_手外31-5.indb

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1 ISSN

2 撓骨遠位端骨折 567 HEARTY APTUS Polyaxial locking plate 2nd row EPL 608 Barton CT 611 小児骨折 1/3 614

3 X 619 LIPUS 623 外傷 suture anchor tension band wiring PIP PIP 665 Intrafocal pinning extension block 670 腱損傷 3D-CT

4 舟状骨偽関節 ,2 ICSRA humpback defomity 694 手根管症候群 699 APB-CMAP 702 2L-INT 706 Pain vision TM 変性疾患 PIP 2 Bouchard 716 PIP 722 炎症性疾患 A 733 感染 739

5 743 その他 747 MP 752 X 症例報告 5CM 765 Dual window approach 2 768

6 J Jpn Soc Surg Hand PLP 24 PLP PLP 緒言 evidence-based medicine EBM 1 EBM ROM PLP 対象と方法 PLP Colles 14 Colles 32 Smith 1 Smith 2 Barton 1 AO/ASIF 23-A2 3 A3 12 B3 1 C1 4 C2 10 C PLP 32 P-Plate 20 D-Plate 2 I-Plate 10 DVR Biomet 11 VA-TCP Distal Radius Plate DePuySynthes ROM stroking massage effleurage /10/

7 568 ROM ROM t P 0.05 図 1 結果 30 ROM ROM CRPS kg 76 図 ROM ROM 3a 3b 3c ROM 考察 PLP PLP ROM 4 2

8 569 図 3a 図 3b 図 3c PLP 11 ROM 1 PLP 18 3

9 570 表 1 図 4 PLP 5 表 2 ROM CRPS ROM PLP まとめ 1 PLP 50 ROM 2 4

10 571 ROM CRPS ROM 4 PLP 文献 1 Bot AG, et al. Recovery after fracture of the distal radius. Hand Clin 28: , Watt CF, et al. Do Colles fracture patients benefit from routine referral to physiotherapy following cast removal? Arch Orthop Trauma Surg 120: , Wakefield AE, et al. The role of physiotherapy and clinical predictors of outcome after fracture of the distal radius. J Bone Joint Surg 82-B: , Maciel JS, et al. A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures. Arch Orthop Trauma Surg 125: , : , Souer JS, et al. A prospective randomized controlled trial comparing occupational therapy with independent exercises after volar plate fixation of a fracture of the distal part of the radius. J Bone Joint Surg 93-A: , Krischak GD, et al. Physiotherapy after volar plating of wrist fractures is effective using a home exercise program. Arch Phys Med Rehabil 90: ,

11 J Jpn Soc Surg Hand HEARTY HEARTY MIZUHO A 26 B 5 C X Cooney s score AO C1 C3 UV Cooney s score C Fair 5 C2 C3 UV 緒言 2002 Orbay HEARTY Mizuho Monoaxial type 100 HEARTY 対象と方法 HEARTY AO A 26 B 5 C1 20 C2 18 C Henry s approach Extended FCR approach Kapandji Radial inclination RI Volar tilt VT Ulnar variance UV 3 Cooney s score AO Paired-t 2014/10/

12 HEARTY 573 図 1 AO-A B 図 2 AO-C1 Mann-Whitney U p 0.05 結果 Tension band wiring CRPS 2 A RI 25 VT 9.5 UV 0.1 B RI 22 VT 12.4 UV C1 RI 24.6 VT 12.3 UV -0.1 RI 25.3 VT 11.0 UV 0.5 UV 2 C2 RI 23.1 VT 10.9 UV C3 RI 21.9 VT 8.3 UV 0.5 RI 22.6 VT 9.4 UV 1.4 UV A C3 Cooney s score C3 A Excellent 73 Good 14 Fair 5 1 Cooney s score Fair 2 CRPS 2 1 Fair C3 45 AO-C3 5 HEARTY plate K-wire 1 7

13 574 HEARTY 図 3 AO-C2 図 4 AO-C3 表 1 Cooney s score 表 2 Cooney s score Fair 8

14 HEARTY 575 図 5 図 6 ROM Cooney s score 90 Excellent 6 考察 Monoaxial type Polyaxial type AO-C Step-off Gap Monoaxial type Low-profile Orbay 1 Monoaxial locking Monoaxial locking Arora 9

15 576 HEARTY 4 AO-C Stellar-1 RI Cooney s score 5 DSS Double-tiered Subchondral Support Polyaxial locking Monoaxial Fair Key stone Biomechanical study 9 10 C2 3 Monoaxial plate Variable-angled type 12 C1 C3 UV AO-C HEARTY まとめ 1 HEARTY C1 C3 UV 3 Cooney s score Fair 4 C2 C3 UV 文献 1 Orbay JL, et al. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg-Am 27: , Wright TW, et al. Functional outcome of unstable distal radius fracture: ORIF with a volar fixed angle thin plate versus external fixation. J Hand Surg-Am 30: , Rozental TD, et al. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg-Am 31: , Arora R, et al. Complications following internal fixation of unstable distal radius fracture with a palmar lockingplate. J Orthop Trauma 21: , AO C Stellar 1 plate 30: 48-51, Melone CP Jr, et al. Open treatment for displaced articular fractures of the distal radius. Clin Orthop Relat Res 202: , Ikeda K, et al. Fixation of an ulnodorsal fragment when treating an intra-articular fracture in the distal radius. Hand Surg 19: , : 39-42, Taylor KF, et al. Biomechanical stability of a fixed-angle volar plate versus fragment-specific fixation system: cyclic testing in a C2-type distal radius cadaver fracture model. J Hand Surg-Am 31: , Gavaskar AS, et al. Fragment-specific fixation for complex intra-articular fractures of the distal radius: results of a prospective single-centre trial. J Hand Surg-Eur 37: ,

16 J Jpn Soc Surg Hand CT Mayo Wrist Score 3 4 緒言 volar locking plate VLP golden standard VLP VLP CT 対象と方法 VLP CT AO A3 6 B3 3 C1 3 C2 10 C3 23 VLP Stellar 2 26 VA-TCP Synthes 6 Acu-Loc Acumed 5 VariAx Stryker 4 Stellar 1 DVR Depuy 1 VLP 図 1 0 2mm VLP VLP CT 0mm 0mm /10/

17 578 図 2 図 4 Mayo Wrist Score 図 3 Mayo Wrist Score MWS 結果 45 3 EDC 2 EPL mm MWS 図 5 MWS 5 MWS 1 59 AO C1 6 5 VA-TCP VLP 3 CT 4 3.4mm 8 10 MWS AO C2 7 Stellar 2 VLP 7 3 MP CT 4 4mm 2mm

18 579 図 6 1 a b c d e CT 図 7 2 a b c d e CT 図 8 3 a b c d e CT MP AO A3 5 Stellar 2 VLP 8 2 CT 13

19 580 5 MWS 70 考察 VLP 1 2 Sügün 3 VLP mm 59 Ozer 4 27 dorasl tangential view X 125 1mm 11 VLP 5 VLP 6 VLP 2mm 0 2mm 2mm EPL EDC EPL EPL まとめ 1 VLP CT 文献 1 Al-Rashid M, et al. Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. J Bone Joint Surg Br 88: , Arora R, et al. Complications following internal fixation of unstable distal radius fracture with a palmar lockingplate. J Orthop Trauma 21: , Sügün TS, et al. Screw prominences related to palmar locking plating of distal radius. J Hand Surg Eur Vol 36: , Ozer K, et al. Dorsal tangential view of the wrist to detect screw penetration to the dorsal cortex of the distal radius after volar fixed-angle plating. Hand N Y 6: , : , J MIOS 52: 77-83, Pichler W, et al. Perforation of the third extensor compartment by the drill bit during palmar plating of the distal radius. J Hand Surg Eur Vol 34: ,

20 J Jpn Soc Surg Hand X voral tilt VT ulnar variance UV VT UV VT UV 緒言 対象と方法 AO A3 43 B2 1 B3 9 C1 6 C2 19 C Tip T Center C Base B 図 1 1 Proximal P 4 1 T 19 C 16 B 14 P /10/06 JA

21 582 図 2 2 Mann-Whitney U-test volar tilt VT ulnar variance UV VT UV X χ2 Mann-Whitney U P 0.05 結果 T 6 46 C 4 40 B 5 56 P T 68 C 75 B 63 4 P T 61.2 C 62.5 B 60.4 P 55.0 T 58.8 C 67.6 B 57.9 P 75.0 T 80.0 C 83.1 B 80.0 P 80.0 T 85.5 C 83.5 B 82.3 P 85.0 T C C B VT T 7.4 C 4.0 B 6.9 P UV -0.4mm -0.04mm VT UV 0.6mm -0.7mm 1 16

22 583 図 3 2 Mann-Whitney U-test 図 4 VT UV 2 Mann-Whitney U-test 図 5 VT UV Mann-Whitney U-test 17

23 584 表 1 Wijffels 考察 23 Chi-square test Mann-Whitney U-test Zenke Base distal radioulnar joint DRUJ DRUJ Stoffelen 5 Mayo wrist score DRUJ DRUJ 23 まとめ 文献 1 TFCC 13: , : 37-41, Zenke Y, et al. The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius. J Bone Joint Surg Br 91: , : , Stoffelen D, et al. The importance of the distal radioulnarjoint in distal radial fractures. J Hand Surg Br 23: , Wijffels M, et al. The Influence of Non-union of the Ulnar Styloid on Pain, Wrist Function and Instability after Distal Radius Fracture. J Hand Microsurg 3: 11-4,

24 J Jpn Soc Surg Hand FPL Buck-Gramcko TAM FPL FPL FPL FPL 緒言 FPL FPL FPL 7 表 1 FPL 7 7 対象と方法 2008 FPL FPL FPL 2 FPL FPL 20mm FPL FPL FDS PL FPL Kleinert zone zone /10/

25 586 表 2 図 2 FPL %TAM 図 Buck- Gramcko FPL FPL FDS interlacing suture 4 FDS pull out 2 FPL bridge graft tension MP IP tension Kleinert 3 6 Buck-Gramcko FPL TAM 結果 2 Buck-Gramcko 図 3 Hand IP total 1 FPL TAM 2 Hand

26 587 図 4 MP IP FPL 1 FPL Kleinert zone zone 4 20mm FDS FPL FDS interlacing suture ROM MP IP Buck-Gramcko FPL 77.1 TAM 考察 FPL Kleinert zone Zone FPL FDS FPL FDS interlacing suture Urbaniak Goldner FPL 1 Schneider FPL Urbaniak Goldner 図 Posner FPL FDS 3 FPL FPL FPL FPL FPL PL 4 FPL FPL FPL 21

27 588 FDS FPL まとめ FPL FPL 文献 1 Urbaniak JR, et al. Laceration of the Flexor Pollicis Longus Tendon: Delayed Repair by Advancement,Free Graft or Direct Suture. J Bone Joint Surg Am 55: , Schneider LH, et al. Restoration of flexor pollicis longus function by flexor digitorum superficialis transfer. J Hand Surg Am 8: , Posner MA, et al. Flexor superficialis tendon transfers to the thumb-an alternative to the free tendon graft for treatment of chronic injuries within the digital sheath. J Hand Surg Am 8: , : ,

28 J Jpn Soc Surg Hand X ulnar variance 0.1mm mm DRUJ Mayo wrist score 82.0 excellent 5 good 15 fair 6 緒言 VLP 図 1 Biyani 対象と方法 2008 VLP AO A2 8 A3 7 C1 1 C2 4 C3 6 typeb Biyani 1 1 type 1 7 type 2 9 type 3 5 type A 20 2B short arm cast X volar tilt VT radial inclination RI ulnar valiance UV DRUJ gap ulnar metaphyseal angulation Mayo wrist score 2 Fish- 2014/10/

