先端医療シリーズ8 整形外科 整形外科 診断と治療の最先端

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20世紀の整形外科の飛躍的な進歩から、21世紀の整形外科の方向を見定めるべく、本書は20世紀末の整形外科学各分野の最先端の進歩の状況を総括しようとするものである。（序文より）

目次

  • 表紙
  • カラーグラビア
  • 著者一覧
  • 序文
  • 目次
  • 第1章 遺伝子治療
  • 1. 遺伝子治療の現状と課題
  • 1.1 はじめに
  • 1.2 遺伝子導入法
  • 1.2.1 レトロウイルスベクター
  • 1.2.2 アデノウイルスベクター
  • 1.2.3 アデノ随伴ウイルス(AAV)ベクター
  • 1.2.3.1 AAVウイルス学的特徴
  • 1.2.3.2 AAVベクターの作製と特徴
  • 1.3 遺伝子治療の方法と対象疾患
  • 1.4 遺伝子治療臨床研究の最近の動向
  • 1.5 遺伝子治療の今後の課題
  • 1.6 おわりに
  • 2. 整形外科疾患の遺伝子治療
  • 2.1 はじめに
  • 2.2 どのような病態に遺伝子治療が必要なのか
  • 2.2.1 遺伝病への遺伝子治療
  • 2.2.2 癌に対する遺伝子治療
  • 2.2.3 非遺伝性, 非腫瘍性疾患への遺伝子治療
  • 2.3 増殖因子の供給としての遺伝子治療
  • 2.3.1 骨再生への応用
  • 2.3.2 軟骨再生への遺伝子治療
  • 2.3.2.1 骨軟骨腫の解析
  • 2.3.2.2 内軟骨腫からの解析
  • 2.4 多因子疾患に対する遺伝子治療に向けて
  • 2.4.1 病態把握の重要性
  • 2.4.2 病態把握のための遺伝子発現プロファイルの作成
  • 2.5 おわりに
  • 3. 骨系統疾患の遺伝子解析
  • 3.1 はじめに - 骨系統疾患とは
  • 3.2 骨系統疾患の遺伝子解析の進展
  • 3.3 疾患遺伝子単離のさらなる展開
  • 3.4 骨系統疾患の遺伝子解析のもたらすもの
  • 3.4.1 分類, 病態の整理
  • 3.4.2 common diseaseの解明
  • 3.4.3 骨格の形成機構の解明
  • 3.5 今後の展望
  • 4. 後縦靱帯骨化症遺伝要因の解明
  • 4.1 はじめに
  • 4.2 OPLLの遺伝背景
  • 4.3 なぜ遺伝要因を解析するか
  • 4.4 罹患同胞対連鎖解析法によるOPLL遺伝子座の特定
  • 4.5 OPLL遺伝子座の染色体6番HLA領域への特定
  • 4.6 コラーゲン11A2遺伝子の遺伝的関与
  • 4.7 コラーゲン11A2遺伝子変異と骨化との関連
  • 4.8 ゲノム全域でのOPLL感受性遺伝子探索
  • 4.9 OPLLモデル動物を用いた解析
  • 4.10 将来における臨床への応用
  • 4.11 おわりに
  • 5. 骨軟部腫瘍に対する遺伝子治療
  • 5.1 はじめに
  • 5.2 遺伝子導入法
  • 5.2.1 ウイルスベクター
  • 5.2.2 レトロウイルスベクター
  • 5.2.3 アデノウイルスベクター
  • 5.2.4 ウイルスベクター投与法
  • 5.2.5 非ウイルスベクター
  • 5.3 癌に対する遺伝子治療
  • 5.3.1 抑制遺伝子を標的とした遺伝子治療
  • 5.3.2 アンチセンスオリゴヌクレオチドを用いた遺伝子治療
  • 5.3.3 免疫遺伝子治療
  • 5.3.3.1 サイトカイン遺伝子の導入
  • 5.3.3.2 接着分子遺伝子の導入
  • 5.3.4 自殺遺伝子治療
  • 5.4 おわりに
  • 6. 関節疾患に対する遺伝子治療
  • 6.1 はじめに
  • 6.2 関節疾患への遺伝子導入法
  • 6.3 HVJ - リポソーム法による関節への遺伝子導入の試み
  • 6.4 関節軟骨修復の試み
  • 6.5 慢性関節リウマチにおける関節破壊抑制の試み
  • 6.6 滑膜細胞増殖抑制の試み
  • 6.7 おわりに
  • 第2章 移植と再生医学の最先端
  • 1. 遊離骨移植
  • 1.1 はじめに
  • 1.2 遊離骨移植の着床過程
  • 1.2.1 移植骨着床の組織形態計測
  • 1.2.2 臨床例における移植骨の着床
  • 1.3 自家骨移植
  • 1.3.1 自家海綿骨移植
  • 1.3.2 自家皮質骨移植
  • 1.3.3 自家骨採取の合併症
  • 1.4 同種骨移植
  • 1.4.1 同種骨保存の要件
  • 1.4.2 同種骨の保存・処理法
  • 1.4.2.1 冷凍
  • 1.4.2.2 凍結乾燥
  • 1.4.2.3 AAAbone (antigen-extracted,autodigested,chemosterilized alloimplant)
  • 1.4.2.4 脱脂
  • 1.5 同種骨使用上の注意
  • 2. 血管柄付き組織移植
  • 2.1 はじめに
  • 2.1.1 遊離皮弁移植
  • 2.1.2 遊離筋肉移植
  • 2.1.3 血管柄付き骨移植
  • 2.1.4 足趾移植 (toe transfer)
  • 2.1.5 血管柄付き関節移植
  • 2.2 考察
  • 3. 脊髄損傷に対する幹細胞移植
  • 3.1 はじめに
  • 3.2 NSCについて
  • 3.2.1 NSCとは
  • 3.2.2 NSCの選択的培養法の確立とin situでの同定法
  • 3.2.3 NSCの分化機構
  • 3.3 脊髄損傷に対する幹細胞移植
  • 3.3.1 移植材料としての幹細胞
  • 3.3.2 移植後の幹細胞の分化
  • 3.3.3 幹細胞移植による機能回復を目指して
  • 3.3.4 脊髄損傷に対する幹細胞移植の現状
  • 3.4 まとめ
  • 4. 骨組織再生
  • 4.1 はじめに
  • 4.2 同種, 同系新鮮骨髄細胞の骨芽細胞への細胞分化
  • 4.3 骨髄細胞によるin vitro骨形成
  • 4.4 ヒト細胞骨髄細胞による骨形成
  • 4.5 考察
  • 5. 末梢神経再生
  • 5.1 はじめに
  • 5.2 軸索内輸送について
  • 5.3 神経栄養因子 (Neurotrophic factor, NTF)について
  • 5.4 再生軸索と成長円錘
  • 5.5 神経再生とシュワン細胞の基底膜
  • 5.6 末梢神経の再生時における神経周膜の再生
  • 5.7 神経の機能的再生
  • 第3章 関節軟骨欠損の修復
  • 1. モザイクプラスティ
  • 1.1 はじめに
  • 1.2 骨軟骨移植法とモザイクプラスティの開発
  • 1.3 モザイクプラスティの原理と方法
  • 1.4 モザイクプラスティの適応
  • 1.5 モザイクプラスティの手技上の注意点
  • 1.6 術後リハビリテーション
  • 1.7 モザイクプラスティの臨床成績
  • 1.8 モザイクプラスティの長所と問題点
  • 1.9 モザイクプラステイの展望
  • 2. アテロコラーゲンゲルを用いた培養軟骨細胞移植
  • 2.1 はじめに
  • 2.2 培養自家軟骨移植法
  • 2.2.1 説明と術前検査
  • 2.2.2 軟骨細胞採取および培養法
  • 2.2.3 培養軟骨細胞移植手術
  • 2.3 臨床成績
  • 2.4 展望
  • 2.5 結語
  • 3. 自己培養骨髄間葉系細胞移植
  • 3.1 はじめに
  • 3.2 骨髄間葉系細胞
  • 3.2.1 骨髄間葉系細胞とは
  • 3.2.2 骨髄間葉系細胞と軟骨修復
  • 3.3 家兎自己骨髄・骨膜間葉系細胞移植による軟骨欠損修復
  • 3.4 ヒト自己培養骨髄間葉系細胞移植による関節軟骨欠損修復
  • 3.4.1 膝蓋骨軟骨欠損修復
  • 3.4.2 変形性関節症の軟骨修復
  • 3.4.3 考察
  • 3.5 今後の研究課題
