Shinji Tomari

Acetabular Diameter Measurement Determines Proper Prosthetic Head Size in Hemiarthroplasty for Femoral Head Osteonecrosis

In hemiarthroplasty for femoral head osteonecrosis, collapse and deformity may make femoral head measurement difficult, thus, precluding the selection of an appropriate prosthetic head. We describe a method for measuring the acetabular diameter using acetabular sizing gauges to estimate the prosthetic head size. We evaluated the precision of this method and found it to be highly accurate and reliable.

Risk factors for re-recurrent carpal tunnel syndrome in patients undergoing long-term hemodialysis.

The purpose of this study was to evaluate risk factors for re-recurrent carpal tunnel syndrome (CTS) in long-term renal hemodialysis (HD) patients. Fifteen wrists of ten HD patients, follow-up period of minimum seven years after reoperation of CTS, were included in this study. Duration of HD, period from first operation to reoperation, shunt side was involved or not, presence of trigger finger and cervical destructive spondyloarthritis, and operative procedure performed during the reoperation (synovectomy was performed or not) were evaluated. Re-recurrent CTS was identified in four out of 15 wrists (27%). The period from first operation to reoperation, which was 3.8 years in the re-recurrence group and eight years in the no re-recurrence group, and the operative procedure had significant differences (synovectomy groups had no re-recurrence vs. no synovectomy groups had 82% re-recurrence). The results of this study suggested that synovectomy would be necessary for recurrent CTS in HD patients.

Radiological Examination of Postoperative Cervical Alignment and Stability in Patients with Dialysis-Associated Spondylosis Excluding Destructive Spondyloarthropathy: Comparison with Patients with Cervical Spondylotic Myelopathy

Introduction Several reports have demonstrated the surgical treatment strategy for patients with dialysis-associated spondylosis in the cervical spine (CDAS) with destructive spondyloarthropathy (DSA). However, studies focusing on the clinical outcome of patients with CDAS without DSA remain scarce. We aimed to review the treatment strategy of patients with CDAS but without DSA. Methods The clinical data and surgical records of consecutive patients with CDAS without DSA (n = 9; D-group) and cervical spondylotic myelopathy (CSM) (n = 30; C-group) who underwent modified double-door laminoplasty(DDL) were reviewed retrospectively. We investigated four radiologic factors in the pre-and postoperative periods that have been reported to be the risk factors for worsening of clinical symptoms in various studies and examined statistical comparison between the D and C groups. Results In the D group, the pre- versus postoperative C2-C7 sagittal angles were not significantly different, and only two patients (22%) had kyphosis postoperatively. There was a significant difference in the pre- and postoperative C2-C7 angles in the two groups (P = 0.031). Regarding the change in segmental alignment, the local open angle increased at the C4/C5 level in the D group. Also there was a significant difference in the local angles between the two groups at C4/5 and C5/6 (P = 0.00038, and 0.037), suggesting that postoperative segmental mobility at C4/5 and C5/6 was higher in the D group than in the C group. Conclusions In the present study, DDL in patients with CDAS without DSA did not adversely affect the postoperative alignment and stability compared with CSM patients with CSM. However, patients in the D group may have a chance to develop DSA change at the C4/5 level in the future, and careful long-term follow-up is warranted.

Complications of Lumbar Spinal Fusion with Transpedicular Screw Fixation Systems

We retrospectively analyzed the incidence and variety of associated complications in 54 patients who underwent lumber spinal fusion using transpedicular screw fixation systems. The average operative time was 3 hours 28 minutes with an average blood loss of 376 grams for one level fusion. Intraoperatively fracture of the pedicle during screw insertion occurred in 5.6% of cases. The neural infury rate was 3.7%. Post operative complications included 7.7% screw breakage, 1.9% AW-GC spacer breakage, 1.9% nut loosening and 9.6% screw loosening. Final results included 9.6% pseudoarthrosis and 9.6% delayed union. In all of these unsuccessful union cases the graft bone collapsed and the “disc height” became narrow in the post operative period. We believe that the AW-GC spacer offers mechanical advantages compared with iliac bone strut grafts alone.

Effect of surgery for dialysis carpal tunnel syndrome

長期透析患者の合併症として手根管症侯群が注目を集めている. 最近20ヵ月間に本症で済生会八幡病院を受診した患者は男20女22計42名で平均年齢54.6歳 (35-77歳), 原疾患は原発性腎症40, 糖尿病性腎症1, 多発性のう胞腎1であった. 両側発症が42名中22名と多く, また17例40%には弾発指の合併がみられた. 本症は内シャント作成手の発症が多く, 内シャント作成から発症までの期間は2-138月平均83.4±37.0月であったが, 両側発症22名中7名では内シャント作成のない手の発症であった. 透析導入から発症までの期間は3-180月平均113.8±36.6月で, 5年未満での発症は3例のみで本症は明らかに長期透析患者の合併症である. 診断は臨床症状に正中神経のdistal motor latencyの遅延を参考にするが, 全例手術所見で確認できた. 42名59手の正中神経除圧術はクーレンカンプ伝達麻酔でtourniquetを使用し無血下に手掌面を広くS字状に切開し, 横手根靱帯の切離, 神経剥離術を行った. 術後6-20月目に経過を観察できた31例43手の術前術後を比較すると手の疼痛夜間痛は100%, 正中神経領域のしびれは86%, 母指球筋の萎縮は77%の手に改善され, 正中神経のdistal motor latencyはabsentが9例から2例に減, 残り34手の平均値は8.71±3.33msecから3.25±0.97msecに改善され, 示指末節手掌面での2点識別覚も識別不能が3例から2例に減, 平均値は15.3±14.4mmから3.6±1.7mmに著明に改善された. 血腫, 感染, 神経損傷, 運動障害, シャントトラブル等の合併症は皆無で手術成績は十分満足できるものであった. 回復の不完全な症例では発症から手術までの期間が長い傾向にあり, 早期の正中神経除圧術が推奨される.

Hip Arthroplasty for Osteoarthritis in Young Adults using Bateman UPF Prosthesis

Ten hip arthroplasties for secondary osteoarthitis is seven yound adults using Bateman UPF prosthesis were undertaken. The average age of the patients at the time of surgery was 45 years, and all were female. Following surgery, all patients improved, especially as regards pain. We concluded that deepening of the acetabulm in the original site and use of self-locking stem were important.