_手外31-6.indb

Transcription

1 ISSN

2 撓骨遠位端骨折 773 Skyline view Polyaxial Locking Plate DSS AO C volar tilt 782 AO C Double-tiered Subchondral Support 786 AO C3 VariAx Double-tiered Subchondral Support TFCC

3 第 5CM 関節 手指 838 PIP マレット指 mallet 861 Mallet 866 伸筋腱皮下断裂 870 tendon callus 875 皮弁 舟状骨 手根管症候群 pillar pain Body Mass Index 895

4 knot tenodesis 912 Kapandji index 末梢神経障害 King ばね指 PIP 944 母指 CM 関節症 CM Thompson Diao 951 CM 956 変性疾患 DIP PIP 961

5 Heberden X 964 腫瘍 MRI 手術 Acutwist 985 Krackow Wide Awake Surgery リハビリテーション CRPS PIP intrinsic plus cast 基礎

6 疫学 TFCC second look 1038 キーンベック病 Kienböck 1042 デュプイトラン拘縮 Dupuytren 1048 外側上顆炎 X 1052 その他 症例報告

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8 J Jpn Soc Surg Hand Cooney X ulnar variance UV volar tilt VT radial inclination RI UV mm mm mm Cooney excellent 19 good 9 緒言 C LP 対象と方法 LP AO C2 4 C bridging intra focal pinnig die punch fracture LP screw X Cooney X ulnar variance UV volar tilt VT radial inclination RI 結果 UV 24 UV mm VT RI UV mm mm mm mm 2015/02/

9 774 図 p VT RI VT RI AO C kg 15kg VT +5 RI UV +0.7mm mm mm mm

10 粉砕型橈骨遠位端骨折の治療経験 775 図 2 左 UV は術直後 -0.14±1.0mm 創外固定除去直前で -0.05±1.0mm 創外 固定除去 1 か月後で +0.14±1.1mm 最終調査時で +0.23±1.1mm であ った 創外固定除去直前と創外固定除去 1 か月後の間に有意な p 損失を認めた 中央 VT は術直後 5.5±4.4 創外固定除去前で 5.6±4.8 創外固定除去 1 か月後で 4.6±3.7 最終調査時で 4.5±3.8 であった 有意な損失 は認めなかった 右 RI は術直後 20.9±4.3 創外固定除去前で 21.0±3.9 創外固定除去 1 か月で 21.2±4.3 最終調査時で 21.4±4.0 であった 有意な損失は 認めなかった 図3 図5 65 歳女性 転倒して AO 分類 C3 型骨折を受傷 創外固定除去直前 UV は +1.7mm VT は +5 RI は 24 であった UV の矯正損失が認められた 図4 図6 3 受傷 5 日目 手術を施行した UV は +0.7mm VT は +5 RI は 24 であった 創外固定除去 1 か月後 UV は +2.2mm VT は +5 RI は 22 であった UV の矯正損失が認められた

11 776 図 7 UV +2.2mm VT +5 RI 24 図 AO C3 図 9 5 UV -2.1mm VT +2 RI 17 図 10 UV -1.3mm VT +1 RI 24 AO C kg 25kg VT RI +17 UV mm 1-1.3mm -1.3mm 10 4

12 777 考察 bridging type 3.9 UV 1 UV Dicpinigaitis LP Osada LP UV 1 step off 2 Rhee 122 UV UV 3 VT RI UV UV LP LP まとめ UV 文献 1 Dicpinigaitis P, et al. Can external fixation maintain reduction after distal radius fractuers? J Trauma 57: , Osada D, et al. Prospective study of distal radius fractures treated with a volar locking plate system. J Hand Surg Am 33: , Rhee SH, et al. Factors affecting late displacement following volar locking plate fixation for distal radial fractures in elderly female patients. JBJS 95-B: ,

13 J Jpn Soc Surg Hand Skyline view Polyaxial Locking Plate DSS AO C3-2 3 Double-tiered subchondral support DSS skyline view DSS DSS 2008 AO C3 2 C X X DSS DSS 緒言 Double-tiered subchondral Support DSS Orbay AO C3 2 C3 3 DSS DSS Skyline View SV Polyaxial Locking Plate PLP 5 SV AO C3 2 C3 3 DSS DSS 対象と方法 AO C3 2 C 図 1 Skyline view ab skyline view cd Modified skyline view 2014/11/

14 DSS 779 表 1 表 2 X AO C C3 3 7 DSS Monoaxial locking plate MLP BIOMET DVR anatomic volar locking system DVR 7 C3 2 5 C3 3 2 DVR PLP MES APTUS 2.5 locking system APTUS str yker Variax distal radius locking plate system VariAx DSS 9 C3 2 6 C3 3 3 standard Polyaxial locking plate MES ADAP- TIVE distal radius system 2.5 ADAPTIVE APTUS DSS 8 C3 2 6 C3 3 2 DSS X volar tilt VT ulnar valiance UV radial inclination RI 3 Bonferoni 1 結果 1 DVR 1 X UV VT 2 DSS 2 RI DSS 2 7

15 780 DSS 図 2 DVR a b c 考察 DVR 2 8 AO C3 DVR 9 AO C3 DVR watershed line 2 PLP MLP PLP AO C 3 DSS 1 PLP DSS 図 3 a b Standard 1 c d Modified 2 図 4 DSS 3 skyline view ADAPTIVE Medoff

16 DSS 781 図 5 DSS watershed line 2 DSS watershed line DSS DSS AO C3 2 C3 3 61: , Polyaxial Locking Plate Monoaxial Lock Plate AO C 30: , Figul M, et al. Unstable distal radius fracture in elderly patient-volar fixed angle plate Osteosynthesis prevent secondary loss of reduction. J. Trauma 68: , Skyline view polyaxial locking plate 36: 20-23, Riddick AP, et al. Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixiation. J. Hand Surg. Eur 37: , Klammer G, et al. Intraoperative imaging of the distal radioulnar joint using a modified skyline view. J. Hand Surg. Am 37: , DVR 29: , Synthes Extra-articular locking plate 27: , Medoff RJ. Essential Radiographic Evaluation for distal radius fractures. Hand Clin 21: , 2005 まとめ 1 AO C3 2 C3 3 2 AO C3 2 C3 3 DSS 文献 1 Orbay JL. Volar plate fixation of distal radius fractures. Hand Clin 21: , DVR DSS 9

17 J Jpn Soc Surg Hand volar tilt volar tilt VT VT VT loss ulnar variance UV loss VT a b c 3 X VT loss UV loss VT loss a 3.77 b 1.90 c 0.48 VT loss 3 VT VT loss UV loss a 0.36mm b 0.41mm c 0.29mm UV loss 3 VT VT VT 緒言 DRF LPF 1 Volar tilt VT loss VT VT loss UV loss 対象と方法 X UV X VT VT 12 VT a 15 b c a 29 b 41 c 57 a 62.9 b 61.5 c /3 AO C ACUMED Acu-Loc Distal Radius Plate Acu-Loc 44 DePuy DVR Anatomic Volar Plate DVR 4 Stellar 39 Stellar2 1 Synthes LCP volar column distal radius plate LCP 6 Synthes 2.4mm Variable Angle LCP Two-Column Volar Distal Radius Plate VA-TCP 33 VT loss VT- VT UV loss UV- UV VT loss UV loss Tukey EZR version VT VT loss VT UV loss 結果 VT loss a 3.77 b 1.90 c /11/

18 VT 783 図 1 3 図 2 VT loss a b c 図 3 VT VT loss r p VT loss abc 2 VT VT loss r p UV loss a 0.36mm b 0.41mm c 0.29mm UV loss 4 VT UV loss r p 考察 VT VT X VT DRF LPF VT 6 AO typec VT VT loss UV loss 11

19 784 VT 図 4 UVloss 3 p 0.62 図 5 VT UVloss r p 表 1 VT UV VT loss 1.02 UV loss 0.56 VT loss 1.69 UV loss 0.34 VT VT loss VT VT VT subchondral support 6 double-tiered subchondral support VT まとめ 12

20 VT 785 VT VT VT VT UV loss 文献 1 Kanda Y. Investigation of the freely available easy-to-use software EZR for medical statistics. Bone Marrow Transplantation 48: , Gartland JJ, et al. Evaluation of healed Colles fractures. J Bone Joint Surg Am 33: , Smilovic J, et al. Conservative treatment of extra-articular Colles type fractures of the distal radius: prospective study. Croat Med J 44: , X 17: 16-20, Metz VM, et al. Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am 24: , Drobetz H, et al. Volar Fixed-Angle Plating of Distal Radius Extension Fractures: Influence of Plate Position on Secondary Loss of Reduction A Biomechanic Study in a Cadaveric Model. J Hand Surg 31A: , : , VariAx plate 61 1 : 76-80, : , : 59-65,

21 J Jpn Soc Surg Hand AO C Double-tiered Subchondral Support AO C Double-tiered Subchondral Support DSS 20 D DSS 18 N D 70.4 N 65.7 D C1 6 C2 12 C3 2 N C1 4 C2 12 C3 2 D MODE DRP N ACU-LOC 9 VA-TCP 9 RI VT UV Mayo wrist score 2 RI D 0.8 N 1.1 VT D 0.5 N 2.5 UV D 1.0mm N 1.2mm VT Mayo wrist score D 89.3 N 89.4 MODE DRP DSS VT DSS MODE DRP locking fixed angle 緒言 AO C Orbey 1 Double-tiered Subchondral Support DSS 2 DSS DSS 対象と方法 C DSS D 20 DSS N 18 D N D 5 15 N 4 14 AO D C1 6 C2 12 C3 2 N C1 4 C2 12 C3 2 D N D MODE Distal Radius Plate MDM MODE DRP N ACU-LOC distal radius plate ACU-LOC 9 Variable angle LCP Two-Column Volar Distal Radius Plate Synthes VA-TCP 9 1 D N X radial inclination RI volar tilt VT ulna variance UV Mayo modified wrist score 2014/11/

22 DSS DSS 787 表 1 表 2 D N Mann-Whitney s U test p 0.05 結果 RI VT UV D RI / VT / UV mm/ mm N RI / VT / UV mm/ mm D RI VT UV mm N RI VT UV mm VT D N RI UV 2 2 Mayo modified wrist score D Excellent 6 Good 12 Fair 2 Poor N Excellent 9 Good 7 Fair 1 Poor a-c 6 AO type C2 7 MODE DRP DSS tensionband wiring 13 9 Mayo modified wrist score 90 Good RI 20.1/19.9 VT 10.2/10.0 UI -1.4/ d-f AO type C1 ACU-LOC 1 DSS 15

23 788 DSS DSS 図 1-a 1 X 図 1-b 1 X 図 1-c 1 9 X 図 1-d 2 X 図 1-e 2 X 図 1-f 2 11 X tensionband wiring Mayo modified wrist score 95 Excellent RI 20.7/19.6 VT 9.6/5.6 UI -1.3/0 VT 考察 AO C3 DSS 2 2 DSS DSS VT DSS 3 5 DSS 1 2 DSS DSS 16

24 DSS DSS 789 表 3 DSS DSS DSS VT DSS DSS 3 AO C3 DSS DSS Cooney score C3 DSS MODE DRP 2 DSS FPL fixed angle fixed angle DSS variable angle fixed angle まとめ AO C DSS 20 DSS 18 RI UV 図 2 MODE Distal Radius Plate MDM VT DSS VT DSS MODE DRP locking fixed angle 文献 1 Orbey JL, et al. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop 445: 58-67, AO C3 Double-tiered Subchondral Support 27: , AO C3 VariAx plate 29: 67-71, DVR plate APTUS2.5 Plate 29: 76-78, AO C3 2 volar tilt 33: ,

25 J Jpn Soc Surg Hand AO C3 VariAx Double-tiered Subchondral Support AO C3 VariAx DSS VariAx medium 6 32 DSS D 21 DSS N 11 Mayo wrist score X 2 Mayo wrist score D 87.9 N 86.0 VT D VariAx DSS 緒言 AO C3 1 2 Double-tiered Subchondral Support DSS Orbay 1 2 APTUS2.5 DSS DSS DSS VT DSS VariAx C3 DSS DSS DSS DSS D 2 fixed angle DSS N 1 D 21 N 11 D C N C 対象と方法 AO C3 146 VariAx medium 6 32 Variable angle 図 1 a DSS b DSS 2015/02/

26 VariAx DSS 791 図 2 Mayo wrist score 図 D 7 N 6.9 VariAx medium Mayo wrist score ulnar variance UV volar tilt VT radial inclination RI gap step off UV VT RI T p 0.05 結果 D N D N Mayo wrist score D 87.9 N D UV mm VT RI N UV mm VT RI D VT P Gap D 2.48mm 0.53mm 0.02mm N 1.69mm 0.19mm 0.08mm Step off D 0.87mm 0.11mm 0.05mm N 0.62mm 0.09mm 0.08mm D 2 1 CRPS 1 D 25 C3.2 DSS UV 0mm VT 0.3 RI N 77 C3.2 fixed angle guide UV 1mm VT 2.5 RI 0 5 考察 DSS

27 792 VariAx DSS 図 4 1 a X b CT c X d 7 X 図 5 2 a X b CT c X d 10 X VariAx Watershed line polyaxial locking plate fixed variable angle DSS 2 DSS Neuhaus 3 A C 2 1 VT 1 8 C C3 20

28 VariAx DSS 793 表 1 C3 C3 VLP 4 DSS DSS 2 5 C3 DSS DSS VT C3 1 2 DSS DSS VT DSS C VariAx DSS C3 C3 DSS まとめ 1 AO C3 VariAx medium 32 DSS DSS 2 Mayo wrist score 3 DSS DSS VT 4 VariAx DSS C3 文献 1 Orbay J, et al. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. 445 Clin Orthop: 58-67, AO C3 Double-tiered Subchondral Support 27: , 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 2 : , Arora R, et al. Complications Following Internal Fixationof Unstable Distal Radius Fracture With a Palmar Locking-Plate. J Orthop Trauma 21 5 : , AO C3 2 volar tilt 33: , AO C : , AO C3 21

29 794 VariAx DSS 33: , non-bridge 27 1 : S-157, AOC : ,

30 J Jpn Soc Surg Hand Acu-Loc Plate Acu-Loc/Acu-Loc2 screw Acu-Loc plate locking plate 324 Acu-Loc Plate mm screw plate X 4 plate 緒言 Acu-Loc plate locking plate 2000 Acu-Loc 2013 Acu-Loc2 Acu-Loc plate 3.5mm screw hole 1 Acu-Loc plate Acu-Loc χ2 Acu- 対象と方法 A2 132 A3 71 B1 4 B2 6 B3 9 C1 66 C2 19 C3 17 Implant Acu-Loc DepuySynthes VA-TCP 92 DRP 16 ME-System APTUS Stryker VariAx Implant Implant Implant 図 1 screw hole 表 1 Implant 2014/11/

31 796 表 2 Loc Acu-Loc 198 L n 27 N n 171 student t χ2 4 2 L N χ2 Acu-Loc Implant P 0.05 図 2 図 3 結果 X screw hole Acu-Loc plate plate 2 Acu-Loc plate p hole /27, hole 17/27 63 L N L p L p L N 3 Acu-Loc Implant 4 4 Implant 図 4 4 考察 Feerick 1 biomechanics screw screw screw screw 24

32 797 表 3 plate screw 図 5 CT plate plate 27 screw plate 3 screw CT 5 Acu-Loc screw Implant Implant Acu- Loc plate plate Acu-Loc plate Acu-Loc screw 3.5mm 3 plate 2 screw Acu-Loc locking screw screw 6 plate screw lock- 図 6 Acu-Loc locking screw plate 10 ing screw plate screw Phillips 2 self-tapping screw torque nonself-tapping screw Acu-Loc 3.5mm locking screw torque self-tapping screw screw locking screw cortical screw 1 locking screw 7 screw locking screw 25

33 798 screw tap tap self-tap torque 図 7 locking screw Robert 3 4 locking plate screw screw p Acu-Loc plate Implant Acu-Loc screw locking screw screw locking screw self-tapping screw tap cortical screw cortical screw まとめ locking plate screw hole Acu-Loc 13.6 tap 文献 1 Feerick E. M, et al. Cortical bone failure mechanisms during screw pullout. J.Biomechanics 45: , Phillips J.H, et al. Comparison and Torque Measurements of Self-Tapping and Pre Tapped Screw. J Plast Recontr Surg 83: , Clayton R.A.E, et al. Association Between Decreased Bone Mineral Density and Severity of Distal Radial Fractures. J Bone Joint Surg 91A: 613-9, : 795-9,

34 J Jpn Soc Surg Hand Plate presetting arthroscopic reduction technique PART AO B1 2 B2 1 B3 3 C1 16 C2 16 C3 24 Frykman type 3 4 type 4 8 type 7 16 type 8 34 CT 2parts 35 3parts 21 4parts 6 CT K-wire K-wire CT Gap 2mm Step off 1mm die-punch 緒言 対象と方法 Plate presetting arthroscopic reduction technique PART 3 Henry Kirschner K-wire K-wire PART AO B1 2 B2 1 B3 3 C1 16 C2 16 C3 24 Frykman type 3 4 type 4 8 type 7 16 type 8 34 CT 4 5 2parts 35 3parts 21 4parts 6 Computed 2014/12/

35 800 図 1 Manipulative reduction Probing reduction Mayo wrist score Disability of Arm Shoulder and Hand DASH X Volar tilt VT Ulnar variance UV Radial inclination RI Tomography CT Gap Step off 1mm Examination only 27 Manipulative reduction 16 Probing reduction 19 Examination only Manipulative reduction Probing reduction Examination only 結果 CT Gap step off Gap step off CT Gap 2.3mm Step off 1.3mm Gap 1.0mm Step off 0.8mm Gap Step off 2 Gap T P Step off P 0.1 図 2 CT Gap Step off 28