29 590 図 2A X 図 2B X er s exact test Chi-squared for independence test Mann-Whitney s U test p 0.05 結果 X VT RI UV -0.5mm -2 3mm -0.6mm -2 3mm 2mm 2 DRUJ gap 0.3mm 0 2mm 0.7mm 0 3mm 2mm 3 ulnar metaphyseal angulation kg 7 26kg Mayo wrist score excellent 5 good 15 fair 6 1 UV mm DRUJ gap mm Ulnar metaphyseal angulation Mayo wrist score AO Biyani 2 X 考察 mini condylar plate 2 locking plate 3 hook plate 4 Namba 5 Cha 6 Yoneda 7 8 Biyani type

30 591 表 angulation DRUJ Mayo wrist score DRUJ TFCC DRUJ distal oblique bundle 10 まとめ

31 592 文献 1 Biyani A, et al. Fracture of the distal radius and ulna. J Hand Surg Br 20: , Ring D, et al. Condylar blade plate fixation of unstable fractures of the distal ulna associated with fracture of the distal radius. J Hand Surg Am 29: , Dennison DG. Open reduction and internal locked fixation of unstable distal ulna fractures with concomitant distal radius fracture. J Hand Surg Am 32: , Lee KL, et al. Distal ulna hook plate fixation for unstable distal ulna fracture associated with distal radius fracture. Orthopedics 35: , Namba J, et al. Intra-articular distal ulnar fractures associated with distal radial fractures in older adults: early experience in fixation of the radius and leaving the ulna unfixed. J hand Surg Eur 34: , Cha SM, et al. Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older. J Hand Surg Am 37: , Yoneda H, et al. Primary excision of the ulnar head for fractures of the distal ulna associated with fractures of the distal radius in severe osteoporotic patients. J Hand Surg Eur 39: , : , Diaz-Garcia RJ, et al. A Systematic Review of Outcomes and Complications of Treating Unstable Distal Radius Fractures in the Elderly. J Hand Surg Am 36: , Moritomo H. The distal interosseous membrane: Current concepts in wrist anatomy and biomechanics. J Hand Surg Am 37: ,

32 J Jpn Soc Surg Hand LIPUS 27 L LIPUS 27 L L 29.5 L 37.3 L L 58.4 L 68.3 L Student-t p 0.05 LIPUS LIPUS ADL 緒言 Low intensity pulsed ultrasound LIPUS LIPUS 対象と方法 L LIPUS 27 L L 6 21 L 4 23 L L L A1 2 A3 5 C1 4 C2 6 C3 10 L A3 2 C2 5 C3 20 L DVR Biomet 23 ADAPTIVE MES 2 VA-TCP SYNTHES 2 L DVR 15 ADAPTIVE 8 VA-TCP 1 MODE 2 VARIAX Stryker 1 Palmer Tilt PT Radial Inclination RI Ulnar Variance UV X 1 FCR L 1 LIPUS X 結果 2014/10/

33 594 図 1 図 2 CRPS Excellent 26 Good 1 L 14.5 L 12.3 PT L L -6.3 PT L 10.8 L PT L 10.7 L -11 L 0.1 L 0.4 RI L 18.1 L 10.1 RI L 25 L 24.4 PT L 24.7 L 24.8 L 0.3 L 0.4 UV L 2.9mm L 2.6mm RI L 0.9mm L 1.2mm PT L 1mm L 1.5mm L 0.1mm L 0.3mm L 37.3 L 29.5 L 1 L 68.3 L 58.4 L 2 Student-t 考察 NSAID LIPUS LIPUS 1997 Kristiansees LIPUS 4 LIPUS LIPUS LIPUS 5 LIPUS LIPUS ADL LIPUS LIPUS LIPUS LIPUS 28

34 595 ADL CT Tomosynthesis まとめ LIPUS LIPUS LIPUS LIPUS ADL 文献 1 Kristiansen TK, et al. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, doubleblind, placebo-controlled study. J Bone Joint Surg Am Jul;79 7 : , LIPUS 33: , OTA/AO A3 type 33: 53-57, LIPUS non-bridging prospective study 31: , : , Leung KS, et al. Complex tibial fracture outcome following treatment with low-intensity pulsed ultrasound. Ultrasound in Med & Biol 30: ,

35 J Jpn Soc Surg Hand SLI DRF SLI 65 SLI Geissler grade 3 Geissler grade 2 power analysis VAS DASH PRWE SLI 緒言 distal radius fracture DRF gap stepoff 1 2 scapholunate instability SLI DRF DRF Geissler 3 grade 3 SLI grade grade SLI DRF SL SLI 対象と方法 DRF locking plate ORIF radiocarpal midcarpal SLI AO A2 4 A3 3 B1 5 C1 34 C2 23 C3 16 ORIF CT 2mm gap step-off radial inclination volar tilt SL Geissler grade 2 grade 3 4 SLI Geissler grade 3 grade 4 SL /10/

36 SL 597 表 1 図 SL VAS DASH PRWE T 5 power analysis sample size 結果 p power analysis effect size DASH power analysis power 0.8 α error 0.05 sample size 考察 DRF SLI TFCC SLI Forward 7 Geissler grade 3 SLI 1 SL Gartland and Wersey score grade 2 Watson 8 SL SLAC 15 31

37 598 SL 表 2 図 2 Geissler grade 3 SLI ADL Geissler grade 3 evidence β 0.8 SLI dorsal capsulodesis Spearman DASH PRWE DASH 30 9 PRWE 15 4 DASH PRWE 32

38 SL 599 DASH Geissler grade 3 evidence case-control study 2 Geissler grade 3 grade 4 evidence of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg Br 22: , Forward DP, et al. Intercarpal ligament injuries associated with fractures of the distal part of the radius. J Bone Joint Surg Am 89: , Watson HK, et al. The natural progression of scaphoid instability. Hand Clin 13: 39-49, まとめ SLI SLI 文献 1 X 23: , : , Geissler WB, et al. Intercarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 78: , : 72-76, : 14-20, Lindau T, et al. Intraarticular lesions in distal fractures 33

39 J Jpn Soc Surg Hand APTUS 2.5 APTUS 2.5 緒言 monoaxial locking plate MLP polyaxial locking plate PLP PLP APTUS2.5 ME PLP 1 対象と方法 1 APTUS tri-lock 1 1A 1B 0.7Nm 1C 図 1 APTUS B 1 2 C 2 1D 15 2 SAWBONES Solid rigid polyurethane 10pcf 2.4mm APTUS /10/

40 APTUS 図 2 図 3 A B C Nm B 8 C 5 Mann-Whitney U APTUS 2.5 correction 5 babyfoot 4 adaptive A 5 B 1 C B C 結果 A B C A C B C A B 4 1 1B 図 4 0.7Nm A B C C 20% 35

41 602 APTUS2.5 図 5 図 6 0.7Nm B 7 B 6 C 1 6 X 考察 PLP MLP Biomechanical study PLP MLP 1 PLP X APTUS Nm PLP mM

42 APTUS angular stability まとめ 0.7Nm 文献 1 Rausch S, et al. Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model a biomechanical study. Injury 42: , APTUS2.5 30: 9-11, DVR plate APTUS2.5plate 29: 76-78, Matrix Smart Lock Plate 31: , : , : ,

43 J Jpn Soc Surg Hand Polyaxial locking plate 2nd row Polyaxial locking plate AO A2 3 C X volar tilt, ulnar variance, radial inclination 2 緒言 2 2 polyaxial locking plate PLP 対象と方法 PLP Aptus2.5 Medartis, Basel, Switzerland 50 AO A2 3 C row 1R 2 7 図 1 1row 2rows 2014/10/

44 605 表 rows 2R 1 3 X volar tilt, ulnar variance, radial inclination Mayo wrist score t 5 1R A2 2 A3 9 C1 8 C2 7 2R A2 2 A3 10 C1 7 C2 6 結果 X Mayo wrist score 1 1R 2 2R 1 1R 2R 1 考察 2 DSS double tiered subchondral support C3 1 DSS watershed line Mehring 2 Moss 3 Drobetz 4 Neuhaus 5 X 1R 2R 1R 2R 39

45 C3 DSS 図 2 図 3 2 まとめ 1R 2R 1 図 4 DSS 2 40

46 607 文献 1 Osada D, et al. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 33: , Mehling I, et al. Number and locations of screw fixation for volar fixed-angle plating of distal radius fractures: biomechanical study. J Hand Surg Am 35: , Moss DP, et al. A biomechanical comparison of volar locked plating of intra-articular distal radius fractures: use of 4 versus 7 screws for distal fixation. J Hand Surg Am 36: , Drobetz H, et al. More is not necessarily better. A biomechanical study on distal screw numbers in volar locking distal radius plates. Injury 44: , Neuhaus V, et al. Radiographic alignment of unstable distal radius fractures fixed with 1 or 2 rows of screws in volar locking plates. J Hand Surg Am 38: ,

47 J Jpn Soc Surg Hand EPL EPL EPL 2 EPL 緒言 AO C type VLP VLP X CT C type C type 3 図 1 b/a 対象と方法 VLP A0 C1 4 C2 1 C3 5 Stellar 2 7 Variax 2 MES APTUS 2 1 X / / volar tilt VT radial inclination RI ulnar variance UV CT 2 1 EPL VLP 3 EPL 2014/10/

48 609 表 1 RI VT UV EPL EPL EPL 結果 RI VT UV 0.6mm mm mm EPL 2 3 EPL bowstringing 1 85 A0 C3 26 VLP Variax 2 3 EPL AO C3 20 VLP Stellar 2 4 EPL EPL 5 bowstringing 図 2 A. X B. CT C. X 図 考察 mm X 4 C3 43

49 AO A type C3 C3 EPL 図 4 A. X B. CT C. X まとめ C3 3 EPL 図 EPL 3 1 monoaxial polyaxial TFCC triangular fibrocartilage complex 12 文献 1 Rozental TD, et al. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg 31: , : , : , Haug L.C, et al. A new radiological method to detect dorsally penetrating screws when usinig volar locking plates in distal radial fractures. The Bone Joint J 95: , : , Polyaxial Locking Plate Monoaxial Lock Plate AO C 30: , Yukata K, et al. Early breakage of a titanium volar locking plate for fixation of distal radius fracture: case report. J Hand Surg 34: , Genda E, et al. Theoretical stress analysis in wrist joint;neutral position and functional position. J Hand Surg 25: , Lindley B, et al. The effects of screw length on stability of stimulated osteoporotic distal radius fractures fixed with volar locking plates. J Hand Surg 37: ,

50 J Jpn Soc Surg Hand Barton CT Barotn CT Barton Barton CT VTd 10 D ND 11 D VTd 48.1 ND VTd 26.3 D ND D 5 38 ND D 7 ND 4 quick DASH score 2 Barton 54 CT D 緒言 Barton AO B3 CT Barton CT VTd 1 2a, b 対象と方法 Barton Radial inclination Volar tilt Ulnar variance RI VT UV CT 図 1 VTd 2014/10/

51 612 Barton CT 3a 3b 6 11 D 7 ND 4 Qucik DASH score Mann- Whitney U Fisher p 0.05 結果 RI18.0 VT21.7 UV 3.4mm 29.8mm CT VTd38.9 VTd 10 Deformity D 4a VTd 10 Non-Deformity ND 4b Barton D ND VTd D 48.1 ND RI VT UV 1 D VTd 8 VTd D ND Quick Dash score D ND 考察 Barton ligamentotaxis 1 図 2a 図 3a 図 4a 10 D 図 2b 図 3b 図 4b 10 ND 46

