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1.
Tomomasa Nakamura Hideyuki Koga Koji Otabe Masafumi Horie Toshifumi Watanabe Kazuyoshi Yagishita Ichiro Sekiya Takeshi Muneta 《Journal of orthopaedic science》2019,24(1):147-152
Background
It is still controversial whether which femoral tunnel creation technique is best during anterior cruciate ligament reconstruction (ACLR). We aimed to clarify the features of three different techniques based on the femoral tunnel position created with the same tunnel-creating concept and the measurement data.Methods
The femoral tunnel of double-bundle (DB) ACLR was created using the behind-remnant approach in a remnant preserved manner following the policy of our institute. The trans-tibial approach (TT) was applied for all primary ACL injured cases until December 2012. The trans-portal approach (TP) was applied from January to September 2013, and the outside-in approach (OI) was indicated from October 2013 to March 2014. We compared the femoral tunnel aperture positions with the postoperative three-dimensional computed tomography (3D-CT). Additionally, the femoral tunnel length and the septum distance of each anteromedial (AM) and posterolateral (PL) tunnel were analyzed.Results
The AM tunnel aperture position of TT was significantly higher and shallower than that of TP in knee flexion position. The femoral tunnel length of TP was significantly shorter than that of TT and OI. The septum between each tunnel of OI trended wider than that of TT and TP.Conclusions
The AM tunnel aperture position of TT runs the risk of a high and shallow position. TP runs the risk of insufficiently short tunnel length. It is important to apply each method flexibly to each case because no single best approach was found. 相似文献2.
Arata Yuuki Takeshi Muneta Toshiyuki Ohara Ichiro Sekiya Hideyuki Koga 《Journal of orthopaedic science》2017,22(2):300-305
Background
Associations of lateral/medial knee instability with anterior cruciate ligament (ACL) injury have not been thoroughly investigated. The purposes of this study were to investigate whether lateral/medial knee instability is associated with ACL injury, and to clarify relevant factors for lateral/medial knee instability in ACL-injured knees.Methods
One hundred and nineteen patients with unilateral ACL-injured knees were included. Lateral/medial knee instability was assessed with varus/valgus stress X-ray examination for both injured and uninjured knees by measuring varus/valgus angle, lateral/medial joint opening, and lateral/medial joint opening index. Manual knee instability tests for ACL were evaluated to investigate associations between lateral/medial knee instability and anterior and/or rotational instabilities. Patients' backgrounds were evaluated to identify relevant factors for lateral/medial knee instability. Damage on the lateral collateral ligament (LCL) on MRI was also evaluated.Results
All parameters regarding lateral knee instability in injured knees were significantly greater than in uninjured knees. There were significant correlations between lateral knee instability and the Lachman test as well as the pivot shift test. Patients with LCL damage had significantly greater lateral joint opening than those without LCL damage on MRI. Sensitivity of LCL damage on MRI to lateral joint opening was 100%, while its specificity was 36%. No other relevant factors were identified. In medial knee instability, there were also correlations between medial knee instability and the Lachman test/pivot shift test. However, the correlations were weak and other parameters were not significant.Conclusions
Lateral knee instability was greater in ACL-deficient knees than in uninjured knees. Lateral knee instability was associated with ACL-related instabilities as well as LCL damage on MRI, whereas MRI had low specificity to lateral knee instability. On the other hand, the association of medial knee instability on ACL-related instability was less than that of lateral knee instability.Levels of evidence
Level IV, case series with no comparison group. 相似文献3.
4.
