鈴木 崇根

手根管開放術の際に母指球皮線に沿った皮切を置くと,しばしば母指球筋が尺側に張り出していることがある.本研究の目的は母指球皮線に対する母指球筋の尺側縁の位置を検討することである.新鮮凍結屍体16体31手.男性15手女性16手.平均年齢89歳.母指球皮線と母指球筋の最尺側縁をC点M点とし,中指中線をY軸,有鉤骨鉤を通るY軸への垂線をX軸,橈側を+とする座標上に鋼線でマーキングしてX線撮影した.C(X)とM(X)の値を比較し,関連性を検討した.C(X)とM(X)の平均座標は1.2±2.9mm,0.3±4.4mmであった.C(X)とM(X)の相関係数はr=0.33で相関は低かった.C(X)とM(X)の相関は小さく,皮線は筋の尺側縁を反映していないと考えられた.母指球皮線形成に影響する因子については筋肉や動きの要素よりも遺伝的要因が大きいとの報告があるが,本研究ではこの説を支持する結果を得た.(著者抄録)

Background: Hip pain is transmitted to the dorsal horn of the spinal cord via the dorsal root ganglion (DRG), which contains two types of neurons with differential sensitivity to neurotrophic factors. If either type predominantly innervates the hip joint, it may represent a good target for hip joint pain treatment. Methods: Inflammation was induced in the left hip joint of rats (n = 10) by using complete Freund's adjuvant. Fluoro-Gold (FG) was applied to the hip joint after 7 days, and T12-L6 DRGs were double-stained for calcitonin gene-related peptide (CGRP) and isolection-IB4 1 week later. Results: FG-labeled neurons in the control group were distributed throughout the left DRG from T13 to L5, primarily in L2 to L4, and CGRP-positive neurons were significantly more frequent than IB4-binding neurons. In the inflammatory group, FG-labeled neurons were similarly distributed, primarily at L3 and L4, and CGRP-positive neurons were significantly more frequent than IB4-binding neurons. The percentage of CGRP-positive neurons was significantly greater in the inflammatory group (P < 0.05). Conclusions: Most small neurons innervating the hip joint express CGRP. Furthermore, hip joint inflammation caused an increase in CGRP-positive neurons, but not in IB4-binding neurons. Our results suggest that CGRP-expressing nerve growth factor-dependent neurons are primarily responsible for hip joint pain and may represent therapeutic targets. (C) 2016 The Japanese Orthopaedic Association. Published by Elsevier B. V. All rights reserved.

Background Hip pain is transmitted to the dorsal horn of the spinal cord via the dorsal root ganglion (DRG), which contains two types of neurons with differential sensitivity to neurotrophic factors. If either type predominantly innervates the hip joint, it may represent a good target for hip joint pain treatment. Methods Inflammation was induced in the left hip joint of rats (n = 10) by using complete Freund's adjuvant. Fluoro-Gold (FG) was applied to the hip joint after 7 days, and T12–L6 DRGs were double-stained for calcitonin gene-related peptide (CGRP) and isolection-IB4 1 week later. Results FG-labeled neurons in the control group were distributed throughout the left DRG from T13 to L5, primarily in L2 to L4, and CGRP-positive neurons were significantly more frequent than IB4-binding neurons. In the inflammatory group, FG-labeled neurons were similarly distributed, primarily at L3 and L4, and CGRP-positive neurons were significantly more frequent than IB4-binding neurons. The percentage of CGRP-positive neurons was significantly greater in the inflammatory group (P &lt  0.05). Conclusions Most small neurons innervating the hip joint express CGRP. Furthermore, hip joint inflammation caused an increase in CGRP-positive neurons, but not in IB4-binding neurons. Our results suggest that CGRP-expressing nerve growth factor-dependent neurons are primarily responsible for hip joint pain and may represent therapeutic targets.

Study Design.A retrospective radiological study on vascular anatomy.Objective.The aim of this study was to evaluate the anatomical and radiological features of lumbar segmental arteries with respect to the surgical field of the oblique lateral interbody fusion (OLIF) approach by using magnetic resonance imaging (MRI).Summary of Background Data.OLIF surgery restores disc height and enables indirect decompression of narrowed spinal canals through an oblique lateral approach to the spine, by using a specially designed retractor. In a minimal surgical field, injuring segmental arteries can cause massive hemorrhage.Methods.We reviewed 272 lumbar MRIs. In the sagittal images, the intersection of one-third of the anterior and median lines of the intervertebral disc (IVD) was considered the center of the virtually installed OLIF retractor. The cephalad/caudal distances from the center and branch angles of segmental arteries to the longitudinal axes of the aorta were measured to determine whether the segmental arteries run into the surgical area. Statistical significance was set at P<0.05.Results.The branch angles of segmental arteries were significantly acute (90 degrees) in L1-L3 arteries and significantly blunt (>90 degrees) in L4 and L5 arteries. The average distance to the center of the caudal adjacent IVD was significantly larger, and there were generally low possibilities for the existence of segmental arteries below half of the vertebral height, where the surgeons can install fixation pins with ease and safety. Among the lumbar segmental arteries, L5 showed specific characteristics with significant deviation, a four times (4.1% vs. L1-L3 segmental arteries) higher adjacency rate, and a two-fifth (38.6% vs. 100%) lower existence rate.Conclusion.Segmental arteries can be involved in the surgical field of OLIF especially in the lower lumbar spine level of L4 and L5 arteries, which can directly run across IVDs. L5 segmental arteries can also be iliolumbar arteries that have an abnormal trajectory by nature.

Pelvic ring fractures are defined as life-threatening injuries that can be treated surgically with external or internal fixation. The authors report on an 81-year-old woman with an unstable pelvic fracture accompanying multiple traumas that was successfully treated with a less invasive procedure. The patient was injured in a traffic accident and sustained a total of 20 fractures, including pelvic ring, bilateral rib, and lumbar transverse processes fractures, and multiple fractures of both upper and lower extremities. The pelvic ring fracture was unstable with fractures of the bilateral sacrum with right sacroiliac disruption, right superior and inferior pubic rami, left superior pubic ramus, and ischium. During emergency surgery, bilateral external fixation was applied to the iliac crest to stabilize the pelvic ring. Second and third surgeries were performed 11 and 18 days after the first emergency surgery, respectively, to treat the multiple fractures. At the third surgery, the pelvic ring fracture was stabilized surgically using a less invasive posterior fixation technique. In this technique, 2 iliac screws were inserted on each side following an 8-cm midline posterior incision from the S-1 to S-3 spinous process, with the subcutaneous tissue detached from the fascia of the paraspinal muscles. The S-2 spinous process was removed and 2 rods were connected to bilateral iliac screws to stabilize the bilateral ilium in a switchback fashion. A crosslink device was applied to connect the 2 rods at the base of the S-2 spinous process. Following pelvic fixation, percutaneous pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides, and connected to the cranial rod connecting the bilateral iliac screws, thus completing the lumbopelvic fixation. The postoperative course was favorable with no postoperative complications. At the 10-month follow-up, bone union had been achieved at the superior ramus of the pubis, the patient did not complain of pain, and her activities of daily life returned to preinjury status. Unstable pelvic ring fractures need to be sufficiently stabilized for good surgical outcome. However, to avoid postoperative complications, a less invasive treatment is preferred, particularly in cases with poor general condition. This procedure is less invasive and provides sufficient stabilization to the unstable pelvic ring fracture, and thus is the ideal surgical procedure for such cases.

