{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390282679810992000.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.14930/jsma1939.67.286"}},{"identifier":{"@type":"NDL_BIB_ID","@value":"9394822"}},{"identifier":{"@type":"URI","@value":"http://id.ndl.go.jp/bib/9394822"}},{"identifier":{"@type":"URI","@value":"https://ndlsearch.ndl.go.jp/books/R000000004-I9394822"}},{"identifier":{"@type":"NAID","@value":"130001820340"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2008126604"}}],"dc:title":[{"@language":"en","@value":"IDIOPATHIC NECROSIS OF THE FEMORAL HEAD"},{"@language":"ja","@value":"特発性大腿骨頭壊死症"},{"@value":"特発性大腿骨頭壊死症--大腿骨頭回転骨切り術の長期治療成績と摘出骨頭の病理組織学的検討"},{"@language":"ja-Kana","@value":"トクハツセイ ダイタイコツトウ エシショウ ダイタイコツトウ カイテン ホネキリジュツ ノ チョウキ チリョウ セイセキ ト テキシュツ コットウ ノ ビョウリ ソシキガクテキ ケントウ"}],"dcterms:alternative":[{"@language":"en","@value":"—Clinical Long-term Results of Transtrochanteric Rotational Osteotomy and Histopathological Study—"},{"@language":"ja","@value":"―大腿骨頭回転骨切り術の長期治療成績と摘出骨頭の病理組織学的検討―"}],"description":[{"type":"abstract","notation":[{"@language":"en","@value":"Long-term clinical results after transtrochanteric anterior rotational osteotomy for idiopathic osteonecrosis of the femoral head and histopathological study of the removed femoral head were evaluated in patients who eventually underwent arthroplasty. From 1987 to 1996, transtrochanteric rotational osteotomy was used to treat 35 hips in 26 patients with osteonecrosis of the femoral head. Every hip case had anterior rotational osteotomy and follow-up periods ranged from ten to 18 years. When the end point of the study was defined as postoperative progress to collapse of the femoral head, the 10-year survival rate was 84% and that of the 15-year was 76%. When the end point was defined as an advanced stage after operation, the 10-year survival rate was 68% and the 15-year, 35%. This operation that indicates the ratio of the intact area of the posterior part of the femoral head to the total articular surface on the lateral view of the hip roentgenogram patients should be more than 33%, and for postoperative patients, the transposed intact area should occupy more than 36% of the accetabular weight-bearing area after osteotomy and the intentional varus position. In addition, excellent results were obtained in patients within the limits of the above indications. The risk factors for postoperative progressive collapse include advanced types, 66% or less, and 40% or less of the intact area of the posterior part on the lateral view of the hip roentgenogram. Even though favorable medium-term results had excellent success, in some patients an advanced stage was observed in the long-term results of more than 10 years, resulting in arthroplasty. In the removed femoral head in 8cases eventually undergoing arthroplasty, repair of the osteonecrotic area was histopathologically evaluated. Large sections and 1/4 section specimens were stained with hematoxylin-eosin. The osteonecrotic area, a band-like sclerotic area, and an intact area were identified on the large section specimens, leading to measurement of the following: (1) the maximum thickness of appositional bone formation, (2) the mean thickness of the creeping substitu-tion, (3) coverage of the necrosis trabecula, and (4) the area of all bone trabecula. The osteonecrosis was repaired when the appositional bone was formed from the band-like sclerotic area to the area around the necrotic bone, resulting in proximal expansion throughout the entire necrotic area. Pathological features of the osteonecrotic area without weight-bearing stress were almost identical to MRI findings. The final pathological findings in the repair of osteonecrosis constitutes not replacement with intact tissues, but filled with thickened trabeculae following the disappearance of necrotic tissues and fibrosis."