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脳性麻痺（以下；CP）患者の股関節は股関節周囲筋力の不均衡や骨形態異常により，亜脱臼や脱臼をしばしば生じ，若年発症の変形性股関節症の原因となる．従来，CP患者の病期の進んだ変股症に対しては大腿骨頭切除術や股関節固定術が施行されてきたが，確実な除痛とADL維持という点で十分に満足できる成績をえられていない．そこで，より早期の除痛，機能回復を目的としてTHAが選択される．今回，中高年のCP患者の末期OA2例3股に対し，THAを施行した．それぞれ術後1年，5ヶ月と短期成績であるが，いずれの症例も股関節痛は消失し，疼痛出現前のADLを再獲得できており，患者満足度も高い．術後合併症に関しては今後更なる長期の経過観察が必要であるが，今回の症例のように股関節痛の出現前はある程度ADLが自立しており，低下した機能が回復する見込みのある場合にはTHAの手術適応があると考える．

【目的】特に誘因無く両側骨頭下骨折を生じた両側大腿骨頭壊死症例を経験したので報告する．【症例】59歳 男性．主訴は両大腿部痛．ステロイド使用歴なし．飲酒歴は，30歳から15年間，毎日日本酒3合程度．年間60日の潜水歴があった．1年前より特に誘因なく両股部痛が出現．半年後歩行不能となり近医受診し，両側大腿骨頭骨折と診断され，当科紹介となった．単純X線写真にて両側骨頭下骨折を認めた．右側には頚部に比較的大きな嚢胞像を認めた．CTでは右側は嚢胞との近位境界で骨頭骨折を生じていた．両側ともTHAが行われ，摘出骨頭の病理組骨診断でempty lacunaeがみられ，骨壊死の診断であった．【考察】広範な大腿骨頭壊死であった為に，荷重部の骨頭圧潰ではなく，骨頭下骨折を起こしたと考えられた．右側は頚部に形成された嚢胞も骨頭骨折に関わっている可能性があると思われた．

We observed ultrasonographic blood flow findings of the nutritional artery of the recollapsed femoral head in patients with osteonecrosis treated by transtrochanteric rotational osteotomy of the femoral head. Between July 1998 and September 2000, the nutritional artery of 26 hips (23 patients) were observed intraoperatively by ultrasonography. After rotating the femoral head, the nutritional artery was checked by ultrasonography in fibrofatty tissue beneath divided quadratus femoris muscle seven times while changing the angle of hip flexion. The patients consisted of 16 males and seven females with a mean age of 41 years (age range: 23 to 60 years). Recollapsed femoral head was identified in five (19%) of the 26 patients after one year or more followup. The hips of the recollapsed femoral head confirmed ultrasonographic flow at an average of one (range: 0 to 3 times), and the hips without recollapsed femoral heads demonstrated a mean four times (range: 2 to 7 times). There was significant difference between with and without recollapse. We conclude that ultrasonographic findings of the nutritional artery is helpful for assessing the short-term results of hips treated by transtrochanteric rotational osteotomy of the femoral head.

Between February and September of 2000, we carried out radial magneic resonance imaging (MRI) on 8 hips consisting of 5 pre-osteoarthritis and 3 early stage osteoarthritis. There were 7 female patients with a mean age of 28 years (age range: 16-50 years). The radial MRI results were compared with intraoperative arthroscopic findings. In the weight-bearing portion, from 45° ante rosuperior to 45° posterosuperior, all patients had various tears of the acetabular labrum. In the anterosuperior portion, 4 hips (50%) showed imcomplete tears, 3 hips (38%) showed complete tears, and only 1 hips (18%) showed intact labrum. In the superior portion, each of the 3 hips (38%) showed imcomplate and complete tears. In the posterosuperior portion, each of the 3 hips (38%) showed imcomplete tears and intact labrum. The arthroscopic normal labrum was clearly depicted as a homogenous triangular area of low signal intensity. The incomplete tears were depicted as a moderate signal intensity or central high signal intensity. The complete tears were depicted as a diffuse and obscure high signal intensity. We conclude that radial MRI may be a useful non-invasive diagnostic method for tears of the acetabular labrum in oseoarthritis.

