<原著>腰椎椎間板ヘルニアに対するCTガイドのもとでの Nucleotome Flex II による経皮的椎間板摘出術

Six patients with lumbar herniated discs were treated using the Nucleotome Flex II system under computed tomography (CT) guidance. Excellent results were obtained in patients whose intraoperative CT showed that the tip of the nucleotome was located at the posterior part of the disc. The nucleotome flexed within the area where the dye had spread during the preoperative computed tomographic discography (CTD). On the other hand, in both good and poor cases, the tip of the nucleotome could not flex posteriorly because of strong resistance. In these cases, preoperative CTD showed disc protrusion with a narrow dye base. The findings following open discectomies of poor cases showed that the dye lacking area consisted of a relatively intact annulus fibrosus. A relatively intact annulus fibrosus may obstruct the flexion of the nucleotome, resulting in a poor outcome in such cases.6例の腰椎椎間板へルニアの症例に対して, CTガイドのもとで Nucleotome Flex II による経皮的椎間板摘出術を施行した. 優の成績が得られた症例においては, 術中のCT所見において, nucleotome の先端が椎間板の後方部分（へルニアに近い部分）に到達していた. これらの症例では術前のCT椎間板造影像において, 造影剤の充満されている部分の中で nucleotome が屈曲していた. 他方, 良と不可の症例においては, nucleotome は強い抵抗のため後方へ屈曲できなかった. これらの症例の術前のCT椎間板造影像では, Castro のいう narrow dye base とし、う所見であった. 不可の症例では, 引き続き open discectomy が行われたが, narrow dye base において認められた造影剤が入りこまない部分は比較的健常な線維輪であった. 比較的健常な線維輪が nucleotome の屈曲を妨げ, その結果としてヘルニアに近い椎間板の後方部分が切除されなかったため, 成績が不良となったと考えられた

Estimation of Obstacle Avoidance in Children with Developmental Disorders and Normal Children

[目的]本研究の目的は,発達障害児の障害物回避の見積もり能力を明らかにすることであった。[方法]対象は5～6歳の発達障害児と健常児,各9名とした。視覚弁別課題として,7.0m離れた位置から異なる高さの2本のバーの高低を比較させた。また,接触回避を見積もる課題として,異なる高さのバーを1本ずつ呈示し,かがみ込むことなしに,身体を接触させずに通り抜けることができるかどうかを回答させた。[結果]視覚弁別課題では発達障害児の正答数は9.22±.63回,健常児は9.78±.42回であり,有意な差は見られなかった。見積もり課題では,発達障害児の正答数は7.78±.67回,健常児は8.56±.73回であり,発達障害児の正答数が有意に少なかった。[結語]発達障害児は身長とバーとの相互関係からバーへの接触回避を見積もる能力が劣っていたために,障害物に接触する頻度が高いのではないかと考えられた。[Purpose] The purpose of this study was to investigate the ability of children with developmental disorders (CDD) to make estimations related to the avoidance of obstacles. [Method] Participants were 9 CDD and 9 healthy children (HC) who had been diagnosed as having attention deficit-hyperactivity disorder or Asperger's syndrome, aged 5-6. As a visual discrimination task, participants compared 2 bars at different heights from a distance of 7.0m. Furthermore, in order to test their estimation of obstacle avoidance, bars of different heights were displayed one by one, and participants were asked to judge whether it would be possible to pass without crouching or bumping into the bars. [Results] CDD and HC performed similarly in the visual discrimination tests. However, CDD fell behind HC in their ability to use body images to estimate the possibility of pass-under movements. [Conclusion] These results suggest that the reason that CDD bump into obstacles lies in the inaccuracy of their own body images. The above results indicate that it is difficult for CDD, in comparison to HC, to make estimations of the possibility of avoiding physical contact with obstacles based on body image

A Study of Physical Contact in Passing-Under Movements : Children with Developmental Disorder Have More Collisions

[目的]本研究の目的は,くぐり動作を用いて,発達障害児と健常児の障害物への身体接触を比較検証することであった。[対象]5～6歳の健常児と発達障害児,各9名を対象とした。[方法]課題は7種類の遊具と高さの異なる6つのバーを交互に設置したコースを通り抜けることであった。障害物との接触回避に関する注意喚起を与えない条件,接触回避を与える条件,そして接触回避および早く移動することを促す条件の3条件を設け,それぞれ1試行ずつ行わせた。[結果]発達障害児は健常児に比べて,条件に関わらず接触頻度が高かった。また,発達障害児は腰部の接触頻度が高かった。[結語]発達障害児の接触の多さは,注意の欠陥が原因ではないと考えられる。また,視覚フィードバックを随時利用して,接触しないようにくぐり動作を行うことが困難な状況において身体接触が多いことから,身体特性情報に基づく行為の見積もりの不正確さが,発達障害児の身体接触の多さの原因であることを示唆した。[Purpose] In this study, we examined physical contact with obstacles by children with and without developmental disorders (DD). [Subjests] Participants were nine children with DD and nine normal children. [Methods] All participants went through a course with seven pieces of playground equipment and six bars at different heights under three conditions: the first trial was with no instruction, the second trial was with an instruction to avoid collision, and the third trial was with an instruction to avoid collision and go through as fast as possible. [Results] The children with DD had more physical contact with the bars than normal children, indicating that attention deficit was not the cause of the increased contact in the children with DD. They also showed a significantly higher number of waist-contacts when compared to the normal children. This suggests that the children with DD had more contact when concurrent visual-feedback could not be used during avoidance movements. [Conclusion] It is possible that incorrect estimation based on body-characteristic information is the cause of the increased contact in the children with DD