52 Barton CT 613 表 1 D ND 54 CT Barton 2 Barton buttress buttress plate 3 4 Harness Barton buttress plate 5 Barton CT Barton 54 D ND CT Boyer 6 23 lateral tilted radiograph X D ND CT K-wire buttress plate 文献 1 Lakshmanan P, et al. Ligamentotaxis for Barton s and paediatric distal radial fractures. J Orthop Surg 17: 28-30, Mehara AK, et al. Classification and treatment of volar Barton fractures. Injury 24: 55-59, de Oliveira JC. Barton s fractures. J Bone Joint Surg 55: , Aggarwal AK, et al. Open reduction and internal fixation of volar Barton s fractures: a prospective study. J Orthop Surg 12: , Harness N, et al. Volar Barton s fractures with concomitant dorsal fracture in older patients. J Hand Surg Am 29: , Boyer MI, et al. Anatomic tilt x-rays of the distal radius: an ex vivo analysis of surgical fixation. J Hand Surg Am 29: , まとめ Barton 47

53 J Jpn Soc Surg Hand / /5 1/ 緒言 1 1/3 2 対象と方法 /3 28 1/3 1/3 17 結果 / / / /10/

54 615 表 1 表 2 1/3 表 3 表 4 1/3 1/ Synthes Distal Radius Plate 1 1 1/ / /

55 616 図 1 1 図 / Synthes Distal Radius Plate 考察 40 2 /

56 617 図 3 2 図 Jordan 40 6 Zamzam 3 Sharma 4 McQuinn

57 Zamzam 3 Sharma 7 1 Sharma 1/ Hagino Bone mineral density BMD BMD / まとめ /3 文献 1 14: , /3 32: , Zamzam MM, et al. Displaced fracture of the distal radius in children:factors responsible for redisplacement after closed reduction. J Bone Joint Surg Br 87: , Sharma S, et al. Dorsal cortical comminution as a predictor of redisplacement of distal radius fractures in children. Injury 42: , McQuinn AG, et al. Risk factors for redisplacement of pediatric distal forearm and distal radius fractures. J pediatr Orthop 32: , Jordan RW, et al. Displaced paediatric distal radius fractures-when should we use percutaneous wires? Injury 43: , : , Hagino H, et al. Fracture incidence and bone mineral density of the distal radius in Japanese children. Arch. Orthop. Trauma Surg 109: , /3 plate 61: 71-75,

58 J Jpn Soc Surg Hand X maximum ulnar bow MUB Pearson s Grace Eversmann MUB 3.4mm MUB p MUB 緒言 Kirschner K-wire X 対象と方法 K-wire /3 8 1/3 1/3 1 1/3 1/ X Maximum ulnar bow MUB Grace Eversmann JOAscore ΔMUB Pearson s P 0.05 結果 Grace Eversmann 7 3 JOA score /10/

59 620 表 1 図 1a 図 1b 1.8mm K-wire 図 1c EPL X MUB 3.4mm 2 6.8mm 1 ΔMUB MUB p /3 K-wire K-wire MUB 2mm 1.8mm Grace Eversmann excellent JOAscore /3 K-wire MUB 2.7mm 1.6mm Grace Eversmann good JOAscore

60 621 図 2a 図 2b 1.5mm 1.8mm K-wire 図 2c 考察 K-wire Van der Reiss Shah K- wire Grace Eversmann K-wire K-wire 7 K-wire K-wire Lister EPL Lister EPL anatomical snuff box K- wire

61 MUB MUB bowing bowing Maximum radial bow bowing 10 ADL ADL JOAscore 99.4 ADL limitation 3 3 1/3 13: , : , Van der Reiss WL, et al. Intramedullary nailing versus plate fixation for unstable forearm fractures in children. J Pediatr Orthop 18: 9-13, Shah AS, et al. Stabilization of adolescent both-bone forearm fractures: A comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma 24: , Lee S, et al. Intramedullary fixation for pediatric unstable forearm fractures. Clin Orthop 402: , pp , MB Orthop 13: 67-73, : , 2011 まとめ 1 K-wire 2 EPL K-wire Lister anatomical snuff box 3 MUB 文献 1 Tarr RR, et al. The effects of angular and rotational deformities of both bone of the forearm. J Bone Joint Surg 66: 65-70, Kay S, et al. Both-bone midshaft forearm fractures in children. J Pediatr Orthop 6: ,

62 J Jpn Soc Surg Hand LIPUS LIPUS LIPUS Mann-Whitney U LIPUS bridging callus LIPUS LIPUS LIPUS 緒言 low-intensity pulsed ultrasound LIPUS 40 5 LIPUS LIPUS 対象と方法 LIPUS Control LIPUS LIPUS 1 LIPUS Control LIPUS LIPUS /10/

63 624 表 1 Control LIPUS 図 1 Period A B LIPUS Period A Period B 3 bridging callus Period C X 2 Period A 3 bridging callus Period B Period C Period B 1 Period C 3 2 X Mann-Whiteney U p 0.05 結果 Period A LIPUS 20.6 Control 29.8 LIPUS 1-a Period B Control 74.7 LIPUS b Period C Control LIPUS c LIPUS Control Control 4 X X Period C 1 58

64 625 Control 2 LIPUS 1/ LIPUS retrospective study LIPUS X 図 2 考察 Control 4 X a b c 32 d 350 LIPUS bridging callus LIPUS 6 LIPUS まとめ LIPUS 文献 1 Osteoporosis Japan 13: , Fernandez FF, et al. Nonunion of forearm shaft fractures in children after intramedullary nailing. J Pediatr Orthop 18: , Lobo-Escolar A, et al. Delayed Union in Pediatric Forearm Fractures. J Pediatr Orthop 32: 54-57, Schmittenbecher PP, et al. State-of-the-art treatment of forearm shaft fractures. Injury 36: S-A25-S-A34, Kristiansen TK, et al. Accelerated healing of distal radial fractures with the use of specific, low-intensity ultrasound. A multicenter, prospective, randomized, doubleblind, placebo-controlled study. J Bone Joint Surg Am 79 7 : , Orthopaedics 26 7 : 1-4,

65 J Jpn Soc Surg Hand X Lister - - Weiss 1 Viegas 1 3CM - - Cuenod 3 interference screw 1 Viegas Blatt capsulodesis 24 Weiss 5 X 緒言 SL Scapholunate advanced collapse SLAC wrist SL 6 main stabilizer SL 6 対象と方法 SL Watson scaphoid shift test finger extension test X 3mm SL Larsen SL gap 3mm 3mm 3mm Geissler Grade 3 1 Grade 4 3 Garcia Elias SL Stage III 2 stage IV 4 Berger 7 ligament splitting dorsal approach c-wire joystick SL c-wire Herbert screw Lister - - BRB Weiss 1 1 Viegas 2 Blatt capsulodesis 3 1 3CM - - BLB Cuenod interference screw 1 4 wire 12 Herbert screw visual analogue scale 100 VAS Disabilities of the Arm, Shoulder and Hand DASH 2014/10/

66 627 表 1 / modified Mayo wrist score mmws X SL SL SL Wilcoxon signed rank test p 0.05 結果 VAS p DASH p p mmws poor good 2 fair 4 p X SL 2.7mm 1mm 4.2mm 0.5mm 0mm 2mm p mm 0mm 2mm p SL 4mm 3mm 5.1mm 2.2mm 1mm 4mm 図 1 X A B p SL p Weiss 5 SL Weiss X SL 1.2mm SL 3mm SL 60 SL SL 1-A, B SL Herbert screw 3CM BLB 61

67 mm 2-A, B, C 2 9 VAS 40 0 DASH mmws 25 poor 80 good X SL 0mm SL 53 X SL 0mm SL 2mm SL 63 3-A, B, C 6 4-A, B 考察 SL Garcia Elias stage I II Stage V STT Stage VI four corner fusion 図 2 A - - B 3CM - - C 図 3 X A B C 図 4 A B 62

68 629 Stage III, IV stage III dorsal capsulodesis BLB Stage IV Brunelli 5 Garcia Elias 6 three ligament tenodesis RASL Reduction-association Scapholunate procedure 24 SL SL Viegas Blatt capsulodesis Cuenod Weiss Stage III SL BLB 8 Lister BRB 3CM BLB Viegas 1 Szabo 9 Blatt capsulodesis 16 X SL 2mm SL 2mm SL 50 Cuenod 3CM BLB 2 interference screw X 4 SLAC wrist まとめ SL Garcia Elias Stage III, IV Lister BRB Weiss 1 文献 1 Weiss AP, et al. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg 23A: , Viegas SF, et al. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg 24A: , Blatt G, et al. Capsulodesis in reconstructive hand surgery : Dorsal capsulodesis for the unstable and volar capsulodesis following excision of the distal ulnar. Hand Clin 3: , Cuenod P, et al. Osteoligamentoplasty and limited dorsal capsulodesis for chronic scapholunate dissociation. Ann Chir Main Memb Super 18: 38-53, Brunelli GA, et al. A new technique to correct carpal instability with scaphoid rotary subluxation: a pre- liminary report. J Hand Surg 20A: , Garcia-Erias M, et al. Three-Ligament Tenodesis for the Treatment of Scapholunate Dissociation: Indications and Surgical Technique. J Hand Surg 31A: , Berger RA, et al. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 35: 54-59, Harvey EJ, et al. Autograft replacements for the scapholunate ligament: a biomechanical comparison of handbased autografts. J Hand Surg 24A: , Gajendran VK, et al. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation. J Hand Surg 32A: ,

69 J Jpn Soc Surg Hand 自由投稿論文 or or or 緒言 対象と方法 or or or subzone 1 zone 2 1 guillotine 2 local crush 3 extensive crush 4 avulsion 2 microsurgeon E1 80μg/ 2 3 capillary refill pin prick 結果 / 3 10 / / 13 8 / 3 15 / / subzone 2 2 subzone 3 4 subzone 4 3 zone 3 12 zone 4 6 zone 5 1 subzone 2 2 subzone 3 1 subzone 4 2 zone /10/

70 631 図 1 図 3 図 4 図 2 2 zone t 2 5 考察

71 632 Davis Sears E 7 complete avulsion injury 66 incomplete avulsion injury 78 avulsion avulsion 文献 : , MOOK 15: , Komatsu S, et al. Successful replantation of a completely cut-off thumb: case report. Plast Reconstr Surg 42: , : , : , : , Davis Sears E, et al. Replantation of finger avulsion injuries: a systemic review of survival and functional outcomes. J Hand Surg Am 36 4 : , 2011 まとめ

72 J Jpn Soc Surg Hand crush amputation 2 heatpress injury TAM S1 1 S2 2 S3 2 緒言 5 対象と方法 crush amputation 2 heatpress injury DIP 2 DIP 3 3 結果 TAM Semmes - Weinstein S1 1 S2 2 S heatpress injury 2/3 2014/10/

73 634 1 XP cm denude 0.4mm 図 TAM 96 S2 3 4 考察 Hemipulp flap 1 2 図 2 図

74 635 図 4 1 PIP MP PIP PIP まとめ 文献 1 20: , : 19-24, Pepars 40: 35-43, Brent 18: 64-68, : , : ,

75 J Jpn Soc Surg Hand ALT flap ALT flap cm cm flow through type T-portion flow through type 緒言 ALT flap 対象と方法 ALT flap 結果 34 12cm 13 5cm 18 9cm cm 9.4cm 5 1 palmal carpal branch flow through type /10/

76 637 表 1 表 2 表 3 ALTflap ALT flap

77 638 図 a b c d 16 e ALT flap f 1 29 MP 16 ALT flap 14 9cm 図 a b c d PIP 72

78 図 a b c 21 1 d ALT flap 21 ALT flap 13 10cm 1 考察 4 ALT flap 2 10cm T-portion flow through type 4 5 1mm 表 4 73

