記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In order to restore the neutral limb alignment in total knee arthroplasty (TKA), surgical procedure usually starts with removing osteophytes in varus osteoarthritic knees, however, that the exact influence on alignment correction is unknown. The purpose of this study was to define the influence of osteophyte removal alone on limb alignment correction in the coronal plane in TKA for varus knee. METHODS: Fifteen medial osteoarthritic knees with varus malalignment scheduled for TKA were included in this study. After registration of a navigation system, each knee was tested at maximum extension, and at 30, 40 and 60 degrees of flexion before and after osteophyte removal. External loads of 10 N-m valgus torque at each angle and in both states were applied. Subsequently, the widths of the resected osteophytes were measured. RESULTS: The average pre-operative hip-knee-ankle angle was -14.2 degrees. The average width of osteophytes was 7.6 mm in femur and 5.3 mm in tibia, respectively. Angle corrections after osteophyte removal were 3.4 degrees at maximum extension, 3.4 degrees at 30 degrees flexion and 3.6 degrees at 60 degrees flexion; and at all angles, the difference was significant. There was positive correlation between the widths of osteophytes and the degree of angle correction at 30 degrees. CONCLUSION: Correlation was found at 30 degrees of knee flexion between the widths of osteophytes and the degree of angle correction in the coronal plane in TKA. We found the degree of angle correction per 1mm width of osteophyte removal to be 0.4 degrees.

DOI： 10.1272/jnms.JNMS.2020_87-503

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Total knee arthroplasty (TKA) aims to correct the rotation as well as the alignment and the articulation of the osteoarthritic knee. In this study, we hypothesized that TKA affects hip rotational movement, in addition to improving knee kinematics. The objective was to evaluate the variation in lower extremity alignment and hip rotational range of motion (ROM) with TKA. METHODS: A total of 53 knees among 47 patients with primary varus knee osteoarthritis who were scheduled for primary TKA in our institute were enrolled. Hip rotational ROM was measured in the supine position with 90° flexion of the hip and knee before and 3 weeks after TKA. Variations in tibial axis alignment compared to femoral axis alignment by bone resections were also examined as changes in the joint lines of the distal femur and the proximal tibia using plain radiography and computed tomography. RESULTS: The average internal and sum of the internal and external hip rotational ROM increased significantly; however, the external hip rotational ROM was not significantly changed after TKA. The imaging findings also showed that the axis of the lower leg externally rotated 2.5° with a 4° external rotation of the distal femur and a 6.5° correction of the varus deformity. CONCLUSION: TKA was proven to vary the neutral position of hip rotational movement and to increase hip rotational range of motion.

DOI： 10.1272/jnms.JNMS.2020_87-401

PubMed

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Morphological features of the distal femur and proximal tibia associated with cartilage degeneration are unknown. This study aimed to elucidate local anatomical parameters of the knee which correlate with articular cartilage degeneration using MRI T1ρ mapping. METHODS: This study involved 200 subjects with knee pain (mean age, 48.7 years; range, 14-80 years) with no severe osteoarthritic changes on plain X-ray. T1ρ values were measured in the regions of interest on the surface layer of the cartilage on mid-coronal images of the femorotibial joint. Assessment of medial and lateral posterior tibial slope (MTS, LTS) and medial and lateral femoral condylar offset ratio (MFCOR, LFCOR) was performed using sagittal proton density-weighted imaging. Morphological assessment of posterior root and horn of menisci was also performed according to a modified Whole Organ Magnetic Resonance Imaging Score (WORMS) of the knee. RESULTS: Multiple regression analysis revealed that a decrease in MTS was associated with increased T1ρ values in the medial tibia, independent of age, osteoarthritic changes on plain X-ray, femur-tibia angle (FTA), and posterior medial meniscal lesions. CONCLUSIONS: Shallow MTS correlates with cartilage degeneration in symptomatic patients. This parameter could help in understanding the etiology of osteoarthritis in the early stage. Future kinematic studies will be needed to confirm our findings.

