04_手関節正面像における.indd
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1 Arts and Comparison between the standardized and the Nagasawa technique in the plain P-A radiograph of normal wrist Key words: wrist, radiography, standardized technique, Nagasawa technique Summary In this study, we compared the plain P-A radiograph of 30 normal wrists between the standardized and the Nagasawa technique. Measurement includes radial inclination, ulnar variance, % styloid process of ulnar, and distal radio-ulnar distance. Consequently, there were no statistical difference in all measured items between the two techniques. The radiographs obtained through the standardized and the Nagasawa technique are thought to be able to adapt the same measurement criteria. X Kienböck Masanori Yamaguchi , Hironobu Koseki 2, Kousei Enguchi , Hitoshi Iwanaga 3, Hiroyuki Shindo 3 1 Department of Radiology, Wajinkai Hospital 2 Department of Locomotive Rehabilitation Science, Unit of Rehabilitation sciences, Nagasaki University Graduate School of Biomedical 3 Department of Orthopedic Surgery, Wajinkai Hospital X X 1, 2 X 3 Palmer X
2 本研究の目的は 基準撮影法と長沢法で撮影した手 に準じた 座位 肩関節 90 屈曲 肘関節 90ﾟ屈曲位 関節正面単純 X 線像における各計測値を比較し 両者 の 2 通りである 図 1A B 手の平を下面にして手 の違いについて調査 検討することである 関節をカセッテ面に置き 橈骨軸と第 3 指の骨軸が一 致するように調整後 背屈してできる背側手首皺線を 対象と方法 X 線中心点として背掌方向撮影を行った 撮影時 被 手指 手関節に既往疾患や愁訴がないボランティ を除いた自然な伸展位をとるようにした 撮影肢は利 アの健常成人 30 例を対 象とした 男性 15 例 15 関 き手に関係なく全例右側とした 得られた画像にお 節 女性 15 例 15 関節であり 年齢は 歳で平 ける橈骨遠位端尺側傾斜 RI radial inclination 均 26.3 歳であった X 線画像は 単純 X 線高電圧装 尺骨変異 UV ulnar variance 尺骨茎状突起の 置 KXO-80G, Toshiba, Tokyo, Japan と絞り装 位置 %SP % styloid process 遠位橈尺骨間距 置 TF-6TL-6, Toshiba, Tokyo, Japan を使って 離 RUD radio-ulnar distance を計測した 解 撮影し CR Regius model 190 V stage, Konica 剖学的に弯曲している橈骨の骨軸の設定は 橈骨茎 Minolta M&G, Inc., Tokyo, Japan で画像化した 撮影条件は 50kV 8mAs 250mA 32msec 撮 影距離は 1m とした 手技を標準化するために 撮影 は統一した設定条件に沿って 1 人の診療放射線技師が 状突起から 5cm と 10cm 地点での中点を結ぶ線と 験者の筋緊張をほぐすためリラックスさせ 余分な力 し RI は標準的測定法に準じて測定した 6-8 UV は 行った 撮影肢位は 手関節基準撮影法とされる 座 Gelberman の方法を採用し 尺骨遠位端が短い場 合は minus variant 尺骨遠位端が長い場合は plus variant とした 9 %SP は 尺骨茎状突起の頂点から 位 肩関節 90 外転 肘関節 90ﾟ屈曲位 と 長沢法 尺骨遠位関節面に垂線を下ろし 内側端からの位置を A B 図1 Radiographic positioning A Standardized tech. B Nagasawa tech. 図2 Measurements of distal radius and ulnar A Radial inclination RI B Ulnar variance UV C % styloid process %SP and Radio-ulnar distance RUD 日本診療放射線技師会誌 vol.63 no.768
3 Arts and RUD 10cm 2 %SP RUD 3 30 U 2 ANOVA Bonferroni/Dunn 5% RI UV mm %SP % RUD16.4.7mmRI UV 0.5.8mm %SP % RUD16.3.7mm P>0.05 2RI UV mm %SP % RUD mm RI RUD P< ANOVA P>0.05 X ulnar variance Kienböck X 1, X Gartland 6 60 X RI Smilovic Statistically signifi cant difference between male and female P<
4 Gelberman 9 UV mm 0.7.7mm 7 RI UV mm 5mm 13 RI RI UV mm RI UV mm X UV neutral 0 RI RUD RUD RI RI Epner 15 UV Yeh 16 Pennock 17 RI UV Jung 18 UV 1 UV 2 RI UV %SP RUD X RI UV %SP RUD X 0 P< A B A RI radial inclination BUV ulnar variance C %SP %styloid process RUD radioulnar distance vol.63 no.768
5 Arts and 1 X Metz VM, Gilula LA: Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am, 24, , Palmer AK, et al.: Ulnar variance determination. J Hand Surg, 7, , Gartland JJ, Werley CW: Evaluation of healed colles fractures. J Bone Joint Surg, 33, , X Nana AD, et al.: Plating of the Distal Radius. J Am Acad Orthop Surg, 13, , Gelberman R, Salamon P, Jurist J, Posch J: Ulnar variance in Kienbock s disease. J Bone Joint Surg, 57, , TFCC Ulnar Variance Palmer AK, Werner FW: The triangular fibrocartilage complex of the wrist anatomy and function. J Hand Surg, 6, , Friedman S, Palmer A: The ulnar impaction syndrome. Hand clinics, 7, , Smiloviæ J, Biliæ R: Conservative treatment of extraarticular Colles type fractures of the distal radius: prospective study. Croat Med J, 44, , Epner RA, et al.: Ulnar variance The effect of wrist positioning and roentgen filming technique. J Hand Surg, 7, , Yeh GL, et al.: Effects of forearm rotation on the clinical evaluation of ulnar variance. J Hand Surg, 26, 12-16, Pennock AT, et al.: The effects of forearm rotation on three wrist measurements: Radial inclination, radial height and palmar tilt. Hand Surgery, 10, 17-22, Jung JM, et al.: Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br, 83-B, ,
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