_手外31-4.indb

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1 ISSN

2 橈骨遠位端骨折 locking plate MODE Distal Radius Plate CT Subchondral support DRF 387 TFCC 損傷 TFCC DASH 自由投稿論文 391 外傷 PIP 394 zone Terrible Triad 403

3 JuggerKnot 1.0mm 416 CT 骨性マレット 426 two extension block 430 屈筋腱損傷 D-CT 445 ばね指 449 変性疾患 453 K-wire OA 457 PIP 1 461

4 Heberden 466 リウマチ low profile splint 473 手根管症候群 末梢神経 熱傷 492 手術法 その他 3D-CT CM

5 症例報告

6 J Jpn Soc Surg Hand X 3 6 Mayo wrist score X Ulnar variance Volar tilt Radial inclination X 緒言 D3 D3 1 D 2 対象と方法 Acu-Loc Distal Radius Plate System ACUMED DXA dual-energy X-ray absorptiometry young adult mean YAM μg/ X Mann-Whitney U test P AO A2 2 A3 4 C1 4 C2 3 C3 2 A2 1 A3 9 B3 1 C1 5 C2 3 C /09/

7 350 表 1 表 2 X 表 3 Mayo wrist score X Ulnar variance Volar tilt Radial inclination Mann-Whitney U test g/cm 2 Wilcoxon signed-rank test 0.05 結果 3 6 mayo wrist score 1 X Ulnar variance Volar tilt Radial inclination 2 g/cm g/cm 考察 D D 22 D 3 D 4 2

8 351 Lee D 6 5 D D 6 7 D D D 8 9 D 8 D X DXA 文献 1 Matsumoto T, et al. A new active vitamin D3 analog, eldecalcitol, prevents the risk of osteoporotic fractures--a randomized, active comparator, double-blind study. Bone 49: , D Clinical Calcium 23: , Bischoff-Ferrari HA, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA 291: , Verhaar HJ, et al. Muscle strength, functional mobility and vitamin D in older women. Aging 12: , Lee HJ, et al. Evaluation of vitamin D level and grip strength recovery in women with a distal radius fracture. J Hand Surg Am 38: , D 14: , D 84: , Oyen J, et al. Vitamin D inadequacy is associated with low-energy distal radius fractures: a case-control study. Bone 48: , Jang WY, et al. Vitamin D levels in post-menopausal Korean women with a distal radius fracture. Injury 43: , まとめ 3

9 J Jpn Soc Surg Hand 緒言 carpal tunnel pressure CTP 1 2 volar locking plate VLP CTP 対象と方法 AO type A 7 A2 4 A3 3 type C 8 C1 2 C2 4 C3 2 1 FCR FCR trans- FCR approach VLP VA-LCP TC DRP 2.4 Synthes PA 6 VLP CTP 18G 2cm CTP 1 X radial inclination volar tilt ulnar variance CTP Student t p /10/

10 353 表 1 表 2 X 図 1 trans-fcr approach PL 結果 15 radial inclination volar tilt ulnar variance -0.2mm 0mm 図 2 CTP 73.6mmHg mmhg 13.2mmHg 0 34mmHg 13.1mmHg 2 47mmHg 5

11 354 p N P N 54.8mmHg 5 117mmHg P 95.1mmHg mmHg N 10.8mmHg 0 29mmHg P 16.0mmHg 5 34mmHg N 7.5mmHg 2 13mmHg P 19.6mmHg 5 47mmHg N P P CTP CTP 62.9mmHg 5 151mmHg 116.3mmHg mmHg 10.8mmHg 0 29mmHg 22.7mmHg 5 34mmHg 7.2mmHg 2 13mmHg 37.0mmHg 30 47mmHg CTP p 0.02 p 図 3 CTP 考察 VLP 3 5 CTP CTP Gelberman CTP 40 50mmHg 6 CTP 73.6mmHg VLP CTP 13.1mmHg CTP Dresing CTP mmHg 2 CTP CTP 図 4 CTP 図 5 CTP CTP CTP 6

12 355 CTP 7 CTP CTP 95.1mmHg CTP 3 40mmHg 116.3mmHg 37.0mmHg CTP CTP 6 Gelberman RH, et al. Tissue pressure threshold for peripheral nerve viability. Clin Orthop Relat Surg 178: , Hori K, et al. Protective effect of edaravone for tourniquet-induced ischemia-reperfusion injury on skeletal muscle in murine hindlimb. BMC Musculoskelet Disord 14: , まとめ CTP CTP CTP CTP CTP 文献 1 Wolf SW, et al. Green s operative hand surgery. 6th edition. Philadelphia. Elsevier/Churchill Livingstone. pp , Dresing K, et al. Compartment pressure in the carpal tunnel in distal fractures of the radius. Arch Ortop Trauma Surg 113: , Fuller DA, et al. Carpal canal pressure after volar plating of distal radius fractures. J Hand Surg Br 31: , Ho AW, et al. Hand numbness and carpal tunnel syndrome after volar plating of distal radius fracture. Hand NY 6: 34-38, Itsubo T, et al. Differential onset patterns and causes of carpal tunnel syndrome after distal radius fractures: a retrospective study of 105 wrists. J Orthop Sci 15: ,

13 J Jpn Soc Surg Hand locking plate locking plate X radial inclination 1.0 volar tilt 1.7 ulnar variance 3.1mm Mayo Modified Wrist Score excellent 11 good 9 fair 2 poor 0 82 緒言 locking plate WHO locking plate AO A2 5 A3 9 B3 4 C1 1 C2 3 Trans-FCR approach APTUS collection ME 15 APTUS baby foot ME 4 Acu-Loc 3 2 X radial inclination RI volar tilt VT ulnar variance UV Mayo Modified Wrist Score MMWS 2 対象と方法 locking plate 結果 X RI 21.4 VT 7.1 UV -1.0mm RI 20.4 VT 5.4 UV 2.2mm RI 1.0 VT 1.7 UV 3.1mm 1 MMWS 82 excellent 11 good 9 fair /10/

14 357 表 1 X UV poor AO B3 1ab APTUS collection 1cd UV 1.5mm RI 1 VT 2 1ef kg 100 MMWS AO A3 2ab UV +3.3mm 2cd UV 2.7mm 2ef kg 95 MMWS 85 図 1 1 X a,b c,d 8 図 2 2 X a,b c,d 6 9

15 358 考察 Grade C 3 Jupiter 60 4 YAM 70 6 Mayo Wrist Score MWS 5 Arora 65 RCT 1 ADL 1 75 MWS Q-DASH 6 retrospective MWS Q-DASH 4 6 ADL/QOL Arora 12 DASH PRWE 1 UV DASH PRWE まとめ 75 locking plate 文献 1 Arora R, et al. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg 93A 23 : , Cooney WP, et al. Triangular fibrocartilage tears. J Hand Surg 19A 1 : , pp1-130, Jupiter JB, et al. Surgical treatment of redisplaced fractures of the distal radius in patients older than 60 years. J Hand Surg 27A 4 : , : 1-4, : 5-8,

16 J Jpn Soc Surg Hand VLP VLP VLP VLP VLP AO CT 緒言 VLP VLP VLP VLP 対象と方法 VLP AO A3 5 C1 3 C2 5 C3 11 JSSH score quick DASH multidetector CT 結果 VLP die punch Frog Loc JSSH score quick DASH CT mm 1 VLP /09/

17 360 図 1 1 CT mm 図 図 3 2 VLP Central depression key stone 3.5mm JSSH score 95 2 VLP 63 Central depression key stone 3.5mm 3 VLP wedge JSSH score m Central depression key 図 4 2 stone 7.6mm 5 VLP 6 12

18 361 図 5 3 Central depression key stone 7.6mm 図 6 3 VLP 図 7 3 JSSH score 95 図 8 4 Frag-Loc die punch JSSH score Frag Loc 72 die punch VLP Frag Loc JSSH score

19 362 表 1 考察 VLP 1 VLP VLP VLP VLP 1 2 VLP 3 4 die punch Frog Loc 4 VLP VLP CT Key stone 3.5mm VLP 4 1 central depression 2 Volar Tilt 10 3 Central depression VLP VLP die punch Frag-Loc die punch sigmoid notch gap monoaxial type plate screw Frag-Loc Frag-Loc VLP 14

20 363 VLP AO CT まとめ VLP VLP 3 4 die punch Frog-Loc 4 AO CT 文献 1 AO type C3 33: , : , : , multiple plates fragment specific fixation 47: ,

21 J Jpn Soc Surg Hand MODE Distal Radius Plate 3D-CT MODE Distal Radius Plate CT Modified Mayo Wrist Score Excellent 15 good 17 Fair 16 DASH score 10.2 X Radial Inclination 21.2 Voral Tilt 8.9 Ulnar Variance 0.3mm Radial Langth 10.3mm CT mm screw mm 緒言 MODE Distal Radius Plate MODE DRP 3D-CT subchondral support X CT 対象と方法 MODE DRP AO A2 10 A3 3 C1 19 C2 12 C3 4 MODE DRP monoaxial locking plate narrow standard wide size variation 2.5mm 7 2 double-tired subchondral support monoaxial locking screw trans-fcr approach Intermediate fibrous zone IFZ intrafocal pinning condylar stabilizing 1 IFZ 1 Modified Mayo Wrist Score MWS 2 Disability of Arm Shoulder and Hand DASH 3 X radial inclination RI volar tilt VT ulnar variance UV radial length RL 2014/10/

22 365 図 1 1 図 2 図 3 full range 4 CT CT Lister 4mm 4mm 2a b 2 a b 3a b a b FPL 3 5 watershed line Type 1 Type 2 Type 3 4 FPL 17

23 366 図 4 表 1 X CRPS 6 X X paired t-test ANOVA p 0.05 結果 MWS Excellent 15 good 17 Fair 16 Poor 0 DASH score X RI VT UV mm RL mm VT RL P 0.05 RI UV P 0.05 P Lister 4mm mm Lister mm Lister 4mm mm a mm b 1 #1 10.2mm #2 11.7mm 2 #4 14.3mm #5 13.3mm #1 #4 P #2 #5 P 表 2 18