Pelvic ring fractures are defined as life-threatening injuries that can be treated surgically with external or internal fixation. The authors report on an 81-year-old woman with an unstable pelvic fracture accompanying multiple traumas that was successfully treated with a less invasive procedure. The patient was injured in a traffic accident and sustained a total of 20 fractures, including pelvic ring, bilateral rib, and lumbar transverse processes fractures, and multiple fractures of both upper and lower extremities. The pelvic ring fracture was unstable with fractures of the bilateral sacrum with right sacroiliac disruption, right superior and inferior pubic rami, left superior pubic ramus, and ischium. During emergency surgery, bilateral external fixation was applied to the iliac crest to stabilize the pelvic ring. Second and third surgeries were performed 11 and 18 days after the first emergency surgery, respectively, to treat the multiple fractures. At the third surgery, the pelvic ring fracture was stabilized surgically using a less invasive posterior fixation technique. In this technique, 2 iliac screws were inserted on each side following an 8-cm midline posterior incision from the S-1 to S-3 spinous process, with the subcutaneous tissue detached from the fascia of the paraspinal muscles. The S-2 spinous process was removed and 2 rods were connected to bilateral iliac screws to stabilize the bilateral ilium in a switchback fashion. A crosslink device was applied to connect the 2 rods at the base of the S-2 spinous process. Following pelvic fixation, percutaneous pedicle screws were inserted into L-4 and L-5 vertebral bodies on both sides, and connected to the cranial rod connecting the bilateral iliac screws, thus completing the lumbopelvic fixation. The postoperative course was favorable with no postoperative complications. At the 10-month follow-up, bone union had been achieved at the superior ramus of the pubis, the patient did not complain of pain, and her activities of daily life returned to preinjury status. Unstable pelvic ring fractures need to be sufficiently stabilized for good surgical outcome. However, to avoid postoperative complications, a less invasive treatment is preferred, particularly in cases with poor general condition. This procedure is less invasive and provides sufficient stabilization to the unstable pelvic ring fracture, and thus is the ideal surgical procedure for such cases.

Study Design. A retrospective multicenter survey. Objective. To investigate the perioperative complications of oblique lateral interbody fusion (OLIF) surgery. Summary of Background Data. OLIF has been widely performed to achieve minimally invasive, rigid lumbar lateral interbody fusion. The associated perioperative complications are not yet well described. Methods. The participants were patients who underwent OLIF surgery under the diagnosis of degenerative lumbar diseases between April 2013 and May 2015 at 11 affiliated medical institutions. The collected data were classified into intraoperative and early-stage postoperative (<= 1 mo) complications. The intraoperative complications were then subcategorized into organ damage (neural, vertebral, vascular, and others) and other complications, mainly related to instrumental failure. The collected data were also divided and analyzed based on whether the surgeon was certified to perform the surgery and the incidence of complications in the early (April 2013-March 2014) and late stages (April 2014-May 2015) of OLIF introduction. Results. In the 155 included patients, 75 complications were reported (incidence rate, 48.3%). The most common complication was endplate fracture/subsidence (18.7%), followed by transient psoas weakness and thigh numbness (13.5%) and segmental artery injury (2.6%). Almost all these complications were transient, except for three patients who had permanent damage: one had ureteral injury and two had neurological injury. Postoperative complications included surgical site infection (1.9%) and reoperation (1.9%). Whether the primary operator was experienced did not affect the incidence of complications. Regarding the introductory stage, the incidence of complications was 50% in the early stage and 38% in the late stage. Conclusion. The overall incidence of perioperative complications of OLIF surgery reached 48.3%, of which only 1.9% resulted in permanent damage. Our analysis based on surgeon experience indicated that the OLIF procedure could be performed without increasing incidence of complications, under the guidance of experienced supervisors.

Objective: To determine the distribution of referred hip pain in patients with idiopathic osteonecrosis of the femoral head (ION).Methods: We prospectively documented 119 hips in 90 patients with ION (mean age 51 years). Patients identified the location of pain originating in their hip on a drawing of the body. Osteoarthritis of the hip (OA) was used as a historical cohort.Results: Referral of pain originating from the hip in patients with ION was 93% (111 hips) to the groin, 68% (81 hips) to the knee, 36% (43 hips) to the anterior thigh, 34% (40 hips) to the buttock, 18% (22 hips) to the lower leg, 9% (11 hips) to the greater trochanter, and 8% (9 hips) to the low back. About 97% (115 hips) of pain was located in the hip region (groin, buttock, and greater trochanter) and 77% (92 hips) showed referred pain (anterior thigh, knee, lower leg, and low back). Pain from ION was significantly more frequent in the knee and lower leg, but significantly less frequent in the lower back than pain from OA.Conclusion: We should be aware of ION masquerading as pain in the knee or anterior thigh.

Background: The purpose of this prospective cohort study was to clarify the safety and efficacy of total hip arthroplasty via the direct anterior approach in the supine position with a novel mobile traction table. Methods: The first experience of consecutive surgeries by a single surgeon using the direct anterior approach with a traction table is described with a two-year follow-up period. Of 121 patients, 100 patients without previous hip surgeries, severe deformity, or cemented implants were divided into two groups comprising the first 50 patients and the second 50 patients. Results: The implant survival rate was 99% at the two-year follow-up. Revision surgery was required for periprosthetic femoral fracture in one patient. The complication rate possibly related to the traction table was 5% (5 patients): three anterior dislocations, one periprosthetic femoral fracture, and one intraoperative perforation caused by femoral rasping. The complication rate tended to decrease in the second group compared to the first group (4% versus 6%). Mean surgical time (72.0 minutes versus 82.5 min, p = 0.027), rate of allogeneic blood transfusion (2% versus 24%, p = 0.001), and cup alignment in the safe zone (100% versus 88%, p = 0.027) were significantly improved in the second group compared to the first group. Conclusion: The direct anterior approach with a novel mobile traction table showed a positive learning curve for surgical time, rate of allogeneic blood transfusion, and cup alignment in the safe zone.