36 801 図 3 2parts 図 4 3parts Gap step off Examination only 27 Manipulative reduction 16 Probing reduction 19 3 CT Gap Step off Examination only Gap 1.3mm Step off 0.6mm Manipulative reduction Gap 2.3mm Step off 1.0mm Probing reduction Gap 3.6mm Step off 2.5mm Gap 2mm Step off 1mm 3 Gap Probing reduction Examination only P 0.01 Step off Probing reduction Examination only Probing reduction Manipulative reduction P 0.01 CT Gap Step off 1mm CT 2parts 26 3parts 17 4parts 6 2parts 4 Sagittal Frontal rim Doral-rim Die-punch 4 3 Sagittal 1mm Examination only 7 6 Manipulative reduction 1 Frontal Doral-rim Manipulative reduction 6 4 Examination only 1 Probing reduction 1 Die-punch Examination only 13 3 Manipulative reduction 6 Probing reduction 4 3parts sagittal Frontal rim T Die-punch Die-punch 2 Reverse T Depression 4 3part T Die-punch 2parts T 7 Examination only 1 Manipulative reduction 3 Probing reduction 3 Die-punch 7 Examination only 2 Manipulative reduction 1 Probing reduction 4 4parts 6 Probing reduction Mayo Wrist Score 89.1 DASH 9.1 X VT RI UV 0.69mm mm 1.5 VT RI UV 1 62 AO C3-1 Frykman Type 8 29

37 802 図 5 4parts 6 図 AO C3-1 2part 図 7 1 Xp 2parts 6 CT Die-punch Gap 0mm Step off 2mm Probing Die-punch Mayo wrist score AO C3-2 Fr ykman Type 8 4parts 8 CT

38 803 図 AO C3-2 4part 図 Mayo wrist score 考察 1 2mm OA 図 10 2 Xp 31

39 804 CT Step off Gap Manipulative reduction Probing reduction 2 CT Gap 2mm Step off 1mm Die-punch Depression AO Frykman X CT Rozental 9 Tanabe 10 CT Gap Step off Henry CT Die-punch depression 文献 1 Doi K, et al. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am 81 8 : , Hattori Y, et al. Arthroscopically assisted reduction with volar plating or external fixation for displaced intra-articular fractures of the distal radius in the elderly patients. Hand Surg 12 1 : 1-12, Abe Y, et al. Plate presetting arthroscopic reduction technique for the distal radius fractures. Tech Hand Up Extrem Surg 12 3 : , OS NOW instruction 15: , Guofen C, et al. Arthroscopically assisted reduction and immobilization of intraarticular fracture of the distal end of the radius: several options of reduction and immobilization. Tech Hand Up Extrem Surg 9 2 : 84-90, Knirk JL, et al. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 68 5 : , Ruch DS, et al. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy 20 3 : , Wiesler ER, et al. Arthroscopic management of distal radius fractures. J Hand Surg Am 31 9 : , Rozental TD, et al. Evaluation of the sigmoid notch with computed tomography following intra articular distal radius fracture. J Hand Surg Am 26 2 : , Tanabe K, et al. Intra-articular fractures of the distal radius evaluated by computed tomography. J Hand Surg Am : , まとめ 32

40 J Jpn Soc Surg Hand TFCC 自由投稿論文 DRUJ TFCC TFCC N 143 T 58 AO ulnar variance radial inclination dorsal volar tilt N 58.8 T 63.4 ulnar variance N 2.33mm T 3.60mm N 54.5 T 72.4 T TFCC 緒言 TFCC TFCC MRI 1 DRUJ TFCC 対象と方法 AO A2 48 A3 36 B1 2 B2 1 B3 5 C1 45 C2 51 C3 13 DRUJ TFCC 23G TFCC DRUJ TFCC 12 TFCC N 143 T 58 AO ulnar variance radial inclination dorsal volar tilt dorsal volar tilt volar tilt11 3 T 2 2Fisher exact test P 0.05 結果 T P N 58.8 T 63.4 P AO N 2015/01/

41 806 TFCC 図 1 図 2 表 1 表 2 AO 表 3 ulnar variance dorsal volar tilt radial inclination 表 4 表 5 A60 B8 C75 T A24 B0 C34 2 ulnar variance N 2.33mm T 3.60mm P radial inclination dorsal volar tilt N 54.5 T 72.4 P T P P 0.00 TFCC 8 TFCC

42 TFCC 807 考察 TFCC TFCC ulnar variance TFCC AO radial inclination dorsal volar tilt radial inclination dorsal volar tilt TFCC ulnar variance radial translation TFCC TFCC TFCC Lindau 6 7 ulnar variance TFCC TFCC 50 TFCC TFCC TFCC まとめ TFCC TFCC TFCC ulnar variance TFCC 文献 1 22: 14-20, Gartland JJ JR, et al. Evaluation of healed Colles fractures. J Bone Joint Surg 33A: , TFCC 13: , Nakamura T, et al. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures. J Wrist Surg 3: 12-17, Moritomo H, et al. Influence of ulnar translation of the radial shaft in distal radius fracture on distal radioulnar joint instability. J Wrist Surg 3: 18-21, Colles 26: , Lindau T, et al. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg 25A: , : ,

43 J Jpn Soc Surg Hand X P 0.05 Cooney DASH 緒言 対象と方法 t p 0.05 AO A3 3 C1 3 C2 5 C3 13 A3 9 C1 4 C2 6 C3 22 Mann-Whitney U p DRV Locking Hearty Cooney DASH radial inclination RI volar tilt VT ulnar variance UV sigmoid notch DRUJ gap 1 3mm 7 RI VT UV 2014/09/

44 809 表 1 図 1 DRUJ gap sigmoid notch mm 表 2 DASH X t Cooney Mann-Whitney U p 0.05 結果 2 Cooney AO C3 DASH RI VT UV RI VT UV DRUJ gap 3mm DRUJ gap 3mm Cooney 表 3 考察 37

45 Chen tip base DRUJ Zenke DRUJ Fujitani 7 DRUJ gap 3mm DRUJ DRUJ gap 3mm DRUJ まとめ 文献 1 Chen YX, et al. Will the untreated ulnar styloid fracture influence the outcome of unstable distal radial fracture treated with external fixation when the distal radioulnar joint stable. BMC Musculoskelet Disord 14: 186: 1-8, Zenke Y, et al. Treatment with or without internal fixation for ulnar styloid base fractures accompanied by distal radius fractures fixed with volar locking plate. Hand Surg 17: , : , May MM, et al. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg 27 A : , : , : , Fujitani R, et al. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg 36 A : ,

46 J Jpn Soc Surg Hand closing wedge osteotomy closing wedge osteotomy ECU opening wedge osteotomy 緒言 Fernandez 1 opening wedge osteotomy closing wedge osteotomy 対象と方法 radial inclination RI volar tilt VT ulnar variance UV 5mm 8mm 6.5mm closing wedge osteotomy ECU 3 4 RI VT UV Modified Mayo Wrist Score 結果 ADL 1 Modified Mayo Wrist Score RI 19.4 VT /11/

47 812 表 1 表 2 表 kg RI 18 VT -34 UV 7mm kg RI 18 VT

48 813 図 1 DRUJ follow up まとめ 図 2 11 考察 DRUJ 2 3 Fernandez opening wedge osteotomy 1 DRUJ 2 closing wedge osteotomy 4 4 closing wedge osteotomy 文献 1 Fernandez DL. Collection of post traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg 64 8 : , : , : 57-60, : closing wedge osteotomy 24: , Minami A, et al. Treatment of osteoarthritis of the distal radioulnar joint : long-term results of three procedures. Hand Surg 10: , Field J, et al. Poor result of Darrach s Procedure after wrist injuries. J Bone Joint Surg Br 75-B: 53-57, Darrach 29: , M.S. George M.S, et al. The Sauve-Kapandji pocedure and The Darrach procedure for distal radio-ulnar joint disfunction after colles fracture. Journal of Hand Surgery British and European Volume 29B:6: ,

49 J Jpn Soc Surg Hand FPL VLP EPL EPL 3D-CT 緒言 VLP 17 対象と方法 AO A2 8 C1 6 3 X 14 3D-CT 3D-CT SIMENS SO- MATOM Definition AS 3D plus AZE Aplio 10MHz 結果 8 9 VLP EPL 12 EDM 1 4 FPL 2 FPL FDP FDS 1 FDP FDS FDP 1 EPL 5 3 3D-CT 3 8 EPL 6 3D-CT VLP 9 EPL 5 EIP 3 PL 1 2 ADL IP ADL EDM 2015/01/

50 815 表 1 17 EDM Sauve-Kapandji FPL 2 FDS 1 1 FPL IP X AO A2 4 3D-CT EPL 1 EPL 3 EPL EPL excursion EPL 2 IP 2 72 VLP Acu-Loc 1 1 IP DIP PIP DIP X 3D-CT 3 FDS FPL 43

51 816 図 1 X AO A2 3DCT EPL 図 2 3 EPL 図 3 DIP PIP DIP X 44

52 817 図 4 X AO C1 図 5 X 3DCT EDC FDP ADL 3 71 X AO C1 VLP Matrix IP X 4 EPL EIP IP 考察 EPL 45

53 X CT 3D-CT VLP X 3D-CT EDC 5 FPL EPL VLP FPL Watershed line tilting angle VLP VLP EPL EPL 6 7 EPL retrospective 3D-CT 6/7 1/7 1 EPL EPL excursion EIP VLP EPL EIP 2 FPL FDS 3 excursion FDP まとめ 17 46

54 819 文献 1 Monthly book Orthopedics 23: 73-79, : , Benson E.C, et al. Two potential causes of EPL rupture after distal radius volar plate fixation. Clin Orthop Relat Res 451: , Al-Rashid M, et al. Delayed ruptures of extensor tendon secondary to the use of volar locking compression plates for distal radius fractures. JBJS 88-B: , pp80-85, Bonatz E, et al. Rupture of the Extensor Pollicis Longus Tendon. Am J Orthop 25: , Cooney W, et al. Complication of Colles fractures. JBJS 62-A: , Klug R, et al. Rupture of the flexor pollicis longus tendon after volar fixed-angle plating of a distal radius fracture. J Hand Surg 32-A: , : , Cross A, et al. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg 33- A: ,

55 J Jpn Soc Surg Hand FPL 5 FPL FPL FPL 5 65 FPL 34.4 FPL 2 FPL FPL 1 緒言 FPL 5 FPL X FPL 対象と方法 FPL 5 FPL FPL LCP Distal Radius System SYNTHES 1 OSR plate JMM 4 X X X 結果 FPL X 2014/11/

56 821 volar-tilt radial-inclination ulnar-variance 1.44mm 0-2.7mm 4 X 3.26mm mm 3.9mm mm mm mm 2.23mm 0-5.0mm t X 5 p IP 図 1 X 表 1 49

57 822 表 2 FPL 18 図 2 1 X 図 3 1 図 4 1 図 LCP Distal Radius System SYNTHES IP X X FPL 図 TAM 96 TAM

58 IP 3 OSR plate JMM IP X 7 CT 8 FPL 5 TAM 100 TAM 74 図 7 2 X 考察 FPL watershed-line 図 8 2 CT 51

59 824 FPL 1 Soong X grade 0 grade grade grade 2 2 grade 1 Soong watershed-line FPL X FPL 6 5 X 3.26mm X 3.90mm X FPL 8 9 FPL ulnar-variance 1.44mm volar-tilt LCP Distal Radius System SYNTHES 1 OSR plate JMM 4 FPL FPL 1 まとめ FPL 1 文献 1 Orbay JL, et al. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res 445: 58-67, Asadollahi S, et al. Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthopaed Traumatol 14: , Valbuena SE, et al. Rupture of flexor tendon following volar plate of distal radius fracture. Report of five cases. Chir main 29: , Soong M, et al. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 93: , Monda MK, et al. Volar locking plate implant prominence and flexor tendon rupture. Acta Orthop. Belg 76: , : 20-22, Bell JS, et al. Rupture of flexor pollicis longus tendon: a complication of volar plating of the distal radius. J Bone Joint Surg Br 80: , : , : ,

60 J Jpn Soc Surg Hand 緒言 review article 5 1, 対象と方法 Chi square P ,464 2, , /11/

61 826 表 1 表 2 結果

62 827 図 1 図 / / P P P 考察 10 review 2 表 3 55

63 P P まとめ 2 文献 1 Schmidt ANDREW H, et al. Orthopaedic Knowledge Update Trauma 4: Chapter 20 fracture of the forearm and distal radius. vol4. AAOS. Rosemont. pp , Wolfe SCOTT W, et al. Green s OPERATIVE HAND SURGERY: Chapter 17 Distal radius fractures. vol6. Elsevier. Churchill Livingstone. pp , : 0-0, Kitav A, et al. Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am 38 6 : , Soong M, et al. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 36 1 : 3-9, Ruch DS, et al. Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures. Arthroscopy 20 3 : ,

64 J Jpn Soc Surg Hand fist fight CM 2 15 MP excellent 6 good 3 poor 1 15 緒言 対象と方法 fist fight 4 1 Lundreen 1 typea 2 typeb 2 typec 3 typed X 2 4 X step off mm 1.61mm ORIF CM 2 15 MP 4 ORIF 2 結果 Xp step off mm 0.95mm X 2 excellent 6 good 3 poor /11/

65 830 5 表 1 表 2 図 1 step off Lundeen C X kg 45kg 4 X 5 excellent 7 52 Lundreen A kg 42kg X 7 excellent 考察 5 58

66 第 5 中手骨基部関節内骨折の治療 図2 図4 図6 症例 3 症例 3 症例 初診時 Xp 図3 症例 3 術前 CT 術中 Xp 図5 症例 3 術後 Xp 初診時 Xp 図7 いる Petrie ら 3) は筋腱牽引による転位や亜脱臼の機序 は第 1CM 関節と類似するが 隣接 CM 関節との支 持性や 要求される機能の違いから保存的治療を行 い手術的治療と比較し 症状に差がなかったことか 症例 7 最終診察時 Xp ら徒手整復が困難な症例に保存的治療を推奨し Bora ら 4) は受傷早期の転位の少ない症例に対して 保存的治療を勧め Lundeen ら 1) は step off や骨折 型 亜脱臼度 関節症変化は術後成績に影響を与え ないと保存的治療を推奨している 59

67 832 5 Niechajev 5 Petersen 6 ORIF 7 15 step off 7 36: , 1985 まとめ 文献 1 Lundeen J.M, et al. Clinical results of intraarticular fractures of the base of the fifth metacarpal treated by closed reduction and cast immobilization. J Hand Surg 25: , CM 18: , Petrie P.W, et al. Fracture-subluxation of base of fifth metacarpal. Hand 6: 82-86, Bora F. W, et al. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg 56: , Niechajev I. Dislocated intra-articular fracture of the base of the fifth metacarpal:aclinical study of 23 patients. Plast Reconstr Surg 75: , Petersen K, et al. Intra-articular fractures at the base of the fifth metacarpal. A clinical and radiographical study of 64 cases. J Hand Surg 17: ,

68 J Jpn Soc Surg Hand CM 5 CM Bennet Rolando Bennet 3 Roland 7 2 low profile plate excellent 8 good 2 緒言 5 CM CM 2 5 CM Bennett Rolando 5 対象と方法 Bennett 3 Roland Leibinger low profile plate Rolando 3 5 DFS Biomet 1 Stryker Cooney 3 clinical scoring system 結果 Cooney excellent 8 good power grip Bennett Rolando Mann-Whitney U-test Cooney clinical score 1 Rolando 7 Cooney clinical score /12/

69 834 5 表 1 図 1 Bennett Rolando Cooney clinical score 図 2 Rolando CM X 3 5 Rolando CT 4 MPR 62

70 5 835 図 3 X 図 4 CT 3D CT 3D CT MPR 図 5 図 DFS Biomet 6 K K X 7 MP ulnar gutter splint IP 3 MP 4 K 6 8 X 8 congruity 63

71 836 5 図 7 X 図 8 8 X congruity 図 metacarpal decent 9 Cooney excellent 95 考察 5CM ,5CM 2 CM CM CM 5 CM 4 Bennett Rolando 5 CM 6 CM 5 Rolando 1 7 4,5CM CM 64

72 alignment 9 Rolando 10 CM 4 Cooney clinical score good CM 4 4CM まとめ 文献 1 Bora FW, et al. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg 56- A: , Cain JE, et al. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg 12A: , Cooney WP, et al. Difficult wrist fractures. Perilunate fracture-dislocation of the wrist. ClinOrthop Relat Res 214: , CM 22: 80-86, : , CM 12: , : , : 53-56, Rolando 14: 37-41, CM 19: ,

73 J Jpn Soc Surg Hand subzone 緒言 対象と方法 subzone 結果 Complex regional pain syndrome cm DIP /11/

74 839 表 1 図 a b c d e n 考察 67

75 840 図 a b c d e DIP

76 841 まとめ subzone 文献 1 26: 11-14, Iwasawa M, et al. Dorsally extended digital island flap for repairing soft tissue injury of the fingertip. J Plast Reconstr Aesthet Surg 64: , : , MB Orthop 26: 55-60, : ,

77 J Jpn Soc Surg Hand PIP PIP PIP Kirushner wire K-wire screw screw plate 緒言 PIP PIP 対象と方法 PIP CT 2 PIP PIP K-wire PIP 3 1 A3 C2 pulley 4 2 2a 2b 2015/02/