  • 3.5.1 成長因子投与
  • 3.5.2 in vitroでの軟骨への分化誘導
  • 4. 再生医工学による軟骨修復
  • 4.1 組織培養工学を用いた生体外再生軟骨
  • 4.2 培養軟骨用基盤材料
  • 4.3 軟骨再生の将来展望
  • 4.4 まとめ
  • 第4章 創外固定の適応拡大
  • 1. 骨延長術の現状と課題
  • 1.1 はじめに
  • 1.2 皮質骨切り方法について
  • 1.3 仮骨延長法の導入にいたる経緯について
  • 1.4 当科における創外固定法および骨延長術の発展について
  • 1.5 仮骨延長法の整形外科難治性疾患への応用について
  • 1.6 おわりに
  • 2. 感染症偽関節に対する骨延長術
  • 2.1 はじめに
  • 2.2 骨延長術の歴史
  • 2.3 治療法の実際
  • 2.4 本法の特徴
  • 2.4.1 感染した偽関節部の完全切除
  • 2.4.2 切除した両骨片端の骨接合
  • 2.4.3 健常部での骨延長
  • 2.5 問題点と将来の展望
  • 2.5.1 治療期間が長い
  • 2.5.2 創外固定器抜去時期決定の客観的方法がない
  • 2.5.3 ピン感染が多い
  • 2.5.4 骨幅の拡大
  • 2.6 まとめ
  • 3. 骨延長による腫瘍切除後の再建
  • 3.1 骨延長術と再建
  • 3.1.1 はじめに
  • 3.1.2 骨延長術
  • 3.1.3 適応
  • 3.2 再建術の基本原則
  • 3.2.1 腫瘍の切除
  • 3.2.2 延長法の選択
  • 3.2.3 骨欠損の再建方法
  • 3.2.3.1 Bone transport
  • 3.2.3.2 Shortening-distraction
  • 3.2.4 関節の安定化
  • 3.2.5 髄内釘の併用
  • 3.2.5.1 先入れ法 (primary nailing)
  • 3.2.5.2 後入れ法 (delayed nailing)
  • 3.2.6 創外固定器の選択
  • 3.3 各種関節再建術の実際
  • 3.3.1 Type1. 骨幹部の再建 (diaphyseal reconstruction)
  • 3.3.2 Type2. 骨幹端部の再建 (metaphyseal reconstruction)
  • 3.3.3 Type3. 骨端部の再建 (epiphyseal reconstruction)
  • 3.3.4 Type4. 関節直下の再建 (subarticular reconstruction)
  • 3.3.5 Type5. 関節固定術 (arthrodesis)
  • 3.3.6 術後リハビリテーション
  • 3.4 治療成績
  • 3.5 骨延長術の利点と問題点
  • 3.5.1 骨延長術の利点
  • 3.5.2 骨延長術の問題点と対策
  • 3.5.2.1 創外固定期間
  • 3.5.2.2 合併症
  • 3.5.2.3 骨延長下の骨血流
  • 3.5.2.4 化学療法下の骨形成能
  • 3.6 今後の展望
  • 3.7 まとめ
  • 4. イリザロフ法による内反足治療
  • 4.1 はじめに
  • 4.2 先天性内反足とは
  • 4.3 内反足に対するイリザロフ法とは
  • 4.4 イリザロフ法の適応
  • 4.5 手術方法
  • 4.6 変形矯正の順序
  • 4.7 症例 : 4才女子 (先天性内反足遺残変形)
  • 4.8 考察
  • 第5章 生体材料を用いた運動器再建
  • 1. 新しい生体材料の開発と展望
  • 1.1 はじめに
  • 1.2 バイオアクテイブセラミックス
  • 1.3 人工骨・軟骨複合材料の開発
  • 1.3.1 生体適合性
  • 1.3.2 人工軟骨の骨床への強固な接着・固定
  • 1.3.3 臨床応用
  • 1.4 おわりに
  • 2. 生体内吸収性材料
  • 2.1 はじめに
  • 2.2 整形外科領域での吸収性生体材料
  • 2.3 吸収性骨接合材
  • 2.3.1 種類
  • 2.3.2 ポリグリコール酸 (PGA)
  • 2.3.3 ポリジオキサノン (PDS)
  • 2.3.4 ポリ乳酸 (PLA)
  • 2.3.4.1 ポリ乳酸の種類
  • 2.3.4.2 高強度PLLA骨接合材
  • 2.4 吸収性骨接合材の将来の展望
  • 3. 人工靱帯
  • 3.1 はじめに
  • 3.2 人工靱帯開発の歴史的背景
  • 3.3 人工靱帯の種類
  • 3.4 人工靱帯 (scaffold型) の条件
  • 3.5 人工靱帯 (scaffold型) による再建ACLの生物学的成熟過程
  • 3.6 次世代の人工靱帯 (scaffold型)
  • 3.7 人工靱帯の将来展望
  • 4. 人工関節の進歩
  • 4.1 はじめに
  • 4.2 架橋ポリエチレン (Cross - linked polyethylene)
  • 4.2.1 高線量ガンマ線照射RCH1000 (UHMWPE : 分子量106)
  • 4.2.2 臨床応用と成績
  • 4.2.2.1 臨床例におけるRCH1000・ソケットの摩耗
  • 4.2.2.2 除去ソケットのSEM像
  • 4.2.2.3 生体内および生体外におけるソケットの物性変化
  • 4.2.3 UHMWPEに対する至適高線量ガンマ線照射の追求
  • 4.2.3.1 50, 100, 150Mrad高線量ガンマ線照射によるUHMWPEの架橋と低摩耗効果
  • 4.2.3.2 高線量ガンマ線照射による架橋UHMWPEの物理的・化学的特性変化
  • 4.2.4 高線量照射架橋ポリエチレンのエージング試験による経時的な物理的・化学的特性変化
  • 4.2.5 等方向2軸変形試験 (equi - biaxial deformation test又はsmall punch test)
  • 4.2.6 現在臨床使用されている架橋ポリエチレン
  • 4.3 アルミナ骨頭とアルミナ・ソケットの人工股関節
  • 4.4 おわりに
  • 5. 生体材料を用いた脊柱再建
  • 5.1 脊柱の機能的役割
  • 5.2 脊椎手術の適応
  • 5.3 脊椎手術 (脊柱再建) に応用される生体材料
  • 5.4 脊椎固定spinal fusionに応用されるspinal instrumentation
  • 5.5 後方脊柱再建術Posterior spinal reconstruction with posterior instnmentation
  • 5.5.1 頚椎後方インストルテーション
  • 5.5.2 胸椎・胸腰椎後方インストルテーション
  • 5.5.2.1 Hook & Rod System
  • 5.5.2.2 Pedicle Screw & Rod System
  • 5.5.3 腰椎後方インストルテーションPosterior Lumbar Instrumentation
  • 5.5.3.1 腰椎固定用椎弓根スクリュー・ロッドシステム
  • 5.5.3.2 腰椎後方椎体間固定の適応
  • 5.5.3.3 椎体間スペーサーに関する課題
  • 5.6 前方脊柱再建術Anterior spinal reconstruction with anterior instrumentation
  • 5.6.1 頚椎前方インストルテーションCervical Anterior Instrumentation
  • 5.6.2 胸椎・腰椎前方脊柱再建術へのAntcrior Instrumentationの応用
  • 5.6.2.1 胸椎・腰椎脊柱変形のanterior instrumentationによる矯正固定
  • 5.6.3 胸椎・腰椎椎体切除後のAnterior Instrumentation応用脊柱前方再建術
  • 5.6.3.1 胸椎転移性腫瘍の椎体全切除とKaneda SR/ISOIAの応用脊柱再建, 胸椎 (T12) 甲状腺癌転移による脊髄麻痺