Shuji Taketomi Hiroshi Inui Ryota Yamagami Kohei Kawaguchi Keiu Nakazato Kenichi Kono Manabu Kawata Takumi Nakagawa Sakae Tanaka 《Journal of orthopaedic science》2018,23(3):546-551
Background
The purpose of this study was to analyze the association between the prevalence of meniscal and chondral lesions and the timing of surgery in patients undergoing primary anterior cruciate ligament (ACL) reconstruction to determine a safe time for surgery.Methods
This retrospective study involved 226 patients (91 females and 135 males; median age, 29 years) undergoing primary ACL reconstruction. Time interval from ACL injury to surgery (median, 4 months; range, 1–420 months) and concomitant meniscal and cartilage lesions in ACL reconstruction were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine the precise threshold interval to surgery to prevent meniscal or cartilage lesions. The risk of lesion occurrence after each cutoff period was determined using odds ratio (OR).Results
The incidences of medial meniscus (MM), lateral meniscus (LM), and cartilage lesions were 43.8%, 32.7%, and 27.4%, respectively. ROC analysis revealed that patients who waited for more than 6, 4, and 5 months for ACL reconstruction had a significantly greater risk of associated MM, LM, and chondral lesions, respectively. Patients who underwent ACL reconstruction ≥7 months after injury had OR of 4.1 (p < 0.001) for the presence of MM lesion as compared with those who underwent reconstruction within 6 months. Similarly, patients who underwent ACL reconstruction ≥5 months after injury had OR of 1.9 (p = 0.023) for the presence of LM lesion as compared with those who underwent reconstruction within 4 months, and patients who underwent ACL reconstruction ≥6 months after injury had OR of 2.9 (p < 0.001) for chondral lesion as compared with those who underwent reconstruction within 6 months.Conclusion
ACL reconstruction should be performed within approximately 6 months after the injury to prevent associated meniscal or chondral lesions. 相似文献5.
Akira Tsujii Hiroshi Amano Yoshinari Tanaka Keisuke Kita Ryohei Uchida Yoshiki Shiozaki Shuji Horibe 《Journal of orthopaedic science》2018,23(1):122-126
Background
Radial/oblique tears of the midbody of the lateral meniscus significantly impair the ability of the meniscus to withstand the tibiofemoral load, requiring meniscal repair. However, healing status after meniscal repair has not been fully elucidated. This study aimed to evaluate arthroscopic findings after inside-out suture repair for isolated radial/oblique tears of the midbody of the lateral meniscus.Methods
From 2011 to 2015, 18 consecutive patients with isolated radial/oblique tears of the midbody of the lateral meniscus underwent arthroscopic inside-out repair with the tie-grip suture technique. All knees were stable with no previous surgery. All patients were evaluated by second-look arthroscopy at six months postoperatively. Activities including jogging were not allowed until meniscal status was evaluated arthroscopically. To analyze factors associated with healing rates, age, time from injury to initial surgery, and tear zone were compared.Results
Second-look arthroscopy revealed complete healing in four (22%) patients, partial healing in seven (39%), and failure to heal in seven (39%). Significant differences were observed for tear zone (p < 0.0001), but not for age and timing of repair.Conclusions
Arthroscopic evaluation revealed that inside-out repair with the tie-grip suture technique for isolated radial/oblique tears of the midbody of the lateral meniscus achieved complete or partial healing only in 61% of patients. Satisfactory results were observed particularly in patients with tears extending to the vascular zone, whereas those with tears in the avascular zone failed to achieve healing. Therefore, the operative indication of inside-out repair for radial/oblique tears of the midbody of the lateral meniscus might be limited to tears extending into the vascular zone. Given that 39% of cases were arthroscopically considered a failure even if patients complained of no symptoms in daily life, decisions should be made carefully to allow patients to return to sports activities. 相似文献6.
Junichi Hata Kazuki Endo Osahiko Tsuji Shota Arakawa Masakazu Sato Kazuo Yagi Kanehiro Fujiyoshi Hideyuki Okano Masaya Nakamura 《Journal of orthopaedic science》2019,24(5):873-880
ObjectivesTo determine the changes of muscle conditions of lower leg after stretch shortening cycle exercises by MRI.Subjects and methodsThis study included 20 healthy male adult volunteers. After conducting control MRI, each subject performed 3 sets of exercise loading, each set consisting of 100 repetitions of rebound jumping on one foot. MRIs were performed immediately after exercise loading (0 h), 6, 30, and 168 h later. After constructing T1/T2/Fractional Anisotropy (FA)/Apparent Diffusion Coefficient (ADC) maps, the changes of three skeletal muscles of the leg (the tibialis anterior [TA], soleus [SOL], and gastrocnemius [GA]) were quantitatively evaluated in each map at each time point.ResultsThe T1 and T2 values were prolonged after exercise loading, and there was a delay in the recovery of T1 at 6 and 30 h after exercise loading, as compared to those of T2 values over time. The ADC values were elevated in all three muscles immediately after exercise loading, then recovered more slowly than T1 and T2, and still had not returned to baseline 168 h after exercise loading. The FA value decreased in all three muscles after exercise loading, with the greatest decrease occurring immediately after exercise loading. As with the ADC values, the FA values were slow to recover from the decrease, and had not returned to baseline levels 168 h post-loading.ConclusionThe delay of T1 value recovery suggested that the T1 value may reflect the muscle condition like fatigue and damage. Changes in the ADC and FA values over time suggested that structural changes such as minute muscular injuries can be detected by diffusion-weighted MRI. Meanwhile, the changes observed in the T1 and T2 values suggested that the measured relaxation time data reflected not only the water volume in the muscle, but also the muscle condition after exercise loading. 相似文献
7.