Study Design. A retrospective radiological study on vascular anatomy. Objective. The aim of this study was to evaluate the anatomical and radiological features of lumbar segmental arteries with respect to the surgical field of the oblique lateral interbody fusion (OLIF) approach by using magnetic resonance imaging (MRI). Summary of Background Data. OLIF surgery restores disc height and enables indirect decompression of narrowed spinal canals through an oblique lateral approach to the spine, by using a specially designed retractor. In a minimal surgical field, injuring segmental arteries can cause massive hemorrhage. Methods. We reviewed 272 lumbar MRIs. In the sagittal images, the intersection of one-third of the anterior and median lines of the intervertebral disc (IVD) was considered the center of the virtually installed OLIF retractor. The cephalad/caudal distances from the center and branch angles of segmental arteries to the longitudinal axes of the aorta were measured to determine whether the segmental arteries run into the surgical area. Statistical significance was set at P &lt 0.05. Results. The branch angles of segmental arteries were significantly acute (≤ 90�) in L1-L3 arteries and significantly blunt (&gt 90�) in L4 and L5 arteries. The average distance to the center of the caudal adjacent IVD was significantly larger, and there were generally low possibilities for the existence of segmental arteries below half of the vertebral height, where the surgeons can install fixation pins with ease and safety. Among the lumbar segmental arteries, L5 showed specific characteristics with significant deviation, a four times (4.1% vs. L1-L3 segmental arteries) higher adjacency rate, and a two-fifth (38.6% vs. 100%) lower existence rate. Conclusion. Segmental arteries can be involved in the surgical field of OLIF especially in the lower lumbar spine level of L4 and L5 arteries, which can directly run across IVDs. L5 segmental arteries can also be iliolumbar arteries that have an abnormal trajectory by nature.

全身新鮮凍結屍体2体4肢を用いて、膝関節屈曲ギャップと重力の関係について検討した。今回、重力の影響も含め後十字靱帯温存/切除(CR/PS)、膝蓋骨整復/反転(PR/PE)など様々な条件下での屈曲ギャップを計測した。その結果、TKAにおける術中屈曲ギャップ計測には関節面張力、CR/PS、PR/PE、大腿部重量のすべてが影響することが示唆された。今回の検討から、術後の歩行、階段昇降などの状態を反映するためには適切な大腿部重量減免処置と十分な関節面張力下での計測を行う必要があると考えられた。

Background and Objective Cortical bone trajectory (CBT) spondylodesis is a novel screw fixation method in which screws are inserted through the pedicle in a caudal-medial to cephalad-lateral direction, providing a similar or more rigid spinal fixation compared with traditional pedicle screws. However, the traditional CBT technique requires invasive detaching and opening of the paraspinal muscle. In a small clinical prospective study we introduced a percutaneous CBT fixation technique by modifying the percutaneous pedicle screw (PPS) technique and evaluated the short-term outcome. Materials and Methods We enrolled 40 patients with lower back pain (LBP) and limb r; adicular pain with a diagnosis of spondylolisthesis who underwent transforaminal lumbar interbody fusion surgery. The patients were divided into two groups according to screw trajectory: the percutaneous CBT (pCBT) and the traditional PPS arms (20 patients in each). A consecutive group of 20 patients underwent traditional PPS, and the other underwent pCBT; dorsal spondylodesis was combined with transforaminal lumbar interbody fusion (TLIF) in both groups. Perioperative data such as operative time, blood loss, duration of fluoroscopy, and total incision length were investigated. Postoperative outcomes were evaluated using the visual analog scale (VAS) for LBP and leg pain at baseline, 1, 6, and 12 months. A p value < 0.05 was considered statistically significant. Results We observed no significant disadvantages in pCBT patients in perioperative and postoperative data compared with the PPS group. There were no complications. The pCBT patients showed a significantly shorter total incision length (p < 0.01) with a significantly shorter duration of fluoroscopy (p < 0.05). The postoperative VAS score was significantly improved in the pCBT group, especially 6 months after the surgery (p < 0.05). Conclusion The pCBT spondylodesis provided an outcome comparable with PPS fixation with a tendency for improvement 1 year postsurgery. This technique can be used in appropriate cases, combined with lumbar interbody fusion.

Background and Objective Cortical bone trajectory (CBT) spondylodesis is a novel screw fixation method in which screws are inserted through the pedicle in a caudal-medial to cephalad-lateral direction, providing a similar or more rigid spinal fixation compared with traditional pedicle screws. However, the traditional CBT technique requires invasive detaching and opening of the paraspinal muscle. In a small clinical prospective study we introduced a percutaneous CBT fixation technique by modifying the percutaneous pedicle screw (PPS) technique and evaluated the short-term outcome. Materials and Methods We enrolled 40 patients with lower back pain (LBP) and limb r adicular pain with a diagnosis of spondylolisthesis who underwent transforaminal lumbar interbody fusion surgery. The patients were divided into two groups according to screw trajectory: the percutaneous CBT (pCBT) and the traditional PPS arms (20 patients in each). A consecutive group of 20 patients underwent traditional PPS, and the other underwent pCBT dorsal spondylodesis was combined with transforaminal lumbar interbody fusion (TLIF) in both groups. Perioperative data such as operative time, blood loss, duration of fluoroscopy, and total incision length were investigated. Postoperative outcomes were evaluated using the visual analog scale (VAS) for LBP and leg pain at baseline, 1, 6, and 12 months. A p value &lt 0.05 was considered statistically significant. Results We observed no significant disadvantages in pCBT patients in perioperative and postoperative data compared with the PPS group. There were no complications. The pCBT patients showed a significantly shorter total incision length (p &lt 0.01) with a significantly shorter duration of fluoroscopy (p &lt 0.05). The postoperative VAS score was significantly improved in the pCBT group, especially 6 months after the surgery (p &lt 0.05). Conclusion The pCBT spondylodesis provided an outcome comparable with PPS fixation with a tendency for improvement 1 year postsurgery. This technique can be used in appropriate cases, combined with lumbar interbody fusion.

【背景】大腿骨ステム周囲骨折は人工股関節置換術後の重大な合併症でありしばしば治療に難渋する。本研究の目的は,大腿骨ステム周囲骨折に対する骨接合術の治療成績を明らかにすることである。【対象・方法】対象は2007年4月から2014年3月までの間に当院で手術を行い,骨癒合まで経過観察できた全9例である。患者背景は平均年齢:76歳(65-96歳),平均経過観察期間:14ヵ月,骨折型はVancouver B1:5例,B2:1例,C:3例であった。全例で外側アプローチによるロッキングプレートを用いた骨接合術を行い,使用インプラントはVancouver B:LCP-DF逆向き5例,LCP-broad 1例,Vancouver C:LCP-DF 3例であった。骨折型に応じて骨折部の締結固定とプレート上のケーブル固定を併用した。手術時間と出血量,骨癒合率と骨癒合期間,歩行能力,手術時整復位と合併症について検討した。【結果】手術時間は平均146分(119-191分),術中出血量は平均213ml(64-439ml)であった。全例で骨癒合が得られ,平均骨癒合期間は6.5ヵ月であった。9例中7例で受傷前の歩行能力が保たれたが,1例は股関節周囲の異所性骨化により,1例は96歳という超高齢により術後歩行能力が低下した。術後単純レントゲンでは7例で良好な整復位が得られたが,2例で4mmの骨片間gapを残した。そのうち1例では経過中にステムの沈下を,もう1例では遷延癒合を認めたが,臨床成績は良好であった。感染やインプラント破綻などの重篤な合併症は認めなかった。【考察】ケーブル併用ロッキングプレートによる大腿骨ステム周囲骨折に対する骨接合術の成績は良好であった。整復不良例では術後合併症を生じており,正確な整復位獲得と強固な固定が治療成績の関与することが示唆された。(著者抄録)