24 367 表 3 X 2 1 Type 1 10 Type 2 8 Type 3 1 Type 3 1 FPL CRPS 3a b 考察 CT 4 6 CT Lister Lister 4mm 1.0mm Drobetz 7 4mm 3mm subchondral support double subchondral support 1 1 polyaxial locking plate 8 monoaxial locking plate common disease golden standard Interobserver difference Intraobserver difference 19

25 368 monoaxial まとめ MODE DRP 文献 1 MB Orthop 13: 71-80, Cooney WP, et al. Difficuly wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 214: , Imaeda T, et al. Validation of the Japanese Society for Surgery of the Hand Version of the Disability of the Arm, Shoulder, and Hand DASH-JSSH Questionnaire. J Orthop Sci 10: , Multislice CT 30: , : 25-28, DVR 29: , Drobets H, et al. Osteosynthesis of distal radial fractures with a volar locking screw plate system. Int Orthop 27: 1-6, polyaxial locking plate 33: , : , : ,

26 J Jpn Soc Surg Hand full grip X 1 1 MP 1 p p 0.06 緒言 対象と方法 AO 3 4 alignment 5 1 MP MP PIP MP PIP 7 1 NRS full grip 1 7 StatViewJ-5.0 software SAS Institute NC t- χ2 5 結果 /09/

27 370 表 1 図 1 1 p p AO C A C alignment Radial incli- 図 3 図 2 AO 22

28 371 図 4 alignment nation RI Volar tilt VT Ulnar variance UV MP 1 MP MP PIP MP PIP MP p NRS 0 10 p= 表 2 1 表

29 372 表 4 1 p p 考察 MP 1 A3 C3 4 C C C MP 1 24

30 373 まとめ 文献 : 61-65, : 39-44, distal radius plate X 29: 36-38, : , : ,

31 J Jpn Soc Surg Hand CT 36 CT X Palmar tilt Ulnar tilt CT 緒言 VLP AO 1 Martineau 2 3 Harness 4 Berger short radiolunate ligament keystone 5 CT 対象と方法 VLP 1 CT AO v c d CT Tanabe 6 1a X Ulnar Variance UV Palmar Tilt PT Radial Inclination RI UV PT RI ΔUV ΔPT ΔRI Step off gap mm lvlf wvlf ldlf wdlf 1b UV 2mm PT 25 PT 0 RI 15 1mm 2014/09/

32 375 図 1 a Tanabe CT Radial Styloid RS DorsoRadial DR DorsoUlnar DU Sigmoid Notch SN VolarUlnar VU VolarRadial VR 6 b CT lvlf ldlf wvlf wdlf ΔUV ΔPT ΔRI UV PT RI gap step off Spearman AO Tanabe ΔUV ΔPT ΔRI UV PT RI Mann-Whitney 結果 AO d 22 C1 4 C2 6 C3 12 c 2 C3 2 v 12 C1 3 C2 4 C3 2 B3 3 Tanabe d c d 図 2 d v c Tanabe 1a 27

33 376 表 1 CT * p 0.05 表 2 * p 0.05 v d 2 v 2.3 c c lvlf wvlf ldlf wdlf d v d lvlf ldlf wvlf wdlf p 0.05 lvlf wdlf v d p UV 3 2mm plus variance 3.3mm 1 2.2mm 2 RI 1 14 PT d 1-2 1mm 4 2mm 10 lvlf wvlf ldlf wdlf P 0.05 PT 0.36 p 0.05 d 0.56 p 0.01 v UV mm d mm p 0.05 wvlf ΔPT p 0.05 wvlf p 0.05 d wdlf UV 0.43 p 0.05 Palmar Tilt d Ulnar Variance 考察 Harness 7 B3 4 short radiolunate ligament 5 3D-CT 7 Tanabe

34 Mandziak CT 8 X PT UV VLP 9 Periosteal sleeve AO UV 3mm 1 PT 1-2 RI 1 14 まとめ CT Palmar tilt AO B 文献 1 Cooney WP, et al. The Wrist: Diagnosis and Operative T r eatment.chapter12 Fractur es of the Distal Radius:Overview of Diagnosis,Classification,and Treatment Considerations. 2nd ed. Philadelphia. Lippincott Williams & Wilkins. pp , Martineau PA, et al. Volar Plating of AO C3 Distal Radius Fractures: Biomechanical Evaluation of Locking Screw and Locking Smooth Peg Configurations. J Hand Surg 33A: , : 19-22, Harness NG, et al. Loss of Fixation of the Volar Lunate Facet Fragment in Fractures of the Distal Part of the Radius. JBJS 86A: , Berger RA, et al. The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surg 15A: , Tanabe K, et al. Intra-Articular Fractures of the Distal Radius Evaluated by Computed Tomography. J Hand Surg 36A: , Rozental TD, et al. Evaluation of the sigmoid notch with computed tomography following intra-articular distal radius fracture. J Hand Surg 26A: , Mandziak DG, et al. Ligament contribution to patterns of articular fractures of the distal radius. J Hand Surg 31A: , Ulnodorsal fragment 27: 43-46,

35 J Jpn Soc Surg Hand ms 22 ECTR 9 ECTR ECTR 緒言 対象と方法 cm 3.6ms ms 3.8ms ms 4.0ms ECTR A 2 B 15 C 4.0ms 17 D 4.0ms 67 表 1 表 2 A D /09/

36 379 表 3 B 図 1 B 結果 A 2 ECTR B 3 3 ECTR 3 B 12 3 ECTR ECTR B ECTR 1 B 8 3 C 6.8ms 1 ECTR C D ECTR D

37 380 図 2 1 図 ECTR ECTR 3 考察 ECTR 2 ECTR ECTR ECTR 9 32

38 ECTR 17 ECTR 6.0ms ms ECTR ms ms X ECTR ECTR ms 1 ECTR ECTR ECTR ms ECTR 10 まとめ ECTR 文献 1 Itsubo T, et al. Differential onset patterns and causes of carpal tunnel syndrome after distal radius fracture: a retrospective study of 105 wrists. J Orthop Sci 15: , Dyer G, et al. Predictors of acute carpal tunnel syndorome associated with fracture of distal radius. J Hand Surg Am 33: , Fuller DA, et al. Carpal canal pressures after volar plating of distal radius fractures. J Hand Surg Br 31: , Ho AW, et al. Hand numbness and carpal tunnel syndrome after volar plating of distal radius fracture. HAND 6: 34-48, : 28-32, : , : , : , : , Jablecki CK, et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology 58: ,

39 J Jpn Soc Surg Hand VLP open wedge mm 11.1mm mm 15mm 緒言 VLP VLP VLP inplant failure 4 VLP 対象と方法 3 20 P 7 A 10 N 3 P A N Colles Smith Chauffeur Salter Hallis P LCP-T 5 OSR 1 Stellar 1 A Stellar 1 Stellar2 6 DVR 1 N APTUS-flap Stellar VATCP 1 K K VLP Condylar stabilizing RI 10 VT 0 UPV 0mm 3 P A N RI VT UPV mm C 1 Step off VT RI UPV 2014/09/

40 383 表 1 C S Ch Chauffeur SH 表 2 a b cooney score E exellent G good F fair P poor 3 Cooney score t p 0.05 結果 P 14.8mm A 11.1mm a Cooney score 3 2-b P 5 A 2 35

41 384 表 3 a mm b P 1 A 2 TFCC P 1 CRPS A 1 N a mm mm b mm VLP Cooney Score mm 1 4 tricortical 1 2 考察 VLP 4 5 VLP 6 36

42 385 図 1 a b c 図 2 a b 1 4 c VT 20 UPV 3mm step off 2mm VLP VLP mm 9.5mm Fernandez mm Oskam 3 6mm 37

43 mm 3DCT 10 9 Monoaxial Locking plate; Stellar plate Polyaxial locking plate; APTUS2.5 26: 23-26, D 24: , 2008 まとめ mm 15mm 文献 1 closing wedge osteotomy 21: 61-64, Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg 64: , Oskam J, et al. Corrective osteotomy for malunion of the distal radius : The effect of concomitant ulnar shortening osteotomy. Arch Orthop Trauma Surg 115: , Orbay JL. The treatment of unstable distal radius fractures with volar fixation. J Hand Surg 5: , Malone KJ, et al. Surgical correction of dorsally angulated distal radius malunions with fixed angle volar plating: a case series. J Hand Surg 31: , Henry M. Immediate mobilization following corrective osteotomy of distal radius malunions with cancellous graft and volar fixed angle plates. J Hand Surg 32E: 88-92, : 52-56, Open Wedge Osteotomy 29: ,

44 J Jpn Soc Surg Hand Subchondral support DRF VLP P-plate subchondral support X 6 radial inclination RT volar tilt VT ulnar variance UV P-plate VLP 緒言 VLP 1 VLP Subchondral support 2 1 Subchondral support VLP 対象と方法 P-plate P-plate AO A2 4 A3 4 B3 1 C1 1 C3 1 P-plate pronator fossa Watershed line 1 X radial inclination RT volar tilt VT ulnar variance UV X 結果 X 5.96mm 3.85mm 8.46mm 6 RI VT UV 1.2mm 0 2.8mm 2014/09/

45 388 VLP 1 80 AO A2 P-plate Watershed line 4.55mm X RI 19 VT 23 UV 1mm 6 X RI 23 VT 23 UV 2mm 6 RI 4 VT 0 UV 1mm AO A3 P-plate 8.46mm X RI 21 VT 13 UV -1mm 6 X RI 21 VT 11 UV 0mm 6 RI 0 VT 2 UV 1mm 3 考察 VLP Subchondral support 2 Subchondral support 3 VLP Key stone Subchondral support P-plate

46 VLP

47 390 VLP P-plate D-plate P-plate Subchondral support 6 P-plate Subchondral support P-plate : 39-42, Colles 53: , : , APTUS2.5 30: 9-11, 2013 まとめ P-plate VLP 文献 1 Polyaxial Locking Plate 29: , : , : 5-8,

48 J Jpn Soc Surg Hand TFCC DASH 自由投稿論文 TFCC DASH TFCC kg kg kg 87 14p 0.05 DASH r p 0.05 r p 0.05 TFCC DASH 緒言 TFCC 4 5 TFCC the Disability of the Arm, Shoulder, and Hand questionnaire DASH 対象と方法 TFCC Palmer 1B 1A TFCC inside-out TFCC trans-osseous 6 Palmer 1A JAMAR DASH disability/symptom DRUJ ballottement test Ulnocarpal stress test Pearson /09/