We observed lower extremity blood flow in deep venous thrombosis (DVT) patients using ultrasonography after orthopaedic hip joint operation. Between July 1999 and June 2000, four patients underwent total hip arthoplasty and hemi-surface arthroplasty was performed on one. We measured the flow volume of the femoral vein and the great saphenous vein using ultrasonography on all patients after venography. The patients consisted of one male and four females with a mean age of 67 years (age range: 47 to 74 years). Deep venous thrombosis was identified in two (40 percent) of the five patients. There was no significant difference in the flow volume of the femoral vein between the DVT (+) group and DVT (-) groups (129±33ml/m, 165±89ml/m). The flow volume of the great saphenous vein in the DVT (+) group increased significantly (189±108ml/m, 51±22ml/m p

We observed the blood flow in the femoral vein and greater saphenous vein using color Doppler ultrasonography after orthopaedic lower extremity operation. Between March 1999 and February 2000, 108 patients underwent 18 total knee arthroplasties, 46 total hip arthroplasties, and 44 hip osteotomies. We performed venous duplex ultrasonography twice on both lower extremities of all patients at a mean of seven days (range; five to eight days) and fourteen days (range; twelve to fifteen days) postoperatively. There were 25 male and 83 female patients with a mean age of 55 years (age range; 20 to 84 years). Greater saphenous blood flow increased in 49 (23 percent) of the 216 extremities. Thirty-two were ipsilateral, and 17 were contralateral. We suggest that these findings indicate asymptomatic deep venous thrombosis. With the numbers available, we were able to detect an association between an increase in the greater saphenous venous flow and procedures (P

It is well known that in femoral head osteonecrosis patients, necrosis and collapse are usually located in the anterosuperior portion of the femoral head. We evaluated the usefulness of a “look-up” plane X-ray view of osteonecrosis for early detection of femoral head collapse. We examined 20 joints in 17 patients. Osteonecrosis was classified into four stages according to radiographic signs (demarcation line, crescent line, collapse and joint space narrowing). Eight joints were classified as stage 2 and 12 joints as stage 3. Collapse, crescent line and demarcation line were evaluated on three types of radiographs; ordinary anteroposterior (AP) and lateral views and the “look-up” view. Seventeen of the 20 hips clearly showed more than 2mm collapse on the “look-up” view. The incidence of clear collapse was higher than that on the AP view. The incidence of crescent line was also higher. There were no significant differences in the demarcation line between the look-up view and AP view. Magnetic resonance imaging and tomography are useful and routinely used to define necrotic lesions. However, the “look-up” view is a simple and inexpensive method for the early detection of femoral head collapse in osteonecrotic patients.

Hip joints in radiographs were magnified in order to examine the appropriate magnification of templates for preoperative planning in total hip arthroplasty (THA). The magnification of each hip joint, in postoperative radiographs after THA, was calcurated using inserted implants (socket or femoral stem) as scales. The relationship between the magnifications and grade of obesity or hip flexion contracture was also examined. In most hips, the percentage of magnification was between 110 and 120. Obesity or hip flexion contracture did not influence the magnification. These date suggest that degrees above 110% are more appropriate than 110% for the magnification of templates.

We treated a patient who had been suffering from a wide range of deep venous thrombosis (DVT) in the lower right extremity after the right transfer of the acetabulum. The patient noticed swelling and pain in the lower right extremity two weeks after the operation. The defects of the contrast medium were seen between the right common iliac vein and calf venula when venography was performed. A slight wedgeshaped defect was also seen in the lower left lung when lung blood flow scintigram was performed. The patient was diagnosed as DVT with slight pulmonary embolism (PE). Immediately we routinely treated this patient with anticoagulant therapy that consists of intravenous heparin medication. In order to prevent lethal PE during the therapy, we implanted a percutaneous infra vena cava filter (IVC filter) capable of trapping large thrombus and inducing spontaneous fibrinolysis at this site. Furthermore, fibrinolytic therapy consisting of intravenous urokinase medication was added. During the therapy, swelling and pain of the lower right extremity improved with the decreasing in the serum D-dimer. The IVC filter seems to be useful for preventing acute lethal PE following a wide range of DVT after hip surgery. However, long term follow-up of this patient seems to be required.