  • 5.6.3.2 第12胸椎骨粗鬆症圧迫骨折後椎体圧潰
  • 5.6.3.3 脊椎感染症へのInstrumentation応用
  • 5.7 人工椎間板応用の脊柱再建術Reconstruction with Artificial Intervertebral Disc
  • 5.8 結び
  • 6. 生体材料を用いた運動器再建
  • 6.1 はじめに
  • 6.2 鋼線 (ワイヤー)
  • 6.2.1 Kirschner鋼線, スタイマンピン, ラッシュピン
  • 6.2.2 締結用鋼線
  • 6.3 プレート
  • 6.4 ねじ (スクリュー)
  • 6.4.1 皮質骨スクリュー
  • 6.4.2 海綿骨スクリュー
  • 6.4.3 果骨スクリュー
  • 6.4.4 Herbertスクリュー
  • 6.5 髄内釘
  • 6.5.1 Reamed nail
  • 6.5.2 Unreamed nail
  • 7. 非吸収性ポリエチレン繊維を用いた頚椎固定術
  • 7.1 はじめに
  • 7.2 対象
  • 7.3 方法
  • 7.4 結果
  • 7.5 考察
  • 7.6 まとめ
  • 第6章 股関節
  • 1. ステロイド性大腿骨頭壊死症の実験モデルと発症予防
  • 1.1 特発性大腿骨頭壊死症
  • 1.1.1 はじめに
  • 1.1.2 分類・疫学
  • 1.1.3 病因
  • 1.1.4 病態
  • 1.1.5 診断
  • 1.1.6 実験モデルの必要性
  • 1.2 骨壊死動物モデル
  • 1.2.1 ステロイド単独投与による骨壊死モデル
  • 1.2.1.1 はじめに
  • 1.2.1.2 方法
  • 1.2.1.3 結果
  • 1.2.1.4 考察
  • 1.2.2 基礎疾患にステロイドを併用投与したモデル
  • 1.2.2.1 はじめに
  • 1.2.2.2 過凝固状態を基盤としたモデル
  • 1.2.2.3 免疫異常を基盤としたモデル
  • 1.3 予防法開発への応用
  • 1.3.1 はじめに
  • 1.3.2 実験モデルを用いた検討
  • 1.3.2.1 ニワトリでの実験
  • 1.3.2.2 家兎での実験
  • 2. 大腿骨頭回転骨切り術
  • 2.1 手術の開発の背景
  • 2.1.1 大腿骨頭壊死の原因と疫学
  • 2.1.1.1 原因
  • 2.1.1.2 疫学
  • 2.1.2 大腿骨頭壊死症の自然経過と従来の治療法
  • 2.1.2.1 自然経過
  • 2.1.2.2 従来の治療法と治療成績
  • 2.1.3 骨頭回転骨切り術の発想
  • 2.2 大腿骨頭回転骨切り術の理論
  • 2.2.1 大腿骨頭回転骨切り術の前提となる事実
  • 2.2.2 大腿骨頭回転骨切り術の理論
  • 2.3 手術の適応
  • 2.3.1 手術適応の原則
  • 2.3.2 手術適応の決定の方法
  • 2.4 手術の実際
  • 2.4.1 作図
  • 2.4.2 術式の実際
  • 2.4.2.1 体位
  • 2.4.2.2 皮切と筋膜切開
  • 2.4.2.3 展開
  • 2.4.2.4 関節包の輪状切開
  • 2.4.2.5 骨頭の観察
  • 2.4.2.6 切骨面のX線による確認と骨切り
  • 2.4.2.7 骨頭の回転
  • 2.4.2.8 骨切り部の内固定
  • 2.4.2.9 創閉鎖
  • 2.4.3 後療法
  • 2.5 手術の成績
  • 2.6 他疾患への応用
  • 2.6.1 大腿骨頭すべり症
  • 2.6.1.1 大腿骨頭すべり症の病態
  • 2.6.1.2 大腿骨頭すべり症における手術適応
  • 2.6.1.3 手術における注意点
  • 2.6.2 ペルテス病
  • 2.6.2.1 ペルテス病の病態
  • 2.6.2.2 手術適応
  • 2.6.2.3 手術における注意点
  • 2.6.3 大腿骨頭骨化障害・離断性骨軟骨炎
  • 2.7 結語
  • 3. 人工関節周囲のosteolysisの原因と対策
  • 3.1 はじめに
  • 3.2 病態
  • 3.2.1 osteolysisとインプラントの弛み
  • 3.2.2 osteolysisのX線所見
  • 3.2.3 osteolysisの病理所見
  • 3.2.4 osteolysisのメカニズム
  • 3.2.4.1 炎症性サイトカインの関与
  • 3.2.4.2 蛋白質分解酵素の関与
  • 3.2.4.3 macrophage - osteoclast interaction
  • 3.3 osteolysisの対策
  • 3.3.1 osteolysisの治療
  • 3.3.2 osteolysisの予防
  • 3.3.2.1 新しい人工材料による摩耗粉の減少
  • 3.3.2.2 マクロファージの不活性化
  • 3.3.2.3 ビスフォスフォネートの使用
  • 3.4 今後の展望
  • 4. カスタムメイド人工股関節
  • 4.1 はじめに
  • 4.2 カスタムメイドステムの概要
  • 4.2.1 カスタムメイドステムの変遷
  • 4.2.2 手術適応
  • 4.2.3 デザインコンセプト
  • 4.2.4 ステムの製作
  • 4.2.5 ステムの表面性状
  • 4.2.6 術前準備
  • 4.2.7 手術手技
  • 4.2.8 後療法
  • 4.3 臨床成績
  • 4.4 おわりに
  • 5. 人工股関節全置換術のコンピューターナビゲーション
  • 5.1 はじめに
  • 5.2 術前準備および手術計画
  • 5.3 手術室での3次元赤外線センサーと赤外線発光ダイオードマーカーの設置
  • 5.4 レジストレーション
  • 5.5 ナビゲーション
  • 5.6 症例
  • 5.7 ナビゲーションシステムの評価と今後の展望
  • 6. セメントレス人工股関節
  • 6.1 はじめに
  • 6.2 人工股関節の歴史
  • 6.3 THA弛みのmechanism
  • 6.4 第1世代セメントレスTHAと, その問題点
  • 6.5 第2世代セメントレスTHA
  • 6.5.1 S-ROMの特徴
  • 6.5.2 S-ROMの短所
  • 6.6 症例
  • 6.7 最後に
  • 第7章 最小侵襲による脊椎手術
  • 1. 内視鏡脊椎手術
  • 1.1 はじめに
  • 1.2 対象とする疾患と難易度
  • 1.3 手技のステップ
  • 1.3.1 アプローチの要諦
  • 1.3.2 腰部椎間板ヘルニア摘出
  • 1.3.3 椎間孔鏡のアプローチ (Wiltzの展開に内視鏡を応用)
  • 1.3.4 後腹膜アプローチ
  • 1.3.5 経腹膜アプローチ
  • 1.3.6 胸腔アプローチ
  • 1.4 結果
  • 1.5 考察
  • 1.5.1 歴史的推移
  • 1.5.2 内視鏡視下手術の利点
  • 1.5.3 合併症と問題点
  • 1.6 まとめ
  • 2. 脊椎脊髄外科におけるNavigation Surgery
  • 2.1 定位手術 (Stereotactic Surgery) と脊椎外科
  • 2.2 ナビゲーション手術
  • 2.2.1 イメージガイドシステム (コンピュータナビゲーションシステム) の原理
  • 2.2.1.1 赤外線
  • 2.2.1.2 磁場
  • 2.2.1.3 その他
  • 2.2.2 Stealth Station
  • 2.3 ナビゲーションの実際
  • 2.3.1 レジストレーション
  • 2.3.2 術前操作
  • 2.3.2.1 CTの撮影
  • 2.3.2.2 3-D画像, マップの作成
  • 2.3.2.3 手術プランの作成, レジストレーションポイントの設定
  • 2.3.3 術中操作
  • 2.3.3.1 レジストレーション