78 PIP 843 図 1 a b c 図 2 2c screw K-wire pull out wire plate 2d 5 6 K-wire DIP PIP PIP K-wire 結果 X PIP X PIP screw K-wire 71

79 844 PIP 図 3 16 a b c 図 4 31 a b c 19 d X PIP screw pullout wire pullout wire X 考察 Hintringer 2 K-wire 3 72

80 PIP 845 K-wire screw pull out wire 4 low profile plate Plate PIP まとめ 1 PIP 文献 1 PIP 12: , Hintringer W, et al. Perkutane Versogung von Intraartikularemn Frakturen der Fingermittelgieder. Handchirurgie 18: , PIP 12: , Low-Profile mini-plate PIP 23: ,

81 J Jpn Soc Surg Hand X 3 X 3 / 0 / 緒言 VCM CPC 対象と方法 VCM CPC DIP CRP 6 5 MRSA X MRI DIP 表 /11/

82 847 図 1 VCM CPC VCM CPC HOYA C.C. 6 g 3 ml C.C. 150 mg 1-2 mm DIP crease VCM CPC retrospective 結果 X X X 3 / 0 /60 0 /70 0 / MRSA X 2 MRI DIP 3 VCM CPC X 2 6 VCM CPC 75

83 848 図 X 図 MRI T2 DIP 図 4 1 X VCM CPC 図 VCM CPC 図 DIP X DIP X MRI 4 DIP X 6 MRI DIP 7 VCM CPC X VCM CPC 76

84 849 図 MRI T2 MRI T2 DIP 図 8 4 VCM CPC 1 2 DIP VCM CPC 図 9 8 DIP 考察 DIP MRI 3, 7 VCM CPC VCM CPC 1 Edin In vitro VCM 10,000 μg/ml VCM 1,000 μg/ml 7 In vitro VCM 2.5 CPC 1,000 μg/ml 8 VCM 77

85 850 VCM CPC CPC VCM 文献 1 Phemister DB. The effect of practice on articular surfaces on pyogenic and tuberculous arthritides and its bearing upon treatment. Ann Surg 80: , Mathews CJ, et al. Bacterial septic arthritis in adults. Lancet 375: , Ross JJ, et al. Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis 36: , Goldenberg DL, et al. Acute Infectious Arthritis; A review of patients with nongonococcal joint infections with emphasis on therapy and prognosis. The Am J Med 60: , Song HK, et al. Current presentation and optimal surgical management of sternoclavicular joint infections. Ann Thorac Surg 73: , : , Edin ML, et al. Effect of cefazolin and vancomycin on osteoblasts in vitro. Clin Orthop 333: , : , 2004 まとめ DIP VCM CPC 3 DIP DIP 78

86 J Jpn Soc Surg Hand MP 緒言 9 対象と方法 X CT 9 4 MRI 結果 MP /10/

87 852 9 図 2 MRI 図 1 X 図 3 X MP 図 4 MRI 図 5 10 X MP 57 MP X MRI MP MP X MP CT

88 9 853 図 6 CT 図 8 X 図 PIP 図 9 23 DIP X

89 854 9 図 10 6 X X 6 X 10 考察 まとめ 9 82

90 9 855 文献 1 pasteurella 36: , : , : , : 7-12,

91 J Jpn Soc Surg Hand Self Locking Finger Joint 緒言 RA Self Locking Finger Joint SLFJ 表 1 対象と方法 SLFJ RA MP 3 4 PIP 結果 MP 1 0 / / 40 Joint Anchor JA JA 1 JA 2 MP 2014/12/

92 857 図 1 1 図 JA PIP 3 2 MP 2 MP -10 / / MP 3 1 JA 3 1 図

93 858 図 4 4 図 6 4 図 PIP 2 SLFJ JA 4 PIP -44 / 50 JA / PIP

94 859 図 7 5 図 9 5 図 JA FDS half slip JA FDS PIP -10 / 60 考察 JA JA JA JA SLFJ JA

95 860 FDS half slip まとめ 1 RA 6 SLFJ 2 JA 3 JA 4 文献 1 27: , MP 29: 78-85, PIP OS now Instruction 25: ,

96 J Jpn Soc Surg Hand mallet 4 mallet DIP K-wire tension band wiring DIP DIP K-wire DIP K-wire 緒言 56 mallet DIP K-wire 4 mallet 対象と方法 tension band wiring TBW 5 mini screw fixation MSF 11 DIP DIP joint temporally fixation DTF 4 TBW 4 5 K-wire 4 MSF 10 DTF K-wire K-wire DIP K-wire 結果 TBW /11/

97 862 mallet 図 MSF DTF TBW DTF MSF DIP K-wire DIP K-wire 表 1 90

98 当科における骨性 mallet の手術治療成績 仮固定した群 8 例 男 5 例 女 3 例 平均患者年齢 54.8 歳 石 黒 法 4 例 TBW 法 1 例 DTF 法 3 例 平均手術時間 10 分 平均経過観察期間 24 週 と仮 固定しない群 7 例 男 5 例 女 2 例 平均患者年齢 47.3 歳 MSF 法 7 例 平均手術時間 15 分 平均経 過観察期間 24 週 を比較した 仮固定した群 8 例 は 優 2 例 良 1 例 可 1 例 不可 4 例であり 仮 固定しない群 7 例 は 優 5 例 良 2 例であった また この 1 年間の 40 歳以上の症例は MSF 法を 積極的に選択したところその成績は 6 例中 優 4 例 良 1 例 不可 1 例であった 症例提示 症例 1 56 才 女性 右小指 主婦 ポケットに小指をひっかけ受傷 そのまま翌日か ら海外旅行へ出発した 3 週間後に帰国し近医受診 骨折の診断をうけ当科紹介となった 患者は装具療 法やワイヤーの皮膚からの突出 また皮膚切開も受 け入れず 受傷から 4 週間後に 1.0mm K-wire 2 本 にて DTF 法をおこなった 術後 12 週間で抜釘 13 週後の最終来院時 DIP 関節の自動屈曲 25 度 自動 伸展 0 度であった レントゲン上骨癒合したが 初 診時から見られた関節症変化の進行がみられた 図 2 蟹江の評価で不可であった しかし患者本人は 完全伸展できることに満足とのことであった 症例 2 46 才 男性 右環指 建設業 草野球でボールがぶつかり受傷するが放置してい た 疼痛続くため 2 週間後に近医を受診し 骨折の 診断をうけ当科紹介となり受傷から 17 日目に手術 となった MSF 法をおこない 術後 6 週間の副子 固定を指示した 24 週後の最終来院時 レントゲ ン上骨癒合良好 図 3 であり DIP 関節の自動屈曲 50 度 自動伸展 0 度 蟹江評価で優であった 図 4 症例 3 60 才 男性 右環指 事務職 ソフトボールが指にぶつかり受傷 同日近医受診 し骨折の診断をうけ 当科紹介受診となり受傷から 5 日目に手術となった MSF 法をおこない 整復 位良好であったが 術後 2 週間で骨片の転位みられ たため合計 10 週間の副子固定をおこなった 17 週 後の最終来院時 レントゲン上関節面に間隙残るが 骨癒合良好であり 図 5 DIP 関節の自動屈曲 60 度 自動伸展 -5 度 蟹江評価で優となった 図 6 考 察 当科では骨性 mallet の手術治療法として成績が安 図4 863 図2 症例 1 単純レントゲン写真像 図3 症例 2 単純レントゲン写真像 症例 2 最終時の手術創と指可動域を示す 定し 手技が簡便な石黒法 2) を基本術式としている しかしながら約 1 か月の間 鋼線が皮膚から露出して おり 日常生活動作の制限が必要となる また TBW 法 3) は確実な整復と固定が得られるが 手技が複雑 でありまた侵襲が大きいため最近では陳旧例に対し てのみおこなっている 4) 近年 微小スクリューを用 91

99 864 mallet 図 5 3 図 6 3 図 7 Martin 1.0mm micro module system MSF 1.1mm C-wire DIP extension block pin 1.2mm Leibinger screw 5 SYNTHES Modular Hand System 1.3mm screw 6 extension block screw 1.0mm 1.3mm 1.5mm 7 5mm DIP 0.7mm K-wire DIP Martin 1.0mm micro module system 7 0.7mm 7mm K-wire DIP 7 MSF

100 mallet mallet K-wire DIP 1 40 MSF 8 DIP Heberden mallet mallet DIP K-wire MSF mmK-wire 0.7mm 1.0mm 5 27: , : , : , Heberden 30: , Mallet finger 27: , Mallet 22: 58-61, 2005 まとめ 4 mallet DIP K-wire 文献 1 14 mallet finger 34: , mallet finger closed reduction 5: , tension band wiring 40: , tension band wiring 27: ,

101 J Jpn Soc Surg Hand Mallet K K 緒言 1 0.7mm Kirschner K K 対象と方法 type 1 9 type 2 14 type 3 13 type type 1 7 type 2 3 type 3 22 type mm K 0.7mm K /11/

102 Mallet 867 図 1 a 0.7mmK b c 図 2 a b a 2 DIP DIP extension lag X step off OA Mann-Whitney s U test 5 Fisher s exact test 5 結果 DIP extension lag extension lag extension lag 3 X step off mm mm OA OA 1 3 K K type 3 0.7mmK

103 868 Mallet 図 3 図 4 59 type 3 a 2 b c 図 5 39 type 3 a 15 b c X step off 0.59mm DIP type 3 0.7mmK X step off 0.74mm 考察 extension block pin 96

104 Mallet mm K 5 double extension block pin 6 K screw 7 hook plate 8 screw plate 1 K heat necrosis 9 OA K DIP DIP DIP 10 K DIP K K 3D-CT まとめ K K 文献 1 mallet finger closed reduction 5: , : , mallet finger 34: , extension block pin 28: 23-25, MB Orthop 25: 41-45, mallet finger double extension block 27: , : , hook plate 55: 87-90, Khanna A, et al. The thermal effects of Kirschner wire fixation on small bones. J Hand Surg 24-B: , : ,

105 J Jpn Soc Surg Hand RA MP RA 4 1 Behcet arc of movement 緒言 対象と方法 MP EDC EIP EDM MP 2 RA 7 DRUJ 6 Kienbock 2 Madelung Behcet 1 Behcet Madelung 1 2 EDM RA 4 RA MP arc of movement lag One way ANOVA Fisher P 0.05 結果 /02/

106 871 表 1 S-K Sauve-Kapandji 図 1 MP arc of movement * p 0.03 ** P MP arc of movement MP arc of movement MP Behcet DRUJ 1 RA 4 ECRL MP MP 1 Kienbock 99

107 872 図 2 70 Kienbock stage 3b 図 3 70 Kienbock EDC EDC 3 EDC EDC EDC MP 20 lag lag 70 Kienbock MP 10 6 MP MP 10 lag MP X-P Lichtman stage 3b Kienbock 2 EDC EDC EDC MP 20 lag 10 lag 図 4 70 Kienbock 10 MP lag MP MP 20 lag lag 4 100

108 873 EIP EDC EDM 考察 MP MP 45 lag RA DRUJ Kienbock Behcet Madelung EIP MP 120 DRUJ EDC Darrach EDC MP MP lag arc of movement MP arc of movement 1 2 lag amplitude ECRL ECRB ECU MP lag 30 1 MP lag EIP EDM まとめ

109 874 3 MP lag 4 2 文献 1 18: , : , Nakamura S, et al. Tendon grafting for multiple extensor tendon ruptures of fingers in rheumatoid hands. J Hand Surg 27B: , Chung US, et al. Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands. J Hand Surg 35E: , : , Moore JR, et al. Tendon ruptures in the rheumatoid hand: analysis of treatment and functional results in 60 patients. J Hand Surg 12A: 9-14, Sakuma Y, et al. Number of ruptured tendons and surgical delay as prognostic factor for the surgical repair of extensor tendon ruptures in rheumatoid wrist. J Rheumatol 41 2 : ,

110 J Jpn Soc Surg Hand tendon callus EPL tendon callus tendon callus Tendon callus interlacing suture loop 2 2 TAM TAM Tendon callus 緒言 EPL EIP 1 EPL tendon callus tendon callus 4 対象と方法 IP MP Zone T4 1 1 Lister EPL tendon callus Tendon callus Tendon callus tendon callus 2 interlacing suture MP IP 2 TAM 結果 /01/

111 876 Tendon callus EPL 表 1 表 2 TAM IP 30 MP 12 1 EPL EPL tendon callus 2 Lister tendon callus 2 interlacing suture TAM Zone I II 4 tendon callus 図 1 3 考察 EPL EPL EIP 1 tendon callus tendon callus tendon callus 図 2 3 tendon callus 104

112 Tendon callus EPL 877 図 3 3 Tendon callus 図 4 3 図 5 3 A. B. advancement 3 Tendon callus tendon callus tendon callus EIP Tendon callus EIP 4 tendon callus 5 2 tendon callus EIP tendon callus option まとめ Tendon callus EPL 105

113 878 Tendon callus EPL 文献 1 27: , bridge graft 24: 33-38, Tendon callus 24: , : ,

114 J Jpn Soc Surg Hand PIP Semmes-Weinstein PIP 10 緒言 oblique triangular flap 1 15mm hemipulp flap mm mm 25 30mm flag flap Semmes-Weinstein SWT PIP 対象と方法 mm 結果 /12/

115 SWT PIP PIP 表 1 考察 PIP PIP mm 2 /60 576mm 2 /55 600mm 2 /16 600mm 2 /56 638mm 2 /25 6 表 2 SWT 表 3 SWT 108

116 881 Matsuzaki mm mm mm 2 3 PIP PIP PIP 3 39: , Lai CS, et al. : A versatile method for reconstruction of finger defects: reverse digital artery flap. Br J Plast surg 45: , Orthopaedics 9: 35-44, : , Matsuzaki H, et al. Preventing postoperative congestion in reverse pedicle digital island flaps when reconstructing composite tissue defects in the fingertip: a patient series. Hand Surg 17: 77-82, Reverse digital flag flap 39: , Sensory Recovery in Reverse Vascular Pedicle Digital Island Flap 17: , ROM 25: 38-43, 2009 まとめ PIP 文献 1 3: , Han SK, et al. The reverse digital artery Island flap: clinical experience in 120 fingers. Plast Reconst surg 101: ,

117 J Jpn Soc Surg Hand 緒言 対象と方法 Tc- 0.2ml 結果 RI 10 hot spot a b 20 8cm 2a b c 4 3a b 2015/01/

118 883 表 1 図 1 図 2 図 3 111

119 884 図 4 図 5 4 RI 10 2 hot spot 2 5a b cm 2 6a b c d 2 7a b 8 RI 10 1 hot spot 2 9a b 考察 112

120 885 図 6 図 7 図 8 図 Shesol 5 network 1990 Chen

121 RI 10 2 まとめ RI 文献 1 Huang GH, et al. Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg 60: , Koshima I, et al. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg 19: , Becker C, et al. Postmastectomy lymphedema: longterm results following microsurgical lymph node transplantation. Ann Surg 243: , Armer JM. The problem of post-breast cancer lymphedema; Impact and measurement issues. Cancer Invest 23: 76-83, Shesol B, et al. Successful lymph node transplantation in rats restoration of lymphatic function. Plast Reconstr Surg 63: , Chen H, et al. Lymph node transfer for the treatment of obstructive lymphoedema in the canine model. Br J Plast Surg 43: , : , : ,

122 J Jpn Soc Surg Hand CT CT Filan&Herbert Type B1 B OsiriX v.5.7 DICOM 20mm 24mm Type B2 緒言 Herbert Herbert computed tomography CT 表 1 対象と方法 CT Filan&Herbert 5 Type B1 B Filan&Herbert Type B1 5 Type B CT Philips Brilliance mm OsiriX v /11/

123 bit NewtonGraphics Inc. DICOM 3DMPR 3DMPR sagittal coronal axial Thickslab 3mm 1 3mm 3mm 3mm sagittal coronal 図 1 MPR 図 2 図 3 116

124 889 表 2 sagittal coronal 1 2 sagittal coronal sagittal 2 結果 Type B1 B mm mm Type B2 B mm mm 2 B1 sagittal B2 sagittal 4 B 考察 2 1 図 4 B mm 24mm B1 humpback 20mm B1 117

125 890 B2 Heinzelmann 30 Cadaver 31mm 4mm 27mm 7 Heinzelmann B2 Soubeyland Cadaver CT 8 B1 B2 Meermans 9 10 X-P CT CT 20mm 24mm 2 Type B2 3 CT 文献 1 Herbert TJ, et al. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 66: , AO 2 pp , Hart A, et al. Central versus eccentric internal fixation of acute scaphoid fractures. J Hand Surg Am 38: 66-71, Ezquerro F, et al. The influence of wire positioning upon the initial stability of scaphoid fractures fixed using Kirschner wires A finite element study. Med Eng Phys 29: , Filan SL, et al. Herbert screw fixation of scaphoid fractures. J Bone Joint Surg Br 78: , Dodds SD, et al. Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation. J Hand Surg Am 31: , Heinzelmann AD, et al. Anthropometry of the human scaphoid. J Hand Surg Am 32: , Soubeyland M, et al. Comparison of percutaneous dorsal versus volar fixation of scaphoid waist fractures using a computer model in cadavers. J Hand Surg Am 34: , Meermans G, et al. A comparison of 2 methods for scaphoid central screw placement from a volar approach. J Hand Surg Am 36: , Kahoe NJ, et al. Incidence of osteoarthritis in the scapho-trapezial joint after Herbert screw fixation of the scaphoid. J Hand Surg Br 28: , まとめ 1 118