49 392 TFCC DASH 結果 Excellent 1 DASH 表 DRUJ ballottement test 2 14 Ulnocarpal stress test kg kg kg p 0.06 p 0.16 p 0.05 p DASH r p r p 考察 Richards 図 1 図 3 DASH 図 2 DASH 図 4 DASH 44

50 TFCC DASH De Smet 3 4 TFCC TFCC TFCC TFCC ulnar variance ulnar variance mm mm mm 8 ulnar variance mm mm 9 TFCC debridement MRI 9 X TFCC ulnar variance TFCC ulnar variance Ruch DASH 10 DASH DASH 90 DASH 90 DASH まとめ TFCC DASH 文献 1 LaStayo P, et al. Quantification of the relationship between dynamic grip strength and forearm rotation: preliminary study. Ann Plast Surg 35 2 : , Richards LG, et al. How forearm position affects grip strength. Am J Occup Ther 50 2 : , De Smet L, et al. Effect of forearm rotation on grip strength. Acta Orthop Belg 64 4 : , : , TFCC 26 1 : 76-76, TFCC MB Orthop : 33-38, TFCC 5: 27-32, Jung JM, et al. Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 83 7 : , Tomaino MM, et al. The importance of the pronated grip x-ray view in evaluating ulnar variance. J Hand Surg Am 25 2 : , Ruch DS, et al. Arthroscopically assisted repair of peripheral triangular fibrocartilage complex: factors affecting outcome. Arthroscopy 21 9 : ,

51 J Jpn Soc Surg Hand PIP PIP PIP PIP PIP 緒言 PIP PIP PIP PIP 対象と方法 PIP PIP 5 4 X ADL ADL PIP X 結果 PIP ADL /10/

52 PIP 395 表 1 表 2 図 1 5 A B X PIP 図 2 5 A X B 2 4 PIP C PIP

53 396 PIP 図 3 6 A B X PIP 図 4 6 A X B 2 6 C ADL 考察 Bowers 1 PIP 11 2 critical lateral-volar complex PIP 1 48

54 PIP 397 PIP 1 2 FDS half slip Cutis FDS 7 FDS 1 PIP FDS FDS 5 6 MRI PIP まとめ 1 PIP 7 2 文献 1 Bowers WH, et al. The proximal interphalangeal joint volar plate. : A clinical study of hyperextension injury. J Hand Surg 6: 77-81, PIP 25-2: 46-53, Curtis RM, et al. Treatment of injuries of proximal interphalangeal joint of fingers. Curr Pract Orthop Surg 23: , Palmer AK, et al. Chronic recurrent dislocation of the proximal interphalangeal joint of the finger. J Hand Surg 3: 95-97, Ochiai N, et al. Vascular anatomy of flexor tendons.. Vincular system and blood supply of the profundus tendon in the digital sheath. J Hand Surg 4: , Saito S, et al. Biomechanics of the volar plate of the proximal interphalangeal joint: A dynamic ultrasonographic study. J Hand Surg 36A: ,

55 J Jpn Soc Surg Hand zone 1 zone DIP PIP cold intolerance cold intolerance 緒言 zone zone 対象と方法 R F R F R 13.3 F 14.6 zone 1 5 R 4 6 F 9 5 Graft on flap DIP PIP cold intolerance CI Mann-Whitney 2 t CI 2 X /09/

56 zone 表 1 表 2 表 3 2 t SPSS12.0J 結果 2 DIP R F PIP R F R S1 1 S2 3 S3 4 S4 2 F S1 2 S2 3 S3 6 S4 2 R 4/ F 8/ CI R 7/ F11/ R 4 F t p zone

57 400 zone 1 図 1 1 X 図 2 1 X 図 3 1 X 1 1 CI zone 1 4 Graft on flap 5 9 CI X 69 6 考察

58 zone 図 4 2 X 図 5 2 X 図 X screw 6 zone 1 53

59 402 zone 1 Fishmouth CI 10 CI MB Orthopaedics 26: 24-30, : , : , : 5-540, : , MB Orthopaedics 26: 55-60, Glickman LT, et al. Sensory recovery following digital replantation. Microsurgery 11: 2-2, まとめ 1 zone 1 2 cold intolerance 3 4 cold intolerance 文献 1 Yamano Y. Replantation of the amputated distal part of the fingers. J Hand Surg 10Am: , : , graft on flap 20: , graft on flap 54

60 J Jpn Soc Surg Hand Terrible Triad Terrible triad JOA 89 緒言 Terrible triad Pugh 2 Pugh Terrible triad 7 対象と方法 CT Regan 7 type 2 O Driscoll 3 axial Anteromedial facet fracture 6 Tip fracture CB brace JOA core 結果 6 1 screw 4 C-wire /09/

61 404 Terrible Triad 表 JOA score O Driscoll Anteromedial facet fracture screw screw cut bending hook plate buttress 1/2 4 2 buttress CB ROM JOA score m 図 1 1 X 図 2 1 CT 34 O Driscoll Anteromedial facet fracture 3/ CB ROM 56

62 Terrible Triad 405 図 3 1 図 4 1 X 図 5 7 X ADL JOA score 74 考察 Pugh Terrible triad 4 Pugh 7 Terrible triad JOA 89 Terrible triad 図 6 7 CT

63 406 Terrible Triad 図 7 7 図 8 7 X 5 25 advance Zeider 6 CBCC coronoid-brachialis capsular ligamentous complex Terrible triad ROM 2 7 Terrible triad Terrible triad 58

64 Terrible Triad 407 まとめ 1 Terrible triad 7 2 文献 1 Hotchkiss RN. Fractures and dislocations of the elbow. 4th ed. Rockwood and Greens fractures in adults. LIP- PINCOTT. pp , Pugh DM, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg 86A: , O Driscoll SW, et al. Difficult elbow fractures;pearls and pitfalls. Instr Course Lect 52: , Rodriguez-Martin J, et al. Outcomes after terrible triad of the elbow treated with the current surgical protocols. A review. Int Orthop 35: , complex elbow instability terrible triad MB Orthopaedics 26 8 : 19-24, Zeiders GJ, et al. Management of unstable elbows following complex fracture-dislocations-the terrible triad injury. J Bone Joint Surg 90A Suppl : 75-84, Terrible Triad Injyury : 7-74,

65 J Jpn Soc Surg Hand CT 緒言 6 対象と方法 表 1 結果 AO A /10/03 JA

66 409 図 1 X CT 図 2 X CT CT 1 Synthes PHILOS MMT m Gartland type cm 考察

67 410 図 3 図 5 図 4 X pink pulseless hand 3 4 Blakey 5 26 pink pulseless hand Lally Mangat 7 Modi 2 Got 8 図 6 X

68 411 CT CT まとめ 6 CT 文献 1 Jalili A, et al. Axillary artery injury with proximal humerus epiphyseal separation: a rare case report. Med J Islam Repub Iran 4: , Modi CS, et al. Axillary artery injury secondary to displaced proximal humeral fractures: a report of two cases. J Orthop Surg Hong Kong 16: , Malviya A, et al. Pink pulseless hand following supracondylar fractures: an audit of British practice. J Pediatr Orthop B 15: 62-64, Choi PD, et al. Risk factors for vascular repair and compartment syndrome in the pulseless supracondylar humerus fracture in children. J Pediatr Orthop 30: 50-56, Blakey CM, et al. Ischaemia and the pink, pulseless hand complicating supracondylar fractures of the humerus in childhood: long-term follow-up. J Bone Joint Surg 91B: , Lally KP, et al. Long-term follow-up of brachial artery ligation in children. Ann Surg 212: , Mangat KS, et al. The pulseless pink hand after supracondylar fracture of the humerus in children: the predictive value of nerve palsy. J Bone Joint Surg 91B: , Got C, et al. Delayed presentation of a brachial artery pseudoaneurysm after a supracondylar humerus fracture in a 6-year-old boy: a case report. J Pediatr Orthop 30: 57-59, : 55-58,

69 J Jpn Soc Surg Hand pulseless pink hand 緒言 対象と方法 X Smith type II 32 III 55 IV 50 3 Gustilo I 2 II 1 1 Gustilo II pulseless pink hand R IR 2 Pulseless pink hand 4A pulseless pink hand Student T Fisher p /10/

70 413 図 1 図 2 結果 R IR p R 15 IR 67 2 p R 13 IR 56 p IR R 5 IR 44 p pulseless pink hand 11 1 R 2.5 IR 50 p D N V pulseless pink hand X V D 考察

71 414 表 1 図 3 Fleuriau-Chateau puckering Mangat 図 4 D V A X B X C D

72 Bone Joint Surg Am 60: , まとめ 文献 1 Archibeck MJ, et al. Brachialis muscle entrapment in displaced supracondylar humerus fractures: A technique of closed reduction and report of initial results. J Pediatr Orthop 17: , Fleuriau-Chateau P, et al. An analysis of open reduction of irreducible supracondylar fractures of the humerus in children. Can J Surg 41: , Reitman RD, et al. Open reduction and internal fixation for supracondylar humerus fractures in children. J Pediatr Orthop 21: , Mangat KS, et al. The pulseless pink hand after supracondylar fracture of the humerus in children. The predictive value of nerve palsy. J Bone Joint Surg Br 91: , Oh CW, et al. Completely displaced supracondylar humerus fractures in children: Results of open reduction versus closed reduction. J Orthop Sci 8: , Omid R, et al. Current concepts review. Supracondylar humeral fractures in children. J Bone Joint Surg Am 90: , Weiland AJ, et al. Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of fifty-two cases followed for five to fifteen years. J 67

73 J Jpn Soc Surg Hand JuggerKnot 1.0mm JuggerKnot 1.0mm Kirschner 緒言 JuggerKnot 1.0mm Biomet 対象と方法 JuggerKnot 1.0mm MP UCL 6 MP RCL 2 CM 1 PIP RCL JuggerKnot 1.0mm MP MP CM PIP RCL MP 3 PIP 1 3 ROM 結果 X MP UCL MP RCL PIP RCL ROM MP PIP /09/

74 ROM Kirschner 2 42 Green&O Brien type 4A mm mm 2 φ1.2mm Kirschner JuggerKnot 図 1 JuggerKnot FASTak SL LT RLT 4 sugar tongs splint ROM kg 89 ADL DASH score 0 PRWE 2.5 Mayo wrist score 80 good 図 2 X 図 3 X 図 4 X 12 69