  • 2.3.3.2 ナビゲーション
  • 2.3.4 システム使用上の注意点とコツ
  • 2.3.5 ナビゲーションシステムの精度と有用性
  • 2.4 画像診断への応用
  • 2.4.1 応用方法
  • 2.5 イメージガイドシステムの問題点と今後の方向
  • 2.5.1 イメージガイドシステムの問題点
  • 2.5.2 イメージガイドシステムの今後の方向
  • 2.6 まとめ
  • 3. レーザーによる脊椎手術
  • 3.1 整形外科で用いられるレーザー
  • 3.2 レーザーを用いた最小侵襲整形外科
  • 3.3 レーザー脊椎外科の現況
  • 3.3.1 その現況
  • 3.3.2 Ho : YAGレーザーと内視鏡を用いた経皮的腰椎椎間板除圧術
  • 3.3.3 Ho : YAGレーザーと内視鏡を用いた経皮的胸椎椎間板除圧術
  • 3.3.4 Ho : YAGレーザーと内視鏡を用いた経皮的頚椎椎間板除圧術
  • 3.4 脊椎外科での今後の展望
  • 4. 前方Instrumentation (Kaneda SR) を用いた脊椎手術
  • 4.1 胸椎・腰椎の手術治療
  • 4.1.1 脊椎手術の目的
  • 4.1.2 脊椎Instrumentation
  • 4.1.3 胸椎・腰椎の前方Instrumentation
  • 4.1.4 Kaneda SR System
  • 4.2 Kaneda SRによる再建手術
  • 4.2.1 Kaneda SRの適応
  • 4.2.1.1 脊椎損傷
  • 4.2.1.2 骨粗鬆症性外傷後椎体圧潰
  • 4.2.1.3 脊椎腫瘍
  • 4.2.1.4 その他の適応
  • 4.2.2 Kaneda SRの実際
  • 4.2.3 Kaneda SRの課題
  • 5. 経皮的椎間板切除術
  • 5.1 はじめに
  • 5.2 手術手技の基本概念
  • 5.3 適応
  • 5.4 麻酔・手術体位
  • 5.5 手術器具
  • 5.6 手術手技
  • 5.6.1 椎弓間の展開
  • 5.6.2 側視鏡の挿入
  • 5.6.3 黄色靱帯の切離および脊柱管内の操作
  • 5.6.4 術後の処置, 後療法
  • 5.7 臨床成績
  • 5.8 症例呈示
  • 5.9 合併症とその対策
  • 5.10 まとめ
  • 第8章 骨形成促進
  • 1. 低出力超音波パルスLow Intensity Pulsed Ultrasound (LIPUS) による骨折治癒促進
  • 1.1 はじめに
  • 1.2 LIPUSの基礎的研究
  • 1.3 臨床成績
  • 1.4 LIPUSによる骨折治療の実際
  • 1.5 LIPUS特性とプローブ設置についての注意点
  • 1.6 今後の課題
  • 2. Fibroblast Growth Factor (FGF) - 2による骨折治療促進
  • 2.1 はじめに
  • 2.2 骨折治癒過程に見られる現象
  • 2.3 骨折治癒過程の調節因子
  • 2.4 骨軟骨形成におけるFGFsの生理的役割
  • 2.5 FGF-2と骨形成
  • 2.6 FGF-2と骨吸収
  • 2.7 今後の展望
  • 3. ペースト状リン酸カルシウムセメントによる骨粗鬆症性脊椎骨折の治療
  • 3.1 はじめに
  • 3.2 材料特性
  • 3.2.1 組成
  • 3.2.2 硬化特性
  • 3.2.3 結晶性
  • 3.2.4 力学的強度
  • 3.2.5 表面活性
  • 3.3 実験的研究
  • 3.3.1 方法
  • 3.3.2 結果
  • 3.4 臨床的応用
  • 3.4.1 方法
  • 3.4.2 結果
  • 3.5 考察
  • 4. BMPによる骨形成促進
  • 4.1 はじめに
  • 4.2 BMPの特性
  • 4.3 BMPの骨損傷修復への臨床応用
  • 4.3.1 合成BMP (rBMP) の応用
  • 4.3.2 Tissue Engineeringへの応用
  • 4.3.3 遺伝子導入による骨欠損修復の促進
  • 4.3.4 細胞内情報伝達系の利用
  • 第9章 骨軟部腫瘍の治療
  • 1. 病理診断の進歩
  • 1.1 はじめに
  • 1.2 組織形態学的鑑別診断
  • 1.3 免疫組織化学的検索
  • 1.3.1 免疫組織化学の役割
  • 1.3.2 免疫組織化学の実際
  • 1.4 分子生物学的検索
  • 1.4.1 染色体異常と遺伝子変異
  • 1.4.2 Ewing肉腫とpPNET
  • 1.4.3 変異遺伝子検索と問題点
  • 1.5 おわりに
  • 2. パスツール処理自家骨移植
  • 2.1 はじめに
  • 2.2 症例
  • 2.3 手術手技
  • 2.4 結果
  • 2.5 考察
  • 2.6 まとめ
  • 3. 骨肉腫に対する温熱局所潅流術を併用した術前化学療法 : 切除縁を縮小した関節温の試み
  • 3.1 はじめに
  • 3.1.1 骨肉腫の生命予後と患肢温存治療
  • 3.1.2 患肢温存治療の問題点
  • 3.1.3 温存患肢の長期機能の改善 (自己関節機構温存の可能性)
  • 3.2 温熱局所潅流術を併用した術前化学療法
  • 3.2.1 温熱局所潅流術の対象症例
  • 3.2.2 系統的化学療法
  • 3.2.3 温熱局所潅流術
  • 3.2.3.1 温熱局所潅流術の実際
  • 3.2.3.2 温熱局所潅流術症例
  • 3.2.3.3 温熱局所潅流術治療成績
  • 3.2.3.4 温熱局所潅流術の患肢温存治療への意義
  • 3.2.3.5 合併症
  • 3.3 切除縁を縮小した関節温存術
  • 3.3.1 切除縁を縮小した関節温存術の適応条件
  • 3.3.1.1 腫瘍の発生部位
  • 3.3.1.2 著効所見 (経時的臨床・画像所見)
  • 3.3.1.3 生検術による組織学的効果判定
  • 3.3.2 切除縁を縮小した手術方法
  • 3.3.3 切除縁を縮小した関節温存術症例
  • 3.3.4 関節温存術症例の成績
  • 3.4 まとめ
  • 4. 末梢血幹細胞移植を用いた高用量化学療法
  • 4.1 はじめに
  • 4.2 末梢血幹細胞採取 (peripheral blood stem cell harvest, PBSCH)
  • 4.3 PBSCTとBMT
  • 4.4 微少残存病変 (minimal residual disease, MRD)
  • 4.5 ハイリスク・ユーイング肉腫に対するPBSCT併用高用量化学療法
  • 4.6 おわりに
  • 5. 粒子線治療
  • 5.1 はじめに
  • 5.2 粒子線とは
  • 5.3 粒子線の特徴
  • 5.3.1 空間的線量分布
  • 5.3.2 生物効果
  • 5.3.3 各種粒子線の比較
  • 5.4 骨・軟部腫瘍に対する粒子線治療の実際
  • 5.5 粒子線治療の現況
  • 5.5.1 骨・軟部腫瘍に対する粒子線治療の役割
  • 5.5.2 中性子線治療
  • 5.5.3 陽子線治療
  • 5.5.4 重イオン線
  • 5.6 最後に
  • 第10章 骨粗鬆症の診断と治療の進歩
  • 1. 骨粗鬆症の病態と発症メカニズム
  • 1.1 はじめに
  • 1.2 骨粗鬆症の病態
  • 1.3 骨粗鬆症の分類
  • 1.4 閉経後骨粗鬆症
  • 1.4.1 エストロゲンの骨吸収に及ぼす直接作用
  • 1.4.2 エストロゲン欠乏による破骨細胞性骨吸収の機序
  • 1.4.3 エストロゲンの骨形成に及ぼす直接作用
  • 1.4.4 エストロゲン欠乏による骨形成亢進の機序
  • 1.5 老人性骨粗鬆症
  • 1.5.1 加齢に伴う骨吸収の動態
  • 1.5.2 加齢に伴う骨形成の動態
  • 1.5.3 老化モデルマウスにおける骨組織の変動
  • 1.6 おわりに
  • 2. 骨密度測定法の進歩