Kazuki Oishi Eiji Sasaki Takuya Naraoka Yuka Kimura Eiichi Tsuda Hiroshi Shimoda Yasuyuki Ishibashi 《Journal of orthopaedic science》2019,24(3):494-500
PurposeThe influence of tunnel extension outside the anatomical anterior cruciate ligament (ACL) insertion in single-bundle (SB) or double-bundle (DB) ACL reconstruction is unclear. This study aimed to investigate the anatomical relationship between ACL insertion and tunnel extension in SB and DB ACL reconstruction, and the impact of tibial tunnel extension to the insertion of anterior horn of lateral meniscus in terms of injury.MethodsForty-six paired cadaver knees (mean age, 82.7 ± 10.7 years) were used. Right and left knees were used for SB (10 mm) and DB tunnel reaming (6 mm for the anteromedial and posterolateral bundles). Tibial and femoral tunnels were created to aim at the center of the ACL insertion by arthroscopic visualization. The relationship between tunnel extension and ACL insertion was evaluated macroscopically, and there ratio in two groups were compared by chi-square test. Further, the relative risk for meniscus injury based on tunnel placement was estimated. Coronal section of tibia and parallel section to Blumensaat line in femur were prepared to evaluate the relationship among tunnel position, ACL insertion, and anterior horn of the meniscus histologically.ResultsTibial tunnel extension out of the ACL insertion was observed macroscopically in 9 (39.1%) knees of the SB group, and 3 (13.0%) of the DB group (p = 0.045). In femoral tunnels, extension out of the ACL insertion was seen in 8 (34.8%) knees of the SB group and 1 (4.3%) of the DB group (p = 0.011). Partial injuries of the lateral meniscus anterior horn (LMAH) were observed in 5 (21.7%) knees of the SB group and 1 (4.3%) knee of the DB group (p = 0.091). The relative risk for LMAH injury was calculated as 5.0 (odds ratio, 6.1). Microscopically, SB tunnels appeared to expand out of ACL insertion, both in the femur and tibia.ConclusionsThe incidence of tunnel extension out of the ACL insertion in femur and tibia were higher with SB than with DB reconstruction. Furthermore, injury rate of the LMAH in the DB group was lower. 相似文献
8.
Takashi Hirai Toshitaka Yoshii Kenichiro Sakai Hiroyuki Inose Tsuyoshi Yamada Tsuyoshi Kato Shigenori Kawabata Yoshiyasu Arai Kenichi Shinomiya Atsushi Okawa 《Journal of orthopaedic science》2018,23(1):32-38
Background
There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).Methods
Ninety-five patients were prospectively treated with ADF or LAMP for CSM in our hospital from 1996 through 2003. On alternate years, patients were enrolled to receive ADF (1997, 1999, 2001, and 2003: ADF group, n = 45) or LAMP (1996, 1998, 2000, and 2002: LAMP group, n = 50). We excluded 19 patients who died during follow-up, and 25 who were lost to follow-up. Clinical outcomes were evaluated by the recovery rate of the Japanese Orthopaedic Association (JOA) score between the two groups. Sagittal alignment of the C2–7 lordotic angle and range of motion (ROM) in flexion and extension on plain X-ray were measured.Results
Mean age at the time of surgery was 58.3 years in the ADF group and 57.9 years in the LAMP group. Mean preoperative JOA score was 10.0 and 10.5, respectively. Mean recovery rate of the JOA score at 3–5 years postoperatively was significantly higher in the ADF group (p < 0.05). Reoperation was required in 1 patient for pseudarthrosis and in 1 patient for recurrence of myelopathy in the ADF group; no patient in the LAMP group underwent a second surgery. There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group (p < 0.05), but not in ROM.Conclusions
Both ADF and LAMP provided similar good outcomes at 10-year time-point whereas ADF could achieve more satisfactory outcomes and better sagittal alignment at the middle-term. However, the incidence of reoperation and complication in the ADF group were higher than those in the LAMP group.Study design
A prospective comparative study (not randomized). 相似文献9.
