Fluoride-PET(NaF-PET)を用いて人工股関節周囲感染における感染部位の特定の可否について検証した。NaF-PETの集積を人工股関節全置換術後感染群と非感染群にて比較し、術中採取組織に対する細菌培養検査、病理学的検査、RT-PCR結果とNaF-PETの集積との関連性について調査した。THAを施行した20例に対してNaF-PET検査を施行した。感染群におけるNaF-PETの集積による分類はtypeAが4例、typeBが4例、typeCが2例であった。術中採取組織に対する検査結果は細菌培養検査陽性が5例、病理組織検査陽性が8例、RT-PCR検査陽性が10例であった。NaF-PETはTHA後感染群において非感染群と比べ有意な集積を認めた。また、集積type分類を用いることで術前に主感染側(臼蓋・大腿側)の予測が可能であった。

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