126 J Jpn Soc Surg Hand LIPUS LIPUS LIPUS LIPUS LIPUS 12 緒言 70 1 low-intensity pulsed ultrasound LIPUS LIPUS LIPUS 対象と方法 X MRI LIPUS Sonic accelerated Fracture Healing System SAFUS4000J LIPUS DTJ screw LIPUS LS 5 LIPUS LB 5 S 6 B 5 LS 2 S /02/

127 892 表 1 LS 3 LB 4 S 2 B 2 LB 1 B X CT Cooney clinical scoring chart Mann-Whitney U 結果 LS S LB B LB p 0.04 LIPUS LS LB LS p 0.04 LIPUS S B 6 LS LB 9.2 S B 11.2 LIPUS 12 LS S LB B LS LB S B LIPUS LIPUS 1 LS LB excellent 9 good 1 S B excellent 10 good X CT LIPUS excellent 120

128 893 考察 図 1 1 a X b CT c X d CT 3 LIPUS 2006 LIPUS 4 Frankel LIPUS 86 5 Nolte LIPUS LIPUS 7 Jingushi LIPUS 6 8 LIPUS LIPUS 9 LIPUS LIPUS 3 10 LB B LIPUS LIPUS 9 6 LIPUS まとめ 7 LIPUS LIPUS 121

129 894 文献 1 Sendher R, et al. The scaphoid. Orthop Clin North Am 44: , : , Buijze GA, et al. Management of Scaphoid Nonunion. J Hand Surg Am 37A: , : , Frankel VH. Results of prescription use of pulsed ultrasound therapy in fracture management. Surgical technology international VII. San Francisco. Universal Medical Press. pp , Nolte PA, et al. Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma 51: , Gebauer D, et al. Low-intensity pulsed ultrasound: effects on nonunions. Ultrasound Med Biol 31: , Jingushi S, et al. Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures. J Orthop Sci 12: 35-41, LIPUS 48: , Saint-Cyr M, et al. Dorsal Percutaneous Cannulated Screw Fixation for Delayed Union and Nonunion of the Scaphoid. Plast Reconstr Surg 128: ,

130 J Jpn Soc Surg Hand pillar pain Body Mass Index 自由投稿論文 Body Mass Index BMI pillar pain Pillar pain 3 BMI MRI TCL pillar pain Pillar pain BMI pillar pain BMI TCL pillar pain 緒言 1989 ECTR pillar pain OCTR ECTR 1 Pillar pain pillar pain Body Mass Index BMI CTS 5 pillar pain BMI BMI pillar pain portal wrist crease 1cm TCL TCL Pillar pain 6 ECTR 3 pillar pain 2 pillar pain BMI MRI TCL 1 TCL PACS 2 対象と方法 ECTR Menon CTS Relief Kit one 図 1 TCL 2015/01/

131 896 Pillar pain BMI 表 1 StatMate t p p p TCL BMI pillar pain TCL BMI Stat View3.0 結果 Pillar pain Pillar pain Pillar pain Pillar pain TCL mm mm mm TCL 1 p Pillar pain Pillar pain TCL mm pillar pain mm Pillar pain pilllar pain 2 p BMI pillar pain BMI pillar pain BMI Pillar pain BMI 2 p BMI TCL R R 0.43 p BMI TCL 2 R 0.56 p R 0.15 p 0.53 BMI TCL Pillar pain TCL R 0.31 p

132 Pillar pain BMI 897 表 2 pillar pain 図 2 TCL BMI 4 pillar pain BMI R 0.56 p pillar pain BMI 5-1 R 0.49 p R 0.91 p BMI pillar pain pillar pain 6 R 0.12 p 0.54 図 3 TCL BMI 125

133 898 Pillar pain BMI 図 4 pillar pain TCL 図 6 pillar pain 考察 BMI CTS development risk factor Hlebs S 5 pillar pain BMI Pillar pain 4 Pillar pain 2 4 pillar pain BMI 2 図 5 pillar pain BMI

134 Pillar pain BMI 899 pillar pain BMI pillar pain BMI TCL BMI TCL 7 BMI 30 CTS 8 BMI TCL 9 pillar pain Pillar pain 3 pillar pain pillar pain 6 MRI pillar pain 10 Waller pillar pain pillar pain 3 BMI TCL 4 Pillar pain BMI 5 TCL pillar pain 文献 1 Ferdinand RD, et al. Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. J Bone Joint Surg Br 84: , : 48-51, Gartsman GM, et al. Carpal arch alteration after carpal tunnel release. J Hand Surg 11: , pillar pain 26: , Hlebs S, et al. Body mass index and anthropometric characteristics of the hand as risk Factors for carpal tunnel syndrome. Coll Antropol 38: , pillar pain 29: , Kunou M, et al. An anatomical study of the carpal tunnel for endoscopic carpal tunnel release. Nihon Seikeigeka Gakkai Zasshi 68: 78-84, : , Miyamoto H, et al. Comparative study on the stiffness of transverse carpal ligament between normal subjects and carpal tunnel syndrome patients. Hand Sugery. Hand Sugery 18: , pp , 1992 まとめ 1 ECTR pillar pain BMI BMI pillar pain 127

135 J Jpn Soc Surg Hand CTS subsynovial connective tissue SSCT SSCT CTS TNF-α 10 10mg 1 1ml visual analog scale quick-dash 緒言 CTS subsynovial connective tissue SSCT 1 Tumor necrosis factor alpha TNF-α 2 CTS TNF-α 対象と方法 CTS 1 VAS 40mm mg 1 1ml Visual analog scale VAS Quick-DASH DML VAS Quick-DASH 1 DML 4 DML 70mm one-way ANOVA 5 結果 1 VAS Quick-DASH DML /02/

136 901 図 1 VAS 1, 2, 3, 4 図 2 Quick-DASH 図 3 DML 4 考察 1 SSCT SSCT SSCT IL-6 E2 3 TNFα 4 2 TNFα TNFα TNFα 4 2 Korhonen

137 902 VAS Quick-DASH DML CTS SSCT IL-6 E2 -C MMP-2 VEGF TNFα TNFα 8 Tsujii M, et al. Involvement of tenascin-c and PG-M/ versican in flexor tenosynovial pathology of idiopathic carpal tunnel syndrome. Histology and histopathology 21: , Donato G, et al. Pathological findings in subsynovial connective tissue in idiopathic carpal tunnel syndrome. Clinical neuropathology 28: , まとめ 文献 1 Amirfeyz R, et al. Hand elevation test for assessment of carpal tunnel syndrome. J Hand Surg Br 30: , Ohtori S, et al. Epidural administration of spinal nerves with the tumor necrosis factor-alpha inhibitor, etanercept, compared with dexamethasone for treatment of sciatica in patients with lumbar spinal stenosis: a prospective randomized study. Spine 37: , Freeland AE, et al. Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome. Microsurgery 22: , Olmarker K, et al. Selective inhibition of tumor necrosis factor-alpha prevents nucleus pulposus-induced thrombus formation, intraneural edema, and reduction of nerve conduction velocity: possible implications for future pharmacologic treatment strategies of sciatica. Spine 26: , Korhonen T, et al. Efficacy of infliximab for disc herniation-induced sciatica: one-year follow-up. Spine 29: , Korhonen T, et al. The treatment of disc-herniation-induced sciatica with infliximab: one-year follow-up results of FIRST II, a randomized controlled trial. Spine 31: , Hirata H, et al. MMP-2 expression is associated with rapidly proliferative arteriosclerosis in the flexor tenosynovium and pain severity in carpal tunnel syndrome. The Journal of pathology 205: ,

138 J Jpn Soc Surg Hand I 9 II 6 III 15 IV 10 IV III IV fair I 緒言 対象と方法 Tinel Phalen perfect O I II III IV Kelly 3 Kruskal-wallis test Mann-Whitney U-test with Bonferroni correction 0.05 結果 grade I/II/III I 2/7/0 II 2/3/1 III 2/8/5 IV 1/4/5 1 I grade III III IV grade III 1/2/3/4/5 I 0/1/6/1/0 II 0/0/4/1/1 III 0/1/5/3/3 IV 0/1/1/1/6 2 excellent/good/fair/poor I 8/0/0/1 II 3/2/1/0 III 3/9/3/0 IV 0/5/5/0 3 I II excellent good 2014/11/

139 904 図 1 図 2 図 3 III IV fair p 0.05 Kruskal-wallis test p 0.05 I III I IV Mann- Whitney U-test with Bonferroni correction p 0.05 fair 9 poor 1 1 fair poor 3 1 tight grade III grade III 5 6 fair 考察 132

140 905 表 1 poor Gelberman Mondelli Nolan まとめ 文献 1 2: , : , Kelly CP, et al. Early experience with endoscopic carpal tunnel release. J Hand Surg Br 19: 18-21, Lundborg G, et al. Nerve compression injury and increased endoneurial fluid pressure: a miniature compartment syndrome. J Neurol Neurosurg Psychiatry 46: , Gelberman RH, et al. Results of treatment of severe carpal-tunnel syndrome without internal neurolysis of the median nerve. J Bone Joint Surg Am 69: , Mondelli M, et al. Clinical and neurophysiological outcome of surgery in extreme carpal tunnel syndrome. Clin Neurophysiol 112: , Nolan WB 3rd, et al. Results of treatment of severe carpal tunnel syndrome. J Hand Surg Am 17: ,

141 J Jpn Soc Surg Hand pillar pain ECTR pillar pain ECTR ECTR pillar pain 2 pillar pain 緒言 pillar pain ECTR 47 ECTR 146 pillar pain 1 pillar pain 55 ECTR 105 pillar pain pillar pain 2 pillar pain ECTR ECTR 対象と方法 ECTR A mg B mg C ECTR D IMADA Toyohashi City 4.0kgf 1 3 pillar pain χ2 test 結果 A B C /10/

142 907 表 1 D C 1 pillar pain 図 1 ECTR D pillar pain 2 D 1-2 A pillar pain p 考察 ECTR 3 pillar pain 9-15 ECTR pillar pain ECTR pillar pain pillar pain pillar pain ECTR pillar pain Shum 3 12 pillar pain 4 ECTR pillar pain まとめ ECTR pillar pain 文献 1 ECTR pillar pain 22: 6-9, pillar pain 29: , Shum C, et al. The role of the flexor tenosynovectomy in the operative treatment of carpal tunnel syndrome. JBJS 84-A: , : ,

143 J Jpn Soc Surg Hand CTSI CTSI-SS FS CTSI 緒言 対象と方法 APB CTSI Semmes-Weinstein SWT 2PD CTSI SS 11 FS StatView for windows version Wilcoxon 5 80 CTSI 結果 APB 5 10ms 4 10ms CTSI 6 SS FS /11/

144 図 1 SS FS SWT 2PD SS p FS p a b CT- SI-SS CTSI-FS CTSI-FS SWT 1c PD 13.33mm mm 6 p d kg kg kg 6 p e kg kg f CTSI-SS FS SWT 4 2 1kg CTSI-SS FS

145 表 1 6 CTSI-SS FS SWT 4 2 SS p FS p 考察 Wilgis CTSI CTSI SWT 2PD CTSI-SS 1 CTSI-FS CTSI-FS 図

146 CTSI-SS CTSI-FS CTSI-SS FS 文献 1 26: , Wilgis EF, et al. A prospective assessment of carpal tunnel surgery with respect to age. J Hand Surg 31B: , Porter P, et al. The influence of age on outcome after operation for the carpal tunnel syndrome. JBJS 84-B: , Greenslade JR, et al. DASH and Boston questionnaire assessment of carpal tunnel syndrome outcome: what is the responsiveness of an outcome questionnaire? J Hand Surg 29B: , Hobby JL, et al. The effect of age and gender upon symptoms and surgical outcomes in carpal tunnel syndrome. J Hand Surg 30B: , DASH 23: , Leit ME, et al. Patient-reported outcome after carpal tunnel release for advanced disease: A prospective and longitudinal assessment in patients older than age 70. J. Hand Surg 29-A: , Tomaino M, et al. Carpal tunnel release for advanced disease in patients 70 years and older: Dose outcome from the patient s perspective justify surgery? J. Hand Surg 26-B: , : , : , 2004 まとめ

147 J Jpn Soc Surg Hand knot tenodesis 3 knot tenodesis FDS knot 緒言 1-portal FDS knot tenodesis 対象と方法 grade 3 1 M portal FDS FDS slit MP 1-a TJ screw 3.1mm cannulated drill 1-b FDS FDS knot knot c FDS knot slit FDS knot FDS half slip knot FDS knot 1-d 1 CM 3 knot 2 Tip pinch Kapandji s stage Quick DASH score Wilcoxon signed-rank test 5 結果 ETCR Tip pinch /10/

148 knot tenodesis 913 図 1 a MP FDS b cannulated drill c FDS knot d knot 図 2 表 1 0.8kg kg P kg kg n.s. Kapandji s stage P 0.01 Quick DASH score P grade 3 Tip pinch 2.7kg 22.5kg Kapandji s stage 3 Quick DASH score Tip pinch 7.4kg 25.2kg Kapandji s stage 9 Quick DASH score 0 3 考察 Camitz PL Bunnel FDS 141

149 914 knot tenodesis 図 3 68 grade 3 11 Enna EPB Burkhalter EIP Phalen ECU APB EPL interlacing suture 3 4 Interference screw 1 3 ADL switching Froimson 4 Keyhole tenodesis Keyhole tenodesis knot Jayamoorthy 5 2 interference screw keyhole tenodesis 3 Biomechanical study keyhole tenodesis Keyhole tenodesis knot tenodesis slit knot lock knot FDS Okutsu 6 β-tcp ADL まとめ 1 15 knot tenodesis FDS 2 142

150 knot tenodesis knot tenodesis 文献 1 interference screw 25: , Gyon pulley 21: , : , Froimson AI, et al. Keyhole tenodesis of biceps origin at the shoulder. Clin Orthop Relat Res 112: , Jayamoorthy T, et al. Biceps tenodesis: a biomechanical study of fixation methods. J Shoulder Elbow Surg 13: , Okutsu I, et al. Opponoplasty without postoperative immobilization. Hand Surg 16: ,

151 J Jpn Soc Surg Hand Kapandji index 自由投稿論文 Kapandji index perfect O M Kapandji index grade MMT perfect O 9 M 7.1msec Kapandji index stage Kapandji index 5 Kapandji index 緒言 perfect O 1 2 Kapandji index 3 stage 0 stage 10 stage 0 stage 3 stage 6 stage 10 Kapandji index 4 5 Kapandji index Kapandji index Kapandji index 対象と方法 cm 3cm Kapandji index Kapandji 1 MMT perfect O M 1 Kapandji index Perfect O 1 Kapandji index Spearman Mann-Whitney Kraskal-Wallis p /11/

152 Kapandji index 917 図 1 Kapandji index 図 2 結果 Kapandji index stage stage 9 6 stage 8 2 stage 6 2 stage grade MMT Perfect O M 7.1msec msec Kapandji index Kapandji index MMT perfect O M 1 3 考察 perfect O 1 2 O 4 M 1 perfect O 1 perfect O 2 145

153 918 Kapandji index 表 1 Kapandji index Kapandji index Kapandji 3 Kapandji index CM 6 7 van Rijn CM Kapandji index Kapandji index 4 5 Wan 21 Camitz Kapandji index Kapandji index Kapandji index Kapandji index 図 3 Kapandji index M Spearman 146

154 Kapandji index 919 Kapandji index Kapandji index Kapandji index perfect O M Kapandji index Kapandji index Kapandji index Kapandji Kapandji index stage 10 3 stage 10 Kapandji stage Kapandji index grade 3 kapandji test stage 10 Kapandji index Kapandji index 文献 1 Perfect O 23: , perfect O sign 19: , Kapandji AI. Clinical evaluation of the thumb s opposition. J Hand Ther 5: , Wan SH, et al. Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients. Hong Kong Med J 13: , pillar pain 46: , Van Rijn J, et al. A cemented surface replacement prosthesis in the basal thumb joint. J Hand Surg 35-A: , Sabapathy SR, et al. Reconstruction of the thumb amputation at the carpometacarpal joint level by groin flap and second toe tramsfer. Injury 44: , 2013 まとめ Kapandji index 5 perfect O M Kapandji index Kapandji index 5 147

155 J Jpn Soc Surg Hand APB OPP 59 OPP 1 APB OPP APB OPP 緒言 CTS APB OPP 対象と方法 MHz Mylab Five 90 1 OPP 1 APB OPP 図 1 APB 図 2 OPP 結果 20 APB mm mm OPP mm mm APB mm mm OPP mm mm 30 APB mm /10/

156 921 表 1 表 2 2.0mm OPP mm mm APB mm mm OPP mm mm 1 2 / 20 APB OPP APB OPP APB OPP 考察 1 MRI CTS OPP APB OPP APB BMI まとめ 149

157 922 文献 1 Nagaoka M, et al. Endoscopic carpal tunnel release in the elderly. Minim Invasive Neurosurg 49: , Jenkins TM, et al. A prospective pilot study measuring muscle volumetric change in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 14: , Tuncali D, et al. The thenar index: an objective assessment and classification of thenar atrophy based on static hand imprints and clinical implications. Plast Reconstr Surg 117: , Kim S, et al. Investigation of the static and dynamic musculotendious architecture of supraspinatus. Clin Anat 23: 48-55, Yi TL, et al. Reliability of the supraspinatus muscle thickness measurement by ultrasonography. Ann Rehabil Med 36: , Lee DH, et al. Ultrasound evaluation of flexor tendon lacerations. J Hand Surg Am 25: , Wiesler ER, et al. The use of diagnostic ultrasound in carpal tunnel syndrome. J Hand Surg Am 31: , : 47-50,