DOI： 10.1080/14397595.2017.1332539

PubMed

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Femoral rotational alignment is considered an essential factor for total knee arthroplasty because malrotation of femoral components results in poor outcomes. To obtain proper alignment, we developed a superimposable computed tomography (CT) scan-based template to intraoperatively determine the accurate surgical epicondylar axis (SEA), and evaluated the effectiveness of this CT template. METHODS: In the experimental group (n=55), three serial slices of CT images, including medial and lateral epicondyles, were merged into a single image, and SEA was overlaid. SEA was traced onto an image of an assumed distal femoral resection level; this combined image was then printed out onto a transparent film as a CT template. Following a distal femoral resection in TKA, SEA was duplicated onto the femoral surface. Thereafter, the posterior condyle was resected parallel to this SEA. In the control group (n=53), posterior condyles were resected at three degrees of the external rotation from the posterior condylar line (PCL). A posterior condylar angle (PCA) between PCL of the femoral component and SEA was postoperatively evaluated. Positive values indicated external rotation of the femoral component from the SEA. RESULTS: In the experimental group, PCA was 0.01°±1.61°, and three cases were considered as outliers (greater than three degrees or less than -3 degrees). Conversely, in the control group, PCA was 0.10°±2.4°, and 12 cases were considered as outliers. Consequently, dispersion of PCA data was significantly smaller in the experimental group (P=0.004). CONCLUSIONS: The CT template accurately determined intraoperative SEA.

DOI： 10.1016/j.knee.2017.11.009

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本人工関節学会  

内側型変形性膝関節症9例9膝(男性1例1膝、女性8例8膝、平均年齢73.8歳)を対象に、人工膝関節置換術における内側骨棘切除が変形矯正に及ぼす影響について検討した。その結果、術前の膝外側角(FTA)は平均185.1°、最大骨棘幅は大腿側が平均6.4mm、脛骨側が平均3.4mmであった。骨棘切除して外反ストレスをかけると、最大伸展位で5.9°、30°屈曲位で4.8°、60°屈曲位で4.0°の矯正が可能であった。骨棘の幅と骨棘切除による矯正角は、30°屈曲位で正の相関を認めた。矢状面を用いて30°屈曲位での矯正角度と骨棘の大きさの関連を検討すると、1mm幅の骨棘に対して0.3°の矯正が獲得されることが明らかになった。

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本整形外科スポーツ医学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

鎖骨遠位端骨折8例に対してZipTightとプレートを併用した固定を行い、良好な成績を得たので報告する。骨折型はCraig・田久保分類でtype IIbが6例、type V、VIが各1例であった。烏口突起鎖骨間距離は術直後6.4mm、最終観察時では7.4mmであり、JOA scoreは91.5点であった。ZipTight併用により烏口鎖骨靱帯が再建され、良好な安定性が得られ、本術式は有用であると考えた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J03098&link_issn=&doc_id=20170421290012&doc_link_id=%2Fdx3eastj%2F2017%2F002901%2F012%2F0052-0055%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdx3eastj%2F2017%2F002901%2F012%2F0052-0055%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語  

Forefoot fractures are frequently accompanied by severe soft tissue damage. Therefore, treatment should focus not only on fractures but also on soft tissue damage, for which external fixation can be used as a surgical option. A 63-year-old woman presented to the emergency clinic of our hospital with forefoot pain after a motorcycle accident. Comminuted fracture of the proximal part of the metatarsal was diagnosed. Because of the swollen foot and fracture comminution, an operation using the Ilizarov mini external fixator was performed to prevent further damage to the soft tissue. Weight-bearing was permitted seven weeks after the operation, and the extraction of the apparatus was performed nine weeks postoperatively. One year later, the patient had no pain and had returned to ballroom dancing, a hobby which she performed five days a week, with no difficulties. Our results suggest that the Ilizarov mini external fixator should be considered not only for temporary treatment, but also for the entire duration of treatment of first metatarsal fractures associated with severe soft tissue damage.