79 640 図 4 a ALT flap b MDCT 0.9mm 3 4 QOL 19 9cm 1 ALT flap MDCT multi-detector row CT 1 flow 図 5 through 6 ALT flap 4-a 1mm MDCT 6 4-b 1mm 5 74

80 Doyle palmar radiocarpal branch Gray volar carpal branch 1mm Kim J.T, et al. T-Anastomosis in microsurgical free flap reconstruction: an overview of clinical applications. J Plast Reconstr Aesthet Surg 61: , MDCT PEP- ARS 73: 57-65, Doyle J.R, et al. Surgical anatomy of the hand and upper extremity. 1st. Philadelphia. Lippincott Williams & Wilkins. pp , Gray H, et al. Anatomy of the human body. 20th. Philadelphia. Lea & Febger. pp , Koshima I, et al. New Anterolateral Thigh Perforator Flap With a Short Pedicle for Reconstruction of Defects in the Upper Extremities. Ann Plast Surg 51: 30-36, 2003 まとめ 8 flow through 文献 1 25: , : , : , Koshima I, et al. Flow-Through Anterior Thigh Flaps with a Short Pedicle for Reconstruction of Lower Leg and Foot Defects. Plast. Reconstr. Surg 115: , 75

81 J Jpn Soc Surg Hand 自由投稿論文 biological dressing 3 wet dressing 3 wet dressing 24 2 Biological dressing 3 TAM biological dressing 緒言 1 2 対象と方法 TAM DASH / Hand20 Spearman 結果 A-V 3 4 biological dressing 4 3 wet dressing biological dressing /10/

82 643 表 1 図 1 TAM 図 2 DASH Hand TAM TAM 1 DASH Hand a bio- 77

83 644 図 3a 1 51 図 3b 2 図 3c 12 TAM 64 DASH Disability 3.3 Hand logical dressing 3-b wet dressing 2 12 TAM 64 DASH 3.3 Hand c a 14 78

84 645 図 4a 2 31 図 5a 3 42 IP PIP 図 4b 15 TAM 4 DASH Disability TAM 4 DASH b 3 42 IP PIP 5-a 3 15 TAM 73 DASH 28.6 Hand b 図 5b 15 TAM 73 DASH Disability 28.6 Hand20 48 考察 2 Lo 5 3 zone A-V TAM 79

85 indocyanin green ICG 7 Emergency flap biological dressing biological dressing negative pressure wound therapy NPWT 9 dressing 3 wet dressing 3 wet dressing TAM 4 文献 1 Adani R, et al. Degloving injuries of the hand and fingers. Clin Orthop Relat Res 314: 19-25, : , Slattery P, et al. Microsurgical arterialization of degloving injuries of the upper limb. J Hand Surg Am 37: , Thomas BP, et al. Replantation of total degloving of the hand: Case report. J Reconstr microsurg 19: , Lo S, et al. A new classification to aid the selection of revascularization techniques in major degloving injuries of the upper limb. Injury 44: , Degloving injury 25: 48-52, Kamolz LP, et al. Evaluation of skin perfusion by use of indocyanine green video angiography: Rational design and planning of trauma surgery. J Trauma 61: , Lister G, et al. Emergency free flaps to the upper extremity. J Hand Surg Am 13: 22-28, Rowena N, et al. Hand in glove-vac dressing with active mobilization. J Plast Reconstr Aesthet Surg 59: , 2006 まとめ biological 80

86 J Jpn Soc Surg Hand Gustilo type 3A 3 3B 4 3C 3 Zone V VI MP Chen I 4 II 4 III 2 IV Gustilo Chen 緒言 1 2 対象と方法 Gustilo type3a 3 3B 4 3C Zone V VI 1 3 outrigger 1 4 MP MP Chen Chen Gustilo 3 結果 MP Chen Grade I 4 Grade II 2014/10/

87 648 図 1 outrigger 図 2 Gustilo Chen 図 3 a b c d e, f 4 Grade III 2 Grade IV Gustilo Chen Gustilo 3A Chen grade I Gustilo 3B Chen grade II Gustilo 3C Chen grade III PIP Gustilo- 3A Chen Grade I CM Gustilo-3C Chen Grade II 4 考察 82

88 649 図 4 a b c d, e, f 3 4 MP/PIP MP 5 Gustilo 3B- 4 3C- 7 Chen grade I - 3 II - 2 III - 2 IV - 1 Gustilo Chen Chen grade IV まとめ 10 文献 1 MP 10: , : , : , MP, PIP 30: , : ,

89 J Jpn Soc Surg Hand suture anchor tension band wiring suture anchor tension band wiring MP mm suture anchor tension band wiring 0.7mm suture anchor 1 緒言 1 2 suture anchor 対象と方法 MP mm suture anchor JuggerKnot Soft Anchor-1.0 Mini Micro Quick Anchor Plus 1 suture anchor 26G 0.7mm 1 0.7mm suture anchor 0.7mm /10/

90 651 図 1 JuggerKnot Soft Anchor-1.0 Mini Micro Quick Anchor Plus 26G 0.7mm 1 0.7mm C C C 図 2 結果 mm suture anchor extension block 1 0.7mm JuggerKnot-1.0 Mini 1.0mm 6 3 DIP

91 652 表 1 図 3 a 1 43 b 1 c 1 d e

92 653 図 4 a 2 15 b 1 c 3 6 d mm 1 JuggerKnot 1.0-Mini DIP 0 65 考察 tension band wiring tension band wiring 3 Jupiter 4 2 pull-out 5 87

93 654 pull-out suture anchor Cheung suture anchor pullout wiring Jupiter tension band wiring 2 Hasting 3 7 3mm 0.7mm 2.1mm Teoh 2 suture anchor tension band wiring 8 Fiber wire Clyde suture anchor tension band wiring 9 saw bone suture anchor suture anchor suture anchor tension band wiring suture anchor 2mm 0.7mm 2.1mm 2 suture anchor suture anchor JuggerKnot-1.0 Mini MB 3-0 Micro Quick Anchor Plus Micro Quick Anchor Plus まとめ 1 88

94 文献 1 Tan V, et al. Intra-articular fractures of the hand: Treatment by open reduction and internal fixation. J Orthop Trauma 19: , Teoh LC, et al. Mallet fractures: A novel approach to internal fixation using a hook plate. J Hand Surg 32E: 24-30, AO-ASIF 1 pp37-37, Jupiter JB, et al. Tension band wire fixation of avulsion fractures in the hand. Clin Orthop Relat Res 214: , Damron TA, et al. Surgical treatment of mallet finger fractures by tension band technique. Clin Orthop Relat Res 300: , Cheung JPY, et al. Peak load resistance of the JuggerKnot soft anchor technique compared with other common fixation techniques for large mallet finger fractures. Hand Surgery 18: , Hasting H. Unstable metacarpal and phalangeal fracture treatment with screws and plates. Clin Orthop Relat Res 214: 37-52, Tension band fiber wiring 52: , Clyde J, et al. A biomechanical investigation of a knotless tension band in medial malleolar fracture models in composite Sawbones. J Foot and Ankel Surg 52: ,

95 J Jpn Soc Surg Hand Bennett CM CM IP MP 緒言 対象と方法 Bennett CM Compact Lock C VariAx Hand M V 1 CM oblique type O transverse type T Rolando Rolando type R MP IP 100 結果 1 O 2 T 5 R 3 C 6 6 Compact Lock Compact Lock Mandible 2.0 V 4 73 CM /10/

96 1 657 図 1 図 2 表 1 91

97 658 1 図 図 T R T 16 MP IP R 11 MP IP T 14 MP 0 50 IP CM 考察 1 92

98 1 659 図 Rolando CM 4 5 Rolando 1 図 6 Bennett CM

99 まとめ 1 40 文献 1 24: , : , : 56-59, Rolando 19: , : , : ,

100 J Jpn Soc Surg Hand X 緒言 -L- PLLA HA PLLA 対象と方法 H Foucher 4 F 2 H F MP total active motion TAM American society for surgery of hand ASSH 5 X 100 t 5 1 φ2.0mm K-wire K-wire φ1.5mm K-wire φ1.5mm K- wire K-wire K- wire HA/PLLA super fixsorb 30 φ2.0mm 1 buddy taping K-wire 3 Foucher 2014/10/

101 662 図 1 H F Kwire 結果 H F MP TAM TAM ASSH excellent 1, 2 H F P H F H 99.0 F 98.6 図 2 96

102 663 図 3 a X 55 b X c 15 X 16 X 55 3a 3b X excellent c 考察 Foucher Meunier 6 2mm 8 10mm 55 Ali 7 30 angulation Winter 8 MP 97

103 664 MP MP K-wire Ali A, et al. The biomechanical effects of angulated boxer s fractures. The Journal of hand surgery 24: , Winter M, et al. Surgical treatment of the boxer s fracture: transverse pinning versus intramedullary pinning. The Journal of hand surgery, European volume 32: , まとめ X 文献 1 PLLA 48: , HA/PLLA 32: , u-ha/plla 33: , Foucher G. Bouquet osteosynthesis in metacarpal neck fractures: a series of 66 patients. The Journal of hand surgery 20: 86-90, Bosscha K, et al. Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study. Injury 24: , Meunier MJ, et al. Predicted effects of metacarpal shortening on interosseous muscle function. The Journal of hand surgery 29: ,

104 J Jpn Soc Surg Hand PIP PIP PIP PIP 2 70 PIP PIP 緒言 PIP Ilizarov minifixator IMF 1 2 IMF PIP PIP PIP IMF 対象と方法 PIP PIP 1 IMF /10/

105 666 PIP IMF IMF 6 図 1 PIP PIP 結果 PIP -60/80-60/95-15/20-15/65 PIP PIP 1 PIP PIP PIP 図 2 1 PIP A X 3DCT. B IMF C D 1 X 100

106 PIP 667 図 3 2 PIP X A B PIP PIP C 7 3 PIP PIP -60/80 IMF PIP 2 1 PIP -60/ PIP 3 PIP X IMF PIP PIP 7 PIP -15/ PIP 3 PIP PIP -25/30 101

107 668 PIP 図 4 3 A X B C PIP V D IMF PIP IMF PIP -15/90 考察 PIP PIP IMF PIP IMF 102

108 PIP 669 まとめ 文献 1 24: 59-66, : 67-71, : , : , Hamada Y, et al. Surgical rehabilitation for correction of severe flexion contracture of the proximal interphalangeal joint by modified Ilizarov method. J Hand Surg Eur Vol 11: 11-12, Sawaizumi T, et al. Lengthening of the amputation stumps of the distal phalanges using the modified Ilizarov method. J Hand Surg Am 28: , : , : , Hamada Y, et al. Staged external fixation for chronic fracture-dislocation of the proximal interphalangeal joint: outcomes of patients with a minimum 2-year follow-up. J Hand Surg Am 37: ,

109 J Jpn Soc Surg Hand Intrafocal pinning extension block intrafocal pinning extension block 1/ open method intrafocal pin 0.7mm K-wire intrafocal pin DIP extension block 3 step off step off DIP 40 extension loss 緒言 1 DIP extension loss step off intrafocal pinning 対象と方法 / 図 1 A / A B Wehbé 7 X PACS intrafocal pin DIP 1cm open method Kirschner wire K-wire 2-3mm DIP intrafocal pin 0.7mm K-wire 2014/10/