Ryohei Takada Tetsuya Jinno Kazumasa Miyatake Masanobu Hirao Akimasa Kimura Daisuke Koga Kazuyoshi Yagishita Atsushi Okawa 《Journal of orthopaedic science》2018,23(5):783-787
Background
The difference in clinical results between the direct anterior approach (DAA) and the anterolateral approach (ALA) for total hip arthroplasty (THA) is still unclear. The purpose of this study was to compare clinical results, including nerve injuries, between DAA and ALA in one-stage bilateral THA in a prospective, randomized controlled trial.Methods
Thirty patients were recruited for primary bilateral THAs from 2014 to 2016. The left and right hips of each patient were randomly assigned to DAA and the others to ALA. We prospectively compared the clinical results, incidence of lateral femoral cutaneous nerve (LFCN) injury, and tensor fascia lata (TFL) atrophy considered to be related to superior gluteal nerve injury between both approaches.Results
No significant difference was found in the clinical results between both sides at postoperative 1 year. Temporary symptom of LFCN injury was observed only in DAA sides (7/30, 23.3%). The ratio of 3-month postoperative to preoperative cross-sectional area of TFL on computed tomography was significantly lower on the side subjected to DAA (DAA side, 78.8 ± 22.8%) than on the side subjected to ALA (ALA side, 90.7 ± 17.7%) (p < 0.01). In magnetic resonance imaging at postoperative 1 year, the mean grade of fatty atrophy of TFL by Goutalier classification was significantly higher in DAA sides (2.00 ± 1.6) than in ALA sides (1.1 ± 1.3) (p = 0.03).Conclusions
Excellent clinical results for both DAA and ALA were achieved. LFCN injury was found only in DAA sides. Although TFL atrophy was found in both approaches, it was found significantly more in DAA sides. Our study suggested that ALA should be used rather than DAA in terms of the risk of nerve injuries. 相似文献10.
11.
Mitsuru Yagi Nobuyuki Fujita Eijiro Okada Osahiko Tsuji Narihito Nagoshi Takashi Tsuji Masaya Nakamura Morio Matsumoto Kota Watanabe 《Journal of orthopaedic science》2018,23(4):653-657
Background
Cost-utility analysis of surgery for degenerative lumber spondylolisthesis (DS) is essential for healthcare providers and patients to select appropriate treatment. The purpose of this study was to review the cost-utility of decompression alone versus decompression with fusion for DS.Methods
A retrospective review of 99 consecutive patients who were treated for Meyerding grade 1 DS at two representative spine centers was performed. Patients with significant spinal instability were treated by decompression with fusion (F group, 40 patients); all others were treated by decompression surgery alone (D group, 59 patients). All patients were followed for three years. Demographic and radiographic data, health-related quality of life (HRQoL), and the direct cost for surgery were analyzed, and the incremental cost-effectiveness ratio (ICER) was determined using cost/quality-adjusted life years (QALY).Results
There were no differences between the groups in baseline demographics (D vs. F: age 68 ± 9 vs. 66 ± 7 years; 37% vs. 40% female) or HRQoL (ODI: D, 41 ± 16 vs. F, 46 ± 13%). The F group had a higher initial-surgery cost ($18,992 ± 2932) but lower reoperation frequency (7%) than the D group ($7660 ± 2182 and 12%, respectively). The three-year total direct cost was higher for F than for D ($19,222 ± 3332 vs. $9668 ± 6,168, p = .01). ICER was higher for F at one year ($136,408 ± 187,911 vs. $237,844 ± 212,049, p < .01), but was comparable for F and D at three years (D, $41,923 ± 44,503 vs. F, $51,313 ± 32,849, p = .17).Conclusion
At the three-year follow-up, the two methods had comparable cost-utility. Both methods were cost-effective (defined as an ICER within three times the per-capita gross domestic product). 相似文献12.