We combined Tanabe's extensive anterolateral-approach open reduction involving 360-degree circumferential capsulotomy with Pemberton pericapsular osteotomy and/or femoral osteotomy for the reduction of 7 dislocated hip joints in 5 toddlers. patients were placed in the lateral decubitus position. After Tanabe's original procedure of open reduction, femoal osteotomy (shortening/derotation/varus) and/or Pemberton's pericapsular osteotomy were performed easily via this approach. After surgery, X-ray showed the femoral head to be perfectly reduced and excellent acetabular coverage. The latest follow-up X-ray demonstrated no sign of avascular necrosis of the femoral head or acetabulum, and that excellent reduction and acetabular coverage had been maintained. The combination of Tanabe's open reduction with femoral and/or Pemberton pericapsular osteotomies thus appears to present a feasible, safe, practical option in treating hip dislocation in children who have already begun walking.

29 hips (follw-up rate: 44%) underwent hemiarthropathy for the treatment of osteonecrosis of the femoral head (ONFH). Bipolar hemiarthroplasty (Kyocera Physiohip type) was carried out for all the patients. The average age at operation was 47 years old (24-65), and the mean follow-up interval was 6.4 years (2.8-10.9). 1 was at stage 2, 14 at stage 4 at operation. 4 hips receired a second operation due to the failure of rotational osteotomy, and 1 was unknown. The JOA score was evaluated. The pain, ROM, walk and ADL scores were 35 (20-40), 17 (13-20), 13 (5-20), and 16 (820) respectively. The mean total score was 81 (65-100). Femoral head migration was observed in 7 hips (29%). The distance of migration of most hips was within 5mm. 1 hip which had acetabular reaming at operation showed central migration. There was a tendency for migration in most hips at stage 4 at operation. This study showed that bipolar heimarthroplastyis a promising treatment for ONFH hip although further evaluation is required.

We reviewed 18 cases of arthrodesis for hip osteoarthritis at advanced or terminal stage. The average age at operation was 43 years old (22-52), and the mean postoperative period was 10 years (2-20). The mean walking and daily activity life (ADL) JOA scores were 14.8 and 17.0 points, respectively. Although most cases showed good walking and ADL scores, the results of 3 cases with contralateral hip osteoarthritis at operation were poor. Most of the patients could go up and down the stairs without any support, sit on chairs, and put socks on the operated limb by themselves. On the contrary, many could cut the toe nails of the operated limb nor sit on the floor (SEIZA). There was a tendency for gradual increage in low back pain or contralateral-sided knee joint pain after arthrodesis in patients with there symptoms. The degree of pain was low, and no cases underwent operation of the lumbar spine or knee joints after hip arthrodesis. There results suggest that arthrodesis is a promising operation for hemilateral hip osteoarthritis of young patients, especially those who need to stand or walk for long periods in their work.

We reviewed the long-term results of 34 transtrochanteric curved varus osteotomies that had been performed for advanced subluxated osteoarthrosis of the hip. Subjects conprised one male (two hips) and twenty-four female patients (thirty-two hips); the mean age at the time of the operation was 44 years (range, 31 to 53 years). The average duration of follow-up was 14.4 years (range, 10 to 20 years). All hips were evaluated preoperatively and at the time of the latest follow-up according to the Japanese Orthopaedic Association (JOA) clinical hip scoring system. Measurement of acetabular roof obliquity and center-edge (CE) angle was made on the preoperative radiographs and the influence of acetabular coverage on the clinical results was studied.The average JOA clinical score improved from 60.7 points preoperatively to 76.4 points. Most of the improvement in the score was due to pain relief. Fifteen of 34 (44%) had a good or excellent result, and nineteen hips (56%) had a fair or poor result. Five hips (three patients) failed and a total hip replacement was performed.Clinical results correlated well with the extent of preoperative acetabular coverage. The hips with less than 30 degrees of acetabular roof obliquity on the preoperative radiographs achieved better results than those with more than 30 degrees of obliquity. The hips with more than 0 degrees of CE angle also gained better results than those with a CE angle of less than 0 degrees.

Band like sclerosis (BS) of osteonecrosis of the femoral head (ONFH) on X-ray, which conforms to a low intensity band lesion on Magnetic Resonance Imaging (MRI), is one of the charasteristic features of ONFH. BS is histologically characterized as the repair process against necrotic tissue such as appositional bone formation.We histologically examined 12 band like sclerotic lesions on X-ray. BS consists of bone debris produced by the collapse.We should consider that collapse.We should consider that BS in ONFH represents not only appositional bone formation but also the accumulaton of necrotic bone debris.