Neuropathic cancer pain is caused by tumors compressing the spinal nerve roots and is usually difficult to treat. The aim of current study was to determine the influence of NGF antibody on pain-related markers and behavior in a mouse model of neuropathic cancer pain. Twenty mice were used to model neuropathic cancer pain by applying murine sarcoma cells to their left sciatic nerve. Ten mice were sham operated. Two weeks after surgery, the murine sarcoma-affected mice were allocated randomly into treatment groups receiving either sterile saline (saline group) or an anti-nerve growth factor antibody (anti-NGF group). Three weeks after surgery (a week after treatment), the pain-related behavior of mice was evaluated using a CatWalk system. Subsequently, bilateral dorsal root ganglia (DRGs) from the L4-L6 levels and spinal cords at L4-L6 levels were resected. DRGs were immunostained for calcitonin gene-related peptide (CGRP) and activating transcription factor 3 (ATF-3), and spinal cords were immunostained for ionized calcium-binding adaptor molecule-1 (iba-1). Mechanical allodynia was observed in mice from the saline group and was improved in mice from the anti-NGF group. CGRP and ATF-3-immunoreactivity in DRGs and microglia expression in the spinal dorsal horn were upregulated in the saline group compared with the sham group, and they were suppressed in the anti-NGF group compared with the saline group (P<0.05). These findings suggest that anti-NGF therapy might be valuable for treating neuropathic cancer pain.

【目的】股関節の痛みは不明な点が多い。本研究の目的は,ラット股関節nerve growth factor投与モデルにおける炎症性サイトカイン及び疼痛行動を明らかにすることである。【方法】8週齢雄性SDラット(n=36)の左股関節に生食30μlを注入したsham群,FG+NGF(50μg/ml,30μl)を投与したNGF 50群,FG+NGF(100μg/ml,30μl)を投与したNGF 100群の3群(各群n=12)を作成した。実験1として投与7日目,14日目(各群n=6)にCatWalk(Noldus社製)を用いて歩行解析を行った。実験2として投与7日目,14日目に左股関節から滑膜および軟骨を摘出し,炎症性サイトカインであるTNF-α,IL-1β,IL-6をELISA法により定量した。【結果】実験1:歩行解析によりsham群に比してNGF 50群,NGF 100群で疼痛逃避行動が引き起こされた(P<0.05)。実験2:ELISAでは滑膜において炎症性サイトカインはNGF濃度依存性に上昇を認めた。【結論】NGF投与により滑膜の炎症が惹起され,炎症性サイトカインが上昇し,支配感覚神経での炎症性疼痛ペプチドの発現が上昇し,疼痛逃避行動が引き起こされたことから,NGFが股関節の疼痛発現機序に深く関与することが示唆された。(著者抄録)

Background: The extensile extensor digitorum communis (EDC) splitting approach can access the ulnar coronoid process (UCP), which can be used to treat terrible triad injuries. The present study anatomically examined the extensile EDC splitting approach for exposing the UCP. Methods: Twenty fresh frozen cadaveric upper limbs were dissected. The splitting length of the EDC and detachment length of the extensor carpi radialis brevis (ECRB)–extensor carpi radialis longus (ECRL)–brachioradialis (BR) origin were measured to expose the UCP. The distance between the most distal site of the EDC splitting and the point at which the posterior interosseous nerve (PIN) crosses the anterior aspect of the radial shaft, and the distance between the most proximal site of the ECRB-ECRL-BR origin detachment and the point at which the radial nerve crosses the anterior aspect of the humeral shaft were measured. Results: The splitting length of the EDC was 45.4 ± 4.8 mm, the detachment length of the ECRB-ECRL-BR origin was 30.2 ± 4.7 mm, the distance between the distal site of the EDC splitting and PIN was 10.6 ± 6.1 mm (minimum distance, 1.1 mm), and the distance between the proximal site of the ECRB-ECRL-BR origin detachment and the radial nerve was 49.5 ± 9.7 mm (minimum distance, 31.7 mm). Conclusions: The extensile EDC splitting approach can sufficiently expose the UCP. However, splitting must be performed carefully because the most distal site of the EDC splitting is close to the point at which the PIN crosses the anterior aspect of the radial shaft (average distance, 10 mm minimum distance, 1 mm).

Purpose To measure distances from anatomical landmarks to the median nerve, and estimate the length of the flexor-pronator/flexor carpi ulnaris (FCU) detachment necessary to expose the anteromedial facet of the ulnar coronoid process (UCP) using the Hotchkiss over-the-top approach. Methods Dissections were made of 20 fresh-frozen cadaveric upper limbs. Measurements were made of the shortest distance from the medial epicondyle to the median nerve, the distance from the medial epicondyle to the median nerve in line with the flexor-pronator/FCU interval, the shortest distance from the apex of the UCP to the median nerve, and the length of the flexor-pronator/FCU detachment necessary to expose the anteromedial facet of the UCP. Measurements were also made of the length of the ulnar insertion of the brachialis muscle and the shortest distances from the proximal and distal insertions of the brachialis muscle to the median nerve. Results The distances and lengths were as follows: medial epicondyle to median nerve, 31 ± 3 mm in line with the flexor-pronator/FCU interval, 43 ± 5 mm from the apex of the UCP to the median nerve, 7 ± 2 mm the detachment necessary to expose the UCP, 47 ± 6 mm the ulnar insertion of the brachialis muscle, 27 ± 4 mm and the proximal and distal insertions of the brachialis muscle to the median nerve, 14 ± 2 mm and 5 ± 1 mm, respectively. Conclusions The length of the flexor-pronator/FCU detachment necessary to expose the anteromedial facet of the UCP was similar to the distance from the medial epicondyle to the median nerve in line with the flexor-pronator/FCU interval. The distance from the distal insertion of the brachialis muscle to the median nerve was 5 mm. Clinical relevance The results of our study provide information on important points for surgeons to consider when performing distal exposure using the Hotchkiss over-the-top approach.