Yohei Shibata Takehiko Matsushita Daisuke Araki Akihiro Kida Kohei Takiguchi Yuya Ueda Kumiko Ono Tomoyuki Matsumoto Takahiro Niikura Yoshitada Sakai Ryosuke Kuroda 《Journal of orthopaedic science》2019,24(2):301-305
Background
The wide variations in patient demographics and concomitant injuries make the prediction of which patients will regain strength quickly following anterior cruciate ligament (ACL) reconstruction challenging. This study aimed to identify the dominant factor affecting quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft and to construct a predictive model for quadriceps strength recovery using decision tree analysis.Methods
Three hundred and eighty-six patients who underwent ACL reconstruction with a hamstring tendon autograft were included in this study. The isokinetic quadriceps strength at 60°/s was measured preoperatively and at 6 months after surgery. The quadriceps strength index (QSI) was calculated by normalising the peak torque of the involved leg with the uninvolved leg and multiplying it by 100. A stepwise multiple linear regression and a decision tree analysis were performed to assess whether or not the following parameters affect quadriceps strength recovery at 6 months: socio-demographic data and maximum isokinetic quadriceps strength.Results
The preoperative QSI, age, and pre-injury Tegner activity scale were independently correlated with quadriceps strength recovery at 6 month after surgery. The decision tree analysis demonstrated that patients were expected to have a QSI ≥85% at 6 months after surgery if they met one of the following conditions: (1) age <23 years with a preoperative QSI ≥78.8%, (2) age ≥29 years with a preoperative QSI ≥98.0%, or (3) age <16 years with a preoperative QSI <58.5% and pre-injury Tegner activity scale ≥9. By contrast, patients ≥29 years with a preoperative QSI <98.0% were likely to achieve a quadriceps strength index <70% at 6 months after surgery.Conclusions
Based on the results of the decision tree analysis, younger patients could achieve good quadriceps recovery even if they have a lower preoperative QSI, whereas patients ≥29 years need a higher preoperative QSI to obtain good muscle recovery. 相似文献13.
Nobutake Ozeki Takeshi Muneta Kenichi Kawabata Hideyuki Koga Yusuke Nakagawa Ryusuke Saito Mio Udo Katsuaki Yanagisawa Toshiyuki Ohara Tomoyuki Mochizuki Kunikazu Tsuji Tomoyuki Saito Ichiro Sekiya 《Journal of orthopaedic science》2017,22(3):542-548
Background
Meniscus extrusion often observed in knee osteoarthritis has a strong correlation with the progression of cartilage degeneration and symptom in the patients. We recently reported a novel procedure “arthroscopic centralization” in which the capsule was sutured to the edge of the tibial plateau to reduce meniscus extrusion in the human knee. However, there is no animal model to study the efficacy of this procedure. The purposes of this study were [1] to establish a model of centralization for the extruded medial meniscus in a rat model; and [2] to investigate the chondroprotective effect of this procedure.Methods
Medial meniscus extrusion was induced by the release of the anterior synovial capsule and the transection of the meniscotibial ligament. Centralization was performed by the pulled-out suture technique. Alternatively, control rats had only the medial meniscus extrusion surgery. Medial meniscus extrusion was evaluated by micro-CT and macroscopic findings. Cartilage degeneration of the medial tibial plateau was evaluated macroscopically and histologically.Results
By micro-CT analysis, the medial meniscus extrusion was significantly improved in the centralization group in comparison to the extrusion group throughout the study. Both macroscopically and histologically, the cartilage lesion of the medial tibial plateau was prevented in the centralization group but was apparent in the control group.Conclusions
We developed medial meniscus extrusion in a rat model, and centralization of the extruded medial meniscus by the pull-out suture technique improved the medial meniscus extrusion and delayed cartilage degeneration, though the effect was limited. Centralization is a promising treatment to prevent the progression of osteoarthritis. 相似文献14.