Acetabular dysplasia may influence the incidence of collapse in the osteonecrosis of the femoral head. The degree of dysplasia was investigated by measuring the Sharp angle, acetabular oblique angle, acetabular head index, and center edge angle in hips which collapsed and underwent operations except for THA, and comparing with the normal range reported. There was a tendency for collapsed to have more acetabular dysplasia than normal hips. Acetabular dysplasia may be involved in the collapse mechanism.

Transposition osteotomy of the acetabulum has been performed since 1956 and is a circumacetabular osteotomy for the dysplastic hip. Of 178 procedures, carried out for osteoarthritis in dysplastic hips, some of which were performed by Nishio himself, we were able to review 102 hips after 2 to 17 years (mean 5.7 years). The clinical result, evaluated according to the Japanese Orthopaedic Association hip score, was exellent (over 90) in 42%, good (80-89) in 26%, fair (65-79) in 23% and poor (less than 65) in 9%. The results depended on the stage of the disease, that is, the more advanced the stage, the poorer the result. No cases have undergone secondary total hip arthroplasty to date. Adequate medialization, as well as good lateral and anterior coverage, was significantly related to achieving good results. An early stage of osteoarthritis in severely dysplastic hips is thought to be the best indication for this procedure.

A twenty one-year old man was hit by a car and his left hip joint was dislocated posteriorly.After manual reduction, a small bone fragment was found between the joint space. Arthroscopic removal of the fragment was carried out successfully. The osteochondral fragment was 4cm long, 1cm wide, and 0.5cm thick, and derived from the posterior rim of the acetabulum. Full weight-bearing was permitted one week after the operation, and his hip function was recovered completely at a follow-up of four months post-operatively. Arthroscopic surgery proved to be less invasive and more useful than open surgery for the extraction of free bodies in the hip joint.

The laser speckle method is a new technique for evaluation of tissue blood flow using the dynamic laser speckle effect. In 1987, Fujii proposed a new system to visualize the microcirculation map using the laser speckle method. Blood flow of subchondral bone in the femoral condyles of ten rabbits was measured simultaneously by this system and by the hydrogen washout method. Analysis of regression showed that blood flow measured by the lasr speckle method and by the hydrogen washout method was significantly correlated (r=0.777, p=0.0001). The results showed that subchondral bone blood flow could be measured through the articular cartilage by the laser speckle method. The laser speckle method is a non-contact, simple and rapid technique for evaluation of bone blood flow. It is confirmed that this method is useful for the detection of necrotic areas during the surgery for osteonecrosis of the femoral head.

The peroneal nerve is susceptible to trauma, ganglion, fabella, bone tumor, etc. The heterotopic bone mass rarely causes damage to the peroneal nerve. This paper reports a rare case of the peroneal damage caused by heterotopic bone mass of unknown etiology. A 63 year-old man, who did not have a history of antecedent trauma, had pain in the lateral part of his leg after squatting for a long period of time. On the radiogram, a disc-like ossification was found beneath the fibular head. Physical examination showed that the mass seemed to compress the peroneal nerve directly. The mass was extirpated, and the histological examination revealed that it was composed of mature bone tissue. The finding strongly suggested the diagnosis of myositis ossificans nontraumatica by Fine.

Association with urethritis, which is caused by several microorganisms including gonococcus, is recently thought to be important for a diagnosis of Reiter's syndrome, although the syndrome has been classically described as the combination of nongonococcal urethritis, arthritis and conjunctivitis. A 35-year-old man was affected by gonococcal urethritis two weeks before his complaint of lrft knee and right second toe pain. He had also balantitis, mucous membrane erosion, heel pain and weight loss. Moreover, HLA-B 27 was positive in his blood cell, and no bacteriae was detected in the blood or synovial fluid. According to the symptoms and findings, Reiter's syndrome was mostly suspected for this case. The diagnosis of this syndrome is difficult since history of bacterial urethritis is apt to miss to hear from patients with arthritis. Careful history taking seemed to be significant for the accurate diagnosis.

