Shigeharu Nomura

Mycobacterium Kansasii Flexor Tenosynovitis Presenting as Carpal Tunnel Syndrome

We present a case in which Mycobacterium kansasii flexor tenosynovitis caused the development of carpal tunnel syndrome. The diagnosis was made from synovial tissue specimens taken at the time of operation.

An Unusual Role of the Vinculum after Complete Laceration of the Flexor Tendons

Two cases are described with full flexion of the proximal interphalangeal joint produced by an intact short vinculum after complete laceration of both superficialis and profundus tendons. To establish the clinical diagnosis of complete flexor digitorum superficialis division, the necessity of examining the flexion strength of an injured finger is emphasized.

Stress fracture of an os peroneum

Fracture of the os peroneum is relatively rare, and a stress fracture of the os peroneum is even rarer. We report a case of stress fracture of the os peroneum in a 38-year-old laborer who had been working in a crouching position. X-rays showed a multipartite os peroneum. Bone scintigram showed uptake at the os peroneum. The histology of the excised os peroneum revealed various stages of fracture healing. Excision of the fractured os peroneum and reconstruction of the peroneus longus tendon by end-to-end suture resulted in an excellent outcome.

Evaluation of efficacy of TS-110 against postoperative pain and post-traumatic pain. Double blind comparative study using loxoprofen sodium as a control.

手術後疼痛および外傷後疼痛に対するTS-110の臨床的有用性を客観的に評価するため, ロキソプロフェンナトリウムを対照薬として二重盲検法により比較検討した.1.患者背景手術後疼痛においては, 有効性解析対象症例は121例 (T群58例, L群63例) , 安全性解析対象症例は148例 (T群71例, L群77例) , 有用性解析対象症例は121例 (T群58例, L群63例) であり, 外傷後疼痛においては, 有効性解析対象症例は101例 (T群55例, L群46例) , 安全性解析対象症例は115例 (T群61例, L群54例) , 有用性解析対象症例は103例 (T群56例, L群47例) であった.患者背景において, 両群間に手術後疼痛では, 「性別」, 「体重」, 「既往症の有無」, 「合併症の有無」, 「麻酔法」, 「感染の有無」, 観察項目の初期値の「局所熱感」, 外傷後疼痛では「受傷から来院までの時間」以外偏り (p<0.15) のあった項目は認められなかった.なお, これらの偏りの主要評価項目に及ぼす影響をMantel-Haenszel法により検討したが, 影響は認められなかった.2.主要評価項目1) 最終全般改善度改善率 (改善, 以上) は, 手術後疼痛ではT群87.9% (51/58) , L群85.7% (54/63) , 外傷後疼痛ではT群76.4% (42/55) , L群76.1% (35/46) であり, いずれも両群間に有意差は認められなかった.2) 概括安全度「安全である」は, 手術後疼痛ではT群88.7% (63/71) , L群89.6% (69/77) , 外傷後疼痛ではT群86.9% (53/61) , L群92.6% (50/54) であり, いずれも両群間に有意差は認められなかった.3) 有用度有用率 (有用, 以上) は, 手術後疼痛ではT群86.2% (50/58) , L群82.5% (52/63) , 外傷後疼痛ではT群67.9% (38/56) , L群72.3% (34/47) であり, いずれも両群間に有意差は認められなかった.3.副次評価項目1) 初回投与後の効果発現時間初回投与後の効果発現時間は, T群, D群それぞれ, 手術後疼痛においては15分以内12.1% (7/58) , 17.5% (11/63) , 30分以内34.5% (20/58) , 60.3% (38/63) , 45分以内56.9% (33/58) , 76.2% (48/63) , 1時間以内89.7% (52/58) , 87.3% (55/63) であり外傷後疼痛においては, それぞれ15分以内7.3% (4/55) , 6.5% (3/46) , 30分以内23.6% (13/55) , 39.1% (18/46) , 45分以内34.5% (19/55) , 45.7% (21/46) , 1時間以内69.1% (38/55) , 65.2% (30/46) であった.2) 初回投与後の効果持続時間初回薬剤服薬後の鎮痛効果持続時間は, 手術後疼痛・外傷後疼痛いずれにおいても両群ともほぼ同様の分布であった.3) 臨床症状の推移開始時と最終評価日の臨床症状の推移は, いずれの項目も両群ともほぼ同様の推移であった.4) 症状改善度 (患者の自己評価)試験薬剤の効果に関する1日後, 2日後および3日後の患者の自己評価は, 手術後疼痛では, 1日後の「良くなった」以上でT群80.7% (46/57) , L群59.7% (37/62) であり, T群がL群に比し有意 (p<0.05) に高かった.外傷後疼痛では, 両群ともいずれの時期においても同様の値であった.5) 症状改善度 (医師の評価)1日後, 2日後および3日後に評価した各臨床症状の改善度は, 手術後疼痛, 外傷後疼痛いずれにおいても両群のいずれの時期においても同様の値であった.6) 副作用手術後疼痛の副作用はT群に11.3% (8/71) , L群に10.4% (8/77) 認められ, 内訳はT群では腹部不快感3件, 腹痛, 悪心, 眠気各1件およびGOTの上昇1件, GPTの上昇2件, またL群では眠気2件, 腹部不快感, 下痢, 掻痒感, 耳閉感各1件およびGOTの上昇1件, GPTの上昇2件であった.外傷後疼痛の副作用はT群に13.1% (8/61) , L群に7.4% (4/54) 認められ, 内訳はT群では腹痛3件, 腹部不快感, 悪心, 下痢, 発疹, ふらふら感, 肝機能異常, 動悸各1件, またL群では眠気, 肝機能障害各1件およびGOTの上昇1件, GPTの上昇2件であった.4.ITT解析手術後疼痛・外傷後疼痛いずれにおいてもPC解析とほぼ同様の結果であった.以上のことから, TS-110は手術後疼痛, 外傷後疼痛に対し効果の発現時間は短く, 持続性もあり臨床的に有用な薬剤と判断した.