Purpose: Our previous study showed that partial-thickness articular cartilage defects (PTCDs) created in immature rats spontaneously healed to resemble normal hyaline cartilage, but that of mature rats did not. To identify molecules involved in the spontaneous cartilage repair observed in this model, gene expression was compared between PTCD and sham-operated cartilage of immature and mature rats. Materials and Methods: Six sets of gene comparisons were made at 12, 24, and 48 hours after the creation of PTCDs in immature and mature rats using microarrays. All the genes upregulated in immature cartilage at 12 hours were selected for further analysis if their expression pattern was not irregular such that diminished at 24 hours and re-upregulated at 48 hours. Relationships among genes selected through the above steps were analyzed using Ingenuity Pathway Analysis (IPA) software. After deriving networks, important molecules were further narrowed down by location within a network. Genes were regarded as central if they had relationships with more than 10 molecules in a network. Protein localization in tissues was confirmed by immunohistochemistry. Results: Five networks were identified. Their functional annotations were gene expression, cell cycle, growth and proliferation, and cell signaling. Transforming growth factor-beta (TGF-β) was centrally located in the network with the highest IPA score and mothers against decapentaplegic homolog-3 (Smad3) were centrally located in the second highest ranking network. Phosphorylated Smad3 was detected in the nuclei of chondrocytes in immature cartilage. Conclusions: Our data suggest the possible importance of Smad3 in the TGF-β signaling in the spontaneous healing of PTCDs in immature rats.

BackgroundAn examination of the vascular anatomy of the iliotibial tract (IT) has not been previously reported. Because a flap resists infection better than an avascular graft, a vascularized IT graft is useful for reconstructive surgeries pertaining to infected wounds or wounds in contact with artificial material. The purpose of this study was to examine the vascular anatomy of the IT. Materials and MethodsThe study sample consisted of 39 limbs of freshly frozen cadavers. The study was divided into three parts. The ascending and transverse branches of the lateral circumflex femoral artery (LCFA) of all cadavers were injected with latex. Distance from the tensor fasciae latae muscle and the most distal point at which the vessel on the IT was stained by latex was recorded. A microscopic observation was performed for these limbs. The deep femoral artery (DFA) or superior lateral genicular artery (SLGA) was also observed. ResultsThe length of the IT fed by the LCFA was 162.336.2 mm. The IT vascularity was located between the layered structure of the fascia and there was a vascular source for the IT within 1 mm above the IT by optical microscopy. The vascularity derived from the DFA or SLGA was not confirmed in any specimens. ConclusionsBlood supply of the IT was derived from the LCFA and a vascularized IT graft could be elevated in length to approximately 16 cm. This knowledge may be useful for improving the safety of surgery when transferring an IT flap. (c) 2015 Wiley Periodicals, Inc. Microsurgery 36:325-329, 2016.

Background An examination of the vascular anatomy of the iliotibial tract (IT) has not been previously reported. Because a flap resists infection better than an avascular graft, a vascularized IT graft is useful for reconstructive surgeries pertaining to infected wounds or wounds in contact with artificial material. The purpose of this study was to examine the vascular anatomy of the IT. Materials and Methods The study sample consisted of 39 limbs of freshly frozen cadavers. The study was divided into three parts. The ascending and transverse branches of the lateral circumflex femoral artery (LCFA) of all cadavers were injected with latex. Distance from the tensor fasciae latae muscle and the most distal point at which the vessel on the IT was stained by latex was recorded. A microscopic observation was performed for these limbs. The deep femoral artery (DFA) or superior lateral genicular artery (SLGA) was also observed. Results The length of the IT fed by the LCFA was 162.3 ± 36.2 mm. The IT vascularity was located between the layered structure of the fascia and there was a vascular source for the IT within 1 mm above the IT by optical microscopy. The vascularity derived from the DFA or SLGA was not confirmed in any specimens. Conclusions Blood supply of the IT was derived from the LCFA and a vascularized IT graft could be elevated in length to approximately 16 cm. This knowledge may be useful for improving the safety of surgery when transferring an IT flap.

手根管開放術の際横手根靱帯(TCL)上を横切る異常な筋組織ををHypertrophic muscle(HM)と定義し,その解剖学的特徴,正中神経運動神経の異常走行との関連性を検討した.対象は新鮮凍結屍体8体15手.男性9手女性6手,平均年齢89歳.母指球皮線の3mm尺側に皮切を置き展開.Kaplan's cardinal lineと中指橈側線の交点を運動枝分岐点の表在メルクマールMとして用い,実際の分岐点Aとの位置関係を座標化し調査した.MはAより平均6.1mm尺側,11.0mm近位に存在(p0.05).HMの存在率は47%(15手中7手).起始は全例TCL.停止は母指基節骨6手,母指球筋小指球筋間を横走するもの1手.前者6手では正中神経運動枝の分布がみられたが,後者1手は正中・尺骨神経からの分枝は確認できなかった.AはHMあり群はなし群より平均1.7mm尺側,5.0mm近位に存在していた.HM存在時には,より尺側での慎重な手根管開放が奨められる.(著者抄録)

振動による疼痛刺激減弱効果は一定の見解を得ていない。いくつかの研究では実際の注射を用いて効果を検討している。多くは減弱効果を支持し,僅かながら支持していない研究もある。研究者らは,研究の信頼度を高めるためにまったく同じ疼痛刺激を加えて比較しようと努力をしてきた。しかしながら,注射という手技は,実行する医師のスキルにより僅かながら違いが生じるものであり,まったく「同じ」疼痛刺激であると保証することはできない。我々は健常者に対して,よくコントロールされた電気刺激を指尖部に加え,「相同な」表在性の痛みを再現することで振動による疼痛減弱効果を調査した。24人24手が調査対象であり,50mA,0.2msの疼痛刺激を片側の中指指尖部に3回加えた。振動無し,同側中指の中手指節間関節(MP関節)への振動あり,反対側中指のMP関節への振動ありの3種類のトライアルをランダムに実施し,被験者はそれぞれの疼痛値を記録した。与えた振動負荷は108Hzで統一した。統計学的検討の結果,同側中指MP関節への振動負荷は有意に疼痛値が減少した。注射手技にまったく依存しない相同な疼痛刺激を用いた結果,振動による疼痛減弱効果は明らかとなった。(著者抄録)

前腕骨間膜の構造は,腱様組織と膜様部からなる.前腕中央に存在する腱様組織を主とした報告は散見されるが,前腕骨間膜遠位腱様組織に関する報告は少なく,今回前腕骨間膜遠位腱様組織の解剖学的検討を行った.上肢新鮮凍結屍体15体30肢,死亡時年齢68〜97歳を対象とした.前腕骨間膜を露出し,橈骨茎状突起,尺骨切痕底部を基準として遠位腱様組織の橈尺骨での付着位置を骨全長に対する百分率で求めた.腱様組織の幅や厚さも測定を行った.前腕骨間膜遠位腱様組織は,14肢(46.7%)で認めた.腱様組織は尺骨の16.0%,橈骨7.2%の位置を付着位置とし尺側から橈側に斜走していた.また,遠位ではDRUJ関節包に付着していた.腱様組織の幅,厚さは個体差を認めた.前腕骨間遠位部腱様組織の解剖学的把握は遠位橈尺関節の安定性を把握する上で一助となると考えられた.(著者抄録)