  • 2.1 はじめに
  • 2.2 骨密度測定法の基本性能
  • 2.3 各骨密度測定法の概要
  • 2.3.1 MD
  • 2.3.2 SXA
  • 2.3.3 DXA
  • 2.3.4 pQCT
  • 2.3.5 QUS
  • 2.4 今後の展開
  • 3. マイクロCTによる骨梁形態評価
  • 3.1 はじめに
  • 3.2 マイクロCTの歴史および原理
  • 3.3 マイクロCTの利点
  • 3.4 形状データ処理
  • 3.4.1 分解能
  • 3.4.2 ノイズ除去
  • 3.4.3 閾値処理
  • 3.4.4 3次元画像再構築
  • 3.5 骨の力学的強度を規定する因子
  • 3.5.1 フラクタル次元
  • 3.5.2 一次元ベッチ数
  • 3.5.3 配向性
  • 3.6 マイクロCTの応用例
  • 3.6.1 ビタミンK2が骨梁微細構造に及ぼす影響
  • 3.6.2 尾骨の形態リモデリング
  • 3.7 今後の展望
  • 4. 骨代謝マーカーによるモニタリング
  • 4.1 骨代謝マーカー
  • 4.1.1 骨代謝マーカーとは
  • 4.1.2 骨代謝マーカーの種類
  • 4.1.3 骨代謝マーカーの条件
  • 4.2 骨組織におけるI型コラーゲンの代謝
  • 4.2.1 I型コラーゲンの構造
  • 4.2.2 コラーゲンのピリジニウム架橋
  • 4.2.3 ピリジニウム架橋の分布
  • 4.2.4 骨吸収におけるピリジニウム架橋の代謝
  • 4.3 骨代謝マーカーの測定
  • 4.3.1 骨吸収マーカー
  • 4.3.1.1 ピリジニウム架橋
  • 4.3.1.2 その他
  • 4.3.2 骨形成マーカー
  • 4.3.2.1 骨型アルカリフォスファターゼ (BAP)
  • 4.3.2.2 オステオカルシン (OC)
  • 4.3.2.3 I型コラーゲンプロペプチド
  • 4.3.2.4 骨吸収マーカーとの相関
  • 4.4 骨代謝マーカーの臨床応用
  • 4.4.1 骨量減少の予測 (fast bone loserの発見)
  • 4.4.2 治療薬剤の選択と用量決定
  • 4.4.3 治療効果のモニタリング
  • 4.4.3.1 ホルモン補充療法 (HRT)
  • 4.4.3.2 ビスホスホネート治療
  • 4.4.4 将来の骨折の予測
  • 4.5 骨代謝マーカーの問題点と今後の発展
  • 4.5.1 日内変動
  • 4.5.2 基準値の設定
  • 4.6 おわりに
  • 5. ビスホスフォネートによる治療
  • 5.1 はじめに
  • 5.2 Bisphosphonatesの生体内動態
  • 5.2.1 吸収
  • 5.2.2 分布
  • 5.2.3 代謝
  • 5.2.4 排泄
  • 5.2.5 毒性
  • 5.3 Bisphosphonatesの作用
  • 5.3.1 物理化学的作用
  • 5.3.2 石灰化抑制作用
  • 5.3.3 骨吸収抑制作用
  • 5.3.3.1 破骨細胞への直接作用
  • 5.3.3.2 破骨細胞への間接作用
  • 5.4 臨床応用が進むbisphosphonates
  • 5.4.1 前臨床的試験
  • 5.4.2 臨床成績
  • 5.4.2.1 投与量と投与方法
  • 5.4.2.2 骨塩量に対する効果
  • 5.4.2.3 骨代謝回転に対する効果
  • 5.4.2.4 骨折に対する効果
  • 5.5 骨粗鬆症治療への適応と問題点
  • 5.5.1 蓄積効果と長期的影響
  • 5.5.2 骨粗鬆症の病態と治療適応
  • 5.5.3 骨塩量と骨強度
  • 5.5.4 薬剤中止後の影響
  • 5.6 今後の展望
  • 第11章 慢性関節リウマチ治療の最前線
  • 1. 慢性関節リウマチの発症メカニズムと病態
  • 1.1 はじめに
  • 1.2 RAの滑膜組織
  • 1.3 RAの滑膜増殖と炎症反応
  • 1.4 RAの滑膜増殖を調節するリンパ球
  • 1.5 RAとアポトーシス
  • 1.6 まとめ
  • 2. 慢性関節リウマチの外科的治療
  • 2.1 はじめに
  • 2.2 関節病変に対する外科的治療
  • 2.2.1 滑膜切除術 synovectomy
  • 2.2.1.1 鏡視下滑膜切除術 arthroscopic synovectomy
  • 2.2.1.2 直視下滑膜切除術 open synovectomy
  • 2.2.2 人工物を用いた関節形成術 arthroplasty
  • 2.2.3 その他の手術
  • 2.2.3.1 関節固定術
  • 2.2.3.2 切除関節形成術
  • 2.2.3.3 軟部組織による変形矯正術
  • 2.2.4 輸血
  • 2.2.4.1 冷凍保存式貯血法
  • 2.2.4.2 液状保存式貯血法
  • 2.2.4.3 回収式自己血輸血法
  • 3. 慢性関節リウマチの薬物治療の進歩
  • 3.1 はじめに
  • 3.2 治療を考える上に必要なRA関節炎の病態
  • 3.3 非ステロイド抗炎症剤 (NSAID) の種類と使い方
  • 3.4 NSAIDの副作用とその対策
  • 3.5 COX-2選択的抑制剤の開発
  • 3.6 NSAIDのRA治療体系における位置づけ
  • 3.7 抗リウマチ剤 (免疫調節剤と免疫抑制剤)
  • 3.8 DMARDの副作用
  • 3.9 DMARD併用療法
  • 3.10 RAの薬物療法の進歩
  • 第12章 画像診断法の進歩
  • 1. 骨質の診断法
  • 1.1 はじめに
  • 1.2 骨微細構造の評価
  • 1.2.1 画像解析による骨微細構造の評価
  • 1.2.2 マイクロCT
  • 1.2.3 magnetic resonance imaging (MRI)
  • 1.2.4 シンクロトロン放射線
  • 1.2.5 骨微細構造の定量化
  • 1.2.5.1 形態計測パラメター
  • 1.2.5.2 空間的骨梁構造を表すパラメター
  • 1.3 骨力学特性の評価法
  • 1.3.1 骨強度に関係する骨梁構造パラメター
  • 1.3.2 有限要素解析を応用した構造と力学特性の変化の検討
  • 1.4 material propertyの評価法
  • 1.5 おわりに
  • 2. MRI診断法の進歩
  • 2.1 はじめに
  • 2.2 MRIの特徴
  • 2.3 MRI撮像法の進歩
  • 2.3.1 脊椎・脊髄疾患
  • 2.3.2 関節損傷
  • 2.3.3 骨軟部腫瘍
  • 2.4 おわりに
  • 3. 整形外科領域 (特に軟部腫瘤) における超音波診断法の現状と進歩
  • 3.1 はじめに
  • 3.2 軟部腫瘤の超音波診断の現状
  • 3.2.1 腫瘤の存在の有無
  • 3.2.2 腫瘤の質的診断
  • 3.2.3 治療への応用
  • 3.3 特徴的な超音波像を呈する軟部腫瘤
  • 3.3.1 アテローム
  • 3.3.2 脂肪腫
  • 3.3.3 血管腫
  • 3.3.4 リンパ管腫
  • 3.3.5 神経鞘腫
  • 3.3.6 ガングリオン
  • 3.3.7 血腫
  • 3.3.8 転移性腫瘍
  • 3.4 軟部腫瘤の超音波診断の今後
  • 4. 核医学検査の進歩
  • 4.1 はじめに
  • 4.1.1 形態画像診断法の限界
  • 4.1.2 骨・軟部腫瘍と核医学
  • 4.2 骨シンチグラフィ
  • 4.2.1 骨シンチグラフィの普及と限界
  • 4.2.2 原理と検査法
  • 4.2.3 骨SPECT
  • 4.3 新しい放射性薬品 (SPECT製剤)
  • 4.3.1 99mTC-MIBI
  • 4.3.2 MDR
  • 4.4 PET
  • 4.4.1 FDG
  • 4.4.2 FDGと骨・軟部悪性腫瘍
  • 4.4.3 FDGの非特異的集積
  • 4.4.4 骨・骨髄転移巣