110 671 図 2 DIP DIP intrafocal pin 0.7mm K-wire intrafocal pin extension block pin 1.0mm K-wire DIP 1.0mm K-wire 0.7mm K-wire intrafocal pin extension block pin 1.0mm K-wire extension loss DIP K-wire K-wire 1.0mm K-wire DIP X step off 図 3 step off mm PACS 3 step off 8 extension loss step off PACS X 3 step off 3 DIP X PACS 3 DIP goniometer extension loss DIP DIP 105

111 672 図 4 Extension loss DIP 結果 step off mm step off DIP mm step off DIP DIP mm step off DIP 3 70 excellent 12 good 6 DIP excellent good good DIP r 0.33 p 0.18 r 0.46 p r 0.39 p 0.11 DIP r p extension loss 図 DIP DIP DIP 112 DIP excellent DIP excellent

112 673 図 8 extension block pin 図 図 K-wire cross 40 DIP extension loss good 7 考察 1/3 extension loss DIP 4 step off X step off step off 9 DIP DIP extension loss K-wire 3 K-wire 5 K-wire 9 intrafocal reduction 10 extension loss DIP extension block K-wire extension block pin 8 extension block pin 107

113 674 intrafocal pin K-wire extension block pin intrafocal pin Chung 10 intrafocal pinning 0.7mm K-wire Sauvé-Kapandji intrafocal reduction extension block pin Chung 0.7mm K-wire intrafocal pin intrafocal pin Chung extension loss DIP extension block pin X extension block pin DIP DIP DIP extension loss intrafocal pin intrafocal pin DIP K-wire 18 3 step off step off 1 step off 0.5mm step off Extension loss 5 40 extension loss 1/3 extension loss まとめ 1 1/3 intrafocal pinning extension block 2 1/3 40 extension loss 文献 1 mallet finger closed reduction 5: , : , Mallet 22: 58-61, step off X 30: 65-70, : , Mallet 27: 28-30, Wehbé MA, et al. Mallet Fractures. J Bone Joint Surg. Am 66: , mallet finger 34: , DIP extension block closed reduction J.MIOS 20: 51-57, Chung DW, et al. Anatomic reduction of mallet fractures using extension block and additional intrafocal pinning techniques. Clin Orthop Surg 4: 72-76,

114 J Jpn Soc Surg Hand D-CT D-CT D-CT 3D-CT 3D-CT MRI MRI 3D-CT 緒言 3 surface rendering 3 1 volume rendering CT 3D-CT 対象と方法 D-CT D-CT GE Healthcare Bright Speed Elite SD16 CT 3D auto electoric control AEC 140kV 130mA 3D-CT 1 Y1 3 結果 3D-CT 1 3D-CT /10/

115 676 3D-CT 表 1 図 DIP FDP DIP 1 3D-CT FDP DIP MP 2 6 A1 pulley A5 pulley A2 A4 pulley 3 Y 図 2 図 3 1 3D-CT FDP MP DIP 1 A1 A5 Y1 DIP 4 3D-CT FDP MP MP

116 3D-CT 677 図 DIP 図 D-CT FDP MP MP PA A1 pulley A2 pulley 6 Y DIP 7 3D-CT FDP DIP PIP 8 図 6 2 FDP A1 A2 Y1 3D-CT 3 C2 C3 A5 pulley 9 Y1 考察 Volume rendering 3D-CT CT CT 2 CT window 111

117 678 3D-CT 図 DIP 図 9 7 A5 C2 Y1 図 8 7 3D-CT FDP DIP PIP level WL window width WW 3 FDP FDS WL WW 3D-CT MRI MRI D-CT D-CT 3D-CT 2 6 3D-CT 3D-CT まとめ 3D-CT 3D-CT 112

118 3D-CT 679 3D-CT 文献 1 Volume rendering method 3D-CT 2 52: , : , CT MB Orthop 19:71-77, : , MB Orthop 26: , D-CT 25: ,

119 J Jpn Soc Surg Hand すどう 湏 EPL EIP Golden standard EIP APL APL EIP 4 APL EPL IP extension lag Riddell excellent 5 good 3 Chitnis APL EPL 緒言 EPL EIP 1 2 Golden standard EIP EIP ECRL 3 EPB 3 Chitnis 4 Bullon 5 APL EPL APL 対象と方法 APL 8 EPL 4 EPL 2 EPL 1 EPB 1 EPL EPB 17 EPL APL APL AAPL EPL 1 3 IP Riddell 1 結果 EPL IP extension lag kg 95.4 Riddell excellent 4 good 3 EPB 3 IP 10 Riddell excellent /10/

120 APL 681 図 1 EPL APL APL EPL 図 3 1 X 図 図 2 1 IP 1 3 IP IP DASH 18 X volar shift 23mm 14mm 3 EPL EPL EIP AAPL Riddle Good DASH MP 5 MR T2 high intensity 6 EPB 4 EPL EPB EPB MP 115

121 682 APL 図 5 2 MP 図 7 2 EPB APL 図 図 6 2 MR T2 high intensity APL 7 3 IP MP 10 0 Riddell Excellent 8 考察 EPL EIP 1 2 EIP 8 4 Zilber 6 EIP review EIP EIP EIP Chitnis 4 APL EPL 20 Mugnussen 2 EIP Shannon 3 EIP ECRL EPB EPL APL Chitnis 4 IP Riddell good 9 EIP EPL APL APL 116

122 APL 683 図 9 IP Riddell 1 図 10 APL EPB EPL まとめ 1 APL 8 2 IP extension lag 1 Riddell excellent 5 good 3 3 APL EPL EIP 4 EPB APL 93 7 APL APL 1 Chitnis 4 APL split Tsailas 8 EPL EPB EPL EIP EPB APL EPB APL EPB 10 1 extension lag Chitnis 4 IP Bullon 5 EPL 11 APL 3 rerout Chitnis 4 3 文献 1 Riddell DM. Spontaneous rupture of the extensor pollicic longus: the results of tendon transfer. J Bone Joint Surg 45-B: , Magnussen PA, et al. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg 72-B: , Shannon FT, et al. Surgery for rupture of extensor tendons in rheumatoid arthritis. The Hand 8: , Chitnis SL, et al. Tendon transfer to restore extension of the thumb using abductor pollicis longus. J Hand Surg 18-B: , Bullon A, et al. Reconstruction after chronic extensor pollicis longus ruptures: a new technique. Clin Orthop Relat Res 462: 93-98, Zilber S, et al. Anatomical variations of the extensor tendons to the fingers over the dorsum of the hand: a study of 50 hands and a review of the literature. Plast Reconstr Surg 113: , Van Oudenaarede E. Structure and function of the abductor pollicis longus muscle. J Anat 174: , Tsailas PG, et al. Delayed repair of spontaneous rupture of both the extensor pollicis longus and brevis: a case report. Hand Surg 17: ,

123 J Jpn Soc Surg Hand 緒言 1 対象と方法 表 /10/

124 685 図 1 17 a 2 b c 2 Acutrack mini screw 4 Acutrack 2 mini screw 2 6 MP LIPUS low grade pulsed ultrasound 結果 mm mm 2 3.5mm mm a 2 Acutrack mini screw 1b 2.5 1c a CT 2b Acutrack 2 mini screw 2c 6 2d

125 嚢胞型舟状骨中枢部骨折に対する経皮的内固定術 686 図2 22 歳 男性 数年前から柔道時の両側手関節痛を自覚しているが 明らかな 受傷時期は不明 a 初診時 両側舟状骨の中枢部骨折を認める 骨吸収像は帯状を呈している b CT では 明らかな骨硬化像は認めず 中枢骨片にも骨梁構造を認める c 左手術直後 d 術後 6 か月 e 術後 43 か月で骨癒合を確認 図3 左手術から 4 年後に右手術施行 a 手術直後 b 術後 1 年の時点で骨癒合は得られていない ことで再受診となった この時 左舟状骨は骨癒合 が得られており 特に症状も認めていなかった 図 2e 右舟状骨は画像的に左とほぼ同様であり 右に 対しても経皮的に Acutrack 2 mini screw 固定を行っ た 図 3a しかし 術後 1 年の時点では 右手関 節の症状は消失しているが骨癒合は得られていない 状況であった 図 3b このまま無症候性偽関節と なる可能性はあるが 左と同様に長期経過して骨癒 合を得られる可能性もあり 今後も経過観察してい く予定である 考 察 嚢胞型の舟状骨骨折の内固定に際し 骨移植を併 用するか否かについては 未だコンセンサスが得ら れていないが 自験例も含め 近年では骨移植を併用 せずに経皮的スクリュー固定のみで良好な成績が得 120

126 687 Mahmoud 2 27 Saint- Cyr Mahmoud CT 2mm LIPUS 6 7 まとめ

127 688 文献 1 Ikeda K, et al. Percutaneous screw fixation without bone graft for cystic-type scaphoid fractures. J Trauma 65: , Mahmoud M, et al. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. J Bone and Joint Surg 93B: , Saint-Cyr M, et al. Dorsal percutaneous cannulated screw fixation for delayed union and nonunion of scaphoid. Plast Reconstr Surg 128: , : , Adams BD, et al. Technical factors related to Herbert screw fixation. J Hand Surg 13: , LIPUS 48: , : ,

128 J Jpn Soc Surg Hand PD PM PP 3 RL angle PD PM k-wire PD DISI SLID 緒言 1 1/3 SLID B2 B1 proximal pole B3 B2 B1 B3 3 3 対象と方法 X 3 CT distal PD 5 図 /10/

129 690 1/3 2 middle PM 14 1/3 PP 3 proximal pole PP 6 Schernberg 2 type 1 X 1/3 3 DISI RL angle MRI Cooney scoring system t P 0.05 表 1 3 結果 PD PM PP / 5/0 12/2 6/0 / 3/2 10/4 4/ PP 1 1 Proximal Fragment Ratio PFR RL angle RL angle PD RL angle PM X MRI PP 2 intensity T1 low T2 low high low Mozaic 図

130 691 表 2 3 Zaidemberg DTJ mini screw Meira DISI 10 / 70/ Cooney score 100point 3 Zaidemberg Makino headless screw k-wire PM mm RL angle PD RL angle PM Cooney score point / 51.0/ / / PM 1 24 PD 12 DISI RL angle 23.3 考察 MRI 3 Herbert screw /3 proximal pole 2 X 1 SLID type type 1/3 1/3 3 retrospective DISI PD PP PD DISI SL SLID PD SLID PD SLID 5 125

131 692 図 3 A X B 3 CT C sagital CT D MRI-T1 E MRI-T2 F 10 X G 10 CT H I J PD RL angle DISI PD DISI Humpback deformity DISI MRI T1 low intensity T2 low intensity Mozaic MRI 9 PD PM PP Cooney score PD 2 screw k-wire fresh cadaver 126

132 mm Muzaffar 10 screw 3mm headless screw まとめ RL angle PD 3. 文献 1 31: , Schernberg F, et al. Bruchformen und Fragmentdislokationen des Kahnbeins der Hand. Handchirurgie 19: 59-66, : , salvage 36: , Steinmann SP, et al. Use of the 1,2 intercompartmental supraretinacular artery as a vascularazed pedicle bone graft for difficult scaphoid nonunion. J Hand Surg 27-A: , Jones DBJ, et al. Treatment of Scaphoid Waist Nonunions with an Avascular Proximal Pole and Carpal Collapse. Surgical Technique. J Bone Joint Surg Am 91: , Burger HK, et al. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg 38-A: , : , Gunal I, et al. Correlation of magnetic resonance imaging and intraoperative puncate bleeding to assess the vascularity of scaphoid nonunion. Arch Orthop Trauma Surg 119: , Muzaffar AR, et al. Vascularized Bone Grafting and Herbert Screw Fixation of Scaphoid Nonunions With Avascular Proximal Poles. Tech Hand Up Extrem Surg 6: ,