75 418 図 5 考察 JuggerKnot 1mm pull out wire 図 表 1 suture anchor 70

76 419 Mitek bone anchor PIP X 1 suture anchor Jugger Knot 1.0mm まとめ JuggerKnot 1.0mm 文献 1 Bone anchor PIP J MIOS 20: 19-25, Giannikas D, et al. An unusual complication of Mitek suture anchor use in primary treatment of flexor digitorum profundus tendon laceration: a case report. Cases J 14: 9319, Tiong WH, et al. Extrusion of bone anchor suture following flexor digitorum profundus tendon avulsion injury repair. J Plast Reconstr Aesthet Surg 64: ,

77 J Jpn Soc Surg Hand CT CT screw tension band wiring Plate 緒言 plate 1 plate CT 対象と方法 CT 45 図 1 OA 1 44 CT CT data Aquarius NET 2014/09/

78 成人肘頭骨折の CT 評価 肘頭骨片の形状について 図2 肘頭背側で骨折線が flat spot の橈 側縁と尺側縁と交わる 2 点と flat spot から posterior border に移行 する点の 3 点を含む flat spot を含 む平面を設定し さらにその平面 上に肘頭長軸を設定した 図3 三角形で示した Flat spot を含む 平面上で 短軸方向で肘頭骨片 先端の flat spot 橈側縁からの距 離 1 とその部分での flat spot の横幅 2 を計測し 前者を後 者で除した橈側率を計算した して解析した 近位骨片は通常大きく転位しており 計測に適さないため 肘頭骨片ではなく骨幹部側を 計測した 肘頭背側には 平坦で尺骨長軸に平行とされる flat spot と そこから骨幹部背側にかけては posterior border と呼ばれる構造が存在する 4)5) また 尺骨近 位部背側には 側面像で Proximal Ulna Dorsal Angulation 以下 PUDA と呼ばれる変曲点を持つ弯曲 が存在する 4)6) 実際の測定では まず PUDA の変曲点と flat spot の橈側縁 尺側縁が骨折線と交わる各点の計 3 点を 含む flat spot に平行な平面を設定した さらに この平面上で肘頭近位部の骨軸となる中心線を設定 し この直線を長軸 これと垂直で肘頭背側を走行 する直線を短軸とした 図 2 先に設定した Flat spot を含む平面上で 短軸方 向で肘頭骨片先端の flat spot 橈側縁からの距離とそ の部分での flat spot の横幅を計測し 前者を後者で 除した橈側率を計算した 図 3 関節面では 骨折線は直線となることが多かった ため その骨折線の方向について検討した flat spot に垂直にこの平面を平行移動し 関節面での 橈尺側縁が描出できたスライスで骨折線が短軸から 図5 421 図4 肘頭関節面での骨折線 の傾きを測定 側面像における flat spot と骨折線の 成す角を測定した どの程度橈側に傾いているか radial inclination を測 定した 図 4 側面像では flat spot 平面に垂直で骨片先端を含 む平面上で 骨片先端と関節面での骨折部を結んだ 骨折線が flat spot と成す角を測定した 図 5 結 果 肘頭背側の flat spot 橈側縁と肘頭骨片先端の距離 73

79 422 CT 表 mm flat spot mm flat spot 考察 screw tension band wiring Plate plate plate flat spot plate まとめ 文献 1 Bailey CS, et al. Outcome of plate fixation of olecranon fractures. J Orthop Trauma Nov;15 8 : , Keener JD, et al. Insertional anatomy of the triceps brachii tendon. J Shoulder Elbow Surg Apr;19 3 : , Fleager KE, et al. The anconeus slide : rotation flap for management of posterior wound complications about the elbow. J Shoulder Elbow Surg Dec;20 8 : , Puchwein P, et al. Three-dimensional morphometry of the proximal ulna: a comparison to currently used anatomically preshaped ulna plates. J Shoulder Elbow Surg Aug;21 8 : , Duggal N, et al. The flat spot of the proximal ulna: a useful anatomic landmark in total elbow arthroplasty. J Shoulder Elbow Surg Mar-Apr;13 2 : , Rouleau DM, et al. The proximal ulna dorsal angulation: a radiographic study. J Shoulder Elbow Surg Jan;19 1 : 26-30,

80 J Jpn Soc Surg Hand Gartland Gartland I 12 I 1 III 緒言 対象と方法 carrying angle CA CA Gartland Baumann BA BA BA t p /10/

81 424 表 1 表 2 結果 Gartland I III Baumann p 0.02 Baumann p 考察 Gartland I 1 2 III 1 図 1 図 2 impaction 図 3 A B 76

82 425 Baumann 20 6 remodeling 6 7 Baumann Gartland III Gartland III Baumann 文献 1 Skaggs DL, et al. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am 86: , Pirone AM, et al. Management of displaced extensiontype supracondylar fractures of the humerus in children. J Bone Joint Surg Am 70: , pp57-84, Abe M, et al. Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg Am 20: 5-9, O driscoll SW, et al. Tardy posterolateral rotatory instability of the elbow due to cubitus varus. J Bone Joint Surg Am 83: , Moraleda L, et al. Natural history of unreduced Gartland type-ii supracondylar fractures of the humerus in children: a two to thirteen-year follow-up study. J Bone Joint Surg Am 95: 28-34, : 41-50, : 23-35, : , 2009 まとめ 77

83 J Jpn Soc Surg Hand Minimally Invasive Screw Fixation MISF JSSH MISF Crawford DL SA Excellent 21 Good 30 Fair 5 Poor /59 Fair Poor /8 D N D DL MISF DL 緒言 mm MISF 1 MISF bony origin 2mm Stryker Leibinger screw 1.2mm 1.7mm lag screw MISF 対象と方法 MISF Crawford 1 D 図 /09/

84 427 表 1 Crawford 図 2 X DL a SA b FA c N DL 2-a SA 2-b FA 2-c Fisher s test t p 0.05 結果 Crawford Excellent 21 Good 30 Fair 5 Poor Fair Poor D N D 46 N 34 D D 75 N 31 D DL D 2.79mm N 3.30mm D DL SA FA 考察 extension block pinnninng 3 pull-out 4 tension band wiring 5 hook plate 6 7 umbrella handle technique 8 extension block pin pin tract infection 79

85 428 表 2 表 3 4 ROM extension block pinning umbrella handle technique Pull-out MISF 2mm D N DL DL DL X CT DL DL 80

86 429 cut-out DL D K-wire extension block pin gap step off 22G MISF K-wire cut out cut out cut out 9 DL MISF ROM 8 DL MISF 文献 1 27: , : , Ishiguro T, et al. Extension Block with Kirschner Wire for Fracture Dislocation of the Distal Interphalangeal Joint. Tech Hand Up Extrem Surg 1 2 : , Zhang X, et al. Pull-out Wire Fixation for Acute Mallet Finger Fracures With K-wire Stabilization of the Distal Interphalangeal Joint. J Hand Surg Am 35A: , Damron TA, et al. Surgical Treatment of Mallet Finger Fractures by Tension Band Technique. Clin Orthop Rel Res 300: , Teoh LC, et al. Mallet Fractures: A Novel Approach to Internal Fixation Using a Hook Plate. J Hand Surg Eur 32 1 : 24-30, Kronlage SC, et al. Open Reduction and Screw Fixation of Mallet Fractures. J Hand Surg Br 29 2 : , Rocci L, et al. Percutaneous Fixation of Mallet Fractures by the Umbrella Handle Technique. J Hand Surg Br 31 4 : , : , 1986 まとめ MISF 81

87 J Jpn Soc Surg Hand two extension block extension block pin 1 extension block pin 1 extension block pin 2 two extension block two extension block X DIP 緒言 1 extension block pin 1 1/2 extension block pin 1 extension block pin 2 two extension block two extension block 対象と方法 two extension block X 1/2 two extension block 表 /09/

88 two extension block 431 DIP 1.0mm Kirschner 1 2 extension block pin 1 DIP 1.0mm Kirschner 1 DIP mm Kirschner Kirschner Kirschner 図 1 2 extension block pin 結果 X DIP Two extension block Kirschner t-test p p ADL Two extension block Kirschner Fisher p 図 2 Kirschner DIP Two extension block Kirschner DIP 0 80 図 3 Kirschner 考察 83

89 432 two extension block 図 4 X 図 5 X 図 6 X extension block pin 1 pin 3 1/2 extension block pin 2 extension block pin 2 Lee 4 2 extension block pin DIP extension block pin 5 two extension block 2 Two extension block Kirschner DIP DIP pin Extension block pin 2 pin DIP pin 2 DIP 2 ADL 7 8 two extension block 84

90 two extension block 433 まとめ extension block pin 2 two extension block 文献 1 mallet finger closed reduction 5: , mallet finger 34: , Mallet 27: 28-30, Lee YH, et al. Two extension block Kirschner wire technique for mallet finger fractures. J Bone Joint Surg Br : , Mallet 27: , Mallet 24: , : 58-61, Mallet 26: ,

91 J Jpn Soc Surg Hand MP zone zone 3 1 FDP 6 FDP FDS loop Lim and Tsai 5-0 MP IP TAM Strickland 10 1 緒言 6 strand 1 PIP 2 3 MP 対象と方法 zone zone 3 1 FDP 6 FDP FDS FDP 4-0 loop Lim and Tsai 5-0 FDS FDP A2 4 pully 5 MP IP PIP DIP 3 MP /10/

92 435 図 1 図 2 zone 2 FDS FDP 図 3 FDP 6 strand suture FDS Strickland 結果 TAM Strickland PIP DIP FDP FDS zone 2 2 FDP 4-0 loop Lim and Tsai FDS 4-0loop TAM 97 Strickland 4 5 図 4 3 図 5 87

93 436 考察 strand suture MP PIP DIP 0 MP Kleinert PIP PIP DIP 0 MP PIP DIP 1 まとめ Strickland PIP DIP 文献 1 Zone 6 strand 25: , Zone 30: , : S159-S159, : , No man s land 19: , : ,

94 J Jpn Soc Surg Hand Strickland Pre-RSD 緒言 1917 Harmer 対象と方法 Strickland zone I 3 II 10 FDS FDS TAM Fisher P 0.05 結果 /09/