Carotid-cavernous sinus fistula (CCF) is a rare complication occurring after the Le Fort osteotomy. We aimed to elucidate the cause of CCF in the Le Fort osteotomy. Methods: Eleven fresh cadavers were used. After craniotomy, a Le Fort III bipartition osteotomy was then performed. On the left side, both the lateral wall of the maxilla and the pterygomaxillary junction (PMJ) were divided, in addition to the conventional osteotomy line. On the right side, those parts were kept intact. After the osteotomy, a tensiometer was fixed to the skull base. The sensor was linked with the wall of the carotid artery in the cavernous portion. A down-fracture was then performed initially from the left, followed by the right. Tensile force data of both sides were recorded. Results: In all cases, a higher tensile load was observed on the right side compared to the left side. In right side, two skull base fractures complexed with high pterygoid process fractures, and nine pure high fractures of the pterygoid process were identified. Conclusions: During down-fracture, the wall of the carotid artery experiences significant tensile load. The tensile load on the arterial wall may collapse the fine branches of the carotid artery in the cavernous portion. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Carotid-cavernous sinus fistula (CCF) is a rare complication occurring after the Le Fort osteotomy. We aimed to elucidate the cause of CCF in the Le Fort osteotomy. Methods Eleven fresh cadavers were used. After craniotomy, a Le Fort III bipartition osteotomy was then performed. On the left side, both the lateral wall of the maxilla and the pterygomaxillary junction (PMJ) were divided, in addition to the conventional osteotomy line. On the right side, those parts were kept intact. After the osteotomy, a tensiometer was fixed to the skull base. The sensor was linked with the wall of the carotid artery in the cavernous portion. A down-fracture was then performed initially from the left, followed by the right. Tensile force data of both sides were recorded. Results In all cases, a higher tensile load was observed on the right side compared to the left side. In right side, two skull base fractures complexed with high pterygoid process fractures, and nine pure high fractures of the pterygoid process were identified. Conclusions During down-fracture, the wall of the carotid artery experiences significant tensile load. The tensile load on the arterial wall may collapse the fine branches of the carotid artery in the cavernous portion.

Background: The mechanism for hip pain has been unclear because of a lack of experimental animal models. We aimed to establish an intra-articular injection technique to the rat hip and to document the effect of intra-articular mono-iodoacetate (MIA) injection to the rat hip with radiography and histology. Methods: Using 60 6-week-old male Sprague Dawley rats, 25 mu l of sterile saline (control group; n = 30) and 25 mu l of sterile saline with 2 mg of MIA (MIA group; n = 30) was injected into the right hip joints via posterior approach using a 27G needle. The animals were examined with X-ray and histology 7, 14, 28, 42, and 56 days later (MIA group [n = 6] and control group [n = 6], respectively). Results: The MIA group showed progressive radiographic changes to the hip joint during the experimental period, whereas the control group maintained a normal appearance. The microanatomic appearance was consistent with Xray images of progressive destruction in the MIA group and normal tissue in the control group. Osteoarthritic (OA) changes became apparent at 42 and 56 days in the MIA group. Conclusions: We established an intra-articular injection technique to the rat hip, creating a hip OA model in the rat by intra-articular injection of MIA.

当院における小児前腕骨骨幹部骨折47例における術後再骨折について検討した.経皮的鋼線刺入固定術群(W群,27例),プレート固定術群(P群,20例)の2群において,再骨折率および術後インプラント抜去までの期間を調査し,骨折部位,両骨骨折の有無,骨折型の各項目と再骨折との関係を検討した.W群では5例(18.5%),P群では2例(10%)に再骨折を認めた.W群においては再骨折例で年齢が高い傾向がみられた.インプラント抜去までの平均期間はW群27日,P群213日であった.骨折部位,両骨骨折,骨折型と再骨折との有意な関連は認められなかったものの,再骨折例は全例横骨折であった.年長児に対する経皮的鋼線固定術,横骨折は再骨折のリスク因子と考えられ注意が必要である.(著者抄録)

Purpose: Our previous study showed that partial-thickness articular cartilage defects (PTCDs) created in immature rats spontaneously healed to resemble normal hyaline cartilage, but that of mature rats did not. To identify molecules involved in the spontaneous cartilage repair observed in this model, gene expression was compared between PTCD and sham-operated cartilage of immature and mature rats. Materials and Methods: Six sets of gene comparisons were made at 12, 24, and 48 hours after the creation of PTCDs in immature and mature rats using microarrays. All the genes upregulated in immature cartilage at 12 hours were selected for further analysis if their expression pattern was not irregular such that diminished at 24 hours and re-upregulated at 48 hours. Relationships among genes selected through the above steps were analyzed using Ingenuity Pathway Analysis (IPA) software. After deriving networks, important molecules were further narrowed down by location within a network. Genes were regarded as central if they had relationships with more than 10 molecules in a network. Protein localization in tissues was confirmed by immunohistochemistry. Results: Five networks were identified. Their functional annotations were gene expression, cell cycle, growth and proliferation, and cell signaling. Transforming growth factor-beta (TGF-beta) was centrally located in the network with the highest IPA score and mothers against decapentaplegic homolog-3 (Smad3) were centrally located in the second highest ranking network. Phosphorylated Smad3 was detected in the nuclei of chondrocytes in immature cartilage. Conclusions: Our data suggest the possible importance of Smad3 in the TGF-beta signaling in the spontaneous healing of PTCDs in immature rats.

Purpose To assess the anatomic feasibility of a median-to-radial nerve transfer in cadaver limbs and to quantify the number of axons present in the cut ends of the involved donor and recipient nerves. Methods Ten fresh frozen cadaveric upper limbs were dissected. We investigated whether the flexor carpi radialis (FCR) branch/flexor digitorum superficialis (FDS) branch (donor nerve) reached the posterior interosseous nerve (PIN)/extensor carpi radialis brevis (ECRB) branch (recipient nerve) without tension. We also investigated the length of the transected supinator fascia for FCR-posterior interosseous nerve transfer and the FDS-ECRB positional relationship using the epicondyle line and the midline of the forearm as axes. The findings were used for these 2 types of nerve transfer with evaluation closer to the target muscles. The distance between the point at which the FDS and ECRB branches met and the point at which the ECRB branch entered the muscle was measured. After nerve coaptation, the axon number was determined by histological evaluation. Results In all limbs, the FCR and FDS branches reached the PIN and the ECRB branch without tension. The transected supinator fascia was 17 (3-25) mm long. The distance between the FDS and ECRB branches was 48 (23-65) mm distal to the epicondyle line and approximately 23 (18-27) mm radial to the midline of the forearm. The distance between the point at which the FDS and ECRB branches met and the point at which the ECRB branch entered the muscle was 27 (17-40) mm. The mean axon numbers were FCR, 1501 (932-3022) PIN, 5162 (4325-7732) FDS, 885 (558-962) and ECRB, 548 (433-723). Conclusions The FCR branch could be transferred to the PIN branch and the FDS to the ECRB branch in all limbs without tension. Clinical relevance We provide anatomical and histological information for median-to-radial nerve transfer.