133 J Jpn Soc Surg Hand ,2 ICSRA humpback defomity 1,2 ICSRA MRI T1 rectanglar graft wedge graft humpback 1,2 intercompartmental supraretinacular artery 1,2 ICSRA DISI humpback deformity 1,2 ICSRA humpback deformity 緒言 1,2 intercompartmental supraretinacular artery 1,2 ICSRA 1,2 ICSRA MRI T1 DISI rectanglar graft wedge graft humpback 1,2 intercompartmental supraretinacular artery 1,2 ICSRA humpback deformity 対象と方法 ,2 ICSRA MRI T1 humpback deformity X CT non contrast MRI X carpal height ratio CHR interscaphoid angle ISA radiolunate angle RLA scapholunate angle SLA CT 2 humpback deformity ISA 45 DISI RLA 15 SLA70 t 5 1,2 ICSRA 1 1 DISI 1,2 ICSRA rectanglar graft ,2 ICSRA 2014/10/

134 舟状骨偽関節に対する血管柄付骨移植術 図1 図2 図4 DISI 変形のない場合 DISI 変形のある場合 橈側面からの wedge graft を行う 38 歳男性 近位部舟状骨偽関節 T1 強調画像 T2 強調画像 図3 術前 MRI rectanglar graft を行う 38 歳男性 近位部舟状骨偽関節 図5 を血管茎とした背側からの有茎血管柄付骨移植を行 った 図 3 図 4 図 5 参照 2 DISI 変形を伴う舟状骨偽関節に対しては 背 側より舟状骨偽関節を展開し 手関節掌屈位に保持 して DISI 変形を矯正し 橈骨月状骨間を鋼線で固 定した 舟状骨に鋼線を刺入して仮固定を行い 骨 欠損部の採計または計測を行い 1mm 大きい wedge graft を 1,2 ICSRA を茎として採取した 1,2 ICSRA の血管茎が付いた面が 舟状骨橈側面に面するよう に移植骨を移植して スクリュー固定をおこなった 図 2 症例供覧 50 歳女性 受傷 6ヶ月で来院 1,2 ICSRA 695 術前単純 X 線 CT 38 歳男性 近位部舟状骨偽関節 術前単純 X 線 CT 術後 6ヶ月 を血管茎とした背側からの有茎血管柄付骨移植を行 った 整復困難であったため 掌側切開を追加した 図 6 図 7 図 8 参照 結 果 骨癒合率は 93.7 で 一例で遷延癒合のため追加 で腸骨移植術を行った 骨癒合期間は平均 82.1 日 38 日 176 日 であった 全例スクリューで固定 を行った アキュトラックミニ 12 例 マイクロ 4 例 固定性不十分なものは鋼線を追加した 16 例 中 15 例では背側切開のみで 1 例では整復困難で あったため 掌側切開を追加した 感染例は認めな 129

135 舟状骨偽関節に対する血管柄付骨移植術 696 図6 図7 図8 50 歳女性 humpback 変形を伴う舟状骨偽関節 術前単純 X 線 CT 50 歳女性 humpback 変形を伴う舟状骨偽関節 T1 強調画像 T2 強調画像 50 歳女性 humpback 変形を伴う舟状骨偽関節 単純 X 線 CT 表1 かった 術前可動域は平均背屈 平均掌屈 平均回外 平均回内 術前平均握力は 21.1kg 6.7kg 35kg であった 最終経過観察時手 関節可動域は平均背屈 平均掌屈 平均回外 平 均回内 握力平均 29 3kg 16.7kg 37kg 平均握力健側比 75.9 であった 表 1 舟状骨長は術前平均 20.8mm 17.6mm 23.8mm から 22.6mm 20.0mm 24.4mm と長さが回復した 術前 MRI 術後 6ヶ月 骨癒合期間 手関節 ROM 握力 P CHR は術前平均 か ら と増大したが P 有意 差は認めなかった ISA は術前 か ら術後 に改善した P

136 697 ISA RL P SL P 考察 1,2 ICSRA Zaidemberg Steinmann Waitayawinyu Boyer Chang hump back deformity 1,2 ICSRA hump back deformity 1,2 ICSRA Jones DB humpback deformity 1,2 ICSRA 6 Henry hump back deformity 1,2 ICSRA MRIT1 hump back deformity 1,2 ICSRA SL P RLA P ISA P DISI humpback deformity 1,2 ICSRA 1,2 ICSRA 9.7mm 15mm hump back deformity 8 pedicle 表 2 interscaphoid angle radiolunate angle scapholunate angle 131

137 698 1,2 ICSRA wedge graft hump back deformity 9 humpback deformity ISA 2 1 ISA97 ISA47 1 ISA59 ISA J Hand Surg 31A: , Jones DB, et al. Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg Am : , Henry M. Collapsed scaphoid non-union with dorsal intercalated segment instability and avascular necrosis treated by vascularised wedge-shaped bone graft and fixation. J Hand Surg 32Eu: , Humpback deformity 29: , : 74-78, 2007 まとめ 1,2 ICSRA humpback deformity 文献 1 Zaidemberg C, et al. A new vascularized bone graft for scaphoid nonunion. J Hand Surg 16A: , Steinmann SP, et al. Use of the 1,2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion. J Hand Surg 27A: , Waitayawinyu T, et al. Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis. J Hand Surg 34A: , Boyer MI, et al. Scaphoid nonunion with avascular necrosis of the proximal pole. Treatment with a vascularized bone graft from the dorsum of the distal radius. J Hand Surg 23B: , Chang MA, et al. The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. 132

138 J Jpn Soc Surg Hand M I M/I / / M/I / / / M/I M/I M/I 緒言 MRI MRI MRI 6 8 対象と方法 DML 4.5ms SCV 40.0m/s TOSHIBA Aplio 12MHz M I M/I M/I 3 M/I DML 4ms M/I Con M/I 1 MRI 3tesla M/I MRI M/I M/I 2 M/I Con M/I M/I Con M/I 2014/10/

139 700 M/I ConM/I M/I 3 M/I 4 DML M/I n-vas M/I 1 2 Mann- Whitney U-test 4 5 Spearman p 0.05 表 1 * chi square test ** Mann-Whitney U-test 表 2 結果 ms DML ms p M/I MRI M/I Con M/I M/I n-vas M/I MRI M/I 2 M/I Con M/I M/I M/I Con M/I M/I 2 3 M/I DML M/I n-vas M/I M/I M/I 0.36 MRIM/I 0.53 DML 7.3ms M/I 1 n-vas 2 1 考察 p M/I M/I Con M/I p 0.1. MRI M/I M/ I MRI / / M/I M/I M/I Lee 9 Duncan

140 701 図 1 A M/I 0.36 MRI M/I 0.53 DML 7.3 B M/I 1 n-vas 2 M I 2 M/I DML まとめ : , Atroshi I, et al. Prevalence of calpal tunnel syndrome in a general population. JAMA 282: , Nathan PA, et al. Slowing of sensory conduction of median nerve and carpal tunnel syndrome in Japanese and Amrican industrial workers. J Hand Surg Br 19: 30-34, Rempel D, et al. Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies. Am J Public Health 88: , Nakamichi K, et al. Ultrasonographic measurement of median nerve cross-sectional area in idiopathic carpal tunnel syndrome: Diagnostic accuracy. Muscle Nerve 26 6 : , Cudlip SA, et al. Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression. J Neurosurg 96 6 : , Mondelli M, et al. Ultrasonography before and after surgery in carpal tunnel syndrome and relationship with clinical and electrophysiological findings. A new outcome predictor? Scand J Rheumatol 37 3 : , point plan scan MRI 25 3 : , Lee CH, et al. Postoperative morphologic analysis of carpal tunnel syndrome using high-resolution ultrasonography. Ann Plast Surg 54 2 : , Duncan I, et al. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol : , 文献 1 135

141 J Jpn Soc Surg Hand APB-CMAP MMT 緒言 APB-CMAP APB APB-CMAP 対象と方法 20 4 APB-CMAP ECTR Camitz APB Camitz APB APB-CMAP SL-CMAP SL-CMAP APB-CMAP 結果 APB-CMAP APB-CMAP APB 2014/10/

142 APB-CMAP 703 図 1 APB-CMAP 図 2 APB-CMAP 図 3 MMT 3 SL-CMAP SL-CMAP 7 8 APB-CMAP APB-CMAP APB- CMAP SL-CMAP 図 4 APB-CMAP SL-CMAP 7.5ms 4 ECTR 6 APB-CMAP 137

143 704 APB-CMAP 図 5 図 APB MMT 5 5 APB-CMAP 5.56ms 1.99mV 6 考察 APB-CMAP Camitz Camitz APB- CAMP APB- CAMP APB-CMAP 8 APB- CMAP SL-CMAP APB-CMAP 70 2 SL-CMAP 2 12 APB-CMAP APB MMT 3 Camitz ECTR APB-CMAP 70 2 SL-CMAP ECTR 1 9 CMAP

144 APB-CMAP 705 まとめ APB-CMAP 文献 1 16: , APB-CMAP 24: , : , : , : , Nobuta S, et al. Clinical results in severe carpal tunnel syndrome and motor nerve conduction stdies. J Orthop Sci 10: 22-26, : , : , : , Capasso M, et al. Management of extreme carpal tunnel syndrome : Evidence from a long-term follow-up study. Muscle & Nerve 40: 86-93,

145 J Jpn Soc Surg Hand L-INT 2L-INT 2 1 2L-INT DML SCV 2L-INT 2L-INT DML SCV 2L-INT 22 DML SCV 2L-INT DML SCV 2L-INT DML SCV 緒言 CTS Distal Motor Latency DML Sensory Conduction Velocity SCV CTS DML SCV CTS DML SCV 2 2L-INT 対象と方法 Grade Grade Grade 3 77 DML SCV 2L-INT 2 1 2L-INT 2L-INT 3 10cm CMAP 1 25mm 14cm 2 DML SCV 2L-INT 4.2ms 45m/s 4 0.6ms 0.5ms 3 結果 DML SCV L-INT 2014/10/

146 707 図 3 2L-INT DML 図 1 2 図 4 SCV 図 2 16 DML SCV 2L-INT 13 2L-INT DML SCV DML SCV 2L-INT 22 DML SCV 考察 CTS DML SCV DML SCV CTS CTS 2L-INT

147 708 3 CMAP CTS CTS 2 CTS DML SCV 2L-INT 3 2L-INT DML SCV SCV DML CTS DML SCV 2L-INT CTS 7 8 2L-INT 22 DML SCV 16 DML SCV 2L-INT 13 2L-INT DML SCV 3 2L-INT 2L-INT L-INT CTS DML SCV まとめ 1 2 2L-INT DML SCV 文献 1 Preston DC, et al. Lumbrical and interossei recording in carpal tunnel syndrome. Muscle Nerve 15: , Uncini A, et al. Ring finger testing in carpal tunnel syndrome: a comparative study of diagnostic utility. Muscle Nerve 12: , : 43-47, pp83-85, : , Logigian EL, et al. Lumbrical sparing in carpal tunnel syndrome: anatomic, physiologic, and diagnostic implications. Neurology 37: , Boonyapisit K, et al. Lumbrical and interossei recording in severe carpal tunnel syndrome. Muscle Nerve 25: , Nobuta S, et al. Clinical results in severe carpal tunnel syndrome and motor nerve conduction studies. J Orthop Sci 10: 22-26,