95 438 表 1 表 2 90

96 439 表 3 表 4 図 1a 表 5 40 図 1b 2 Pre-RSD TAM TAM TAM MP 0 0 PIP DIP MP PIP DIP TAM PIP 34 zone II 1 1a b Strickland TAM PIP 40 考察 FDS

97 440 表 6 図 2 2 図 3 Strickland Orkar Pre-RSD TAM PIP PIP Pre-RSD /3 92

98 441 9 Jones P, et al. Idiopathic osteoarthritis and contracture: causal implications. Ann Rheum Dis 64: , Demir SE, et al. Risk factors for complex regional pain syndrome in patients with traumatic extremity injury. Ulus Travma Acil Cerrahi Derg 16: , まとめ 1 1 Strickland TAM PIP 4 文献 1 Elliot D, et al. Avoidance of unfavourable results following primary flexor tendon surgery. Indian J Plast Surg 46: , Strickland JW, et al. Tendon and nerve surgery in the hand; a third decade. 1st ed. St.Louis. Mosby. pp , : , Tang JB. Plastic surgery Vol.6. 3rd ed. London. Elsevier Saunders. pp , : S625, Orkar KS, et al. A comparative analysis of the outcome of flexor tendon repair in the index and little fingers: does the little finger fare worse?. J Hand Surg 37-E: 20-26, Zone II PIP 30: , Ring D, et al. Evidence-based medicine: disproportionate pain and disability. J Hand Surg 35-A: ,

99 J Jpn Soc Surg Hand Zone CM pinning K-wire Zone 4 5 interlacing suture 緒言 Zone 4 5 対象と方法 Zone FDP 5 4 FDP FDP 4 5 FDS 5 1 FDP 4 5 FDS CM K-wire FDS FDP FDP Zone mm interlacing suture tension interlacing suture 3 tension reducing position /09/

100 443 図 1 tension reducing position 1 holding technique 2 PIP DIP Duran 3 MP 結果 FDP 表 1 95

101 444 TAM 考察 Kienböck FPL full grip myostatic contructure まとめ Zone 4 5 interlacing suture 文献 1 Zone IV 19: , : , bridge graft 23: , : , : , : , Khan K, et al. Early active mobilization after second stage flexor tendon grafts. J Hand Surg Br 22: , Leversedge FJ, et al. Flexor tendon grafting to the hand: an assessment of the intrasynovial donor tendon-a preliminary single-cohort study. J Hand Surg Am 25: , Silfverskiöld KL, et al. Early active mobilization of tendon grafts using mesh reinforced suture techniques. J Hand Surg Br 20: , : ,

102 J Jpn Soc Surg Hand D-CT 3D-CT 6 54 FDP 1 FPL 5 3D-CT 3D-CT 緒言 3 CT 3D-CT volume rendering D-CT 対象と方法 3D-CT FDP 1 FPL Aquilion64 ZIO volume rendering MP MP PL TAM 結果 MP 2 MP 4 3D-CT 3 3D-CT TAM D-CT FDP Zone 1 3D-CT TAM 74 Fair D-CT FPL Zone T2 3D-CT TAM 2014/09/

103 446 3D-CT 表 1 88 Good RA IP 3D-CT FPL Zone 4 PL 3D-CT TAM 95 Excellent 3 考察 3D-CT Volume rendering 1 2 Volume rendering CT CT 図 a 3 b 3D-CT FPL Zone1 MP c 3D-CT d 98

104 3D-CT 447 図 a 3D-CT b c 図 a 3D-CT FPL Zone b 3D-CT MPR c 3D-CT d e 99

105 448 3D-CT kV 300mA 0.5 Automatic Exposure Control AEC 5 MP 3D-CT MP FPL FPL MP MP 3D-CT 3 MRI D-CT 3D-CT pp , CT 62: 34-38, CT MB Orthop 19: 71-77, Sunagawa T, et al. Three -dimentional CT imaging of flexor tendon ruptures in the hand and wrist. J Comput Assist Tomogr 27: , D-CT 25: , 2009 まとめ 3D-CT 文献 1 Volume rendering method 52: , Pelc J.S, et al. Volume rendering of tendon-bone relationships using unenhanced CT. Am J Roentgenol 176: , D-CT 21: S201-, CT 100

106 J Jpn Soc Surg Hand MP A1 pulley A1 pulley 4 緒言 TC TC TC 対象と方法 TC TC TC 10mg ml 27G ml MP Patel & Moradia 5 TC Clicking Grade 2 11 Locking Grade 3 10 Grade 2 5 Grade Avius 12.5MHz IP MP 表 1 Patel & Moradia 2014/09/

107 450 表 2 Patel & Moradia 表 3 図 1 a b MP c d MP MP Patel & Moradia 5 2 Mann-Whitney U 5 結果 A1 pulley TC TC 19 3 TC 図 2 3 TC TC 2 4 Grade 1 TC MP TC TC 4 Excellent 19 Good 2 6 Fair 1 Poor 1 102

108 451 図 3 図 6 77 a TC b TC c TC 12 d TC 6 図 4 図 Locking Grade 3 A1 pulley TC Grade 0 Excellent TC Grade 1 Good TC 6 Grade 考察 103

109 Serafini Clicking Locking Locking 15 Verma 35 A1 pulley A1 pulley A1 pulley TC TC TC 4 TC TC まとめ 文献 1 Ring D, et al. A prospective randomized controlled trial of injection of dexamethasone versus triamcinolone for idiopathic trigger finger. J Hand Surg 33A: , : , Sawaizumi T, et al. Intrasheath triamcinolone injection for the treatment of trigger digits in adult. Hand Surg 10: 37-42, : 39-44, Patel MR, et al. Percutaneous release of trigger digit with and without cortisone injection. J Hand Surg 22-A: , Fahey JJ, et al. Trigger-finger in adults and children. J Bone Joint Surg 36-A: , Kolind-Sorensen V. Treatment of trigger-fingers. Acta Orthop Scand 41: , : , Serafini G, et al. High resolution sonography of the flexor tendons in trigger fingers. J Ultrasound Med 16: , Verma M, et al. Serial Ultrasound Evaluation of Pediatric Trigger Thumb. J Pediatr Orthop 33: ,

110 J Jpn Soc Surg Hand OA OA DIP 13 PIP 5 VAS DASH X VAS DASH DIP PIP 緒言 OA 1 X 対象と方法 PIP DIP OA PIP 6 DIP 12 4 PIP DIP PIP DIP 1 Visual analogue scale VAS Disabilities of the Arm Shoulder and Hand DASH X Kellgren-Lawrence K-L grade 9 X Wilcoxison 5 結果 /10/

111 454 OA VAS P DASH P K-L grade 1 PIP 1 grade 2 PIP 2 DIP 4 grade 3 PIP 1 DIP 3 grade 4 PIP 2 DIP 5 grade 1 PIP 1 grade 4 DIP 1 grade 3 DIP 3 2 grade 4 PIP 2 1 grade 4 DIP 5 2 grade 4 DIP DIP PIP 2 K-L grade VAS DASH IP 5 IP K-L grade 3 grade 4 3 IP 5 図 1 PIP DIP 図 2 VAS VAS P 考察 Heberden Buchard OA Watt Ikeda DIP custom-made splint 図 3 DASH score DASH score P

112 OA 455 図 PIP DIP 図 IP 6 7 PIP 8 PIP DIP DIP PIP 3 表 1 OA 107

113 456 OA DIP 9 PIP VAS K-L grade 4 K-L grade grade 4 joint digit prevalence rates. Am J Epidemiol : , : 86-92, : , Bouchard 22: , Kellgren JH, et al. Radiological assessment of oste-oarthritis. Ann Rheum Dis 16 4 : , Watt FE, et al. Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis. Rheumatology Oxford 53 6 : , Ikeda M, et al. Custom-made Splint treatment for Osteoarthritis of the Distal Interphalangeal Joints. J Hand Surg Am 35 4 : , Bouchard 48: , Heberden Bouchard 19: , 2002 まとめ 1 OA 75 VAS 2 3 文献 1 Plato CC, et al. Osteoarthritis of the hand:age-specific 108

114 J Jpn Soc Surg Hand K-wire OA K-wire OA K-wire OA OA X step off 1mm mm OA K-wire OA step off 緒言 Kirschner K-wire K-wire OA K-wire OA X OA 対象と方法 K-wire X DIP 46 PIP 12 IP 4 MP 1 CM 1 DIP /10/

115 458 表 1 VS OA 8 OA mm K-wire X OA OA X Fisher p 0.05 結果 64 K-wire K-wire 1 OA p OA 18 DIP IP PIP OA X OA X step off step off 1mm mm OA 2 p mm K-wire 1 DIP 8 21 X OA MP 1.0mm K-wire 1 MP 3 20 X OA Bennett 1.0mm K-wire 2 CM 8 step off 1mm 6 X OA 3 110

116 459 図 1 21 DIP OA 図 2 MP 20 OA 図 3 Bennett 1mm step off 6 CM 考察 1 intraosseous wiring 2 3 cross pinning K-wire OA OA OA mm K- wire

117 OA DIP DIP OA 80.0 K-wire X step off 1mm OA OA OA OA 8 5 OA 文献 1 47: , Lister G. Intraosseous wiring of the digital skeleton. J Hand Surg Am 3: , Ilizarov minifixator 25: , Pridie KH. A method of resurfacing osteoarthritic knee joints. J Bone Joint Surg 41B: , Insall J. The Pridie debridement operation for osteoarthritis of the knee. Clin Orthop 101: 61-67, Steadman JR, et al. Outcomes of microfracture for traumatic chondral defects of the knee : average 11-year follow-up. Arthroscopy 19: , : , : , mallet finger X 28: , 2012 まとめ K-wire OA OA step off 112

118 J Jpn Soc Surg Hand PIP 1 PIP Bouchard 3 PIP X 22 X X Kellgren-Lawrence grade 0 21 grade 1 16 grade 2 33 grade 3 16 grade 4 15 Heberden 71 CM X 12 PIP 緒言 PIP Bouchard PIP PIP 対象と方法 PIP PIP PIP X X X Kellgren-Lawrence grade X grade 1 X X Heberden CM A1 bowstringing 40 PIP 2014/10/