DOI： 10.1272/jnms.84.144

PubMed

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記述言語：日本語   出版者・発行元：日本最小侵襲整形外科学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

28体54膝の解剖用死体を対象に、写真撮影を行い、脛骨前面と脛骨内側関節面の成す角を脛骨後傾角(PTS)、脛骨前面と関節包付着部の前縁と後縁を結んだ直線の成す角を関節包後傾角(PCS)とした。得られた値を性別、左右別、関節症性変化の有無について比較した。その結果、PTS、PCSの平均は各々8.9°と8.2°と強い相関関係を認めたが、有意差はなかった。性別で比較すると、男女共にPTSとPCSに強い相関関係を認めたが有意差はなく、男女間でもPTSとPCSは共に有意差を認めなかった。左右別で比較すると、左右共にPTSとPCSに強い相関関係を認めたが有意差はなく、左右間でも有意差を認めなかった。関節症性変化の有無で比較すると、関節症性変化がある場合、ない場合ともにPTSとPCSに強い相関関係を認めたが有意差はなく、関節症変化の有無による有意差も認めなかった。人工膝関節置換術の新たな指標としてPCSは有用と考えられた。

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J05177&link_issn=&doc_id=20160815190002&doc_link_id=%2Ffd8kanse%2F2016%2F003502%2F003%2F0109-0113%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffd8kanse%2F2016%2F003502%2F003%2F0109-0113%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

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記述言語：日本語   出版者・発行元：関東膝を語る会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Superior dislocation of the patella without patellar ligament injury is an extremely rare condition. A review of the English-language literature found only 23 reported cases. In addition, the primary factor for dislocation in most of these cases was considered to be osteophytes in the inferior pole of the patella and the anterior surface of the femoral condyle; only 1 case had no osteophytes. We treated a 19-year-old woman who sustained a painful locking of the left knee after colliding with a friend. Plain radiography and computed tomography showed superior-lateral dislocation of the patella and an interlocking between notches in the inferior pole of the patella and the anterior surface of the femoral condyle. Closed reduction without sedation was performed without difficulty, and the patient was able to walk home without pain. After 1 week, the knee was without problems. The patient had no osteophytes in the knee and had no other common risk factors, such as patella alta, ligamentous laxity, genu recurvatum, and paralytic disorders. After a comparison with previously reported cases of superior patella dislocation, we concluded that the primary factor in the present case might have been a different condition.

DOI： 10.1272/jnms.83.24

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

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記述言語：日本語   出版者・発行元：(一社)日本関節鏡・膝・スポーツ整形外科学会  

症例1は39歳男で、不定期のジョギングレベルで誘因なく左膝内側部痛が出現し、X線像では異常を認めなかった。MRIで脛骨内側顆に骨折線を認めたため、3ヵ月間のスポーツ動作の禁止を指示した。初診4週後には疼痛は消失した。症例2は44歳男で、不定期のウォーキングレベルで誘因なく右膝内側部痛が出現し、X線像で軽度の内反が認められた。MRIで脛骨内側顆に骨折線を認めたため、3ヵ月間のスポーツ動作と長時間歩行の禁止を指示した。発症10週後には疼痛は消失した。両症例とも以後再燃を認めず、脛骨プラトー傾斜角度の変化も認めていない。

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記述言語：日本語   出版者・発行元：関東膝を語る会  

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記述言語：日本語   出版者・発行元：関東膝を語る会  

症例1は39歳男性で、左膝関節痛を主訴とした。MRI所見にて脛骨内側顆部にT1強調像で低信号域を認め、骨折の存在が強く疑われた。スポーツ動作制限期間を3ヵ月とした。左膝の痛みは消失し、単純X線にて、MRIの病変部位に一致した線状の骨硬化像が出現し、骨折を裏付けるものであった。症例2は44歳男性で、右膝関節痛を主訴とした。MRI所見にて脛骨内側顆部にT1強調像で低信号域を認め、骨折の存在が強く疑われ、スポーツ活動と長距離歩行の制限期間を3ヵ月とした。発症後4週の単純X線にて、MRIの病変部位に一致した線状の骨硬化像が出現し、骨折を裏付けるものであった。右膝の痛みは発症後10週経過時に消失した。

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：関東整形災害外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本整形外科スポーツ医学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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