158 J Jpn Soc Surg Hand kg 3 6.1kg 6.5kg 緒言 DASH CTSI Hand20 対象と方法 図 1 結果 kg 3 6.1kg 2014/11/07 JA

159 924 表 1 3 表 2 図 2 6.5kg kg kg 3.0kg kg 3 2 考察 23.4 pillar pain 1 pulp pinch QOL kg 1.8kg まとめ 3 152

160 925 文献 1 QOL 25: , : 84-86, : ,

161 J Jpn Soc Surg Hand King King King 6 King K T 緒言 1 2 King 3 King 2 King 対象と方法 King K T Mann-Whitney U-test p 0.05 conduction block 0m/s King 10cm Osborne 3cm 2014/11/ JA 154

162 King 927 表 1 1cm cm Osborne 3cm 結果 K T P U P U 144 P U 189 P U P U 193 P U 150 P U 10 P U 68 P K T U 258 P 1.97 K 2 3 K T K 5 T U 95.5 P cm King 考察 King 155

163 928 King 図 1 King 図 Capo 10 King 3 meta-analysis 6 7 Hicks 8 King King King 2 Osterman 9 King King 7cm King claw finger 156

164 King 929 まとめ King 文献 1 Ward WA, et al. Endoscopically assisted ulnar neurolysis for cubital tunnel syndrome. Tech Hand Up Extrem Surg 13 3 : , Adkinson JM, et al. Minimal-incision in situ ulnar nerve decompression at the elbow. Hand Clin 30 1 : 63-70, Capo JT, et al. Subcutaneous anterior transposition versus decompression and medial epicondylectomy for the treatment of cubital tunnel syndrome. Orthopedics : e713-e717, : , Kroonen LT. Cubital tunnel syndrome. Orthop Clin North Am 43 4 : , Brauer CA, et al. The surgical treatment of cubital tunnel syndrome: a decision analysis. J Hand Surg Eur Vol 32 6 : , Macadam SA, et al. Simple decompression versus anterior subcutaneous and submuscular transposition of the ulnar nerve for cubital tunnel syndrome: a meta-analysis. J Hand Surg Am 33 8 : 1314e1-12, Hicks D, et al. Ulnar nerve strains at the elbow: the effect of in situ decompression and medial epicondylectomy. J Hand Surg Am 27 6 : , Osterman AL, et al. Subcutaneous transposition of the ulnar nerve for treatment of cubital tunnel syndrome Hand Clin 12: ,

165 J Jpn Soc Surg Hand FPL FDP FPL FDP 1 4 M3 2 M4 2 8 M3 6 M4 M2 1 FPL 8 FDP 7.0 M0 9 1 FPL FDP M1 2 2 M4 6 2 緒言 SAINP 1 M0 2 2 対象と方法 FPL FDP SAINP FPL FDP MRC M0 M5 6 M0 M4 M5 FPL FDP Spearmann Mann-Whitney U 結果 FPL M M0 39 M1 10 M /11/

166 931 表 1 FPL M3 M3 表 3 FDP M3 Table-1 表 4 FDP 表 2 FPL M3 2 M4 2 8 M3 6 M4 M2 M3 M4 2 FDP M M FPL M3 1 M4 2 8 M3 6 M4 FPL M4 M1 100 M FPL FDP 1 2 FDP FPL EMG MMT FPL M0 8 5 M1 M2 M0 M3 FDP M M0 1 FPL FDP M1 2 1 M

167 932 図 Spearmann s correlation 表 5 図 2 Spearmann s correlation 160

168 933 表 Mann-whitney U test 表 Mann-whitney U test 表 Mann-whitney U test 7 6 FPL FDP 6 M3 8 考察 M4 Miller-Breslow Seki 7 FDP FPL M M3 FPL FDP M4 6 FPL FDP MMT M3 M3+ M4- M3 M Seki

169 934 FDP M EMG 文献 1 Nagano A. Spontaneous anterior interosseous nerve palsy. J Bone Joint Surg Br 85: , : , Miller-Breslow A, et al. Nonoperative treatment of anterior interosseous nerve paralysis. J Hand Surg Am 15: , : , : , : , Seki M, et al. Neurolysis is not required for young patients with a spontaneous palsy of the anterior interosseous nerve. J Bone Joint Surg Br 88: , : , 2006 まとめ 1 FPL FDP 1 40 M3 20 M M3 60 M M4 162

170 J Jpn Soc Surg Hand 自由投稿論文 S S I 2 A1 pulley 2 S Snapping Locking 1 2 S I S S 75.7 S I 60 緒言 対象と方法 A 2 1 A1 pully MP PIP DIP 1 snapping locking PPD locking MP IP A1 pully snapping locking MP IP 2015/01/

171 936 図1 図2 ストレッチは弾発指に対する保存治療として有効である 示指 小指に対する A1 pulley ストレッチ 手関節軽度背屈位にて MP PIP 関節 90 程度屈 曲 DIP 関節伸展位で母指球と指腹でウッドブロ ック等を握らせ 屈筋腱を最大収縮させる 母指に対する A1 pulley ストレッチ 手関節軽度背屈位にて MP 関節最大屈曲位 IP 関節伸展位または軽度屈曲位にて屈曲させた肢位 を保持するように抵抗をかける 1 回 30 秒以上 1 日 10 回以上実施するよう指導し ている 動的ストレッチでは炎症症状 疼痛の増悪 を来すことが多いので 静的ストレッチを行うよう に指導している 特に疼痛の強い症例では強く短時 間でのストレッチを行わないよう注意し 疼痛が許 容範囲を超えない程度のストレッチで 時間をかけ て実施するよう指導している また ストレッチと並行して温熱療法も実施して いる 3 調査項目 理学療法開始から 1 カ月経過時の症状 疼痛 図3 リラックスさせた肢位で手関節背屈位にて MP IP 関節を他動伸展させる 表1 澤泉改変内田らの基準 snapping locking と経過観察期間中の症状の改 善数 治療成績を検討した 治療成績は 症状の改 善 消失数 残存数 澤泉改変内田らの基準を用い Excellent と Good を成績良好とした 表 1 症状 ステロイド注射有無については以下のように定義し た 1 疼痛は圧痛 伸張痛 弾発現象時の疼痛の 3 項目とした 2 snapping を自動伸展で解除可能な弾発現象 locking は自動伸展では解除出来ない弾発現象とし た 3 ステロイド注射の有無に関して 理学療法期 間中にストレッチのみで治療可能であった S 群 74 例と 症状によりトリアムシノロン A 注射の追 加を要した S I 群 30 例の 2 群に分けた 注射 時期に関しては 担当医の判断で実施している 経 過観察期間中の症状の改善数は Kaplan-Meier 法 を用いて症状残存数を生存曲線として示し 統計学 的評価として Log-rank 検定を用いた 調査はカルテ記載内容から retrospective に実施 した データの利用については当院倫理審査委員会 の許可を得ている 164

172 937 図 4 Snapping, Locking S 図 5 Kaplan-Meier Snapping Locking 1 2 S S+I 結果 1 S /71 S I 60 18/30 snapping S /74 S I /30 locking S /47 S I 90 18/ Kaplan-Meier Logrank S S I snapping locking snapping locking 1 2 S I S 165

173 ストレッチは弾発指に対する保存治療として有効である 938 図6 治療成績 澤泉改変内田らの基準 Excellent と Good を成績良好とした S 群では 75.7 S I 群では 60 で成績良好であった 治療成績は S 群では /74 例 S I 群 では 60 18/30 例 で成績良好であった 図 6 考 察 本研究の結果 理学療法開始から 1 カ月の時点で 疼痛 snapping locking ともにかなりの改善が得 られることが示され 治療として有効であると考え られた 図 4 長期的な症状の変化において S 群 に早期に症状の改善が見られた理由としては 症状 が比較的軽度であった症例が多かった可能性や 患 者が積極的訓練を行えたことが推察される S I 群はストレッチのみでは治療困難でステロイド注射 を追加していること 疼痛 locking の症例数が多 かったことなどから S 群より症状が重篤であった と考える また 疼痛症状および患者の疼痛閾値の 低さ 患者の自主訓練に対するモチベーションの低 さ等がストレッチの積極的実施の妨げになり 症状 の改善につながらなかったことが推察される 更 に 注射による症状改善によりストレッチ実施を本 人の判断で中断し 注射の効果が消失した際に再発 した症例などがあったことが S I 群の治療成績が 低かったことの原因と推察される 図 5 著者らは A1 pully ストレッチの原理として MP PIP 関節最大屈曲 DIP 関節伸展位にて抵抗下に自 動屈曲力を発生させると 反作用のベクトルとの合 力として A1 pulley を掌側に引き上げる力が作用す るものと考えているが 図 7 MP 関節の屈曲角度 が不足すると充分な A1 pulley の拡大が得られない 可能性も考えられる 図 8 さらに腱膨大部が狭 窄部である A1 pulley 内に位置する状態で本法を行 うことで ブジー bougie 効果が生じ A1 pulley 内腔がより拡大すると推察している 図 9 狭い 幅のウッドブロックでストレッチを行うと図 9-a の 状態になり屈曲力を出せず A1 pully 内腔拡大が起 こらず 屈曲時に locking や疼痛を生じさせてしま うことが多い また ウッドブロックの幅が広すぎ ると図 9-b のような状態になり 疼痛は起こりにくい が A1 pulley 内腔拡大が不十分になると考えられる 患指最大屈曲位から徐々に伸展していき snapping や locking が解除される時が図 9-c から 9-b の状態 に移行した瞬間と考えられるので ウッドブロック の幅はこのときの PPD を基準に考えている この 幅は個人差が大きいので A1 pulley ストレッチを 指導する際は 数種類の幅のウッドブロックを用意 し 疼痛が少なく snapping または locking が改善 する幅のものを設定している 最も症状が軽減する 幅のウッドブロックでストレッチを実施した際に 腱膨大部が A1 pulley 直下に位置しているものと考 えている 図 9-c また 定期的にチェックを行い ウッドブロックの幅を適宜調整している これまでに 弾発指に対する理学療法についての 報告は殆どみられないが N.Salim らは理学療法と して wax 療法 超音波 ストレッチ マッサージ等 を実施した群と手術群との比較を報告している 1) しかしながら ストレッチ マッサージの具体的な 治療手技について示されていない また 金子によ 166

174 939 図 7 MP PIP 90 DIP A1 pulley A1 pulley 図 8 MP 図 9 A1 pulley a A1 pulley b A1 pulley A1 pulley c A1 pulley bougie A1 pulley MP flexion blocking splint 2 A1 pully 3 A N.Salim S 75.7 Salim S I Salim

175 940 6 A 19: , MB Orthop 24: 29-33, 2011 まとめ S /74 S I 60 18/30 snapping locking 3 A1 pully 1 文献 1 Salim N, et al. Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. J Hand Surg Eur 37: 27-34, pp ,

176 J Jpn Soc Surg Hand P 緒言 対象と方法 表 /11/

177 942 表 2 図 1 a b, c 結果 P a 1b, c 考察

178 943 Bruner 5 5 まとめ 文献 1 19: 7-8, : , : , : 34-38, Bruner JM. The zig-zag volar-digital incision for flexortendon surgery. Plast Reconstr Surg 47: ,

179 J Jpn Soc Surg Hand PIP 自由投稿論文 PIP PIP PIP PIP PIP PIP 緒言 A1 PIP PIP 6 2 FDS A2 7 FDS FDP A2 8 9 PIP DIP PIP PIP PIP FDP FDS A1 PIP 2 PIP DIP PIP PIP PIP 対象と方法 PIP Dupuytren resting position DIP 2. PIP 3. MP 4. DIP 4 FDS FDP A1 Palmar Aponeurosis A2 A1 PIP /01/

180 PIP 945 図 1 1. resting position DIP 2. PIP 3. MP 4. DIP 1 A2 1 1/2 1/2 4 DIP 1 MP 60 MP PIP 2 MP PIP 3 PIP 4 DIP PIP PIP , 2, 4 PIP two-way repeated measures analysis of variance Tukey- Kramer 5 5 PIP PIP PIP two-way repeated measures analysis of variance Student s t test paired t test 5 173

181 946 PIP 表 1 PIP 表 2 PIP 結果 PIP A2 PIP 0 2 DIP 1 PIP 2 PIP DIP 4 MP 3 3 DIP 1 PIP 2 PIP DIP 4 MP 3 4 PIP PIP PIP PIP -30 2a 2b PIP FDS FDP A1 A2 PIP PIP 35 2c 2d PIP DIP 174

182 PIP 947 図 2 1 a PIP 30 b c 35 d e 0 f 0 2e 2f PIP PIP -40 3a 3b PIP FDS FDP 3c A1 PIP A2 3e A2 C1 3d PIP -25 DIP f 考察 PIP 6 Le Viet Favre FDS FDS 7 8 A2 FDS FDP A2 9 FDS 3 PIP DIP PIP PIP PIP A1 A2 PIP A2 175

183 948 PIP 図 3 2 a PIP 40 b c DIP PIP d A1 PIP A2 e PIP f 5 g 5 表 3 PIP PIP Walbeehm FDP FDS 10 FDP A2 FDS A A1 FDS FDP A2 5b FDS 176

184 PIP 949 FDP A2 5b PIP DIP PIP DIP FDP 5b 5c FDS A2 5d DIP FDP A2 2 A2 A2 FDS FDP A2 図 4 FDS a b FDS A2 A4 chiasma tendinum まとめ 1 PIP 2 PIP A1 FDS FDP A2 3 PIP 図 5 PIP a b FDS FDP A2 PIP c DIP FDP d FDS A2 PIP 177

185 950 PIP 文献 1 Will R, et al. Complications of open trigger finger release. J Hand Surg 35A: , Moriya K, et al. Comparison of the surgical outcomes for trigger finger and trigger thumb: preliminary results. Hand Surg 10: 83-86, Ryzewicz M, et al. Trigger digits: principles, management, and complications. J Hand Surg 31A: , Thorpe AP. Results of surgery for trigger finger. J Hand Surg 13B: , Wolfe SW. Tenosynovitis. In: Green DP, Hotchkiss RN, Pederson WC, eds. Green s operative hand surgery. 5th ed. Philadelphia. Elsevier Churchill Livingstone. pp , PIP 27: , Favre Y, et al. Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture. J Hand Surg 37A: , Le Viet D, et al. Trigger finger treatment by ulnar superficialis slip resection U.S.S.R.. J Hand Surg 29B: , PIP 29: , Walbeehm ET, et al. An anatomical study of the mechanical interactions of flexor digitorum superficial is and profundus and the flexor tendon sheath in zone 2. J Hand Surg 20B: ,

186 J Jpn Soc Surg Hand CM Thompson Diao CM Thompson 2 trapezial facet Diao Eaton stage2 1 stage3 14 stage4 2 MP 20 8 MP 2 MP 2 TSR Trapezial space ratio 緒言 CM suspension arthroplasty MP 1 1 Thompson 2 APL 2 trapezial facet Diao Diao 3 対象と方法 Eaton 4 stage2 1 stage3 14 stage4 2 MP 20 8 MP CM FCR piece by piece 1 APL 1cm CM APL 8cm 2 2 APL interference screw 3 APL Kapandji score 5 MP /11/

187 952 CM Diao 図 図 3 APL interference screw Screw 図 2 APL 図 4 APL trapezial space ratio TSR 6 Wilcoxon 5 結果 APL 2 interference screw 13 MP Kapandji score kg 16.2kg 0.9kg 2.3kg 6 MP TSR CRPS Eaton stage3 CM 1 180

188 CM Diao 953 図 5 A B C Kapandji score 図 6 A B 図 7 TSR Trapezial space ratio A B 181

189 954 CM Diao MP 25 8kg 1.2kg 8 TSR MP 45 9 MP Kapandji score9 15.6kg 3.2kg 2 80 Eaton stage4 MP IP 10kg 0.4kg 3 MP MP Kapandji score9 16kg 2kg TSR 図 8 1 X A B 図 9 1 A B 3 C 31 MP 図 10 2 A X MP IP B 3 MP C MP 182

190 CM Diao 955 考察 Supension arthroplasty FCR LRTI 7 suspension point 2 FCR APL Thompson 2 stabilizer FCR APL 1 2 suspension point LRTI Diao suspension point suspension LRTI Thompson Diao 1 3 Diao 3 APL suspension point interefrence screw APL 2 8 scaphometacarpal impingement TSR 3 APL TSR Diao 3 Soejima 9 APL full slip full slip MP Diao 30 3 MP ADL Diao 3 TSR 82.4 文献 1 CM Thompson 30: , Thompson JS, et al. Complications and salvage of trapeziometacarpal arthroplasties. Instr Course Lect 38: 3-13, Diao E. Trapezio-metacarpal arthritis. Trapezium excision and ligament reconstruction not including the LRTI arthroplasty. Hand Clin 17: , Eaton RG, et al. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg 9-A: , Kapandji A. Clinical test of apposition and counter-apposition of the thumb. Ann Chir Main 5: 67-73, Kadiyala RK, et al. Radiographic assessment of the trapezial space before and after ligament reconstruction and tendon interposition arthroplasty. J Hand Surg 21- B: , Burton RI, et al. Surgical management of basal joint arthritis of the thumb. Part I. Long-term results of silicone implant arthroplasty. J Hand Surg 11-A: , CM Thompson suspensionplasty Surgical Technique vol 3 no 3: , Soejima O, et al. Suspensionplasty with the abductor pollicis longus tendon for osteoarthritis in the carpometacarpal joint of the thumb. J Hand Surg 31-A: , まとめ CM APL suspension point 183