Supracondylar Osteotomy of the Humerus for Correction of Post Traumatic Cubitus Varus.

Twenty patients who had a supracondylar osteotomy of the humerus to correct post-traumatic cubitus varus were reviewed. The mean age of subjects was 9 yaers and 6 months and the mean follow-up period was 5 years and 6 months.The mean carrying angle was -20.5 degrees preoperatively, and -0.2 degrees at follow-up. The correction obtained at surgery was lost in seven; four were lost from the time of operation to that of bony fusion, three were during the skeletal growth.It is thought that the reasons for loss of correction until bony fusion are due to technical factors at surgery, while the loss of correction during skeletal growth may be due to the existence of physeal injuries.The operation should be performed before adolescence, and it is necessary to carefully observe the change in the carryig angle before surgery.

Results of Bateman UPF-Prosthesis Replacement for Osteoarthritis of the Hip Joint

We have been perfoming Bateman prosthesis replacement for the osteoarthritis of the hip joint since 1980. In the present study, 13 cases with 15 joints were examined directly, and 4 cases with 5 joints were examined by questionnaire after follow-up of more than 5 years post-operative course.The age range was from 43 to 75 with an average of 55.4 years.13 cases with 15 joints were evaluated by roentgenograms.The clinical results showed that preoperative total average score of 47.7 points was improved to 80.2 points postoperatively by Japanese Orthopedic Association Hip Score System. Roentgenographic results showed that central migration stopped in 10 cases, loosening and sinking of the prosthesis occurred in no case, clear zone around the prosthesis occurred in 10 cases, and ectopic bone formation occurred in 3 cases postoperatively.

The Experience of Early Controlled Mobilization Following Repair of Zone 5-7 Extensor Tendon Ruptures

We treated ten patients with Zone 5-7 extensor tendon ruptures (RA 5 cases; crush type 3; clear cut 2;) by means of early controlled mobilization using a dynamic splint. Only active flexion was allowed after a few days, but overflexion was blocked by a plaster volar splint. We think that early controlled mobilization contributes to lack of complaints in PIP joint, decreasing of edema, prevention of intrinsic muscle contracture and active exercise of tendon excursion.

Ankle Injuries in Children

The distal tibial epiphyses may be damaged, when the ankles are injured in children.Injuries involving the epiphyseal plate present special problems in diagnosis and management.In our clinic, we have experienced fifteen injuries of the ankles during past ten years.In eleven of these ankles, epiphyseal plates were injured.These were classified according to the Salter-Harris method.The second type was eight, the fourth type was two and the degloving injury one.The second type produced by abduction injuries were easily reduced by the manipulation and the prognosis of this type was good.The fourth type produced by adduction injuries must be reduced exactly by the operation.In this type, growth plate damages were common and progressive deformities were occured.The degloving injury removed the perichondrial ring and permitted bony bridging between the epiphysis and metaphysis.In this type, varus deformity was occured by the bone bridge.