  • 4.4.5 その他のPET製剤
  • 4.4.6 PET医療経済効果
  • 4.5 RIによる骨転移治療
  • 4.5.1 はじめに
  • 4.5.2 89srCl2の鎮痛効果
  • 4.5.3 89srCl2による疼痛緩和適応例
  • 4.5.4 89srCl2投与の前処置
  • 4.5.5 89srCl2投与の実際
  • 4.5.6 89srCl2の副作用
  • 4.5.7 その他の骨親和性β線放出放射性医薬品
  • 4.6 複合画像と複合装置
  • 4.6.1 SPECT/PET兼用装置の開発
  • 4.6.2 複合装置
  • 5. 3次元CT
  • 5.1 3次元画像の作成
  • 5.1.1 3次元データ収集
  • 5.1.1.1 撮影断層厚 (撮影スライス厚)
  • 5.1.1.2 ヘリカルピッチ
  • 5.1.1.3 撮像範囲
  • 5.1.1.4 再構成断層厚 (画像スライス厚)
  • 5.1.1.5 再構成間隔
  • 5.1.2 3次元画像処理・表示
  • 5.1.2.1 多断面画像再構成 multi-planar reconstruction (MPR)
  • 5.1.2.2 surface rendering 法
  • 5.1.2.3 volume rendering 法
  • 5.2 3次元CTの整形外科領域への応用
  • 5.2.1 骨・関節外傷
  • 5.2.2 骨腫瘍
  • 5.2.3 脊椎疾患
  • 5.2.4 血管病変
  • 6. 画像診断の進歩MDCT
  • 6.1 はじめに
  • 6.2 SHCTの実際と画質について
  • 6.2.1 SHCTの実際
  • 6.2.2 CTの画質
  • 6.3 MDCTの特徴
  • 6.3.1 多列検出器による高速スキャン
  • 6.3.2 高画質, 高分解能
  • 6.3.3 画像再構成
  • 6.4 MDCTの欠点
  • 6.4.1 X線被曝
  • 6.4.2 コントラスト分解能
  • 6.4.3 画像データ量
  • 6.5 症例
  • 6.5.1 外傷
  • 6.5.2 感染
  • 6.5.3 腫瘍性病変
  • 6.5.4 関節炎
  • 6.5.5 内分泌, 代謝性疾患
  • 6.6 おわりに
  • 7. 股関節3次元画像解析 -軟骨厚計測のためのフィルタリングと手術支援のための位置合わせ-
  • 7.1 はじめに
  • 7.2 股関節軟骨厚計測
  • 7.3 3次元厚計測手法
  • 7.3.1 内挿処理
  • 7.3.2 ガウス微分による厚計測
  • 7.3.3 in vivo画像における結果
  • 7.4 位置合わせ
  • 7.5 むすび
  • 第13章 各種製品の臨床評価
  • 1. ベスト肩鎖関節プレート
  • 1.1 はじめに
  • 1.2 形状と材質
  • 1.3 曲げ強度
  • 1.4 適応
  • 1.5 手術手技
  • 1.6 後療法
  • 1.7 治療成績
  • 1.8 まとめ
  • 2. HAタイプ人工膝関節
  • 2.1 はじめに
  • 2.2 治験結果
  • 2.3 ヨーロッパでの報告
  • 2.4 HA膝の特徴
  • 2.5 まとめ
  • 3. セメントレス人工股関節の最近の進歩
  • 3.1 はじめに
  • 3.2 短期成績に影響する因子
  • 3.2.1 初期固定性と初期固定の獲得
  • 3.2.1.1 インプラントデザイン
  • 3.2.1.2 大腿骨ステム, 金属シェルの表面構造
  • 3.2.1.3 大腿骨ステム, 金属シェルの表面構造 : 今後の展望
  • 3.2.2 脱臼に対する安定性
  • 3.2.2.1 骨頭径(骨頭頚部比)
  • 3.2.3 正確なインプラント設置 (implantation)
  • 3.2.3.1 instrument devices (設置用器具)
  • 3.2.3.2 navigation system
  • 3.3 中・長期成績に影響を及ぼす因子
  • 3.3.1 osteolysisの発生
  • 3.3.1.1 摺動, 摺動面 (bearing, bearing surface)
  • 3.3.1.2 金属シェルとライナーの固定性・密着性固定強度
  • 3.3.2 stress shieldingに伴う骨の脆弱化
  • 3.3.2.1 インプラント (特にステム) の剛性とstress shielding
  • 3.3.2.2 ステムの遠位部固定
  • 3.4 おわりに
  • 4. カルシトニンの鎮痛作用機序
  • 4.1 はじめに
  • 4.2 実験方法
  • 4.2.1 卵巣摘出モデルラットの作製
  • 4.2.2 Tail withdrawal test
  • 4.2.3 脊髄横断スライス標本の作製
  • 4.2.4 スライス標本を用いた膠様質細胞からの記録および後根電気刺激
  • 4.2.5 In vivoパッチクランプ記録法
  • 4.3 結果
  • 4.3.1 行動学的解析
  • 4.3.1.1 ShamとOVXラットの熱刺激に対する応答の相違とエルカトニン (ECT) の作用
  • 4.3.2 膠様質細胞の電気生理学的性質の比較
  • 4.3.3 AδおよびC線維誘起EPSCに対するセロトニンの作用の変化
  • 4.3.4 In vivoパッチクランプ法によるセロトニン作用の解析
  • 4.4 考察
  • 5. 抗リウマチ剤 / サラゾスルファピリジン腸溶錠 (製品名 : アザルフィジン (R) EN錠)
  • 5.1 はじめに
  • 5.2 RAに対する主な作用機序
  • 5.2.1 免疫調節作用
  • 5.2.2 アデノシンを介する抗炎症作用
  • 5.2.3 骨・関節破壊進行抑制作用
  • 5.3 薬物動態
  • 5.4 RAに対する臨床
  • 5.4.1 用法・用量
  • 5.4.2 日本での臨床成績
  • 5.4.3 海外での成績
  • 5.4.4 我々の使用経験
  • 5.5 副作用
  • 5.5.1 発現頻度
  • 5.5.2 主な副作用と対応
  • 5.5.3 副作用の対策
  • 5.6 まとめ
  • 6. 抗リウマチ剤・リマチル
  • 6.1 はじめに
  • 6.2 開発の背景
  • 6.3 薬物動態
  • 6.4 薬理作用
  • 6.5 投与の実際
  • 6.5.1 用法・用量
  • 6.5.2 臨床効果
  • 6.5.3 適応患者と投与方法
  • 6.5.4 二次性無効での対応
  • 6.6 副作用とその対策
  • 6.6.1 皮膚・粘膜症状
  • 6.6.2 腎障害
  • 6.6.3 胃腸障害
  • 6.6.4 肝障害
  • 6.6.5 血液障害
  • 6.6.6 呼吸器障害
  • 6.6.7 その他の副作用
  • 6.7 おわりに
  • 技術資料編
  • アイメディック社製 Tension band wiring system (pin-sleeve system) の開発
  • 1 はじめに
  • 2 従来のtension band wiringの問題点
  • 2.1 K-鋼線に起因するトラブル
  • 2.2 軟鋼線に起因するトラブル
  • 3 新しいtension band systemの開発
  • 3.1 Pin-sleeveの考え方と基本的構造
  • 4 Wireの強度とSleeveの固定性に関する力学試験
  • 4.1 Wireの引っ張り強度試験
  • 4.2 Sleeveの圧着によるwireのgrip力
  • 5 使用方法
  • 5.1 大転子骨切り部の固定法
  • 5.2 膝蓋骨骨折の固定法
  • 6 展望と新製品
  • アパセラム人工骨
  • 1 はじめに
  • 2 アパセラムの特徴
  • 2.1 純度
  • 2.2 微細構造
  • 2.3 骨癒合特性
  • 2.4 強度
  • 3 アパセラムの臨床応用