191 J Jpn Soc Surg Hand CM CM 2 AOL VAS ASI flat palm 50 3/6 AOL CM 1 緒言 CM ligament reconstruction with tendon interposition LRTI 1 1 FCR anterior oblique ligament AOL FCR PL LR without TI 図 1 a b 1 2 K-wire FCR 2 対象と方法 /11/

192 CM 957 図 2 図 3 a b CM a 1 2 b Eaton stage 2 1 stage 3 6 stage 4 3 stage 3 3 stage FCR 図 4 distance between trapezoideum and 1st metacarpal DTM 3 3mm 10mm short thumb spica 6 3 VAS score flat palm key pinch IP MP TAM total active motion CM CM X arthroplasty space index ASI 3 4 distance between trapezoideum and 1st metacarpal DTM 4 t 5 結果 VAS flat palm

193 958 CM 11.8kg kg kg kg key pinch kg kg kg kg TAM CM CM ASI 1 ASI DTM mm mm 1 51 Eaton 3 6a CM 1 VAS 8 3 flat palm CM 29kg 2.0kg key pinch 4.5kg 2.6kg CM DMT 7.2mm 0mm 6b CT erosion 6c d 考察 2002 CM Burton FCR 2 AOL LRTI 図 5 表 1 ASI prospective randomized study LRTI LR without TI 1.2 K-wire Kriegs 6 LRTI 21 LR without TI

194 CM 959 図 6 1 a XP Eaton 3 CM b DTM 0mm. c d CT erosion 5c d VAS key pinch flat palm 50 3/6 CM isometric CM AOL 1 2 表 2 CM 187

195 960 CM 1 図 7 Thompson DTM CM AOL circumduction pivot point first intermetacarpal ligament IML AOL IML Thompson 7 ECRB IML 文献 1 CM OS NOW 13: 85-90, CM 29: , Yang SS, et al. First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb. J Hand Surg Am 23: , CM 58: , Burton R, et al. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 11: , Kriegs-Au G, et al. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am 86: , Gerwin M, et al. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop Relat Res 342: 42-45, Lins RE, et al. Basal joint Arthritis: Trapeziectomy with Ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Am 21: , Tomaino MM, et al. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am 77: , : , 1993 まとめ 1 CM 2 188

196 J Jpn Soc Surg Hand DIP PIP DIP PIP X 133 cut-off TSH 5.0μIU/mL T4 FT4 0.9ng/dL TSH cut-off 4.0μIU/mL 16.5 FT4 cut-off T DIP PIP 緒言 DIP PIP OA DIP PIP OA DIP PIP OA 対象と方法 DIP PIP X RF CCP FT3 FT4 TSH Tg 結果 FT4 FT3 TSH TSH FT4 FT3 Tg cut-off TSH 5.0μIU/mL FT4 0.90ng/dL TSH 5.0μIU/mL TSH cut-off 4.0μIU/mL cut-off 4.0μIU/mL FT4 0.90ng/dL FT cut-off 0.95ng/dL 2014/11/

197 962 DIP PIP FT4 TSH FT Tg Tg Tg and/or X DIP PIP CM 27 CM OA 考察 Golding 1 Neeck 2 CPK Cakir 3 Dupuytren Heberden 4 Heberden 9 5 Heberden Heberden Ishii 5 Heberden Tg 41 Heberden Heberden Heberden PIP OA Gerster 6 RA 1 12 PIP PIP PIP RA 1 Corvol 7 TSH in vitro Alfadhli 8 9 2, TSH FT Tg DIP PIP OA

198 DIP PIP 963 表 1 表 AST/ALT CPK DIP PIP OA erosive osteoarthritis Heberden Bouchard ICD10 まとめ 1 PIP DIP PIP DIP 3 文献 1 Golding DN. Hypothyroidism presenting with musculoskeletal symptoms. Ann Rheum Dis 29: 10-14, Neeck G, et al. Neuropathy, myopathy and destructive arthropathy in primary hypothyroidism. J Rheumatol 17: , Cakir M, et al. Musculoskeletal manifestations in patients with thyroid disease. Clin Endocrinol Oxf 59: , : , Ishii H, et al. High prevalence of thyroid autoantibodies at diagnosis of Heberden s nodes. Program and abstracts of the American College of Rheumatology 66th Annual Scientific Meeting 66: , Gerster JC, et al. Hypothyroidism presenting as destructive arthropathy of the fingers. Postgrad Med J 61: , Corvol MT, et al. A pituitary growth-promoting factor for articular chondrocytes in monolayer culture. Endocrinology 90: , Alfadhli E. Cholesterol deposition around small joints of the hands in familial hypercholesterolemia mimicking Bouchard s and Heberden s Nodes of osteoarthritis. Intern Med 49: , : , Subclinical hypothyroidism 56: ,

199 J Jpn Soc Surg Hand Heberden X DIP Heberden X Heberden DIP X Heberden Node HN Grade 4 HN Grade 緒言 DIP Heberden 1802 Heberden Heberden self-limiting disease 1 Heberden 10 Heberden X 対象と方法 Heberden X X 3 X 3 X X DIP 2015/01/

200 Heberden X 965 表 1 HN Grade 図 2 図 1 a HN Grade 0 / b HN Grade 1 / c HN Grade 2 / d HN Grade 3 X 2 X Heberden Node Grade HN Grade 1 DIP X DIP X HN Grade 0 1a HN Grade 1 1mm 1b HN Grade 2 1mm 2mm 1c HN Grade 3 2mm 1d DIP X 1mm 5 2 StatFlex V6 χ2 HN 193

201 966 Heberden X 図 3 HN Grade 図 4 HN Grade Grade 5 結果 X HN Grade HN Grade 1 73 HN Grade HN Grade spontaneous fusion HN Grade HN Grade χ2 P 0.05 HN Grade HN Grade 6.2 P 考察 10 Heberden 194

202 Heberden X 967 表 2 図 5 図 6 a b c d Kwok 3 5,631 DIP control 0.89mm OA 0.70mm X Heberden X Heberden Kellgren 4 Swanson 5 Kallman osteophytes X Joint space narrowing Osteophytes Subchondral sclerosis Subchondral cyst Deviation Subluxation 6 6 joint space narrowing Osteophytes 2 X HN Grade 4 195

203 968 Heberden X Heberden HN Grade 2 6 a b 6 c d Heberden DIP HN Grade limitation limitation 845, Kwok WY, et al. Validity of joint space width measurements in hand osteoarthritis. Osteoarthritis Cartilage 19: , Kellgren JH, et al. Radioligical assessment of osteo-arthritis. Ann Rheum Dis 16: , Swanson AB, et al. Osteoarthritis in the hand. J Hand Surg Am 8: , Kallman DA, et al. New radiographic grading scales for osteoarthritis of the hand. Reliability for determining prevalence and progression. Arthritis Rheum 32: , まとめ Heberden 文献 1 Heberden 30: , Heberden : 1 : 18:

204 J Jpn Soc Surg Hand MRI MRI MRI MRI MRI MRI 50 MRI 緒言 MRI MRI 対象と方法 MRI MRI Philips Intera1.5 Stellar 15 MRI 2 1 MRI T1 T2 STIR MRI MRI 結果 /11/

205 970 表 1 表 2 MRI MRI MRI T1 low T2 high MRI 9 2 MRI nidus fluid-fluid level MRI MRI MRI T1 low T2 low-iso 8 T1 T2 low MRI T1 low T2 high 198

206 971 表 3 MRI MRI T1 low T2 high 4 1 blue spot MRI T1 high T2 high 2 MRI 4 2 MRI T1 low T2 high target sign tail sign 1 MRI T1 low T2 low 1 5cm MRI T1 low T2 iso-high MRI MRI 5cm MRI 199

207 972 考察 Tinel like sign terminal branch MRI 100 MRI MRI MRI MRI X CT MRI MRI X CT MRI 100 MRI 6 MRI MRI MRI MRI MRI 63 7 XP MRI 0 6 MRI 25 2 MRI 5cm MRI 4 2 MRI MRI MRI 3.0 MRI X CT まとめ 61 MRI MRI MRI 200

208 973 文献 1 52: , Knight DM, et al. Benign solitary schwannoma:a review of 234 cases. J Bone Joint Surg Br 89: , MRI 26: , : , : , MRI 62: , : ,

209 J Jpn Soc Surg Hand 緒言 対象と方法 HI VISION Avius 10 15MHz MRI 結果 MRI MRI MRI 3 MRI 2014/10/

210 975 図 1 表 mm mm 考察 Kang 6 MRI Antoni A B intensity target appearance 7 target appearance 203

211 976 図 2 表 2 MRI MRI ADL まとめ 204

212 977 文献 1 Whitaker W.G, et al. Benign encapsulated neurilemoma: a report of 76 cases. Am Surg 42: , MB Orthop 25 8 : 23-29, MB Orthop : 25-33, Oademir O, et al. Schwannomas of the hand and wrist: long-term of results and review of literature. J Orthop Surg Hong Kong 13: , Phalen G.S, et al. Neurilemmomas of the forearm and hand. Clin Orthop Relat Res 114: , Kang H.J, et al. Schwannomas of the upper extremity. J Hand Surg 25-B: , : , : , : , : ,

213 J Jpn Soc Surg Hand 緒言 対象と方法 mm 14mm X MRI 図 1 結果 /01/

214 979 表 1 3 図 2 表 2 図 3 3 IPEH Bizzare parosteal osteochondromatous proliferation Frorid reactive periostitis Fisher 4 表

215 980 考察 MRI Höglund MRI 文献 1 Höglund M. Ultrasound diagnosis of soft-tissue tumours in the hand and forearm. Acta Radiol 38: , : , MRI 29: , : , MRI 26: , : , 2006 まとめ

216 J Jpn Soc Surg Hand MRI 90 緒言 対象と方法 結果 mm 5.2mm 2 3mm MRI 1.5T 3T 2 MRI MRI MRI /11/

217 982 図 1 a b d c e f 図 2 MRI mm 考察

218 983 図 3 1 a b c d e f g 1 h 図 4 2 a b c d f 図 5 図

219 984 表 1 2 MRI in situ まとめ 1 2 MRI 3 文献 1 Willard KJ, et al. Benign subungual tumors. J Hand Surg Am 37 6 : , MB Orthopaedics : 27-32, Baek HJ, et al. Subungual tumors: clinicopathologic correlation with US and MR imaging findings. Radiographics 30 6 : , McDermott EM, et al. Glomus tumors. J Hand Surg 31 8 : , : ,

220 J Jpn Soc Surg Hand Acutwist Acutwist DIP Acutwist 2mm 緒言 1 Acutwist 対象と方法 Acutwist DIP 1 1 Acutwist 2 3 図 1 DIP a b Bicortical fixation. bicortical fixation cm 1 Acutwist 30mm /11/

221 986 Acutwist 図 2 Acutwist 図 3 DIP 43 a b c d e f a b X DIP c d X Acutwist bicortical fixation 3 1 e f 7 X 2 Acutwist 結果 DIP snap-off DIP 3 4 bicortical fixation crisscross fixation

222 Acutwist 987 図 4 66 a b c d e f a b X 3 90 c d X 2 crisscross fixation e f 8 X 図 5 64 a b c a X b 8 X c 20 X clear zone 20 考察 loosening back out tension band wiring Acutwist 1.5mm 2mm taper pich DIP Acutwist 215

223 988 Acutwist Heberden 30mm 4 bicortical fixation bicortical fixation bicortical fixation snap-off Acutwist 4 6 FiberWire mm 2 Acutwist snap-off DIP snap-off 2 snap-off まとめ 1 Acutwist bicortical fixation 3 snap-off 文献 1 Wheeler DL, et al. Biomechanical assessment of compression screws. Clin Orthop Rel Res 350: , Cox C, et al. Arthrodesis of the thumb interphalangeal joint and finger interphalangeal joints with a headless compression screw. J Hand Surg Am 39: 24-28, Heberden 30: 96-98, Iwamoto T, et al. An obliquely placed headless compression screw for distal interphalangeal joint arthrodesis. J Hand Surg Am 38: , : , 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: ,

224 J Jpn Soc Surg Hand Krackow Krackow Krackow 8 32 Krackow interlacing suture mattress suture 3 Krackow stiffness 2 Krackow looking loop Krackow 3weaves interlacing suture 緒言 interlacing suture working space mattress suture Krackow interlacing suture mattress suture 対象と方法 clinical anatomy laboratory 8 FDS FDS FDP FPL PIP IP 1/2 FDS FDP FPL PIP IP FDP FDS FPL 2 FDP FDS FDP FPL Krackow K interlacing suture I mattress suture M 3 K 25mm 5mm Krackow 8 locking loop locking notch 1 2 I FDP FDS FPL weave 2weaves 3weaves K 25mm 2weaves weave 5mm weave mattress suture 1 M K 25mm mattress suture mm /01/

225 990 Krackow 図 1 2 A B C B D E F 図 2 25mm 5mm AG-Xplus FDP 10mm preloading 2N 3 Welbeehm 2 0N 15N cyclic loading 5 20mm/min 4 5 N stiffness N/ mm cut out 2 6 stiffness 4 3 non repeated measures ANOVA post hoc test Student- 図 3 K Newman-Keuls test p 0.05 結果 K I M

226 Krackow 991 図 4 図 5 5 cyclic loading 図 6 p N K I M I M p 0.01 K 2 p stiffness N/mm K I M I M K 2 p I M 10 9 K 考察 Krackow 1986 Krackow pull out 3 pull out Krackow Krackow Hashimoto Fuchs Brown 1 Krackow 219

227 992 Krackow 図 7 図 8 図 9 stiffness 図 10 M mattress I 2 cut out K Krackow locking loop locking loop cut out 2weaves I 1 2weaves interlacing suture weaves interlacing suture Krackow Krackow 3weaves interlacing suture limitation FDS cyclic loading 5 Krackow 220

228 Krackow 993 まとめ Krackow 3weaves interlacing suture 文献 1 Tanaka T, et al. Tensile strength of a new suture for Fixation of tendon grafts when using a weave technique. J Hand Surg 31 6 : , Walbeehm ET, et al. influence of core suture geometry on tendon deformation and gap formation in porcine flexor tendons. J hand Surg Eur 34 2 : , Krackow KA, et al. A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg 68 5 : , Deramo DM, et al. Krackow locking stitch versus nonlocking premanufactured loop stitch for soft-tissue fixation: a biomechanical study. Arthroscopy 24 5 : , Sakaguchi K, et al. Biomechanical properties of porcine Flexor tendon fixation with varying throws and stitch methods. Am J Sports Med 40 7 : , : , Hashimoto T, et al. Comparison of step-cut and Pulvertuft attachment for flexor tendon graft: a biomechanics evaluation in an in vitro canine model. J Hand Surg Eur 37 9 : , Fuchs SP, et al. Biomechanical evaluation of the Pulvertaft versus the wrap around tendon suture technique. J Hand Surg Eur 36 6 : , Brown SHM, et al. Mechanical strength of the side-toside versus pulvertaft weave tendon repair. J Hand Surg Am 35 4 : ,

229 J Jpn Soc Surg Hand 緒言 1 対象と方法 ml 23G 60mm 図 1 prosound α7 13MHz /11/

230 995 図 2 A M U R 図 3 MS 図

231 996 図 5 M A 図 7 A 図 6 A 結果 考察 224

232 Gerald まとめ 文献 1 19: , : , : , Retzl G, et al. Ultrasonographic findings of the axillary part of the brachial plexus. Aneth Analg 92: , : , : ,

233 J Jpn Soc Surg Hand Wide Awake Surgery Wide Awake Hand Surgery 緒言 excursion Wide Awake Hand Surgery 1 WAHS WAHS 対象と方法 WAHS 24 4 MP ml PIP 3 MP Bouchard PIP 2014/11/

234 Wide Awake Hand Surgery 999 結果 図 1 1 A PIP 45 B C D 90 7mg/kg ml 1 67 PIP PIP DIP PIP 3D-CT Jersey Finger type 2 Al-Qattan 3 DIP 図 2 2 A DIP PIP B C D 図 3 3 A B C D DIP 3 227

235 1000 Wide Awake Hand Surgery 図 4 4 A IP MP B C D 図 5 5 A PIP 35 B C D 4 65 WAHS Bouchard PIP 考察 WAHS 図 6 5 PIP WAHS ml

236 Wide Awake Hand Surgery 1001 Mann Chowdhry 8 Lalonde 9 1,111 3,110 Harness 10 5mg : , : , Mann T, et al. Epinephrine and Hand Surgery. JHS 37A: , Chowdhry S, et al. Do not use epinephrine in digital blocks:myth or truth? Part A retrospective review of 1111 cases. Plast Reconstr Surg 126: , Lalonde D, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand:the Dalhousie project clinical phase. JHS 30A: , Harness N.G. Digital Block Anesthesia. JHS 34A: , エピネフリン入り局所麻酔剤の指への使用に関して, 本学会は現時点で推奨はしない. まとめ WAHS PIP WAHS 文献 1 Bezuhly M, et al. Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach. Plastic Reconst Sug 119: , Ban LJ, et al. Comparison of three concentrations of simplex lidocaine in local anesthesia for inguinal hernia mesh-repairs. Hernia 15: , Al-Qattan MM. Type 5 avulsion of the insertion of the flexor digitorum profundus tendon. JHS 26B: , I TEO, et al. Patients perspective of wide-awake hand surgery -100 consecutive cases. JHS 38E: ,

237 J Jpn Soc Surg Hand 自由投稿論文 PVC 緒言 1 2 living model non-living model 3 non-living model virtual reality model 8 3 対象と方法 2.5 3mm 20 30cm 5 10cm 1 non-living model PVC- PVC living model 結果 /01/