119 462 PIP 1 図 図 2 Kellgren-Lawrence grade 2 1 EZR on R commander version Kruskal-Wallis Kellgren- Lawrence Cochran-Armitage Mann-Whitney U 5 結果 X 14 2 X 図 3 3 Kruskal-Wallis p post-hoc Steel-Dwass p p post-hoc Steel-Dwass p X 114

120 PIP 図 4 Kellgren-Lawrence grade 0,1 grade 2 grade 1 8 grade 2 32 grade 3 10 X 図 5 Kellgren-Lawrence grade Cochran-Armitage p Kellgren-Lawrence grade X grade 0 grade 1 grade 2 grade 1 8 grade 2 32 grade 3 10 X 4 Heberden CM X grade 0 81 grade1 61 grade X grade p p Kellgren-Lawrence grade 2 PIP 7 a PIP 1 2 図 6 Mann-Whitney U p b PIP 考察 PIP X 115

121 464 PIP 1 図 7 PIP PIP Kellgren-Lawrence grade 2 a PIP b PIP 60 2 PIP X X PIP PIP X PIP 4 X grade 1 PIP X PIP X 4 Bouchard PIP X grade PIP PIP 6 Moriya PIP 7 PIP PIP PIP PIP Bouchard 2 PIP

122 PIP de Quervain PIP Dahaghin Kellgren-Lawrence 2 2 Wilder 40 PIP Kellgren-Lawrence 2 1 Bouchard Wilder 60 7 X grade2 1 X X PIP PIP 10 PIP 10 X X PIP Bouchard PIP Bouchard PIP 2 X まとめ PIP 50 文献 1 Wilder FV, et al. Joint-specific prevalence of osteoarthritis of the hand. Osteoarthritis Cartilage 14: , Dahaghin S, et al. Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability the Rotterdam study. Ann Rheum Dis 64: , Bouchard 22 4 : , Carroll GJ, et al. Confirmation of two major polyarticular osteoarthritis POA phenotypes - differentiation on the basis of joint topography. Osteoarthritis Cartilage 17: , : , PIP 12 2 : , Moriya K, et al. Comparison of the surgical outcomes for trigger finger and trigger thumb; preliminary results. Hand Surg 10: 83-86, Maffuli N, et al. Changing incidence of Achilles tendon rapture in Scotland; a 15-year study. Clin J Sport Med 9: , Cauley JA, et al. Serum sex hormones and severity of osteoarthritis of the hand. J Rheumatol 20: , Maheu E, et al. Hand osteoarthritis patients characteristics according to the existence of a hormone replacement therapy. Osteoarthrisis Cartilage 8 Suppl A : S33-37,

123 J Jpn Soc Surg Hand Heberden Heberden X DIP 2mm Headless compression screw HCS DIP X Visual Analogue Scale VAS VAS DIP 緒言 Heberden HCS 1 X 対象と方法 DIP PIP X Kellgren-Lawrence grade grade grade DIP 3 DIP 2014/10/

124 Heberden 467 図 1 Headless compression screw a Acutrak 2 micro DTJ screw mini b Acutwist 2mm HCS Acutrak 2 micro ACUMED DTJ screw mini Acutwist ACUMED 1 PIP MP VAS X

125 468 Heberden 表 X PIP Fisher VAS Mann-Whitney U student-t VAS PIP VAS PIP X EZR on R commander version 1.21 p 0.05 結果 図 2 5 p X Spearman VAS DIP p VAS VAS VAS PIP X VAS 120

126 Heberden 469 表 2 * Fisher ** 2 Mann-whitney U student t X 3-a X 3-b 考察 Heberden self-limiting 121

127 470 Heberden 図 3 a Repeated-Measures ANOVA p Post-hoc Holm * p 0.05 ** p 0.01 b p Post-hoc Tukey p 0.05 p 0.01 Repeated-Measures ANOVA p Post-hoc Holm * p 0.05 ** p 0.01 図 5 Repeated-Measures ANOVA p Post-hoc Holm ** p 0.01 図 6 Repeated-Measures ANOVA p Post-hoc Holm ** p 0.01 図 4 Repeated-Measures ANOVA p Post-hoc Holm * p 図 7 Repeated-Measures ANOVA p

128 Heberden DIP DIP HCS Kirschner wire Song 3.17mm 2.64mm 2.1mm 1.83mm Acutrak fusion mm Acutrak 2 micro DTJ screw mini Acutrak fusion Acutwist screw PIP wiring DTJ screw mini 3 Acutrak 2 micro 2 screw 10-14mm screw 18mm screw 3 Seagull wing patterns erosive OA X PIP X DIP screw HCS DIP 8 123

129 472 Heberden 図 8 54 DIP X Kellgren-Lawrence grade DIP X DIP DIP まとめ Heberden 98 screw X DIP 文献 1 Heberden 55: , : , Villani F, et al. Distal interphalangeal joint arthrodesis for degenerative osteoarthritis with compression screw: results in 102 digits. J Hand Surg Am 37 7 : , Olivier LC, et al. Arthrodesis of the distal interphalangeal joint: description of a new technique and clinical follow-up at 2 years. Arch Orthop Trauma Surg : , Cox C, et al. Arthrodesis of the thumb interphalangeal joint and finger distal interphalangeal joints with a headless compression screw. J Hand Surg Am 39 1 : 24-28, Song JH, et al. Distal interphalangeal joint arthrodesis with a headless compression screw: morphometric and functional analyses. Arch Orthop Trauma Surg : , interosseous wiring Heberden DIP 30 8 : , Trias A. Effect of persistent pressure on the articular cartilage. An experimental study. JBJS Br 43: , : 67-75, Yamashita N, et al. Arthritis induced immunologically with cationic amidated bovine serum albumin in the Guinea pig. Virchows Arch B Cell Pathol Incl Mol Pathol 60 1 : 57-66,

130 J Jpn Soc Surg Hand low profile splint 6 low- profile splint MP DASH score D/S 29 S/m 34.4 Work 34.4 MP DASH score D/S 13.5 S/m 6.25 Work 2.1 MP 緒言 RA outrigger splint 1 taping 2 outrigger splint bulky ADL taping low profile splint 対象と方法 RA Modified Sauve -Kapandji 2 Darrach 表 /09/

131 474 RA splint 図 1 2parts splint a Cock up splint b splint 図 2 splint 図 3 a PIP DIP MP b IP DIP MP 図 4 a MP PIP/DIP b MP PIP/DIP splint low profile splint splint 2 20 cock up splint 1.a MP DIP 0 splint 1.b 2 splint PIP DIP MP 3 MP PIP DIP MP DIP 3 splint 126

132 RA splint ADL 8 MP rubberband splint 12 ADL MP DASH score 結果 MP ROM MP ROM DASH score Disability/symptom D/S 29.0 Sports/music 34.4 Work 34.4 DASH score D/S 13.5 Sports/music 6.25 Work RA MP 1 MP 2 MP 3 PL Modified S-K 図 lag MP 3 6 MP DASH score Disability/Symptom33.3 Sports/music 18.8 Work MP MP DASH score Disability/Symptom 7.5 Sports/music 図 6 a 12 b

133 476 RA splint Work 0 考察 low profile splint ROM DASH score RA high profile outrigger taping outrigger splint ADL taping tape taping MP MP splint base static type outrigger splint ADL cock up splint MP MP MP splint まとめ RA low profile splint ROM DASH score MP splint 文献 1 45: 95-95, RA 1 22: ,

134 J Jpn Soc Surg Hand ADL mmHg 6 pillar pain DASH score 緒言 CTS 1 2 ADL 対象と方法 B12 1.5cm 4 DHFFR Distal Holdfast Fibers of the Flexor Retinaculum /09/

135 478 図 G continuous infusion technique 10mmHg 10mmHg 10mmHg APB Semmes-Weinstein monofilament test 2 APB VAS 0 100mm DASH score The JSSH Version 6 1 pillar pain pillar pain tip pinch tip T-I side pinch side T-I tip pinch tip T-L 2 APB MMT StatViewJ-5.0 software SAS Institute NC t- Wilcoxon 5 結果 mmHg 26 77mmHg mmHg 0 10mmHg p APB tip tip p DASH score Disability/Symptom score Work score mm 5.9mm p pillar pain 6 DASH score 1 Disability/ symptom score 33 work score 37 考察 130

136 479 表 ECTR 60 10mmHg 6 pillar pain DASH score ECTR 2 ECTR 18 pillar pain ECTR 8 tip pinch ECTR p 0.05 DASH score 4 6 ECTR p 0.05 DASH score pillar pain ADL 6 DASH score mmHg まとめ 60 10mmHg 文献 1 48: , : , : , : 30-40, : 95-98, Ludlow KS, et al. Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Surg 10: , DASH score 30: , : ,

137 J Jpn Soc Surg Hand / 0.59* 0.48* * P 0.01 緒言 図 /10/

138 481 図 2 A B B B A MTT 対象と方法 P 0.01 Welch s t-test 1 Hivision Avius; Hitachi Aloka Medical, Ltd. Analyze 10.0 software Biomedical Imaging Resource, Mayo Clinic, Rochester, MN 2 / x4π mm 1.5Hz kPa 133

139 482 図 3 a b c d / 5 Welch s t-test P Excel Statistics 2012 SSRI Co. Tokyo, Japan 結果 / mm / mm / / / 3 P 0.01 P 0.05 図 / / P P 0.01 考察 134

140 483 図 5 a b c d 8 9 Waller subclinical まとめ 135

141 484 文献 1 Buchberger W, et al. Carpal tunnel syndrome: diagnosis with high-resolution sonography. Am J Roentgenol 159: , Missere M, et al. Echography and the carpal tunnel syndrome. Radiol Med Torino 94: , Ferrari FS, et al. High-resolution ultrasonography in the study of carpal tunnel syndrome. Radiol Med Torino 93: , Drakanoaki EE, et al. Magnetic resonance imaging, ultrasound and real-time ultrasound elastography of the thigh muscles in congenital muscle dystrophy. Skeletal Radiol 39: , Niitsu M, et al. Muscle hardness measurement by using ultrasound elastography: a feasibility study. Acta Radiol 52: , MEDIX 45: 10-15, Yoshii Y, et al. Reliability of automatic vibratory equipment for ultrasonic strain measurement of the median nerve. Ultrasound Med Biol 40: , Orman G, et al. Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings. Ultrasound Med Biol 39: , Real time echo Elastography 30: , Mackinnon SE, et al. Chronic nerve compression--an experimental model in the rat. Ann Plast Surg 13: ,