  • 3.1 頚椎前方固定術用スペーサー
  • 3.2 脊柱管拡大術用スペーサー
  • 3.3 HA stick (骨粗鬆症に対するペディクルスクリュー固定用補填材)
  • 3.3.1 製品の特徴
  • 3.3.2 有効性の確認
  • 4 今後の展開
  • 4.1 硬化型骨補填材
  • 4.2 細胞培養の担体として
  • 5 まとめ
  • 骨粗鬆症治療用ビタミンK2剤 : メナテトレノン (グラケー(R))の開発
  • 1 はじめに
  • 2 開発の経緯
  • 2.1 ビタミンKと骨代謝の研究の経緯
  • 2.2 ビタミンKと骨折の関係
  • 2.3 ビタミンK (K2) の臨床試験
  • 3 特徴
  • 4 今後の展望
  • 新たに開発されたハイピークパルスNd : YAGレーザーによるPLDD (Percutaneus Laser Disc Decompression)
  • 1 はじめに
  • 2 本邦におけるPLDDの現状と問題点
  • 3 実験編
  • 3.1 ハイピークパルスNd : YAGレーザーとアクティブファイバーによるPLDD基礎実験
  • 4 まとめ
  • Kneeopus人工膝関節について
  • 1 はじめに
  • 2 モービルベアリングの基本概念
  • 3 Kneeopusの特徴
  • 3.1 大腿骨コンポーネント
  • 3.2 膝蓋骨コンポーネント
  • 3.3 脛骨コンポーネント
  • 4 接触面積と接触応力
  • 5 今後の課題
  • 6 最後に
  • KOBELCO人工股関節 K-MAXシリーズ
  • 1 はじめに
  • 2 チタン材料
  • 2.1 生体毒性
  • 2.2 機械的特性
  • 2.3 耐腐食性
  • 3 セメントタイプ SS HIPシステム
  • 4 セメントレスタイプ ABC HIPシステム
  • 5 K-MAX Q HIP システム
  • 6 あとがき
  • オープン MR SIGNA Profile / i
  • 1 はじめに
  • 2 オープンMRとは
  • 3 SIGNA Profile / i
  • 4 高性能グラディエントシステム
  • 5 最新のアプリケーション
  • 6 整形外科領域におけるオープン MRI
  • 6.1 キネマティックスキャン
  • 6.2 インターベンションへの可能性
  • 7 おわりに
  • キャスティング製品
  • 1 はじめに
  • 2 開発の歴史
  • 3 キャスティングテープの材質
  • 4 硬化のメカニズムと硬化時間のコントロール
  • 5 キャスティングテープに要求される性能と特長
  • 6 キャスティングテープを応用した付加価値製品
  • 関節機能改善剤 「アルツ (R), アルツディスポ (R)」
  • 1 はじめに
  • 2 ピアルロン酸 (Hyaluronic acid, Hyaluronan)
  • 3 HAの関節疾患への応用
  • 4 関節機能改善剤「アルツ (R), アルツディスポ (R)」
  • 4.1 「アルツ (R) 」の臨床成績
  • 4.2 「アルツ (R) 」の薬効・薬理
  • 5 HAの薬理作用における最近の研究
  • 5.1 イヌ前十字靱帯切除モデルにおける各分子量のHAの滑膜に対する作用およびその局在
  • 5.2 イヌ前十字靱帯切除モデルにおける各分子量のHAのPGE2産生および関節液量に対する作用
  • 6 おわりに
  • レベレーションヒップシステムの生体力学的考察とデザイン根拠
  • 1 はじめに
  • 2 股関節の生体力学
  • 3 レベレーションヒップシステムのデザイン
  • 4 臨床経験
  • 5 まとめ
  • イソフラボン誘導体
  • 1 はじめに
  • 2 イプリフラボンの開発経緯
  • 3 作用機序
  • 3.1 破骨細胞に対する作用
  • 3.2 骨芽細胞に対する作用
  • 4 臨床効果
  • 5 副作用
  • 6 おわりに
  • 超音波骨折治療器セーフス
  • 1 はじめに
  • 2 セーフスの特徴
  • 2.1 世界で唯一の超音波骨折治療器
  • 2.2 二重盲検比較臨床試験にて効果を立証
  • 2.3 難治性骨折に対する効果
  • 2.4 超音波診断装置並みの低出力超音波
  • 2.5 短い治療時間, 簡単操作
  • 2.6 小型軽量のバッテリータイプ
  • 3 超音波条件
  • 3.1 超音波条件
  • 3.2 超音波の伝達状態
  • 4 使用方法
  • 5 使用上の留意点
  • 6 おわりに
  • テロス社製人工靱帯によるACL再建
  • 1 はじめに
  • 2 特徴, 材質, 構造
  • 2.1 特徴
  • 2.2 材質, 構造, 物理特性
  • 3 手術方法の一例
  • 3.1 再建靱帯の製作
  • 3.2 骨孔の製作
  • 4 臨床成績
  • 5 おわりに
  • MRI造影剤 : マグネビスト (R)
  • 1 はじめに
  • 2 製品の特性
  • 2.1 構造
  • 2.2 効能・効果, 用法・用量
  • 2.3 製剤
  • 3 臨床
  • 3.1 薬物動態
  • 3.2 腎機能への影響
  • 3.3 副作用
  • 3.4 適用疾患
  • 4 おわりに
  • COX-2選択的阻害剤の有用性 -ハイペン錠の成績を中心に-
  • 1 はじめに
  • 2 エトドラクのCOX-2阻害作用の選択性
  • 3 COX-2 選択性の臨床的意義
  • 4 まとめ
  • 日立ワイドオープン MRI AIRIS II Comfort
  • 1 はじめに
  • 2 新機能
  • 2.1 造影MRA
  • 2.2 水・脂肪分離画像
  • 2.3 Multiple Array Coil
  • 2.4 Kinematic Study
  • 日立マイクロフォーカスX線コーンビームCT装置
  • 1 はじめに
  • 2 コーンビームCTの原理と特徴
  • 3 MCT-CBシリーズの概要
  • 4 おわりに
  • Real-Time Compound Imaging SonoCT
  • 1 はじめに
  • 2 超音波の性質に基づく画像劣化の要因
  • 3 SonoCTによる画質の向上
  • 4 SonoCT画像
  • 夢の画像処理, マルチ周波数処理 (M.F.P) によるFCRの診断画質の向上
  • 1 はじめに
  • 2 これまでの周波数処理
  • 3 マルチ周波数処理 (MFP)
  • 4 おわりに
  • ボンフィル (Bonfil)
  • 1 はじめに
  • 2 ボンフィルの設計
  • 2.1 骨形成
  • 2.2 骨原性細胞の接着
  • 2.3 骨原性細胞の分化
  • 2.4 蛋白質の吸着
  • 2.5 密度, 気孔率, 強度
  • 3 まとめ
  • バイオペックス (リン酸カルシウム骨ペースト)
  • 1 はじめに
  • 2 バイオペックスの特性
  • 2.1 バイオペックスの組成
  • 2.2 ペーストの練和と硬化
  • 2.3 アパタイト化の進行と強度の発現
  • 2.4 硬化体の体積変化
  • 2.5 安全性と生体親和性
  • 3 まとめ
  • 整形外科領域における三次元診断療法
  • 1 はじめに
  • 2 三次元構築ソフトウェアForge
  • 2.1 データセット
  • 2.2 アイソサーフェース生成
  • 3 Rapid Prototyping
  • 3.1 実体モデルの作成
  • 3.2 実体モデルの使用例
  • ANCA-FIT人工股関節システム
  • 1 はじめに
  • 2 モジュラーネックの有用性
  • 3 セラミックオンセラミックの摺動面
  • 4 アウターカップ
  • 5 ANCA-FITステム
  • 6 カスタムメイドステム
  • 6.1 概要
  • 6.2 CT撮影手順
  • 和文索引
  • 欧文索引
  • 奥付
  • 正誤表