238 1003 図 1 表 1 1mm 2.5mm 2.5mm 3mm 1mm 0.5mm 1mm 1 1.5mm PVC cm 200 PVC 70,000 5, , , , PVC PVC

239 1004 考察 1 2 Hui living model 2 non-living model non-living model mm 1 1.5mm non-living model living model living model nonliving model living model まとめ 232

240 1005 文献 1 Hui KC, et al. Learning curve of microvascular venous anastomosis: a never ending struggle? Microsurgery 20: 22-24, Lascar I, et al. Training program and learning curve in experimental microsurgery during the residency in plastic surgery. Microsurgery 27: , Lannon DA, et al. Non-vital, prosthetic, and virtual reality models of microsurgical training. Microsurgery 21: , Sucur D, et al. Fresh chicken leg: an experimental model for the microsurgical beginner. Br J Plast Surg 34: , Galeano M, et al. The usefulness of a fresh chicken leg as an experimental model during the intermediate stages of microsurgical training. Ann Plast Surg 47: 96-97, Yen DM, et al. New model for microsurgical training and skills maintenance. Microsurgery 16: , Lin TS, et al. Correlation between microsurgical course performance and future surgical training selection by intern and junior residents. Microsurgery 28: , O Toole RV, et al. Measuring and developing suturing technique with a virtual reality surgical simulator. J Am Coll Surg 189: ,

241 J Jpn Soc Surg Hand CRPS complex regional pain syndrome CRPS CRPS Type 1 20 Type Type 2 1 Type TPD 0cm 2 CRPS 緒言 complex regional pain syndrome CRPS CRPS 対象と方法 CRPS CRPS Type 1 20 Type Type Type NSAIDs Vit.B Type 2 1 Visual Analogue Scale VAS tip-palmar distance TPD 結果 VAS 88mm 33mm Type Type Type Type /11/

242 CRPS 1007 表 TPD TPD 0mm 16 42mm 20 80mm 3mm 0 40mm 0mm VAS TPD 考察 CRPS 1 2 VAS Type 1 64 Type Type CRPS Type TPD 42mm 3mm 0mm CRPS

243 1008 CRPS CRPS まとめ CRPS 25 Type TPD 0cm 2 CRPS 文献 1 29: , RSD 45: , Goebel A, et al. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med 152: , Kiefer RT, et al. Efficacy of ketamine in anesthetic dosage for the treatment of refractory complex regional pain syndrome: an open-label phase II study. Pain Med 9: ,

244 J Jpn Soc Surg Hand 自由投稿論文 FDPsynergistic wrist motion EAM zone III V FDP EAM EAM EAM synergistic wrist motion S EAM S 10 S S EAM MP EAM zone III V FDP synergistic wrist motion 緒言 flexor digitorum profundus FDP FDP early active mobilization EAM 1 EAM synergistic wrist motion FDP synergistic wrist motion FDP 2009 EAM synergistic wrist motion 2008 EAM 2009 EAM synergistic wrist motion 対象と方法 zone III V FDP EAM EAM EAM EAM synergistic wrist motion S EAM 2.9 S 2.2 EAM S 2 8 EAM /12/

245 1010 表 1 EAM S OA Kienböck S 1 1 OA 2 2 Kienböck EAM FDP 2 2 S FDP EAM 5 5 S 1 1 EAM 6.1 S FDP FDP EAM EAM 3 3 S MP PIP DIP 0 EAM PIP DIP FDS 4 tension reducing position S EAM synergistic wrist motion MP PIP DIP MP PIP DIP 1 synergistic wrist motion 238

246 1011 図 1 synergistic wrist motion PIP DIP MP MP PIP DIP MP PIP DIP 4 TAM TAM Mann-Whitney total active flexion TAF total extension lag TEL Friedman Bonferroni TAF TEL Mann-Whitney 5 IBM SPSS Statistics Ver.18 SPSS Japan Inc, an IBM company, Tokyo 結果 EAM 13 excellent 6 good 4 fair 3 S 10 excellent 10 TAM EAM S P 0.09 EAM fair 3 OA FDP FDP 1 TAF 3 P TAF 3 6 S EAM P TAF S EAM EAM fair 3 TAF TEL 3 P 239

247 1012 図 2 TAF 図 3 TEL 0.01 TEL S EAM EAM S 3 6 P

248 1013 図 4 67 FDP 10 EAM synergistic wrist motion TAM 考察 FDP EAM FDP EAM 8 7 excellent 1 synergistic wrist motion EAM EAM synergistic wrist motion S S EAM EAM FDP 5 MP EAM zone III V FDP EAM synergistic wrist motion synergistic wrist motion MP zone III FDP EAM Cooney synergistic wrist motion zone III FDP 37.8 mm 2 Boyes MP DIP 29.5 mm FDP MP 15 mm 6 zone III FDP MP MP synergistic wrist motion TEL EAM S zone III S excellent EAM good synergistic wrist motion zone V synergistic wrist motion FDP 7.8 mm zone III 2 synergistic wrist motion EAM MP 241

249 1014 zone V zone V synergistic wrist motion EAM zone III V zone V zone III V S 8 8 excellent EAM fair zone III V zone V EAM zone III synergistic wrist motion S FDP synergistic wrist motion synergistic wrist motion FDP N 2 80 N N synergistic wrist motion synergistic wrist motion 文献 1 20: , Cooney WP, et al. Improved tendon excursion following flexor tendon repair. J Hand Ther 2: , Zhao C, et al. Effect of synergistic wrist motion on adhesion formation after repair of partial flexor digitorum profunds tendon lacerations in a canine model in vivo. J Bone Joint Surg Am 84: 78-84, Moore T, et al. Flexor tendon reconstruction. J Hand Surg Am 35: , : 3-9, Boyes JH. Bunnell s Surgery of the hand. 4th. Philadelphia. J.B Lippincott company. pp 12-16, Lieber RL, et al. Relationship between joint motion and flexor tendon force in the canine forelimb. J Hand Surg Am 21: , Tanaka T, et al. Flexor digitorum profunds tendon tension during finger manipulation. J Hand Ther 18: , Tanaka T, et al. Tensile strength of a new suture for fixation of tendon grafts when using a weave technique. J Hand Surg Am 31: , まとめ zone III V FDP EAM FDP EAM synergistic wrist motion 242

250 J Jpn Soc Surg Hand PIP intrinsic plus cast PIP knuckle cast cast IP cast PIP cast IP cast intrinsic plus position knuckle cast 3 28 PIP 4 PIP 5 4 PIP 10 PIP 3 PIP 2 13 IP cast IP Reyes excellent 24 good 4 fair poor IP cast 緒言 PIP PIP PIP 1 knuckle cast intrinsic plus position cast IP cast PIP cast 対象と方法 IP PIP 4 PIP 5 4 PIP 10 PIP 3 PIP 2 13 IP cast IPcast 26.3 IP Reyes IP cast intrinsic plus position DIP PIP MP cast MP 3 MP 1 結果 Reyes 2 excellent 24 good 4 fair poor 27 PIP 2 suture anchor 2015/02/

251 1016 PIP IP cast IP cast ROM good IP cast 2 図 1 IP cast 図 2 PIP half slip 244

252 PIP IP cast 1017 考察 PIP PIP PIP IP cast IP cast 1 MP IP extrinsic extensor IP 2 block IP PIP 3 4 IP 5 cast cast まとめ 1 PIP Intrinsic plus cast 2 Cast ADL 3 文献 1 MP 8: , Reyes FA, et al. Conservative management of difficult phalangeal fractures. Clin Orthop 214: 23-30,

253 J Jpn Soc Surg Hand 緒言 1 対象と方法 図 1A 図 1B 2014/12/

254 1019 表 1 図 2 58 図 3 3 図 4 X 結果 X 考察 247

255 1020 図 D-CT 図 X ADL まとめ 文献 1 : , : 31-37, : , : ,

256 J Jpn Soc Surg Hand FDS FDS common type absent type FDS FDS 緒言 FDS FDS modified FDS FDS 表 1 FDS Austin 3 5 independent type PIP common type PIP absent type PIP DIP 2015/01/

257 1022 図 1 FDS 34 8 FDS 図 2 FDS 9 FDS FDS FDP FDS FDS FDS 対象と方法 FDS 結果 8 24 FDS 1 FDS 9 26 FDS 2 FDS 250

258 1023 表 2 FDS 8 FDS 図 3 FDS FDP FDS FDS 1 3 FDS FDS FDS FDP 3 考察 FDS modified FDS 3 5 PIP independent type FDS independent type PIP common type FDS 24 FDS common type Kaplan /63 FDS common type PIP DIP absent type FDS FDP FDS FDS 4 FDS FDS FDS common type FDS FDP absent type FDS 8 FDS common type FDS FDS PIP FDS FDS FDS common type 251

259 1024 Zone II FDS 41 FDS Superficialis FDS Tendon of the Little Finger: Clinical Significance. J Clin Diagn Res 8: , まとめ FDS 24 FDS common type 26 FDS 41 FDS 文献 1 Kaplan EB. Muscular and tendinous variations of the flexor superficialis of the fifth finger of the hand. Bull Hosp Joint Dis 30: 59-67, Shrewsbury MM, et al. Flexor digitorum superficialis tendon in the fingers of the human hand. Hand 6: , Austin GJ, et al. Variations of the flexor digitorum superficialis of the small finger. J Hand Surg Am 14: , : , : , Guler F, et al. The prevalence of functional absence of flexor digitorum superficialis to the little finger: a study in a Turkish population. J Plast Surg Hand Surg 47: , Furnas DW. Muscle-tendon variations in the flexor compartment of the wrist. Plast Reconstr Surg 36: , Gupta A, et al. Bilateral Absence of Flexor Digitorum 252

260 J Jpn Soc Surg Hand FDP FDP FDP 30 FDP P P 0.05 FDP FDP 緒言 FDP intrinsic healing 1 FDP FDP FDP FDP FDP FDP FDP 対象と方法 FDP 0.05mm TN mm 5mm 15mm 60mm 25G 2014/11/

261 FDP MP PIP DIP PIP DIP 3 FDP FDP 25mm SPR μsec 20Hz SEN FDP 2kHz A/D 4 FDP FDP 図 1 FDP 図 2 FDP 30 FDP DPA-10A 10 DPA kHz A/D Hz band pass filter 2 500msec integrated electromyogram IEMG IEMG 500mesec 254

262 1027 図 3 FDP PF PDF DF 図 4 FDP B PF PDF DF IEMG Normalized IEMG NIEMG NIEMG Chart7 AD Instruments Australia 5 NIEMG Tukey HSD 5 SPSS IBM SPSS statistics Ver.18 SPSS Japan Inc an IBM company Japan 結果 FDP P P NIEMG

263 1028 図 5 30 FDP NIEMG PF PDF DF 考察 FDP Lieber 3 FDP 6 Savage 45 FDP 45 7 Lieber 30 FDP 30 FDP FDP FDP FDP NIEMG NIEMG FDP FDP FDP FDP 256

264 1029 FDP FDP 文献 1 13: , Savage R, et al. Flexor tendon repair using a six strand method of repair and early active mobilisation. J Hand Surg Br 14: , Silfverskiold K, et al. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg Am 19: 53-60, Small JO, et al. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg Br 14: , Yen CH, et al. Clinical results of early active mobilisation after flexor tendon repair. Hand Surg 13: 45-50, Lieber RL, et al. Relationship between joint motion and flexor tendon force in the canine forelimb. J Hand Surg Am 21: , Savage R. The influence of wrist position on the minimum force required for active movement of the interphalangeal joints. J Hand Surg Br 13: , まとめ FDP 30 FDP FDP FDP FDP 257

265 J Jpn Soc Surg Hand ,345 T 521 S S T S T S T T T 緒言 対象と方法 ,345 24,295 1, χ 2 結果 26,345 T 15 4, S 41 10, T S p 0.01 T S /03/

266 1031 図 図 4 図 5 図 2 図 3 2 T T S T n S n T S T 80 S

267 1032 考察 T 12.8 S T 30 S 30 S T S T 5 文献 1 86: S127-S127, : , : in press-in press, Belmont PJ, et al. Disease and nonbattle injuries sustained by a U.S. army brigade combat team during operation Iraqi freedom. Military Medicine 175: , pp17-32, : , : 1-6, : , 1993 まとめ

268 J Jpn Soc Surg Hand 自由投稿論文 緒言 対象と方法 結果 図 /11/

269 図 2 図 3 図 4 262

270 図 5 図 6 図 7 263

271 1036 表 1 考察 900 1,

272 1037 まとめ 26 文献 / pp82-83, : , : , : , : 1-6, : , : , : , : 92-94,

273 J Jpn Soc Surg Hand second look TFCC ECU TFCC second look TFCC ECU second look Second look 緒言 TFCC ECU PL TFCC 1 2 second look ECU TFCC second look second look 対象と方法 ECU TFCC second look Second look TFCC TFCC 3 excellent 5 7 good 3 3 fair 2 2 poor 1 1 second look second look Second look 23G 結果 DRUJ 8 10 DRUJ 2 2 DRUJ 1 1 Second look 10 excellent good 2 fair poor 1 46 TFCC excellent 1 TFCC ECU TFCC second look /11/

274 TFCC second look 1039 図 1 図 3 DRUJ 図 2 図 4 DRUJ tension TFCC tension 2 DRUJ 3 tension TFCC fair 1 TFCC ECU TFCC ECU interference screw second look 3-4 TFCC 5 6 DRUJ 7 8 考察 TFCC DRUJ 4 TFCC TFCC TFCC TFCC ECU TFCC ECU PL 267

275 1040 TFCC second look 図 5 図 7 DRUJ 図 6 TFCC 図 8 DRUJ Adams-Berger 2 Scheker 9 tenodesis Hui-Linscheid 10 second look second look second look Second look TFCC DRUJ TFCC ECU fair poor TFCC DRUJ second look second look Second look 268

276 TFCC second look 1041 まとめ ECU TFCC second look second look TFCC TFCC 文献 1 20: , Adams BD, et al. An anatomic reconstruction of distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27: , Nakamura T, et al. Repair of foveal detachment of the triangular fibrocartilage complex: Open and arthroscopic transosseous techniques. Hand Clinics 27: , Nakamura T, et al. Distal radioulnar joint instability during forearm rotation: Effect of muscle loading. J Jap Soc Surg Hand 18: , : , Nakamura T, et al. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg Br 21: , Nakamura T, et al. The proximal ligamentous component of the triangular fibrocartilage complex-functional anatomy and three-dimensional changes in length of the radioulnar ligament during pronation-supination. J Hand Surg B 25: , Nakaura T, et al. Open repair of the ulnar disruption of the triangular fibrocartilage complex using double three-dimensional mattress suturing technique. Tech Hand Upper Extrem Surg 8: , Schecker LR, et al. Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J Hand Surg Br 19: , Hui FC, et al. Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal sabluxation of the distal radioulnar joint. J Hand Surg Am 7: ,

277 J Jpn Soc Surg Hand Kienböck 4 Kienböck Lichtman stage 3b 3 stage X CHR carpal height ratio VAS HAND20 CHR HAND Kienböck 1 緒言 Kienböck Kienböck Lichtman stage 3b stage 4 carpal collapse Kienböck 対象と方法 2010 Kienböck Lichtman stage 3b 3 stage Saffar 1 ulnar artery ulnar artery dorsal carpal branch X CHR carpal height ratio VAS HAND /11/

278 1043 表 1 表 2 HAND20 結果 CHR VAS 59mm 21mm HAND X Stage 3b CHR X VAS 70mm 5mm 0mm 10kg 22kg HAND HAND X Stage 3b 4 12 CHR

279 1044 図 1 1 X stage3b 図 2 1 X 60 VAS 70mm 0mm HAND Kienböck X Stage 3b 24 CHR VAS 40mm 10mm 0mm 27kg 35kg 95 HAND CT 3 MRI X stage CHR VAS 55mm 70mm 20kg 18kg 45 HAND X 5 考察 Heymans 50 cadaver hands 1.78ml 0.77ml proximodistal dorsopalmar 0.8mm 90 carpal collapse

280 1045 図 3 3 CT 図 MRI T2 図 5 CT 4 dorsal carpal branch Saffar 273

281 1046 進行期キーンベック病に対する血管柄付豆状骨移植術 図6 本法で用いた血管柄付豆状骨の解剖 を報告し 1) 本邦では 1992 年に Abe らが stage 3 の Kienböck 病 13 例に対して術後平均 73.2 か月の長 期臨床成績 X 線画像評価を報告している 5) また 近年の例では 建部らが 2009 年に 1 例報告し 手 根中央関節の温存と血管柄の拳上の安全性を述べて いる 6) 自験例で手関節痛が改善しなかった症例 4 は術後 7 か月で移植豆状骨を摘出した この豆状骨の病理 学検査では骨梁の萎縮はあるが壊死していない所見 が観察できた 図 7 これは移植後も血管柄付豆 状骨の血流が保たれていたことを意味する 症例 4 の疼痛や術後手関節可動域低下の原因は移 植豆状骨の背側位設置が原因と考えられ 月状骨摘 出部と移植豆状骨の適合の問題 移植豆状骨と手関 節掌側関節包や周囲軟部組織との縫合の問題が考え られる 移植豆状骨の適合の問題として stage 4 になると進行した変形性関節症 手根配列異常から 豆状骨移植に十分な月状骨摘出部のスペースを得ら れないこと 豆状骨の形態的な問題点で移植した場 合に手関節掌背側方向の大きさが不足しているこ と 有頭骨側にしか関節面がないこと 月状骨と軟 骨面の曲率が違うことなどが挙げられる 2)6) 手関 節掌側関節包や周囲軟部組織との縫合の問題とし て 豆状骨を拳上する際 血管柄を損傷しない範囲 で 周囲に尺側手根屈筋腱の一部など軟部組織をつ け 掌側の関節包や周囲軟部組織とできるだけ縫合 図7 症例 4 摘出した移植豆状骨の病理組織像 H-E 染色 し さらに不安定性が残る場合は 舟状骨 移植豆 状骨間や舟状骨 有頭骨間などの 仮固定を併用し たほうがよいと考える また 症例 3 では 術後 24 か月で画像精査上明 らかな豆状骨の圧潰を確認し 豆状骨骨壊死も想定 したが MRIT2 強調画像で高信号を呈し血行あり と判断できること 手関節痛など症状がないことか ら 現状では壊死しておらず 今後長期的な経過観 察が必要であると考える まとめ 進行期 Kienböck 病に対して血管柄付豆状骨移植 274