142 J Jpn Soc Surg Hand Tinel 緒言 Wadsworth 7 Wadsworth 対象と方法 MMT 結果 /09/

143 486 表 MMT MMT 0 24 Tinel MMT MMT 3 考察 Neuralgic Amyotrophy

144 Tinel MRI Tinel まとめ 文献 1 Beekman R, et al. Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow. Neurology 62: , Britz GW, et al. Ulnar nerve entrapment at the elbow: Correlation of Magnetic Resonance Imaging, clinical, electrodiagnostic, and intraoperative findings. Neurology 38: , Buehler MJ, et al. The elbow flexion test. Clin Orthop Relat Res 233: , Foster RJ, et al. Factors related to the outcome of surgically managed compressive ulnar neuropathy at the elbow level. J Hand Surg 6: , : 63-64, Novak CB, et al. Provocative testing for cubital tunnel syndrome. J Hand Surg 19A: , Wadsworth TG, et al. The external compression syndrome of the ulnar nerve at the cubital tunnel. Clin Orthop Relat Res 124: , Wiesler ER, et al. Ultrasound in the diagnosis of ulnar neuropathy at the cubital tunnel. J Hnad Surg 31A: , : , : ,

145 J Jpn Soc Surg Hand 緒言 対象と方法 9 SD g /3 C6 6 C5 C6 C6 1cm 2014/09/

146 489 図 1 28 Nissl Bar μm µm Cresyl violet Nissl μm Iba Wako Japan DAB μm Iba1 1 3 control t Tukey-Kramer 5 結果 12 6 図 2 12 Bar 100μm B 3C D 1 Iba1 control 4A B D 4C D Control Iba1 考察 3 7 Chew 8 141

147 490 図 3 A B C Bar 100μm D 図 4 Iba1 A control B C Bar 100μm; D Iba1 Control Iba1 * p

148 early key events in retrograde degeneration of motoneurons. Cell Death Differ 18: , Chew DJ, et al. A comparative histological analysis of two models of nerve root avulsion injury in the adult rat. Neuropathol Appl Neurobiol 37: , Keswani SC, et al. A novel endogenous erythropoietin mediated pathway prevents axonal degeneration. Ann Neurol 56: , Ohta S, et al. Effects of continuous intravenous infusion of MCI-186 on functional recovery after spinal cord injury in rats. J Neurotrauma 28: , まとめ 文献 1 Giuffre JL, et al. Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am 35: , Koliatsos VE, et al. Ventral root avulsion: an experimental model of death of adult motor neurons. J Comp Neurol 342: 35-44, Li L, et al. Characterization of spinal motoneuron degeneration following different types of peripheral nerve injury in neonatal and adult mice. J Comp Neurol 396: , : , Boillee S, et al. Onset and progression in inherited ALS determined by motor neurons and microglia. Science 312: , Noguchi T, et al. A new cervical nerve root avulsion model using a posterior extra-vertebral approach in rats. J Brachial Plex Peripher Nerve Inj 8: 1-9, Penas C, et al. Autophagy, and BiP level decrease are 143

149 J Jpn Soc Surg Hand ,490 24,300 11,272 ml mmhg 1 6 緒言 30mmHg zone of stasis 対象と方法 Artz Lund and Browder Total burn surface area TBSA Parkland ml 4 kg TBSA 24 Burn Index 2 3 C /09/

150 G Mann-Whitney U 結果 1 C TBSA Burn Index Prognostic Burn Index Burn Index A ,490 24,300mL 11,272mL TBSA 1B TBSA P Burn Index 3 C 2 TBSA 30 C 9 5 Burn Index C Burn Index 図 1 図 2 図 3 TBSA 3A TBSA

151 494 表 1 図 4 図 5 A Day1 B Day1 C Day3 D Day Lund and Browder A B 4C mmHg 21.1mmHg mmHg 22.7mmHg 1 30mmHg 1 38 TBSA C 24 8,572mL mmHg 5A 5B 3 8 5C 5D 146

152 495 図 6 A Day14 B Day14 C Day17 図 7 A Day1 2 B Day3 C Day11 80nnHg 3 D Day A 6B 6C 2 7A 3 7B 11 7C 80mmHg D 57 2 TBSA ,300mL mmHg 45mmHg 3 147

153 考察 1996 Schnall G 7 0 5mmHg mmHg 33mmHg Kumar subcutaneous compartment syndrome 1 30mmHg grade B grade C まとめ 文献 1 Kumar P. Subcutaneous compartment syndrome. Burns 33: , Zawacki BE, et al. Reversal of capillary stasis and prevention of necrosis in burns. Ann Surg 180: , pp , Kahn SA, et al. Resuscitation after severe burn injury using high-dose ascorbic acid: a retrospective review. J Burn Care Res 32: , Schnall SB, et al. Tissue pressures in pyogenic flexor tenosynovitis of the finger. Compartment syndrome and its management. J Bone Joint Surg 78-B: , pp11-12,

154 J Jpn Soc Surg Hand Kirschner Suture anchor suture anchor 緒言 suture anchor pullout suture Kirschner 対象と方法 suture anchor MP PIP mm Kirschner 18 23G Kirschner 2 4mm 1a 1b 1c d 1e 1f 1g 結果 Suture anchor 37 PIP XP PIP 2a b XP PIP 2c PIP 0 80 PIP ADL 考察 pullout suture /10/

155 皮切を追加することなく指節骨に縫合糸をかける方法 498 図1 a 指節骨に骨孔を 2 つ作成し 一方から注 射針を皮膚まで貫通させ縫合糸を通す b これに別の注射針を咬み合わせ 術野と 対側の皮質骨上まで進め 術野から挿入 した注射針は糸を残し抜去する c d 対側から刺入した注射針は先端を対 側の骨皮質を滑らせながら もう一 方の骨孔を探りそこから術野まで貫 通させる e この先端に別の注射針を咬み合わせ術野 と対側の皮膚まで貫通させる f この先端から さきに皮膚を貫通させた 縫合糸を刺入し術野まで貫通させ注射針 を抜去する g この縫合糸を用い軟部組織を縫着する 図2 追加する必要があり 近年では皮切の追加が必要な い suture anchor を用いることが多い 1)2)3)4)5)6) しか しながら 骨粗鬆症の強い場合 4) 術野側の皮質が破 損し suture anchor 刺入が困難な場合 suture anchor の糸が切れた場合 suture anchor を挿入することが 感染の可能性を高めると判断された場合 suture anchor が用意できなかった場合など使用できない場 症例 a 術前 XP b 術中 c 術後 XP 合もある このとき 本法は骨に軟部組織を直接縫 着するという点で suture anchor と同様の効果が期 待でき 入手容易な機材で施行可能で皮切追加の必 要がないことから代用となりうる さらに縫合糸の 種類を選択できる点 縫合糸を複数挿入できる点 体内に金属が残らない点では suture anchor より優 れている 対側の皮下軟部組織を直視下に見ないこ とから 針を刺入しても機能障害が生じる可能性が 少ない部位を選んで穿孔することと 骨膜の上の軟 150

156 499 1c d suture anchor suture anchor suture anchor まとめ suture anchor 文献 1 Wolfe S, et al. Green s Operative Hand Surgery. 6th edition. Philadelphia. Elsvier. pp , Globe EM, et al. The development of suture anchors for use in soft tissue fixation to bone. Am J Sports Med 22: , Kozin SH, et al. Treatment of thumb ulnar collateral ligament ruptures with the Mitek bone anchor. Ann Plast Surg 35: 1-5, MP 25: , : 54-57, PIP 18: 61-63, Stener B. Displacement of the ruptured ulnar collateral ligament of the metacarpo-phalangeal joint of the thumb. JBJS 44B: , Frank WE, et al. Surgical pathology of collateral ligamentous injuries of the thumb. Clin Orthop Relat Res 83: , MP 44: ,

157 J Jpn Soc Surg Hand X mm 5mm 7mm 4 11mm 5mm 6 3mm 7 3mm 1 5mm 緒言 X mm 2 5mm 5mm 1 対象と方法 X 5mm 3mm Kirschner 7 3mm 6 5mm X 2.5mm 30 Conmed 2014/10/

158 501 1 図 1 結果 mm 4 11mm mm 3mm 5mm 3mm 2 X 表 1 表 2 3mm 5mm 153

159 502 図 2 X 図 3 X 8mm 図 4 71 X mm X 2 3mm X 8mm 3 1 X 2 X 考察 2 X 7 5mm 3mm 5mm 154

160 503 2 X まとめ 7mm 3mm 5mm 5mm 文献 1 Universal Subcutaneous Endoscope system 17: 11-15, Sekiya I, et al. The treatment of enchondromas in the hand by endoscopic curettage without bone grafting. J Hand Surg Br 22: , : 9-14, : , : , pitfall 50: , : , : , : , Dietz JF, et al. Endoscopically assisted excision of digital enchondroma. Arthroscopy 23: 678e1-678e4,

161 J Jpn Soc Surg Hand D-CT CM 3 Circumduction CM 3D-CT Circumduction 5 3 retroposition mean SD radial abduction palmar abduction opposition adduction retroposition radial abduction volar abduction opposition adduction 緒言 CM CM in vivo 1 2 Miura 5 X Cheema 6 CT 56 3D-CT 3 circuduction CM impingement 7 CM 8 対象と方法 CT retroposition radial abduction palmar abduction opposition adduction 1 1 3D-CT D-CT MPR 2-4 結果 Circumduction retroposition mean SD radial abduction palmar abduction opposition adduction CM circumduction 2 retroposition /09/

162 3D-CT CM 図 1 図 2 radial abduction 図 3 opposition 図 4 adduction 157

163 506 3D-CT CM 3 表 1 Circumduction 5 表 2 Circumduction 5 radial abduction palmar abduction 1 1 opposition 1 3 adduction 4 考察 CM CM in vivo 1 Miura 5 X Cheema 6 CT retroposition D-CT 1 circumduction CM 3D-CT 2 X