Toshitaka Yoshii Takashi Hirai Akio Iwanami Narihito Nagoshi Kazuhiro Takeuchi Kanji Mori Tsuyoshi Yamada Shoji Seki Takashi Tsuji Kanehiro Fujiyoshi Mitsuru Furukawa Soraya Nishimura Kanichiro Wada Masao Koda Takeo Furuya Yukihiro Matsuyama Tomohiko Hasegawa Katsushi Takeshita Yoshiharu Kawaguchi 《Journal of orthopaedic science》2019,24(1):35-41
Background
Previous studies have shown that patients with cervical ossification of the posterior longitudinal ligament (OPLL) often have co-existing ossification of the nuchal ligament (ONL). However, no studies have focused on ONL and its relevance to the severity of OPLL or ossification of other spinal ligaments, such as anterior longitudinal ligament (OALL), ligamentum flavum (OLF), and supraspinous/interspinous ligament (OSIL).Methods
In this multicenter study, we investigated ossification of the spinal ligaments in the whole spine computed tomography (CT) images of 233 cervical OPLL patients. The severity of ossification was evaluated using ossification index for each spinal ligament, calculated as the sum of the level of ossification. We compared the severity of ossification in each spinal ligament between patients with ONL and those without ONL. Furthermore, we investigated how the number of segments, where ONL exists, affects the severity of ossification in each spinal ligament.Results
One hundred thirty patients (55.8%) had co-existing ONL in the cervical OPLL patients included in this study. The ONL (+) group included more male and aged patients. The cervical ossification indexes of OPLL and OALL were higher in ONL (+) patients than in ONL (?) patients. The thoracolumbar ossification indexes of OALL and OSIL were also higher in ONL (+) patients. Logistic regression analysis revealed that age, gender and cervical OA-index were independent factors correlating to the existence of ONL. In the cervical spine, both the ossification indexes of OALL and OPLL increased as the levels of ONL increased. Similarly, in the thoracolumbar spine, both the ossification indexes of OALL and OSIL were increased as the levels of cervical ONL increased. In the multiple regression analysis, cervical OA-index and thoracolumbar OSI-index showed significant correlation with the number of ONL levels.Conclusions
Co-existence of ONL in cervical OPLL patients was associated with the severity of spinal hyperostosis especially in cervical OPLL, OALL, thoracolumbar OALL and OSIL. 相似文献15.
Slipped capital femoral epiphysis (SCFE) is not frequently encountered during routine practice and diagnosis and treatment are often delayed. It is important to understand symptoms and imaging features to avoid delayed diagnosis. After the diagnosis is made correct classification of the disease is required. The classification should be based on the physeal stability in order to choose safe and effective treatment. However, surgeons should bear in mind that the assessment is challenging and actual physeal stability is not always consistent with the stability predicted by a clinical classification method.
Treatment of stable SCFE
Closed reduction is not indicated for stable SCFE, where continuity between the epiphysis and metaphysis has not been disrupted. Treatment method(s) is (are) chosen from in-situ fixation, osteotomy and femoroacetabular impingement treatment. A single screw fixation is often used to fix the epiphysis and the dynamic method is considered especially for young patients. Traditional three-dimensional trochanteric osteotomies have been associated with procedural complexity and uncertainty. A simpler osteotomy method using an updated imaging analysis technology should be considered. Modified-Dunn procedure is indicated for a severe stable SCFE. However, caution is required because recent studies have reported a high rate of complications including postoperative femoral head avascular necrosis (AVN) and hip instability when this method is indicated for stable SCFE.Treatment of unstable SCFE
Treatment of unstable SCFE is difficult and complication rate is high. Most of unstable SCFE patients were previously treated with closed method and it was difficult to predict an occurrence of postoperative AVN. However, treatment of unstable SCFE has gradually changed in recent years and many studies have shown that physeal hemodynamics can be assessed during treatment. Preoperative assessments include contrast-enhanced MRI and bone scintigraphy. Intraoperative assessments include confirmation of bleeding after drilling the femoral head and monitoring the intracranial pressure by laser doppler flowmetry. It is expected that postoperative AVN can be prevented in many cases by performing the treatment while assessing the intraoperative physeal hemodynamics. Open surgeries have begun to be indicated in the treatment of unstable SCFE through either of anterior approach or (modified) Dunn procedure. The authors expect that recent improvements in assessment of physeal hemodynamics and open treatment method provide improved clinical outcomes in the treatment of SCFE. 相似文献16.