148 J Jpn Soc Surg Hand Pain vision TM Pain Vision TM Pain Vision TM Pain Vision TM Numerical Rating Scale face scale Pain Vision TM 緒言 Visual Analog Scale VAS Numerical Rating Scale NRS 3 Pain Vision TM Pain Vision TM 50Hz 0.3ms C Aβ Aδ Pain Vision TM 4 Pain Vision TM 対象と方法 Pain Vision TM /10/

149 710 Pain vision 図 1 Pain Vision TM NRS 0.3 P 0.1 face scale 0.49 P face scale NRS Face scale Pain Vision TM 3 11 Numerical Rating Scale NRS 6 face scale scale Pain Vision TM t P 0.05 結果 Pain Vision TM NRS face scale NRS face scale 考察 5 6 Pain Vision TM 7 11 NRS 2 face scale 6 図 2 a b NRS c face scale 144

150 Pain vision 711 図 3 a b NRS c face scale * P 0.05 Pain Vision TM VAS NRS Pain Vision TM 8 Pain Vision TM Pain Vision TM 9 10 Pain Vision TM face scale Pain Vision TM まとめ Pain Vision TM Numerical Rating Scale face scale Pain Vision TM 文献 1 Katz RT, et al. Carpal tunnel syndrome: a practical review. Am Fam Physician 49: , Finsen V. Neurophysiology not required before surgery for typical carpal tunnelsyndrome. J Hand Surg Br 26: 61-64, pp69-76, Pain Vision 29: , Orthopaedics 20: 17-20, : , PainVision 57: , Iwatsuki K, et al. Comparative responsiveness of the Hand 20 and the DASH-JSSH questionnaires to clinical changes after carpal tunnel release. J Hand Surg Eur 39: , PainVision 71: , PainVision 19: ,

151 J Jpn Soc Surg Hand STAI SDS Quick DASH CTSI-JSSH VAS STAI SDS STAI SDS 3 6 CTSI-JSSH 緒言 対象と方法 msec State-Trait Anxiety Inventory STAI Self-rating Depression Scale SDS STAI STAI 5 III IV SDS /10/

152 713 Quick DASH CTSI-JSSH Visual Analogue Scale VAS STAI SDS - Quick DASH CTSI-JSSH VAS STAI SDS 図 1 STAI SDS STAI SDS STAI SDS Mann-Whitney U test Friedman s χ2r-test Wilcoxon t-test with Bonferroni correction 0.05 結果 STAI n 11 n 8 Quick DASH CTSI-JSSH VAS Quick DASH VAS CTSI-JSSH 2 SDS n 10 n 9 Quick DASH CTSI-JSSH VAS 3 STAI 3 6 図 2 STAI Quick DASH VAS STAI 147

153 714 STAI 3 Quick DASH CTSI-JSSH VAS 6 Quick DASH CTSI-JSSH 1a SDS CTSI-JSSH 3 3 VAS 6 1b 12 STAI SDS 考察 図 3 SDS SDS 表 1 a STAI Quick DASH CTSI b SDS 3 CTSI 3 VAS 6 148

154 abstract Pogorzelski 7 Hobby STAI Spielberger SDS Zung Quick DASH CTSI-JSSH 1 1 STAI SDS CTS まとめ 3 Q-DASH CTSI-JSSH 6 12 Q-DASH CTSI-JSSH 文献 1 61: 71-78, : , Self-rating Depression Scale 23: , : 63-85, Helliwell PS, et al. Work related upper limb disorder: the relationship between pain, cumulative load, disability and psychological factors. Ann Rheum Dis 51: , Macfarlane GJ, et al. Role of mechanical and psychosocial factors in the onset of forearm pain: a prospective population based study. BMJ 16: , Pogorzelski R, et al. Neurological and emotional profile of carpal tunnel syndrome patients. Przegl Lek 68: , Hobby JL, et al. The effect of psychological disturbance on symptoms, self-reported disability and surgical outcome in carpal tunnel syndrome. J Bone Joint Surg Br 87: , STAI 22: , : ,

155 J Jpn Soc Surg Hand PIP 2 Bouchard Bouchard 3 PIP /10 VAS DASH TAM PIP 緒言 Bouchard PIP Bouchard 対象と方法 PIP 502 QOL A X Bouchard B X 125 A Bouchard a b c d e 1 3cc A1 1 2cc 2cm A2 pulley 2014/10/

156 Bouchard 717 図 1 図 2 a b PIP Bouchard c quadriga phenomenon d PIP e quadriga phenomenon A1 pulley 1cm A1 pulley Disabilities of the Arm, Shoulder and Hand The JSSH Version DASH Visual Analogue Scale VAS PIP total active motion TAM TAM 結果 VAS 88.2mm 10.2mm PIP

157 718 Bouchard 図 3 VAS 1/10 図 4 DASH 図 5 DASH mean TAM X 15 PIP VAS DASH 4 disability sports work kg 19.0kg QOL 5 bowstringing 3 1 考察 PIP 1000 X Bouchard PIP 6 152

158 Bouchard 719 図 6 PIP PIP 図 7 PIP Bouchard bowstringing Bouchard A bowstringing PIP 2 8 PIP Bouchard 9 PIP Le Viet Favre & Kinnen 5 PIP PIP PIP Bouchard PIP 153

159 720 Bouchard 図 8 Bouchard 図 9 PIP PIP PIP Le Viet Favre Bouchard quadriga phenomenon 2-c 1 2 quadriga phenomenon 2-e 1 2 PIP bowstringing 3 Bouchard QOL Bouchard 3 PIP PIP A1 A1 PIP Bouchard PIP 154

160 Bouchard 721 図 10 PIP Bouchard 1 Bouchard Bouchard PIP Bouchard 10 Bouchard Heberden X PIP PIP 文献 1 Bouchard 22: , Le Viet D, et al. Trigger finger treatment by ulnar superficialis slip resection U.S.S.R.. J Hand Surg Br 29B: , Ferlic DC, et al. Flexor tenosynovectomy in the rheumatoid finger. J Hand Surg Am 3: , Marcus AM, et al. Treating trigger finger in diabetics using excision of the ulnar slip of the flexor digitorum superficialis with or without A1 pulley release. Hand NY 2: , Favre Y, et al. Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture. J Hand Surg Am 37: , Dahaghin S, et al. Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability. Ann Reum Dis 64: , Heberden 4: , 1987 まとめ Bouchard QOL 155

161 J Jpn Soc Surg Hand PIP PIP Mayo clinic score Mayo clinic Good 9 Fair 1 Poor 0 X 2 2 PIP RA OA OA 緒言 RA PIP PIP PIP 対象と方法 Self locking finger joint system PIP X PIP A3 pulley PIP buddy taping PIP Mayo clinic score 1 X arc Wilcoxon p 0.05 結果 Mayo clinic score Good 9 Fair /10/

162 PIP 723 図 1 a b c d X e f X Poor 0 X X X 60 PIP PIP a b X OA 1c d e f a 2b X 2c 1 3a e JuggerKnot 1.0mm Biomet Japan 3b c 3d a b c Mayo clinic score Good 考察 PIP 157

163 724 PIP 図 2 a 1 b 1 c 1 X 図 3 a 1 b FDS c d e X PIP 2 158

164 PIP 725 図 4 1 a b c X PIP Linscheid 1 Murray 3 4 Stoecklein RA RA PIP 1 2 buddy taping まとめ PIP

165 726 PIP 文献 1 Linscheid RL, et al. Development of a surface replacement arthroplasty for proximal interphalangeal joints. J Hand Surg 22A: , PIP 27: , Murray PM, et al. Long-term outcomes of proximal interphalangeal joint surface replacement arthroplasty. J Bone Joint Surg 94A: , PIP 23: , Stoecklein HH, et al. Surface replacement arthroplasty of the proximal interphalangeal joint using a volar approach:case series. J Hand Surg 36A: , PIP 30: 92-95, : ,

166 J Jpn Soc Surg Hand 緒言 CPPD CPPD CPPD 5 対象と方法 McCarty definite probable X CPPD definite probable CPPD 80.5 t χ p 0.05 結果 /10/

167 728 表 1 図 考察 X CPPD CPPD 1 Masuda Fam

168 729 図 2 80 A B Fam Louthrenoo retrospective pp , Masuda I, et al. Clinical Feature of Pseudogout Attack. Clin Orthop and Rel Res 229: , Fam AG, et al. Clinical and roentgenographic aspects of pseudogout: a study of 50 cases and a review. Can Med Assoc J 124: , Doumas C, et al. Acute calcific periarthritis of the hand and wrist: a series and review of the literature. Emerg Radiol 14: , Sallis JD, et al. Inhibitors of articular crystal formation. Curr Opin Rheumatol 15: , Louthrenoo W, et al. Calcium pyrophosphate dehydrate crystal deposition: a clinical and laboratory analysis of 91 Thai patients. J Med Assoc Thai 82: , まとめ 文献 1 Terkeltaub RA. Pathogenesis and treatment of crystalinduced inflammation. In: Koopman WJ ed. Arthritis and Allied Conditions. 1. Baltimore. Williams & Wilkins. 163

169 J Jpn Soc Surg Hand fair 3 good 5 excellent fair 3 2 bowstringing A2 A4 bowstringing 緒言 対象と方法 結果 snapping 2 12 excellent 6 good 5 fair 3 good MP 3 snapping MP 3 Fair 3 2 bowstringing 1 4kg 71 snapping MP 2014/10/

170 731 表 1 12 PIP MP -10/78 図 1 MP -50 図 2 図 bowstringing 6 HbA1c 7.2 MP MP MP hard end X MP 1 A1 FDS A1 FDP A1 MP MP MP bowstringing MP 3 考察 bowstringing 5. Will Will

171 Moriya PIP bowstringing A2 A4 bowstringing 2 A2 bowstringing Phillips 3 A1 A2 MP bowstringing A2 A1 MP bowstringing 2 Moriya K, et al. Comparison of the surgical outcomes for trigger finger and trigger thumb:preliminary results. Hand Surgery 10-1: 83-86, Phillips C, et al. Mechanical Analysis of the Palmar Aponeurosis Pulley in Human Cadavers. J.Hand Surgery 21A: , まとめ good A2 A1 bowstringing 文献 1 Will R, et al. Complications of Open Trigger Fingers Release. J.Hand Surgery 35A: ,

172 J Jpn Soc Surg Hand A 40mg 1 5ml 1. Larsen grade 2. visual analogue scale 3. carpal height ratio radio carpal distance ratio radial rotation angle 4. 20mg 緒言 RA 40mg 1 5ml 1. Larsen grade 2. visual analogue scale VAS 3. carpal height ratio CHR radio carpal distance ratio RCDR radial rotation angle RRA 4. 対象と方法 RA 40mg 1 5ml Larsen grade I 8 14 grade II grade III grade VI grade I 1 grade III 3 grade IV 2 1 grade III 2 grade III 1 grade IV 1 1 grade III 2 grade III 1 grade IV 1 1 grade IV 23G 40mg 1 5ml mg 2014/10/

173 734 RA mg grade II 2 1. grade 2. VAS CHR Youm 1 2 RCDR 2 RRA student s t-test 4. 結果 1 grade grade 表 1 grade 表 2 168

174 RA grade grade I grade II ,8,11 2 grade III , grade IV 1,2 5 3,11 2 4, visual analogue scale VAS 79mm 11mm 20mg 80mm 表 3 grade I 表 5 grade III 表 4 grade II 表 6 grade IV 169

175 736 RA 表 7 grade I II grade III IV CHR RCDR RRA 11mm 40mg 76mm 11mm CHR RCDR RRA Larsen grade I II 34 Larsen grade III IV 38 Larsen grade I II CHR RCDR RRA CHR Larsen grade III IV CHR RCDR RRA 考察 RA 2 Darrach Sauvè- Kapandji grade II Sauvè-Kapandji mg 1 5ml 5 VAS CHR RCDR RRA Ostergaard grade 4 / 91 grade grade I grade II / 2 No. 21 grade III No. 22 No / 170

