Radial Shortening Osteotomy Using Volar Locking Plate for Kienböck\u27s Disease

Purpose:The purpose of this study was to report the preliminary results for radial shortening osteotomyfollowed by volar locking plate fixation without post-operative immobilization for the treatment of Kienböck\u27sdisease.Methods:Ten consecutive patients with Kienböck\u27s disease of stages III were treated by radial shorteningosteotomy at the metaphysis using a volar locking plate system. Radial shortening osteotomy was performed for patients with negative or neutral ulnar variance, and combined shortening of radius and ulna for those with positive ulnar variance. The active motion of the digits, wrist, and forearm was encouraged immediately after surgery, and no splints were used.Results:The average follow-up was 26 months. In all the patients, the osteotomized bone united after an average of 11 weeks. Follow-up radiographs showed no further progression of the disease in carpal height,Ståhl\u27s index, or Lichtman\u27s stage classification. Moderate pain reported by all the patients preoperativelysignificantly improved by the final follow-up. Wrist extension, flexion, grip strength, and the Mayo wrist score were significantly improved compared with preoperative values.Conclusions:Volar locking plate fixation without immobilization is a safe and effective procedure for radial shortening osteotomy of Kienböck\u27s disease

シンケイ センイショウ 1ガタ ノ セキチュウ ヘンケイ ニ トモナウ ロッコツ ズ ノ セキチュウカン ナイ ダッキュウ

2006 年4 月～2010 年3 月の神経線維腫症1 型に伴う脊柱変形手術例10 例中3 例に肋骨頭の脊柱管内脱臼がみられた.症例1 は6 歳の男児でT4-8:74°,T8-11:72° の側弯があり,左第4 と第5 肋骨頭の脊柱管内への陥入を認めた.症例2 は11 歳の男児でT3-7:100° の側弯とT3-T9:90° の後弯があり,左第6 肋骨頭が脊柱管内へ脱臼し,脊髄を圧排していた.症例3 は27 歳の女性でT6～9:73°,T9～12:68° の側弯とT6-10:91°の後弯を認め,右第7 肋骨頭の脊柱管内脱臼がみられた.本病態の報告例は少ないが,決して希な病態ではなくdystrophic change を伴う脊柱変形においては,肋骨頭の脊柱管内脱臼による潜在的リスクに注意する必要があると考える.Spinal deformities are common features in neurofibromatosistype-1( NF-1). Several types of deformities have been reported, however, intraspinal rib head dislocation (IRD)due to dystrophic change is very rare and not well understood. Between April 2006 and March 2010, we experienced3 patients with IRD out of 10 consecutive patients who underwent surgical treatment for dystrophic spinal deformities in NF-1. Case 1:A 6-year-old boy who had 74 ° short angular scoliosis at T4-8 and 72 ° at T8-11 underwent surgery in our institute. CT myelography demonstrated dystrophic changes with for aminal enlargement, vertebral body scalloping, rib penciling and mild IRD. He underwent the Growing Rod techniques and finally underwent posterior spinal fusion (PSF) from T1 to L2 combined with prophylactic rib head resection followed by anterior spinal fusion(ASF) with autologous fibular strut graft. No neurological complications were observed postoperatively and complete bony fusions were achieved. Case 2:Neurologically intact11-year-old boy presented with spinal deformity and caféau-lait spots. Radiography showed 100 ° scoliosis at T3-7and 72 ° at T3-9. CT myelography demonstrated dystrophic changes and IRD and impingement of spinal cord. He underwent PSF with removal of the T6 rib head followed by ASF. Case 3:A 27-year-old woman presented with back pain and spinal deformities. Radiography showed 73 °scoliosis at T6-9 and 91 ° at T9-12. CT myelography demonstrated dystrophic changes and IRD. She also underwentPSF with removal of T7 rib head followed by ASF. AllIRDs were observed at the apex of the convex side of scoliosis.It has a potential risk of spinal cord compression and may cause paraplegia or paraparesis. Therefore, high degree of suspicion is warranted for the treatments of scoliosis with intraspinal rib displacement in NF-1

Hyaluronic acid affects the in vitro induction effects of Synthetic PAMPS and PDMAAm hydrogels on chondrogenic differentiation of ATDC5 cells, depending on the level of concentration

Background: It has been a common belief that articular cartilage tissue cannot regenerate in vivo. Recently, however, we have found that spontaneous hyaline cartilage regeneration can be induced in vivo by implanting a synthetic double-network (DN) hydrogel, which is composed of poly-(2-acrylamido-2-methylpropanesulfonic acid) (PAMPS) and poly-(N,N'-dimethyl acrylamide) (PDMAAm). However, the mechanism of this phenomenon has not been clarified. Recently, we have found that single-network PAMPS and PDMAAm gels can induce chondrogenic differentiation of ATDC5 cells in vitro even in a maintenance medium. In the in vivo condition, there is a strong possibility that the induction effect of the gel itself is enhanced by some molecules which exist in the joint. We have noticed that the joint fluid naturally contains hyaluronic acid (HA). The purpose of this study is to clarify in vitro effects of supplementation of HA on the differentiation effect of the PAMPS and PDMAAm gels. Methods: We cultured the ATDC5 cells on the PAMPS gel, the PDMAAm gel, and the polystyrene (PS) dish surface with the maintenance medium without insulin for 7 days. HA having a molecular weight of approximately 800 kDa was supplemented into the medium so that the concentration became 0.00, 0.01, 0.10, or 1.00 mg/mL. We evaluated the cultured cells with phase-contrast microscopy and PCR analyses. Results: On the PAMPS gel, supplementation with HA of 0.01 and 0.10 mg/mL significantly increased expression of type-2 collagen mRNA (p = 0.0008 and p = 0.0413) and aggrecan mRNA (p = 0.0073 and p = 0.0196) than that without HA. On the PDMAAm gel, supplementation with HA of 1.00 mg/mL significantly reduced expression of these genes in comparison with the culture without HA (p = 0.0426 and p = 0.0218). Conclusions: The in vitro induction effects of the PAMPS and PDMAAm gels on chondrogenic differentiation of ATDC5 cells are significantly affected by HA, depending on the level of concentration. These results suggested that there is a high possibility that HA plays an important role in the in vivo spontaneous hyaline cartilage regeneration phenomenon induced by the PAMPS/PDMAAm DN gel