Eijiro Okada Takashi Tsuji Kentaro Shimizu Masanori Kato Kentaro Fukuda Shinjiro Kaneko Jun Ogawa Kota Watanabe Ken Ishii Masaya Nakamura Morio Matsumoto 《Journal of orthopaedic science》2017,22(1):3-9
Purpose
To clarify correlations between spinal fracture and delayed paralysis in patients with diffuse idiopathic skeletal hyperostosis (DISH) using computed tomography (CT) with multiplanar reformatting (CT-MPR). DISH increases susceptibility to unstable spinal fractures, leading to neurological deterioration. The pathomechanism of the neurological injury is unclear.Methods
This multicenter retrospective study included 42 DISH patients (32 male; 10 female) treated for 45 spinal fractures during a 5-year period. The mean age at the time of injury was 77.1 ± 10.1 years. The cause of injury, delay in diagnosis, fracture location, and neurological status were recorded, and anterior- and posterior-column fractures, a fracture displacement over 3 mm, and posterior-column ankylosis were assessed using CT-MPR.Results
Most fractures (73.8%) resulted from trivial trauma, such as falling from a standing or sitting position. Diagnosis was delayed in 47.6% of the patients, primarily due to delays in seeking medical attention (65.0%). Although 78.6% of the patients were neurologically intact at the time of injury, 54.8% developed paralysis, defined by a change in one or more Frankel-score levels during short-term follow-up. Of the fractures, 39.1% were in the vertebral body, and 60.9% were at the disc level. Fractures with posterior-column ankylosis were significantly associated with delayed paralysis.Conclusions
CT-MPR was useful for evaluating spinal fractures and determining treatment in patients with DISH. Fractures associated with posterior-column ankylosis resulted in unstable three-column injuries that led to delayed neurological deterioration. Early surgical stabilization of such fractures is recommended to avoid delayed paralysis. 相似文献17.
Koichi Ogura Kosuke Uehara Toru Akiyama Yusuke Shinoda Shintaro Iwata Satoshi Tsukushi Eisuke Kobayashi Takeshi Hirose Tsukasa Yonemoto Makoto Endo Yoshikazu Tanzawa Fumihiko Nakatani Hirotaka Kawano Sakae Tanaka Akira Kawai 《Journal of orthopaedic science》2019,24(3):539-547
BackgroundAccording to improved functional outcome and life expectancy in orthopaedic oncology patients, there has been a growing interest in not only oncologic and functional outcomes but also health-related quality of life (HRQOL), including body image, mental status, or social activities, after surgery. However, there has been a lack of disease-specific measures focusing on the ability of orthopaedic oncology patients to evaluate their HRQOL comprehensively. Therefore, our aims in the present study were 1) to develop a patient-oriented disease-specific outcome measure of HRQOL for musculoskeletal oncology patients (COMMON-LE), and 2) to examine the practical applicability, reliability and validity of the COMMON-LE for patients with musculoskeletal tumors in the lower extremity.MethodsThe COMMON-LE was developed by expert committee of orthopaedic oncology and rehabilitation. A total of 101 patients were surveyed using the COMMON-LE, as well as the TESS, the MSTS score, and the SF-36, to assess their psychometric characteristics, including reliability, validity, and responsiveness.ResultsThe COMMON-LE showed no marked floor and ceiling effects. Test-retest reliability and internal consistency determined using the intraclass correlation coefficient (0.928) and Cronbach's alpha (0.948–0.968), respectively, were excellent. Each domain of the COMMON-LE (pain, ADL, socioemotional condition and general health) was well correlated with the scores of the standard measures (SF-36, TESS, MSTS score). Factor analysis and the AIC network showed the questionnaire items of the COMMON-LE were clearly separable into three clusters according to their content, corresponding to each domain of the questionnaire.ConclusionsWe have successfully developed and validated a disease-specific measure, the COMMON-LE, to evaluate not only physical function, but also various aspects of HRQOL in patients with musculoskeletal tumors. The COMMON-LE has sufficient reliability and internal consistency, and good validity, and appears to be practically applicable to this group of patients. 相似文献
18.