282 Kienböck 1 24 文献 1 Saffar P, et al. Replacement of the semilunar bone by the Pisiform. Description of a new technique for the treatment of Kienböck s disease. Ann Chir Main 1: , Heymans R, et al. The Pedicled Pisiform Transposition in Kienböck s disease. Handchir Mikrochir Plast Chir 25: , Canovas F, et al. Circular arterial supply of the pisiform bone. Acta Anat 157: , Alexander P, et al. Pedicled Vascularized Bone Grafts for Scaphoid and Lunate Reconstruction. J Am Acad Orthop Surg 17: , Abe M, et al. Replacement of the Lunate by the Pisiform in Kienböck s Disease. Wrist Disorders. Springer-Verlag. Tokyo. pp , : ,

283 J Jpn Soc Surg Hand Dupuytren Dupuytren PIP Dupuytren diathesis PIP 3 1 Dupuytren 緒言 Dupuytren Dupuytren 対象と方法 Meyerding MP 30 ADL 2 PIP VY Meyerding Tubiana 3 2 Meyerding 4 Wilcoxon t-test 3 Meyerding PIP Dupuytren 6 MP PIP MP PIP Mann-Whitney U-test 4 Tubiana Very good Good Fair Poor 2x2 Chi square test 5 Hand /11/

284 Dupuytren 1049 表 1 表 2 表 3 結果 1 Tubiana 23 Very good 6 Good 12 Fair 2 Poor 3 Meyerding 1 Fair Poor PIP 70 MP 85 PIP

285 1050 Dupuytren 表 4 表 5 Hand 20 4 PIP Dupuytren 4 5 Hand Meyerding 2 3 ADL PIP 3 1 Dupuytren 考察 Dupuytren 30 MP PIP 7 VY CRPS PIP Dupuytren PIP PIP 8 278

286 Dupuytren 1051 表 Hand Meyerding 2 3 ADL bulky dressing 9 1 PIP 3 PIP Dupuytren 1 PIP 10 まとめ Dupuytren 文献 1 Meyerding HW. Dupuytren s contracture. Arch, Surg 32: , Dupuytren OS NOW 28: , Tubiana R, et al. Prognosis and treatment of Dupuytren s contracture. J Bone Joint Surg 37-A: , Tonkin MA, et al. The proximal interphalangeal joint in Dupuytren s Disease. J Hand Surg 10-B: , Adam RF, et al. Prognosis in Dupuytren s disease. J Hand Surg 17-A: , Hindocha S, et al. Dupuytren s diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence. J Hand Surg 31-A: , von Rijssen AL, et al. Percutaneous needle fasciotmy for recurrent Dupuytren disease. J Hand Surg 37-A: , Dupuytren 17: ,

287 J Jpn Soc Surg Hand X 6 ECRB X L X 30 N t P 0.05 X PRUJ PRUJ 緒言 ECRB 3 X 対象と方法 L X 30 N X 2 Anterior Joint Space AJS Lateral Joint Space LJS 1 Lateral Shift LS Anterior Shift AS 2 Proximal Radioulnar Joint Space PRUJS Proximal Radioulnar Joint Angle PRUJA 3 Anterior Radial Scale ARS /Anterior Radial Narrow Scale ARNS 100 Lateral Radial Scale LRS /Lateral Radial Narrow Scale LRNS Carrying Angle CA Critical Line Critical Line 2014/11/

288 難治性上腕骨外側上顆炎における単純 X 線評価の検討 図1 図2 Anterior Joint Space AJS および Lateral Joint Space LJS 腕橈関節の関節裂隙を 上腕骨小頭関節 面の中心から橈骨頭関節面までの垂線距 離を測定 正面像では AJS とし 側面像 では LJS とする 図 Lateral Shift LS および Anterior Shift AS 橈骨頭の側方変位量として 小頭関節面の中 心と橈骨頭中心の距離を測定 正面像では LS とし 側面像では AS とする ただし 正 面像では外側への変位を正とし 側面像では 前方 屈側 を正とする Proximal Radioulnar Joint Space PRUJS および Proximal Radioulnar Joint Angle PRUJA PRUJS 橈骨頭関節環状面の高さの中点から 橈骨切痕までの距離を 測定 近位橈尺関節面と橈骨頭関節環状面のなす角度を測定 縁までの距離 Lateral Critical Line Distance LCLD を測定した 橈骨を基準としたものを LCLD R と し 尺骨を基準としたものを LCLD U とした ただ し Critical Line を基準とし 外側を正とした 図 5 統計学的評価は t 検定を用い P 0.05 を有意差あ りとした 結 果 腕橈関節裂隙の正面像の評価である AJS は L 群 2.51±0.41mm N 群 2.34±0.56mm P 0.10 で あり 側面像での評価である LJS は L 群 3.52± 0.95mm N 群 3.22±0.63mm P 0.10 であった N 群の方が狭い傾向であったが有意差は認めなかっ た LS は L 群 -0.77±0.06mm N 群 0.42±1.02mm であり有意差なし P 0.10 AS は L 群 0.61± 1.26mm N 群 1.25±1.33mm P 0.05 であり N 群が有意に大きく 橈骨頭は前方 屈側 方向へ変 位していた PRUJS は L 群 2.59±0.46mm N 群 281

289 1054 X 図 4 ARS LRS ARNS LRNS ARS/ ARNS 100 LRS/LRNS 100 図 5 Carrying Angle CA Lateral Critical Line Distance LCLD CA LCLD Critical Line Clitical Line LCLD R LCLD U 表 mm L P 0.05 PRUJA L N P 0.10 ARN/ARNS 100 L 173 N 172 P 0.10 LRS/LRNS 100 L 167 N 166 P 0.10 CA L N L P 0.10 LCLD R L mm N mm P 0.10 LCLD U L mm N mm P 0.05 LCLD R LCLD U L 考察 282

290 X X AS AS N N 53.2 LCLD U L N LCLD R LS PRUJS L alignment 7 alignment impingement alignment alignment X 1 alignment alignment alignment 8 alignment alignment 4 alignment 文献 1 25: 55-59, : , update 56: , Antuna SA, et al. Snapping plicae associated with radiocapitellar Chondromalacia. Arthroscopy 17: , : 13-16, : , : , Kim HJ, et al. Influence of forearm rotation on proximal radioulnar joint congruency and translational motion using computed tomography and computer-aided design technologies. The Journal of hand surgery American ed. 36: , まとめ 1 X 2 LCLD R LCLD U L 3 283

291 J Jpn Soc Surg Hand CECS CECS CECS 緒言 Chronic exertional compartment syndrome. CECS CECS5 8 対象と方法 MRI 20 MRI MRI T 結果 2015/02/20 JCHO

292 1057 表 図 1 MRI MRI 2 2 MRI T 図 2 MRI T2 ECRB EDC FDP FDS Supinator

293 1058 図 3 MRI 図 5 図 4 MRI 1 3 MRI kg MRI 1 T2 ECRB ECU FDP FDS Supinator 4 図 6 MRI MRI 6 考察 CECS 286

294 1059 表 CECS MRI MRI CECS CECS / / CECS Pritchard 10 CECS まとめ CECS

295 1060 MRI CECS T2 CECS CECS 文献 : , Raphael BS, et al. Chronic exertional compartment syndrome of the forearm in a major league baseball pitcher. Am J Sports Med 39: , Kumar PR, et al. Bilateral chronic exertional compartment syndrome of the dorsal part of the forearm: the role of magnetic resonance imaging in diagnosis: a case report. J Bone Joint Surg Am 85: , O heireamhoin S, et al. Chronic exertional compartment syndrome of the forearm in an elite rower. Case Rep Orthop 2011: , Soderberg TA. Bilateral chronic compartment syndrome in the forearm and the hand. J Bone Joint Surg Br 78: , Goubier JN, et al. Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases. Br J Sports Med 37: , Zandi H, et al. Results of compartment decompression in chronic forearm compartment syndrome: six case presentations. Br J Sports Med 39: 35-39, Brown JS, et al. Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy. J Hand Surg Eur 36: , Winkes MB, et al. Long-term results of surgical decompression of chronic exertional compartment syndrome of the forearm in motocross racers. Am J Sports Med 40: , Pritchard MH, et al. Chronic compartment syndrome, an important cause of work-related upper limb disorder. Rheumatology 44: ,

296 J Jpn Soc Surg Hand US US MRI 2mm 4 12 US CI CI CI CI US 緒言 US MRI MRI US MRI 対象と方法 US MRI US Xario 12 MHz 10cm 3 1 MRI MAGNE- TOM Skyra 3T SIEMENS US 2 3 2mm 3 US MRI 2mm 2015/02/

297 1062 表 1 図 1 US 図 2 MRI T2WI 結果 mm US CI CI LR CI LR CI CI CI LR CI LR CI MRI CI CI LR CI LR CI 0.00 US MRI CI CI LR CI LR CI 考察 2mm US LR LR Harvey / 1- LR+ / 1+ US 290

298 US 1991 Simpson 3 US mm US 10cm 3 5 MRI MRI MRI US US MRI 2mm 50 Harvey Adachi まとめ US MRI 文献 1 5 pp , Harvey FJ, et al. Surgical availability of the plantaris tendon. J Hand Surg Am 8: , Simpson SL, et al. The plantaris tendon graft: an ultrasound study. J Hand Surg Am 16: , Dr EBM 28?? 42: 66-67, Leekam RN, et al. Using sonography to diagnose injury of plantaris muscles and tendons. Am J Roentgenol 172: , Adachi B. Beitrage zur anatomie der Japaner. Die statistik der muskelvarietaten. Z Morphol Anthropol 12: ,

299 J Jpn Soc Surg Hand Gedda Type 3 X CM X X 3 1 CM CM 緒言 Gedda Type 3 X CM Gedda type 3 対象と方法 Gedda type X 3 1 CM 結果 X 3 4 CM 5 X 1 51 CM 23 3 X 2014/12/

300 Gedda Type 3 fracture 1065 表 1 Gedda type 3 5 図 1 X CM 図 2 CT Gedda Type 3 7 X CM Gedda type 3 1 CT 2 0.7mm k-wire CM 4 図 CM

301 1066 図4 図5 Gedda Type 3 fracture 術直後の X 線と右下 術後 1 年の単純 X 線 骨癒合が得られている 当科初診時単純 X 線 手関節正面像では 骨折片が判別しにくいが CM 関節中心撮 影の側面像で骨折片が確認できた た 他院整形外科を受診し X 線にて明らかな骨傷 は無いとの診断を受けた 左母指 CM 関節部の疼 痛と脱臼感を主訴に受傷から約 5 か月経過して当科 を受診した 当科初診時単純 X 線 手関節正面像では 骨折片 が判別しにくいが CM 関節中心撮影の側面像で骨 折片が確認できた 図 5 初診時 CT 転位のない骨片が存在し CM 関節が 脱臼していた 陳旧性ベネット骨折 Gedda type 3 と 診断した 図 6 術前透視 CM 関節でのストレス撮影を行うと骨 片が付着したまま CM 関節が容易に脱臼した 図 6 骨折片は小さく 内固定は困難と考え CM 関 節脱臼に対する靱帯再建のみ施行した 術中所見 母指背側より展開し 長橈側手根伸筋 図6 CT 画像 転位のない骨片が存在し CM 関節が脱臼していた 術前透視 CM 関節 でのストレス撮影を行うと骨片が付着した まま CM 関節が容易に脱臼した 図7 術中所見 母指背側より展開し 長橈側 手根伸筋腱 ECRL を半裁して採取し 母指と示指の中手骨間の靱帯を再建した 腱 以下 ECRL を半裁して採取し メイラ DTJ 4.0mm 用のドリルでガイドピンを刺入した後に骨孔をあけ ECRL 腱を母指中手骨の背側から掌側に 更に第 2 中手骨掌側から背側に 1.5 周通して母指と示指の中手 骨間の靱帯を再建した 図 7 CM 関節は 1.5mm の 鋼線で固定した 術後経過 術後 3 週で鋼線抜去 4 週で外固定を 外し 左母指の関節可動域訓練を開始した 術後左 母指の疼痛 機能障害を残しておらず 術後 1 年 11 か月の X 線では CM 関節の脱臼は再発していない 図 8 考 察 1886 年に Bennett が この骨折を報告した後 1) 294

302 Gedda Type 3 fracture 1067 図 X CM 図 9 Gedda Classification for Bennett s Fracture Gedda Bennet 3 2 type 1 CM type 2 type 3 CM 9 5 Gedda type 3 Gedda X X 3DCT X 3DCT X CT X Gedda type 1 closed reduction ORIF Lutzr Gedda type 3 Gedda type 3 CM まとめ Gedda type 3 5 Gedda type 3 X CT 3DCT Gedda type 3 CM 文献 1 Bennett EH, et al. On Fracture of the Metacarpal Bone of the Thumb. Br Med J Jul 3; : 12-13, Gedda KO, et al. Studies on Bennett s fracture; anatomy, roentgenology, and therapy. Acta Chir Scand Suppl 193: 1-114, Lutzr M, et al. Closed Reduction Transar ticular Kirschner Wire Fixation Versus Open Reduction Internal Fixation In The Treatment Of Bennett s Fracture Dislocation. Journal of Hand Surgery British and European Volume 28B: 2: , Bennett 18 : ,

303 J Jpn Soc Surg Hand ECRL EPL X 2 X CT 緒言 2 ECRL 3 ECRB EPL 2 ECRL EPL 1 対象と方法 EPL IP X DCT ECRL EPL 4 結果 2 ECRL EPL 4 JuggerKnot 5 K-wire 6 3 ROM 2 IP MP 0 7 考察 EPL 1 EPL ECRL EPL EPL EPL ECRL EPL 4 Cassell /02/

304 第 2 中手骨基部裂離骨折に伴う長母指伸筋腱断裂の一例 図1 初診時単純 X 線正面像 第 2 中手骨基部に骨折を 疑う所見を認める 図4 図5 図2 初診時単純 X 線側面像 骨折は不明瞭である 第 2 中手骨基部から ECRL により近位側に 転位した遊離骨片と骨折部レベルでの EPL 遠位断端を認める 図3 図6 骨折部近位側に腱を JuggerKnot で縫着した 297 図 DCT 像 裂離骨片は手背側に突出し完全に 遊離している 骨折部を K-wire にて固定した 術後 2 年経過時 右母指 IP 関節 MP 関節 とも伸展 0 で左右差は無かった

305 X 2 Durrant 6 3 ECRB EPL X EPL Lister ECRL ECRB 2 EPL 3 EPL 2 X 3 X 3 ECRB EPL EPL ECRL ECRL EPL 4 ECRB 2 6 EPL : , : , Durrant CA, et al. Small flake, big problem: an unreported cause of extensor pollicis longus tendon rupture. Ann R Coll Surg Engl 92 1 : 24-26, Ansede G, et al. Extensor pollicis longus tendon rupture following avulsion fracture of the third metacarpal. Skeletal Radiol 38 1 : 81-84, まとめ 2 ECRL EPL 1 EPL 文献 1 Cassell OC, et al. An unreported cause of rupture of the extensor pollicis longus tendon. J Hand Surg 21 5 : , Björkman A, et al. Rupture of the extensor pollicis longus tendon: a study of aetiological factors. Scand J Plast Reconstr Surg Hand Surg 38 1 : 32-35, Ishida K, et al. Accute rupture of extensor pollicis longus tendon due to avulsed fracture of the second metacarpal base; a case report. Hand Surg : 43-45,

306 J Jpn Soc Surg Hand 自由投稿論文 X Dumontier 緒言 対象と方法 48 X 1 2 LRL RSC RCC X RSC LRL RCC 3a 4 DRC 3b Kirshner 2 BIOMET JuggerKnot 2 DRC 4 結果 Kirshner 6 X kg 38kg Green and O Brien /11/

307 1072 図 1 X 図 3 a b L R 図 2 考察 0.2 Weiss 3 Dumontier 4 1/3 LRL RSC RCC 6 図 4 Kirshner 2 Weiss DRC DRC DIC V DIC 5 300

308 1073 表 1 DRC 図 5 6 X まとめ 1 図 6 1/3 LRL RSC RCC Fr RSC LRL DRC /3 LRL RSC RCC 文献 1 Dunn AW, et al. Fractures and dislocations of the carapas. Surg Clin North Am 52: , Green DP, et al. Open reduction of carpal dislocations: indication and operative techniques. J Hand Surg 3-A: 250-, Weiss C, et al. Irreducible radiocarpal dislocation. J Bone Joint Surg 52-A: , Dumontier C, et al. Radiocarpal dislocations: calassification and proposal for treatment. J.Bone Joint Surg 83-A: , Viegas SF, et al. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg 24A: , : , : 88-91, : 49-52, Watanebe K, et al. Transstyloid Radiocarpal dislocation. Hand Surg 6: , : ,