164 3D-CT CM Circumduction radial abduction palmar abduction X 1-2 CM CM CM 1 impingiment 7 1 Zancolli 8 1 spheroidal part circumduction 1 3D-CT MPR CM 1 1 radial abduction retroposition Edmunds 9 CM dorsal ligament complex screw home 3D-CT in vivo 文献 1 CM Burton-Pellegrini 28: 63-65, CM suspension arthroplasty Mathoulin 28: , CM Thompson 28: , CM 1 28: , Miura T, et al. Comparative in vivo kinematic analysis of normal and osteoarthritic trapeziomatacarpal joints. J Hand Surg Am 29: , Cheema TA, et al. Measurement of rotation of the first metacarpal during opposition using computed tomography. J Hand Surg Am 31: 76-79, Schmidt H-M, et al. Surgical anatomy of the hand. The first edition. Stuttgart. Thieme. pp , Zancolli EA, et al. Atlas of surgical anatomy of the hand. The first edition. New York. Chirchill Livingstone. pp , Edmunds JO, et al. Current concepts of the anatomy of the trapeziometacarpal joint. J Hand Surg Am 36: , まとめ 1 Circumduction retroposition radial abduction palmar abduction opposition adduction 5 3 3D-CT 2 CM

165 J Jpn Soc Surg Hand OA X a 0 a 0 X OA RI CHR UV X VT RLA RSA UV RI VT odds RI OA RI RI 緒言 DRUJ TFCC DRUJ 1 X DRUJ X CT MRI 1 2 DRUJ OA OA OA 対象と方法 X / 488/ / 51/ /66.7 OA 145 / 52/ / / 103/ /67.3 X /10/

166 509 図 図 2 a a 0 a 0 posteroanterior Palmer 3 Nakamura 4 1mm 4 OA X a a 0 a 0 2 OA X radial inclination RI carpal height ratio CHR ulnar variance UV X volar tilt VT radiolunate RLA radioscaphoid RSA 7 8 OA OA Pearson Pearson 2 SPSS Version19 5 結果 OA OA OA 1 1 UV RI VT 2 2 UV RI VT odds RI 考察 DRUJ TFCC DRUJ DRUJ OA X 161

167 510 表 1 表 2 Pearson 表 3 odds OA RI UV VT OA CHR RLA RSA RI odds RI Watanabe

168 511 open wedge osteotomy 85N 74N 75N 83N 7N 11N RI X OA X substantial agreement 5 CT MRI X X hemiresection technique 31: , Schuind FA, et al. A normal database of posteroanterior roentgenographic measurements of the wrist. J Bone Joint Surg Am 17: 24-30, Larsen CF, et al. Measurements of carpal bone angles on lateral wrist radiographs. J Hand Surg Am 16: , Watanabe K, et al. Biomechanical analysis of radial wedge osteotomy for the treatment of Kienböck s disease. J Hand Surg Am 18: , まとめ 1 OA 2 OA 3 Radial Inclination 文献 1 Watanabe A, et al. Ulnar-sided wrist pain. Part : clinical imaging and treatment. Skeletal Radiol 39: , Hess F, et al. A novel technique for detecting instability of the distal radioulnar joint in complete triangular fibrocartilage complex lesions. J Wrist Surg 1: , Palmer AK, et al. Ulnar variance determination. J Hand Surg Am 7: , Nakamura R, et al. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiol 24: 91-94, Katayama T, et al. Distribution of primary osteoarthritis in the ulnar aspect of the wrist and the factors that are correlated with ulnar wrist osteoarthritis: a cross-sectional study. Skeletal Radiol 42: , RA 163

169 J Jpn Soc Surg Hand ROM ROM Intraclass correlation coefficients ICC Standard error of measurement SEM Minimal detectable change MDC ICC 2 SEM 2 MDC 2 ROM 2 緒言 2010 range of motion ROM A ROM B ROM 図 1 A B 2014/09/

170 ROM ROM 513 図 2 A 2 B 5 ROM 2011 Ver ROM ROM 4 1B 5 ROM intraclass correlation coefficients ICC standard error of measurement SEM minimal detectable change MDC 95 MDC ICC SEM MDC 95 対象と方法 Dupuytren 2 1 PIP 1 1 Bouchard A 28 B 15 C 3 2 SPR MP PIP DIP ICC 2 5 ICC

171 514 ROM ROM 図 3 Bland-Altman A 2 MP A Bland-Altman plot 95 B M1 M B C A ROM ICC ICC 1,1 ICC 2,1 Bland- Altman Bland-Altman 2 y 2 x Bland-Altman plot 1 2 t Pearson 5 Bland-Altman 3 SEM MDC 95 R version MDC 95 MDC SEM 結果 ICC SEM MDC ICC 1,1 ICC SEM MP 2 ICC /SEM ICC /SEM PIP 2 ICC /SEN ICC /SEM DIP 2 ICC /SEM ICC /SEM ICC 2,1 ICC SEM 166

172 ROM ROM 515 表 1 MP 表 2 PIP 表 3 DIP MP 2 ICC 0.92/SEM ICC 0.78/SEM 5.40 PIP 2 ICC 0.87/SEM ICC 0.78/SEM 3.22 DIP 2 ICC 0.92/SEM ICC 0.91/EM 3.75 MP 2 ICC 0.85/SEM ICC 0.68/SEM 6.55 PIP 2 ICC 0.81/SEM ICC 0.82/SEM 3.64 DIP 2 ICC 0.82/SEM ICC 0.78/SEM 4.69 MDC 95 MP PIP DIP 考察 4 167

173 516 ROM ROM 図 4 Bland- Altman ICC SEM MDC 95 MDC 95 PIP MDC Hamilton 5 Lewis 6 2 ICC ICC ICC 2 ICC ICC ICC ICC SEM MDC MDC 95 MP 11 PIP 10 DIP MDC 95 MDC 95 まとめ 1 2 ROM 2 5 SEM MDC 95 3 ROM 文献 1 69: , Rothstein JM, et al. Goniometric reliability in a clinical setting: elbow and knee measurements. Phys Ther 63: , Riddle DL, et al. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther 67: , Lunden JB, et al. Reliability of shoulder internal rotation passive range of motion measurements in the supine versus sidelying position. J Orthop Sports Phys Ther 40: , Hamilton GF, et al. Reliability of goniometers in assessing finger joint angle. Phys Ther 49: , Lewis E, et al. Interrater and intrarater reliability of finger goniometric mesurment. AJOT 64: ,

174 J Jpn Soc Surg Hand 緒言 1 対象と方法 mmHg 図 /09/

175 518 図 2 表 1 10 図 H C 10 t P 0.05 結果 10 H ml/min/100g C ml/min/100g H ml/min/100g C ml/min/100g 1 考察

176 519 まとめ 文献 1 No.4 pp79-103, : S572-S572, : 31-34, : , pp61-64,

177 J Jpn Soc Surg Hand 緒言 8 対象と方法 IP PIP MRI 結果 MRI 5 T1 T2 T1 T2 T1 2014/10/

178 521 図 1 A B C 図 2 MRI T1 A C T2 B D T mm A MRI 10 10mm T1 T

179 522 図 3 HE 1 A HE 1.25 B 1-B C 考察 cm Gargan 3 PIP

180 ISSVA MR T1 T2 MRI MRI T1 T2 MRI 9 1.5cm 10 まとめ 文献 1 Lewis MB. Venous varix of finger: case report. Plast Reconstr Surg 60: , Miller W. Venous varix of the finger. Plast Reconstr Surg 62: , Gargan TJ, et al. Varix of the digit. Plast Reconstr Surg 81: , Lanzetta M, et al. Spontaneous thrombosis of palmar digital veins. J Hand Surg 21B: , van Rossum M, et al. Thrombosis of the palmar digital veins: a report of 6 cases and a review of the literature. Ann Plast Surg 55: , Kawakatsu M, et al. A case of venous varix of the volar digit and review of the literature. Hand Surg 14: 53-56, Kawakatsu M, et al. Venous varix on the dorsal aspect of the thumb: report of two cases. Hand Surg 18: , Moss SH, et al. Digital venous anatomy. J Hand Surg Am 10: , Moulton JS, et al. Clinical m\magnetic Resonance Imaging. 2nd. Philadelphia. W.B. Sauders Company. pp , : ,

181 J Jpn Soc Surg Hand clenched fist 2 2 緒言 clenched fist 2 対象と方法 MP PIP DIP 10mm 9mm PIP 8mm 5mm 1a b Staphylococcus aureus A Levofloxacin /09/

182 525 図 1 1 a b X c 1 d 1 X 図 2 2 a b X c 1 d 1 X 1 1c d cm PIP 2a b c d 結果 2 考察 clenched fist 177

183 O Dwyer 3 Cordivari 14 4 Muller まとめ 文献 1 1 pp11-15, : , O Dwyer NJ, et al. Spasticity and muscle contracture following stroke. Brain 119: , Cordivari C, et al. Treatment of dystonic clenched fist with botulinum toxin. Movement Disorders 16: , Muller J, et al. Botulinum toxin treatment in atypical parkinsonian disorders associated with disabling focal dystonia. J Neurol 249: ,

184 J Jpn Soc Surg Hand carpal height 3 2 Mayo wrist score alignment 緒言 RLF 3 2 対象と方法 Lichtman stage IIIb 1A B C MRI T1 1D X / 30 /60 / 20 /35 27kg 53kg Mayo wrist score 図 1 1 A B X cortical ring sign C CT D MRI T1 2014/10/

185 528 2 図 2 1 A B X C 図 3 1 A 3 CT B C CT remodeling D E 4 X Carpal height 2A B 3 2C 3 3A remodeling 3B C 4 / 30 /40 75 /80 / 10 /25 20 /45 43kg 54kg Mayo wrist score Carpal Height Ratio 180

186 2 529 図 4 2 A B X C D CT C D E MRI T1 CHR D E 結果 2 68 Lichtman stage IV 4A B C D MRI T1 4E X / 30 /60 / 15 /30 13kg 27kg Mayo wrist score 図 5 2 CT A 3 impinge B 3 CT 5A 6 5B 3 CHR

187 530 2 図 A B X Carpal height C D 6A B / 30 /60 70 /80 / 10 /20 20 /40 26kg 29kg Mayo wrist score C D 25 考察 STT 1 STT 33 radial styloid impingement 3 RLF carpal height RLF 6 pivot RLF 7 stage RLF RLF Ono STT Nakamura 2 STT RLF STT RLF Palmer 9 / 30 /5 / 10 /15 RLF RLF 2 RLF MRI 10 RLF 182