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本参考文献は電子書籍掲載内容を元にしております。

第1章 遺伝子治療

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13) Ranger AM, Gerstenfeld LC, Wang J et al:The nuclear factor of activated T cells (NFAT) transcriptional factor NFATp (NFATc2) is a repressor of chondrogenesis, J Exp Med 191:9-21, 2000
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14) Okawa A, Nakamura I, Goto S et al:Mutations of NPPS in a mouse model of ossification of the posterior longitudinal ligament of the spine, Nature Genet 19:271-273, 1998
 
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4) Beighton P, Giedion ZA, Gorlin R et al:International classification of osteochondrodysplasias. International Working Group on Constitutional Diseases of Bone, Am J Med Genet 42:223-9, 1992
 
5) Hastbacka J, de la Chapelle A, Mahtani MM et al:The diastrophic dysplasia gene encodes a novel sulfate transporter:positional cloning by fine-structure linkage disequilibrium mapping, Cell 78:1073-87, 1994
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6) Wagner T, Wirth J Meyer J, et al:Autosomal sex reversal and campomelic dysplasia are caused by mutations in and around the SRY-related gene SOX9, Cell 79 (6):1111-20, 1994
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7) Wamlan ML, Abbott M, Apte SS et al:A type X collagen mutation causes Schmid metaphyseal chondrodysplasia, Nat Genet 5(1):79-82, 1993
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8) Vikkula M, Mariman EC, Lui VC et al:Autosomal dominant and recessive osteochondrodysplasias associated with the COL11A2 locus, Cell 80 (3):431-7, 1995
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9) Shiang R, Thompson LM, Zhu YZ et al:Mutations in the transmembrane domain of FGFR3 cause the most common genetic form of dwarfism, achondroplasia, Cell 78:335-42, 1994
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10) Bellus GA, McIntosh I, Smith EA et al:Arecurrent mutation in the tyrosine kinase domain of fibroblast growth factor receptor 3 causes hypochondroplasia, Nature Genet 10:357-359, 1995
 
11) Tavormina PL,Shiang R et al:Thanatophoric dysplasia (types I and II) caused by distinct mutations in fibroblast growth factor receptor 3, Nature Genet 9:321-328, 1995
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12) Hecht JT, Nelson LD, Crowder E et al:Mutations in exon 17B of cartilage oligomeric matrix protein (COMP) cause pseudoachondroplasia, Nature Genet 10:325-329, 1995
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13) Paassilta P, Lohiniva J, Annunen S et al:COL9A3:A third locus for multiple epiphyseal dysplasia, Am J Hum Genet 64 (4):1036-44, 1999
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14) Muragaki Y, Mariman EC, van Beersum SE et al:A mutation in the gene encoding the alpha 2 chain of the fibril-associated collagen IX, COL9A2, causes multiple epiphyseal dysplasia (EDM2), Nat Genet 12 (1):103-5, 1996
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15) Grant SF Reid DM, Blake G et al:Reduced bone density and osteoporosis associated with a polymorphic Sp1 binding site in the collagen type I alpha 1 gene, Nat Genet 14 (2):203-5, 1996
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P.25 掲載の参考文献
1) Matsunaga S, and Sakou T:Epidemiology of ossification of the posterior longitudinal ligament. Ossification of the posterior longitudinal ligament. Springer, Tokyo, pp 11-17, 1997
 
2) Sakou T, Taketomi E, Matsunaga S, Yamaguchi M, Sonoda S, Yashiki S:Genetic study of ossification of the posterior longitudinal ligament in the cervical spine with human leukocyte antigen haplotype. Spine 16:1249 1252, 1991
 
3) Koga H, Sakou T, Taketomi E, Hayashi K, Numasawa T, Harata S, Yone K, Matsunaga S, Otterud B, Inoue I, Leppert M:Genetic mapping of ossification of the posterior longitudinal ligament of the spine. Am J Hum Genet 62:1460-1467, 1998
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4) Numasawa T, Koga H, Ueyama K, Maeda S, Sakou T, Harata S, Leppert M, Inoue I:Human retinoic X receptor β:complete genomic sequence and mutation search for ossification of posterior longitudinal ligament ofthe spine. J Bone Miner Res 14:500-508, 1999
 
5) Li Y, Lacerda DA, Warman ML, Beier DR, Yoshioka H, Ninomiya Y, Oxford JT, Morris NP, Andrikopoulos K, Ramirez F et al:A fibrillar collagen gene, Col11a1, isessential for skeletal morphogenesis. Cell 80:423-430, 1995
 
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2) Swisher SG, Roth JA, Nemunaitis J et al:Adenovims-mediated p53 gene transfer in advanced non-small-cell lung cancer. J Natl Cancer Inst 91 (9):763-71, 1999
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4) 松本嘉寛, 田仲和宏他:EWS-Fli1融合遺伝子による G1期制御因子の発現調節.日整会誌 74:S1244, 2000
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6) Shirakawa T, Ko S-C et al:In vitro suppression of osteosarcoma pulmonary metastasis with intravenous osteocalcin promoter-based toxic gene therapyl Cancer Gene Therapy 5:274-280, 1998
 
7) Koeneman KS, Kao C et al:Osteocalcin directed gene therapy for prostate-cancer bone metastasis. World J Urol 18:102-110, 2000
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8) Seto M, Wakabayashi H et al:Gene therapy of chondrosarcoma using retro Virus vectors encoding the herpes simplex virus thymidine kinase gene. Int J Oncol 14 (6):1137-41, 1999
 
P.36 掲載の参考文献
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2) Evans CH et al:Prospect for treating arthritis by gene therapy. J Rheumatol 21:779, 1994
 
3) 冨田哲也ほか:炎症性疾患の遺伝子治療. 現代医療 29:158-167, 1997
 
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5) Arai Y et al:Adenovirus vector-mediated genetransduction to chondrocytes;in vitro evaluation of therapeutic efficacy of transforming growth factorbeta 1 and heat shock protein 70 gene transduction. J Rheumatol 24:1787-1795, 1997
 
6) Arai Y et al:Gene delivery to human chondrocytes by adeno-associated virus vector. J Rheumatol 27:979-982, 2000
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8) Tomita T et al:In vivo direct gene transfer into articularcartilage by intraarticular injection mediated by HVJ (Sendai virus) and liposomes. Arthritis Rheum 40:901-906, 1997
 
9) Nakamura N et al:Transient introduction of a foreigngene into healing rat patellar tendon. J Clin Invest 97:226-231, 1996
 
10) Tomita T et al:In vivo transfection of NFkB decoy oligodeoxynucleotides suppressed the severity of collagen-induced arthritis as a gene therapy. Arthritis Rheum 1999
 
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第2章 移植と再生医学の最先端

P.42 掲載の参考文献
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8) Akahane M, Ohgushi H, Sempuku N et al:Osteogenic phenotype expression of allogenic rat marrow cells in porous hydroxyapatite ceramics, J. Bone Mineral Res 14:561-568, 1999
 
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第3章 関節軟骨欠損の修復

P.76 掲載の参考文献
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第4章 創外固定の適応拡大

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第5章 生体材料を用いた運動器再建

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14) 大西啓靖,網野博一:アルミナ対アルミナの摺動面を持つ人工股関節の試作 第一報:新デザインと機械的強度.日関外誌 14 (3):267-272, 1995
 
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第6章 股関節

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第7章 最小侵襲による脊椎手術

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第8章 骨形成促進

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第9章 骨軟部腫瘍の治療

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第10章 骨粗鬆症の診断と治療の進歩

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第11章 慢性関節リウマチ治療の最前線

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第12章 画像診断法の進歩

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第13章 各種製品の臨床評価

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技術資料編

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