Y. Nakamura Y. Kihara T. Yokoyama O. Konno H. Iwamoto 《Transplantation proceedings》2018,50(8):2404-2411
Background
To increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively use organs from all donors. Since the revision of the Organ Transplant Law, the number of organ donors after cardiac death (DCD) has decreased but the number of organ donors after brain death (DBD) has increased; however, the number of donor organs and awareness of cadaveric transplantation have increased.Methods
At our institution, 28 patients underwent cadaveric kidney transplantation from January 2001 to December 2016. These patients were classified into 2 groups according to DBD or DCD. Furthermore, 10 patients received transplants from expanded criteria donors (ECD) and 18 received them from standard criteria donors (SCD).Results
Kidney graft survival and engraftment were observed for all patients. There were no significant differences in renal function at 6 months for DBD and DCD transplant recipients. Renal function at 1, 3, and 5 years and serum creatinine levels were better for the ECD group. Renal function at 5 years after transplantation was significantly better for the SCD group than for the ECD group; however, there was no difference in delayed graft function between the SCD and ECD groups. Comparisons of the 3 groups showed good renal function for transplants from DBDs, but there was no significant difference in survival rates.Conclusions
Results were good for all patients. There were no significant differences in outcomes of our patients who received transplants from ECD or SCD. 相似文献19.
Koji Matsumoto Masahiro Hoshino Keita Omori Hidetoshi Igarashi Takashi Tsuruta Koji Yamasaki Hiromi Matsuzaki Takanori Iriuchishima Yasuaki Tokuhashi 《Journal of orthopaedic science》2018,23(2):253-257
Background
It remains unclear whether long fusion including lumbar-sacral fixation is needed in corrective surgery to obtain good global sagittal balance (GSB) for the treatment of traumatic thoracolumbar kyphotic spine deformity. The purposes of this study were to evaluate compensatory mechanism of the spine after corrective surgery without lumbar-sacral fixation and to evaluate the parameters affecting the achievement of good GSB post-operatively.Methods
Twenty (20) subjects requiring corrective surgery (distal end of fixation was L3) were included in this study. The radiographic parameters were measured pre-operatively and at one month after surgery. Sagittal Vertical Axis (SVA), Lumber Lordosis angle altered by fracture (fLL), Thoracic Kyphosis angle altered by fracture (fTK), Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Segmental Lumbar Lordosis (sLL: L3-S/L4-S), and local kyphotic angle were measured. The correlation between correction of local kyphotic angle (CLA) and the change in radiographic parameters was evaluated. Post-operatively, subjects with SVA<50 mm and PI-fLL<10°were regarded as the “good GSB group (G group). The radiographic parameters affecting the achievement of G group were statistically evaluated.Results
fLL, sLL:L3-S and sLL:L4-S were decreased indirectly because the local kyphosis was corrected directly (CLA: 26.5 ± 8.6°) (P < 0.001). CLA and the change in fLL showed significant correlation (r = 0.821), the regression equation being: Y = ?0.63X+3.31 (Y: The change in fLL, X: CLA). The radiographic parameters significantly affecting the achievement of G group were: SVA, PT, PI-fLL, sLL: L3-S, and sLL: L4-S (P < 0.01).Conclusion
The main compensatory mechanism was the decrease of lordosis in the lumbar spine. fLL was decreased to approximately 60% of CLA after surgery. SVA was not corrected by the compensatory mechanism. 相似文献20.
O. Konno T. Yokoyama Y. Kihara Y. Nakamura T. Ueno H. Takeuchi H. Iwamoto 《Transplantation proceedings》2018,50(8):2457-2460