176 RA 737 grade IV No / No / 5 / 5 No mg 5mg Sauvè-Kapandji 3 6 VAS 20mg grade I II CHR RCDR RRA grade III IV CHR RCDR RRA RA CHR CHR RA Chandler 7 RA Salter Ostergaard 4 / RA 20mg 1 RA まとめ 1 RA 40mg 1 5ml 1 4 grade 90 5, mg 3 4 文献 1 Youm Y, et al. Kinematics of the wrist. J Bone Joint Surg 60A: , : , : ,

177 738 RA 29: , A 51: , Ostergaard M, et al. Intra-articular glucocorticoid injections in joint deseases. Ugeskr Laeger 161: , Chandler GN, et al. Deleterious effect of intra-articular hydrocortisone. Lancet 2: , : , Corticosteroid 52: , Salter RB, et al. Hydrocortisone arthropathy. An experimental investigation. Canada Med Asso J 97: ,

178 J Jpn Soc Surg Hand PCR Mycobacterium marinum 2 Mycobacterium Intracellulare 1 4 PCR 3 EB RFP EB RFP CAM EB RFP MINO PCR EB RFP 緒言 対象と方法 EB RFP PCR polymerase chain reaction PCR 結果 CRP MRSA 1 Candida.sp 1 PCR DDH DNA-DNA hybridization Mycobacterium marinum 2 Mycobacterium Intracellulare RFP EB 4 RFP EB CAM 2 RFP EB MINO /10/

179 740 表 1 図 1 1 a b DIP MP A2 A4 pulley 1 MRSA REF EB MP MRI 2-a DIP MP A2 A4 pulley 2-b c REF EB MP MRI 3-a DIP MP A1 A2 A4 pulley 3-b c 174

180 741 図 2 3 a MRI T2 b c 図 3 5 a MRI T2 b c REF EB CAM 考察 CRP 1 2 Mycobacterium marinum PCR Mycobacterium avium-intracellular PCR REF EB CAM MINO

181 742 6 DIP MP 6 まとめ REP EB 6 3 PCR 文献 1 24: , Mycobacterium marinum 23: , : , : , : ,

182 J Jpn Soc Surg Hand ,5 2, Kanavel 4 MRI 緒言 対象と方法 結果 CRP mg/dl MRI T2 MRI ,5 2, MRSA 1 MSSA MRI MRSA VCM 2014/10/

183 744 表 1 表 2 Riorden MRI 4,5 1 2 考察 Mrabet 5 178

184 745 図 図 Kanavel MRI 179

185 746 まとめ 6 Kanavel 4 MRI 文献 1 3 pp , Newman ED, et al. Suppurative extensor tenosynovitis caused by Staphylococcus aureus. J Hand Surg Am 14 5 : , Loncarich D, et al. Suppurative extensor tenosynovitis of the extensor carpi ulnalis tendon sheath. Am J Orthop : , Meier JL, et al. Bursitis and tenosynovitis caused by group G streptococci. J Rheumatol 10 5 : , Mrabet D, et al. Tuberculosis tenosynovitis of the extensor tendons of the wrist. BMJ Case Rep online, pp ,

186 J Jpn Soc Surg Hand mg/ml 1-15ml/hr 緒言 対象と方法 a b 2c 結果 mg/ml 1-15ml/hr PIP 1 3 PIP /10/

187 748 図 1 図 2 a b c 図 3 表 1 182

188 749 図 / 90 PIP 0 / mg/ml 4ml/hr PIP 4 6 PIP -30 / 35 PIP 0 / mg/ml 4ml/hr 4 39 図

189 / / 考察 1884 William Halsted Richard Hall Ilfeld Yu PCA patient-controlled analgesia Horner Borgeat PCIA patientcontrolled interscalene analgesia 5 1.7mg/ml 4ml/hr 4 visual analogue scale VAS CRPS 184

190 751 まとめ 8 文献 1 Hameed U, et al. The Cochrane Library 2014 Continuous interscalene brachial plexus block versus parenteral analgesia for postoperative pain relief after major shoulder surgery Review. The Cochrane Collaboration. England. John Wiley & Sons. pp 1-28, Mian A, et al. Brachial plexus anesthesia A review of the relevant anatomy, complications, and anatomical variations. Clinical Anatomy 27: , Ilfeld B.M, et al. Continuous Interscalene Brachial Plexus Block for Postoperative Pain Control at Home: A Randomized, Double-Blinded, Placebo-Controlled Study. Anesth Analg 96: , Yu B, et al. Non-stimulation needle with external indwelling cannula for brachial plexus block and pain management in 62 patients undergoing upper-limb surgery. International Journal of Medical Sciences 9: , Borgeat A, et al. Patient-Controlled Interscalene Analgesia With Ropivacaine 0.2 versus Bupivacaine 0.15 After Major Open Shoulder Surgery: The Effects on Hand Motor Function. Anesth Analg 92: ,

191 J Jpn Soc Surg Hand MP MP MP MP 緒言 MP MP 対象と方法 MP MP 1 1 結果 MP /10/

192 MP 753 表 1 図 2 図 考察 MP MP 図

193 754 MP constriction band 2 MP constriction band MP constriction band MP 8 9 MP まとめ MP 文献 1 MP 15: , Yamanaka K, et al. Locking of the metacarpophalangeal joint of the thumb. J Bone Joint Surg Am 67: , Inoue G, et al. Locked metacarpo-phalangeal joint of the thumb. J Hand Surg Br 13: , MP 14: , MP locking 5 29: , MP locking 1 3: 65-67, : , MP 4: , MP MP 17: ,

194 J Jpn Soc Surg Hand X X X X mSv 32.5mSv mSv 500mSv/ 緒言 X X X 対象と方法 X 1A 1B C 図 1 A B C 2014/10/

195 756 X 1 X GE Brivo OEC850 X dose area product DAP 1 DAP X 図 2 結果 X DAP 7.14mGym mGym2 0.08mGym mGym2 0.51mGym mSv mSv 0.1mSv 32.5mSv mSv mSv 2.32mSv 5 6 考察 図 3 X 図 4 DAP dose area product 1 X 190

196 X 757 図 5 図 mSv 1 50mSv X mSv 150mSv mSv 500mSv Riley mSv 2 Singer 1 0.2mSv mSv mSv 4 10 Singh mSv DAP Tuohy mini C-arm mSv 6 まとめ mSv mSv 1 2.3mSv 191

197 758 X 文献 1 INNERVISION 25: 46-49, Riley SA. Radiation exposure from fluoroscopy during orthopedic surgical procedures. Clin Ortop 248: , Singer G. Radiation exposure to the hands from mini C- arm fluoroscopy. J Hand Surg 30A: , X 40: , Singh PJ, et al. Measurement of the dose of radiation to the surgeon during surgery to the foot and ankle. J Bone Joint Surg 89B: , Tuohy CJ, et al. Hand and body radiation exposure with the use of mini C-arm fluoroscopy. J Hand Surg 36A: ,

198 J Jpn Soc Surg Hand 緒言 対象と方法 表 結果 /10/

199 760 考察 ECRB 2 chair 2 2 Werner ECRB enthesopathy 1 まとめ 文献 1 pp5-22, Ahmad Z, et al. Lateral epicondylitis. A review of pathology and management. Bone Joint J 95B: , Werner CO. Lateral elbow pain and posterior interosseous nerve entrapment. Acta Orthop Scand Suppl 174: 1-62, MOOK 54: , Hansson KG, et al. Epicondylitis humeri. J Am Med Assoc 94: ,

200 J Jpn Soc Surg Hand retrospective 緒言 neurapraxia axonotmesis 1 retrospective 対象と方法 retrospective MMT 0 CMAP SNAP MMT 4 結果 /10/

201 762 表 1 FU M S , 5, , 6-9, , , 3, , 6, 7, Neviaser CMAP SNAP Semmes-Weinstein test Red

202 763 図 1 2 図 3 10 a b 図 2 3 a b 2a 2b CMAP, SNAP b 3a 5 2 考察 8/11 Kömürcü / MMT 4 32/60 53 MMT 5 10 MMT

203 Kömürcü 3 Birch 4 Kretschmer perineurial window window 9 1 Tinel retrospective 文献 1 Seddon HJ. Three types of nerve injury. Brain 66: , Neviaser 6 3 : , Kömürcü F, et al. Management Strategies for Peripheral Iatrogenic Nerve Lesions. Ann Plast Surg 54 2 : , Birch R, et al. Iatrogenic Injuries of Peripheral Nerves. J Bone Joint Surg 73-B 2 : , Kretschmer T, et al. Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg 94: , : , : , : , : , 2002 まとめ

204 J Jpn Soc Surg Hand CM 自由投稿論文 樻 5 CM CM CM CM MP 緒言 5 CM 対象と方法 CM 38kg 20kg 1/2 power grip push up X 5CM 1 CT 図 1 X 2014/10/

205 766 5CM 図 2 CT 図 4-a power grip 図 3 X 図 4-b power grip 表 1 Cooney X 1 mono cortical bone tension band wiring 3 5CM 結果 2 5 full grip 4-a 40kg 37kg 90 grip b X 考察 CM 1 2 CM CM 200

206 5CM 767 まとめ 5CM MP 2 5 図 5 X gap 3 CM CM 5CM 4 5CM 4 5 CM power grip 4CM 15 5CM 30 6 Cain type CM 文献 1 Dubert TP, et al. Stabilized arthroplasty for old fracture dislocations of the fifth carpometacarpal joint. Tech Hand Up Extrem Surg 13 3 : , : , Proubasta IR, et al. Treatment of Little Finger Carpometacarpal Posttraumatic Arthritis With a Silicone Implant. J Hand Surg 5-A: , Waugh R.L, et al. Carpometacarpal dislocations, with particular reference to simultaneous dislocation of the bases of the fourth and fifth metacarpals. J Bone Joint Surg 30: , Whitson R.O, et al. Carpometacarpal dislocation. Clin Orthop 6: , CM 22: 80-86, Cain JE, et al. Hamatometacarpal fracture-dislocation : Classification and treatment. J Hand Surg., Am 12-A: , CM 5: , CM 12: ,

207 J Jpn Soc Surg Hand Dual window approach 2 Super FIXSORB- MX dual window approach dual window approach 緒言 2013 dual window approach Mares 2 dual window approach 2 対象と方法 2 2 AO C Depuy&Synthes TCP J&J Takiron Super FIXSORB-MX40 X Quick DASH dual window approach 6cm radial ulnar window 2 window 1 2 Super FIXSORB-MX /2 1/3 3 Φ2.0mm 図 /10/

208 Dual window approach 769 図 2 dual window approach 図 3 1/2 1/3 3 2 window 図 4 1 X CT 結果 X Quick DASH score X 1 89 X CT AO type C2-3 Biyani type1 4 dual window approach condylar stabilizing palmar tilt Depuy&Synthes TCP 203

209 770 Dual window approach 図 5 1 X 表 1 図 図 7 2 X CT DRUJ 1/2 5 6 Quick DASH kg 11.5kg mm X CT AO type C2-3 Biyani type3 Gastilo1 7 dual window approach condylar stabilizing palmar tilt Depuy&Synthes TCP 1/3 8 6 X 1 3 X CT Quick DASH kg 10.6kg 9 1 考察 1 2 dual window approach 204

210 Dual window approach 771 図 8 2 X 図 lifting 2 window radial, ulnar side radial window lateral column ulnar window intermediate medial column 4 key stone X 5mm 4 1 1/2 2 1/