Senile patients with low back pain and radiolucency in the same lesion are usually diagnosed as osteoporosis. Some of them should be diagnosed as osteomalacia.We reported two cases of senile osteomalacia with pseudo-arthrosis of pelvis and ribs, whose laboratory findings were as follows; the serum alkaline phosphatase was elevated, and the 25-OH vitamin D was decreased. They were treated with 1α-OH-D3.

Pachydermoperiostosis is a syndrome characterized by clubbing of the digits, periosteal new bone formation, and coarsening of the facial features.The patient is a thirty-one years old man with hydrops of left knee. This case is typical, and has all abnormalities of digits, skin, and diaphyseal bone.We showed this case and discussed the pathogenesis.

Two cases of typical ochronotic arthropathy were reported.Case 1; A 70-year-old man had had a considerable pain in the large joints for about ten years and a gait disturbance for eighteen months. The dark pigementation was noticed in sclera and ear cartilage, and his urine turned dark when a strong alkali was added to it. The ragiological examination showed disc calcification and bamboo spine, characteristic sign of ochronotic arthropathy. And the shoulder, hip and knee joints showed marked osteoarthrosis, but not ankylosis.Case; A 71-year-old woman had low back pain and right caxalgia. The findings of sclera, ear cartilage and urine were the same as Case 1. The ragiological examination showed marked disc degeneration and calcification without vertebral fusion, and moderate osteoarthrosis in the right hip.

We report a rare case of Osteopoikilosis associated with ichthyosis vulgaris and Crohn's disease. A 26-year-old man who was told of an “abnormal” radiograph was referred to our department. A skeletal survey was performed which revealed multiple oval and round densities measuring 3-7mm in diameter. The lesions were bilaterally situated in the epiphysio-metaphyseal region. The bones involved were the long bones and the small bones of the hands, feet, and pelvis. The ribs, skull and vertebral column were not involved. 99mTc-methylen diphosphate bone scan was performed and found to be normal. We describe here a case with osteopoikilosis, Crohn's disease and ichthyosis vulgaris. The etiology of the conditions was unknown, but we subsequently turned our attention to a possible link among these three conditions. The combination of osteopoikilosis, ichthyosis vulgaris, and Crohn's disease is considered a syndrome which is possibly inherited.

We reported idiopathic Fanconi syndrome, which occurred in a 54-year-old female. She felt right coxalgia in 1975 and could not walk. She was suspected as osteomalacia and treated by Vit. D. In August, 1978, she sustained right femoral neck fracture, and then suffered from bilateral tibial and ulnar fractures with pain. She was treated but could not be relieved from pain. In September, 1981, she visited our institute and was diagnosed as Fanconi syndrome.

Osteochondroma is the most frequent benign tumor of the bone. Its migration is well-known but its spontaneous disappearance is rarely reported.A three years and nine months follow-up study of an osteochondroma occurring in the left humerus of a one-year-old boy is reported.The broad-based lump was located on the anteromedial aspect of the left humerus at the proximal diaphysis. The diagnosis of solitary osteochondroma was made roentgenographycally. The lesion was followed with roentgenograms without treatment.Roentgenograms made three months later showed no apparent change in the lesion, but subsequent roentgenograms made fourteen and twenty-four months after the initial roentgenograms showed the gradual regression of the lesion. The final roentgenograms made three years and nine months after the initial roentgenograms showed the lesion to have completely disappeared without surgical intervention.Spontaneous resolution or regression of osteochondromas is rarely recorded, but it is suggested that it may be more frequent.

A Stress fracture of tibial malleolus is rare and only seven cases were reported in the literature. Recently, we encountered a patient who was a seventeen years old boy and had been playing rugby-football. He had a history of pain around his left tibial malleolus for a month, however, he had continued playing rugby. On examination, slight swelling and tenderness were found over the tibial malleolus and pes planovalgus and genu varum were also noticed bilaterally. Radiographs demonstrated oblique fracture line in the left tibial malleolus suggesting the stress fracture and he was kept away from playing rugby for a month. Subsequently, pain was relieved and radiographs showed the sign of recovery. He returned to sports activity without difficulty. In this case, slight deformities of his legs (pes plano-valgus and genu varum) and his role in rugby as right flanker, are considered to cause the stress fracture of the tibial malleolus.