},{"@language":"ja","@value":"特発性大腿骨頭壊死症に対し, 大腿骨頭前方回転骨切り術を施行後10年以上の長期経過観察を行い, 治療成績を検討した.また人工関節置換手術に至った症例の摘出骨頭の病理組織像を検討した.26例35関節の症例を検討し, 術後の骨頭再陥没をEnd pointとした10年期待生存率は84%, 15年生存率は76%であった.術後関節症変化の進行をEnd pointとした場合では, 10年生存率は68%, 15年生存率は35%であった.手術適応は, 一般に術前X線側面像において骨頭の後方または前方に33%以上の健常域の残存, それ以下の場合でも内反を加えることで術後臼蓋部に対する骨頭健常部が36%以上になる症例, 前方回転角度は100度未満である.今回の検討でも, この適応範囲内であれば良好な成績を得ることができ, 人工関節の適応となる時期を遅らせることができた.さらに, 進行した病型・術前後方健常部が66%以下・術後荷重部健常域が40%以下であることが術後再陥没のリスク群であることが分かった.長期成績は病型・病期の軽い症例ほど良好であるが, 進行例でも当手術の十分な適応となり得た.長期観察にて, 短中期の成績での良好な成績であっても10年以上の観察で, 関節症が進行し人工関節置換術に至る症例があることがわかった.人工関節置換手術に至った6例8関節の摘出骨頭において, 大腿骨頭回転骨切り術後の元骨壊死領域の修復像を病理組織学的に評価した.Hematoxylin-eosin染色の大切片及び1/4切片標本を作製し, 大切片標本上の元壊死部, 分界部, 健常部 (1cm<SUP>2</SUP>) の三箇所において, (1) 壊死骨梁の表面に形成された新生骨の厚さの最大値 (2) 添加骨梁の平均値 (新生骨梁の面積/新生骨が壊死骨梁と接する部分の長さ) (3) 被覆率 (新生骨面積/壊死骨梁面積) (4) 骨梁面積を計測した.荷重を免れることにより, 元骨壊死部の修復は, 帯状硬化部から壊死骨周囲に新生骨形成が起こり, 近位に向けて壊死領域全体へ進んでいた.摘出骨頭の病理像は, MRI画像所見とほぼ一致した.荷重ストレスを逃れた元壊死部の修復は病理組織学的に健常組織に置換されていくのではなく, 壊死組織や繊維化が消失し肥厚した骨梁に満たされた組織像となる, これが壊死修復の病理組織学的な終末像と考えられた."}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410572171223643520","@type":"Researcher","personIdentifier":[{"@type":"NRID","@value":"9000020922239"}],"foaf:name":[{"@language":"en","@value":"TOYOSHIMA Yoichi"},{"@language":"ja","@value":"豊島 洋一"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Orthopaedic Surgery, Showa University School of Medicine"},{"@language":"ja","@value":"昭和大学医学部整形外科学教室"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"00374342"},{"@type":"EISSN","@value":"21850976"},{"@type":"NDL_BIB_ID","@value":"000000011560"},{"@type":"ISSN","@value":"00374342"},{"@type":"LISSN","@value":"00374342"},{"@type":"NCID","@value":"AN00117027"}],"prism:publicationName":[{"@language":"en","@value":"Journal of The Showa Medical Association"},{"@language":"ja","@value":"昭和医学会雑誌"},{"@language":"en","@value":"J Showa Med Assoc"},{"@language":"en","@value":"J. Showa. Med. Assoc."},{"@language":"ja","@value":"昭医会誌"},{"@language":"ja","@value":"昭和医会誌"}],"dc:publisher":[{"@language":"en","@value":"The Showa University Society"},{"@language":"ja","@value":"昭和大学学士会"}],"prism:publicationDate":"2007","prism:volume":"67","prism:number":"4","prism:startingPage":"286","prism:endingPage":"297"},"url":[{"@id":"http://id.ndl.go.jp/bib/9394822"},{"@id":"https://ndlsearch.ndl.go.jp/books/R000000004-I9394822"},{"@id":"https://search.jamas.or.jp/link/ui/2008126604"}],"availableAt":"2007","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=osteonecrosis%20of%20the%20femoral%20head","dc:title":"osteonecrosis of the femoral head"},{"@id":"https://cir.nii.ac.jp/all?q=transtrochanteric%20rotational%20osteotomy","dc:title":"transtrochanteric rotational osteotomy"},{"@id":"https://cir.nii.ac.jp/all?q=long-term%20results","dc:title":"long-term results"},{"@id":"https://cir.nii.ac.jp/all?q=histopathological%20study","dc:title":"histopathological study"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A4%A7%E8%85%BF%E9%AA%A8%E9%A0%AD%E5%A3%8A%E6%AD%BB%E7%97%87","dc:title":"大腿骨頭壊死症"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%A4%A7%E8%85%BF%E9%AA%A8%E9%A0%AD%E5%9B%9E%E8%BB%A2%E9%AA%A8%E5%88%87%E3%82%8A%E8%A1%93","dc:title":"大腿骨頭回転骨切り術"},{"@id":"https://cir.nii.ac.jp/all?q=%E9%95%B7%E6%9C%9F%E6%88%90%E7%B8%BE","dc:title":"長期成績"},{"@id":"https://cir.nii.ac.jp/all?q=%E7%97%85%E7%90%86%E5%AD%A6%E7%9A%84%E6%A4%9C%E8%A8%8E","dc:title":"病理学的検討"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:0031047647"},{"@type":"NDL_SEARCH","@value":"oai:ndlsearch.ndl.go.jp:R000000004-I9394822"},{"@type":"CIA","@value":"130001820340"}]}