Introduction: Although muscle injury is a common source of pain, the mechanism causing such pain is not completely known. We have previously reported nerve growth factor (NGF) as a proinflammatory mediator involved in acute pain, and clinical trials have shown the effectiveness of anti-NGF antibodies for management of low back pain. Here, we aim to examine the effects of anti-NGF antibodies on muscle-derived pain by studying their effects on sensory innervation in a rat muscle injury model. Methods: A nervous system tracer, Fluoro-Gold, was applied to both gastrocnemius muscles of 24 male Sprague Dawley rats to stain the sensory nerves. Then, the drop-mass method was used to damage the right gastrocnemius muscle of the posterior limb. Anti-NGF antibodies (50 μL) were injected into the injured muscles in 12 rats. Tissues were evaluated 1, 3, and 7 days post-injury by performing haematoxylin-and-eosin (HE) staining. The percentage of the total number of FG-positive cells that were also positive for a pain-related neuropeptide, calcitonin gene-related peptide (CGRP), was determined for the bilateral dorsal root ganglia from L1 to L6 7 days post-injury. Results: HE staining showed active inflammation, indicated by increased basophil and eosinophil accumulation, at the injury site 1 and 3 days post-injury, as well as scar tissue formation 7 days post-injury. Injection of anti-NGF reduced muscle necrosis 1 and 3 days post-injury, and resulted in replacement of granulation tissue and muscle fibre regeneration 7 days post-injury. Anti-NGF also significantly inhibited CGRP among FG-positive cells (treatment group 38.2%, control group 49.6% P &lt 0.05). Discussion: This study found active inflammation induced by NGF, which may contribute to pain after muscle injury. Anti-NGF antibodies successfully suppressed the pain mediator NGF and inhibited inflammation, suggesting NGF as a target for control in pain management.

The endothelial-specific receptor, tyrosine kinase with immunoglobulin-like loops and epidermal growth factor homology domains-2 (Tie2) is a member of the tyrosine kinase family and is ubiquitous in normal tissues; however, little is known about the mechanisms and roles of Tie2 in oral squamous cell carcinomas (OSCCs). In the current study, we investigated the expression status of Tie2 in OSCCs by quantitative reverse transcriptase-polymerase chain reaction, immunoblotting, and immunohistochemistry and the functional mechanisms of Tie2 using its overexpressed OSCC (oeTie2) cells and Tie2 blocking by its antibody. We found that Tie2 expression was down-regulated significantly (p &lt; 0.05) in OSCCs compared with normal counterparts in vitro and in vivo. Interestingly, oeTie2 cells showed higher cellular adhesion (p &lt; 0.05) and lower cellular invasion (p &lt; 0.05) compared with control cells; whereas there was similar cellular proliferation in both transfectants. Furthermore, cellular adhesion was inhibited and invasion was activated by Tie2 function-blocking antibody (p &lt; 0.05), indicating that Tie2 directly regulates cellular adhesion and invasion. As expected, among the clinical variables analyzed, Tie2-positivity in patients with OSCC was correlated closely with negative lymph node metastasis. These results suggested for the first time that Tie2 plays an important role in tumor metastasis and may be a potential biomarker for OSCC metastasis.

Study Design: Retrospective study.Purpose: To determine whether low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy could prevent thetransition of acute low back pain to chronic low back pain.Overview of Literature: Inadequately treated early low back pain transitions to chronic low back pain occur in approximately 30%of affected individuals. The administration of non-steroidal anti-inflammatory drugs is effective for treatment of low back pain in theearly stages. However, the treatment of low back pain that is resistant to non-steroidal anti-inflammatory drugs is challenging.Methods: Patients who presented with acute low back pain at our hospital were considered for inclusion in this study. After the diagnosisof acute low back pain, non-steroidal anti-inflammatory drug administration was started. Forty patients with a visual analogscale score of &gt 5 for low back pain 1 month after treatment were finally enrolled. The first 20 patients were included in a non-steroidalanti-inflammatory drug group, and they continued non-steroidal anti-inflammatory drug therapy for 1 month. The next 20 patientswere included in a combination group, and they received low-dose tramadol plus non-steroidal anti-inflammatory drug combinationtherapy for 1 month. The incidence of adverse events and the improvement in the visual analog scale score at 2 months after the startof treatment were analyzed.Results: No adverse events were observed in the non-steroidal anti-inflammatory drug group. In the combination group, administrationwas discontinued in 2 patients (10%) due to adverse events immediately following the start of tramadol administration. At 2months, the improvement in the visual analog scale score was greater in the combination group than in the non-steroidal anti-inflammatorydrug group (p &lt 0.001).Conclusions: Low-dose tramadol plus non-steroidal anti-inflammatory drug combination therapy might decrease the incidence ofadverse events and prevent the transition of acute low back pain to chronic low back pain.

Study Design: Retrospective case series. Purpose: To elucidate the impact of postoperative occiput-C2 (O-C2) angle change on subaxial cervical alignment. Overview of Literature: In the case of occipito-upper cervical fixation surgery, it is recommended that the O-C2 angle should be set larger than the preoperative value postoperatively. Methods: The present study included 17 patients who underwent occipito-upper cervical spine (above C4) posterior fixation surgery for atlantoaxial subluxation of various etiologies. Plain lateral cervical radiographs in a neutral position at standing were obtained and the O-C2 angle and subaxial lordosis angle (the angle between the endplates of the lowest instrumented vertebra (LIV) and C7 vertebrae) were measured preoperatively and postoperatively soon after surgery and ambulation and at the final follow-up visit. Results: There was a significant negative correlation between the average postoperative alteration of O-C2 angle (DO-C2) and the average postoperative alteration of subaxial lordosis angle (Dsubaxial lordosis angle) (r=-0.47, p=0.03). Conclusions: There was a negative correlation between DO-C2 and Dsubaxial lordosis angles. This suggests that decrease of midto lower-cervical lordosis acts as a compensatory mechanism for lordotic correction between the occiput and C2. In occipito-cervical fusion surgery, care must be taken to avoid excessive O-C2 angle correction because it might induce mid-to-lower cervical compensatory decrease of lordosis.

Study Design: Retrospective case-control study. Purpose: To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Overview of Literature: Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. Methods: The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Results: Stepwise logistic regression revealed kissing spine (p =0.024 odds ratio, 3.80) and foraminal stenosis (p &lt 0.01 odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. Conclusions: When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

The feasibility of a user-specific finite element model for predicting the in situ strength of the radius after implantation of bone plates for open fracture reduction was established. The effect of metal artifact in CT imaging was characterized. The results were verified against biomechanical test data. Fourteen cadaveric radii were divided into two groups: (1) intact radii for evaluating the accuracy of radial diaphysis strength predictions with finite element analysis and (2) radii with a locking plate affixed for evaluating metal artifact. All bones were imaged with CT. In the plated group, radii were first imaged with the plates affixed (for simulating digital plate removal). They were then subsequently imaged with the locking plates and screws removed (actual plate removal). Fracture strength of the radius diaphysis under axial compression was predicted with a three-dimensional, specimen-specific, nonlinear finite element analysis for both the intact and plated bones (bones with and without the plate captured in the scan). Specimens were then loaded to failure using a universal testing machine to verify the actual fracture load. In the intact group, the physical and predicted fracture loads were strongly correlated. For radii with plates affixed, the physical and predicted (simulated plate removal and actual plate removal) fracture loads were strongly correlated. This study demonstrates that our specimen-specific finite element analysis can accurately predict the strength of the radial diaphysis. The metal artifact from CT imaging was shown to produce an overestimate of strength.

【目的】演奏に関連する筋骨格系障害(Playing-related musculoskeletal disorder;PRMD)を有する音楽家は多い.今回は疫学調査を行い国内音楽家の現状を明らかにし,その危険因子を検討した.【対象と方法】プロ演奏家と指導者16名,音大生17名,愛好家28名の計61名に対しアンケート調査実施した.無作為に選んだ26名を医師が診察し他覚的所見を確認した.【結果】男性22名,女性39名,平均年齢35歳,平均経験年数27年,平均練習時間1日2.7時間であった.楽器の内訳は弦楽器37名,鍵盤楽器22名,木管楽器5名,金管楽器2名であった(重複含む).罹患部位は上肢が49%と最多で,そのうち指と前腕が6割を占めた(重複含む).PRMD罹患率は84%,PRMDのうち整形外科疾患の占める割合は27%,平均最大時VAS65,平均調査時VAS23であった.プロ演奏家の手指ジストニアは演奏に致命的な影響を及ぼし楽器を転向していた.【考察】過去の文献で危険因子として報告された弦楽器・性別・練習時間,および演奏レベルは明らかな危険因子ではなかった.しかし多くの音楽家がPRMDを自覚しており今後診療体制の充実が期待される.(著者抄録)

目的:尺骨神経皮下前方移所術を安全に行うために分枝の解剖学的特徴を明らかにすること。方法:新鮮凍結屍体8体16肢で皮下前方移所術を施行。尺骨神経の分枝である関節枝、尺側手根屈筋(FCU)尺骨頭・上腕頭、深指屈筋の筋枝を同定し、各分枝の数、分岐位置、分岐部から関節・筋進入部までの長さ、筋枝の筋内剥離可能長、神経幅を測定した。さらに前方移所に伴って要した分枝の処置を記録した。結果:前方移所の際に最も重要なFCUについては、分枝数が5肢(31%)で1本のみであった。分枝長は尺骨頭枝20mm、上腕頭枝23mm、筋内剥離可能長はともに35mm、神経幅は1mmであった。前方移所に伴い3肢で関節枝のみ切離を要した。結論:FCU筋枝の筋内剥離可能長は約35mmであり、筋枝が移所の支障となる場合に、特に分枝数が1本の症例でも筋内剥離により筋枝を温存して前方移所術を行うことが可能と考えられた。(著者抄録)

当科において分離受動術および有茎血管柄付き脂肪弁挿入を行った先天性橈尺骨癒合症例における術後の腕橈関節アライメントと成績との関連につき検討した.1年以上経過観察可能であった7例8肢を対象とした.腕橈関節アライメントは単純X線側面像で前方脱臼型,中間型,後方脱臼型に分類した.術前では前方脱臼型が5肢,中間型が2肢,後方脱臼型が1肢であった.術直後では前方脱臼型が2肢,中間型が3肢,後方脱臼型が3肢であった.最終診察時では前方脱臼型が2肢,中間型が1肢,後方脱臼型が5肢であった.前腕回内外可動域は,最終診察時には自動で前方脱臼型において回内37.5±8.0°,回外20.0±10°,後方脱臼型において回内44.0±23°,回外29.0±20°であり,腕橈関節アライメントによる成績には有意差を認めなかった.整復位を保持することは困難であり,橈骨頭脱臼への対策が必要であると思われた.(著者抄録)

Extensile EDC splittingアプローチは肘関節前外側の良好な視野が得られ、terrible triad損傷のアプローチ法として応用可能である。本研究の目的は、本アプローチを用いて尺骨鉤状突起を露出するための解剖学的検討を行うことである。新鮮凍結屍体8肢を用いた。尺骨鉤状突起の露出に必要なEDC切離量は43.9±6.0mm、短橈側手根伸筋(ECRB)-長橈側手根伸筋(ECRL)付着部切離量は27.4±2.4mmであった。展開を拡大し、遠位では後骨間神経(PIN)、近位では橈骨神経(RN)を露出した。EDC切離最遠位部からPINが橈骨骨幹部前面を通る点までの距離は6.4±5.6mm、ECRB-ECRL付着部切離最近位部からRNが上腕骨骨幹部前面を通る点までの距離は45.0±5.2mmであった。EDC切離最遠位部とPIN最短部位までの距離は約6mmと接近するので注意が必要である。(著者抄録)

Background: Methicillin-resistant Staphylococcus aureus (MRSA)-caused pyogenic spondylitis is a serious complication associated with lumbar fusion surgery. Often, anti-MRSA drugs are not used properly or patients discontinue drug use because of side effects including renal failure. Case presentation: We report a case at our hospital of a 54-year-old male renal-transplant patient who developed MRSA vertebral osteomyelitis after spinal fusion and was treated effectively with linezolid. After diagnosis of post-fusion surgery osteomyelitis, we conducted emergency flushing and debridement and began linezolid treatment (1200 mg/day, divided) immediately after the surgery. The level of C-reactive protein gradually decreased and became negative 4 weeks after the initiation of linezolid treatment. Serum creatinine level was approximately 1.3 mg/dL throughout the treatment period, indicating no deterioration in renal function. Conclusion: These results suggest that early flushing and debridement together with linezolid administration is an effective treatment for MRSA vertebral osteomyelitis in renal-transplant patients.

【目的】有限要素解析(以下、FEA)を用いた前腕骨骨幹部の骨強度測定法を確立すること。【方法】新鮮凍結屍体より橈骨14本を採取した。橈骨骨幹部の骨強度予測には橈骨8本を使用した。CT/FEAを用いて骨強度を予測し、さらに実測値と比較することで予測値の妥当性を検証した。残りの6本はプレート固定した状態でCTを撮影し、そのデータよりプレートの情報のみを除去した後に骨強度を予測した。さらに、実際にプレートを抜去した後、再度CT撮影を行い、骨強度を予測した。これらの値を実測値と比較することで、アーチファクトの影響について検討した。【結果】橈骨の骨強度の予測値と実測値の間には強い相関関係を認めた。プレートによるアーチファクトによって、骨強度予測値は32%上昇していた。【結語】新鮮凍結屍体を用いて、プレートのアーチファクトの影響も考慮したFEAによる前腕骨骨幹部骨強度測定法を確立した。(著者抄録)