{"created":"2023-05-15T09:04:48.639366+00:00","id":10278,"links":{},"metadata":{"_buckets":{"deposit":"70a09de9-c6f0-4e1b-8b79-738c091e3a8c"},"_deposit":{"created_by":15,"id":"10278","owners":[15],"pid":{"revision_id":0,"type":"depid","value":"10278"},"status":"published"},"_oai":{"id":"oai:sapmed.repo.nii.ac.jp:00010278","sets":["1674:1736:1738"]},"author_link":["12938","12939","12940","12941","12942"],"item_2_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2004-03-31","bibliographicIssueDateType":"Issued"},"bibliographicPageEnd":"89","bibliographicPageStart":"86","bibliographicVolumeNumber":"20","bibliographic_titles":[{"bibliographic_title":"北海道整形外科外傷研究会会誌 = The Journal of Hokkaido Orthopaedic Traumatology Association"}]}]},"item_2_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"骨幹端部から骨幹部の広範囲の粉砕を伴った橈骨遠位端骨折(AO分類23C2-3)の一例を経験した. 患者は38歳男性でバイクによる交通事故で受傷した. 橈骨遠位端骨折は1.開放性骨折, 2.関節内骨折, 3.関節面の転位はX線像上3mmであり, 骨幹端部の粉砕は関節面から近位7.5cmまで及んでいた. 初期治療としての創外固定施行後にプレート固定を考慮したが, 粉砕の範囲が広く適当な長さのプレートが存在しない為断念し, 受傷8週目にKirschner鋼線による髄内固定を施行した. 受傷16週でX線像上骨癒合が得られており, 手関節可動域は背屈65°, 掌屈45°, 前腕回内65°, 回外55°であった. 本症例のような骨幹端部の粉砕の強い橈骨遠位端骨折に対しては, 二枚の小プレートを用いた内固定術も骨折の手術治療として考慮されうる.高エネルギー外力による若年者の橈骨遠位端粉砕骨折の治療方針は, 正確に関節面を整復し, ulnar variance, ulnar inclination, volar tiltなどの関節外のアライメントを保持することである6). 関節面のgapやstep offの残存は将来の関節症変化を引き起こし3), また変形治癒は手関節痛, 可動域や握力の低下をもたらし臨床成績を悪くさせる要因となる4). 保存的治療ではこのような解剖学的整復やアライメントの保持は難しく, 手術治療が選択されることが多い. また粉砕が強い場合は経皮ピンニングのみでは整復, 保持とも不十分で, プレート固定や創外固定が選択される. 一方長期の創外固定は手関節の拘縮, RSDなどを生じやすく, 敬遠される傾向にある2). 今回著者らは, 橈骨遠位骨幹端部広範囲粉砕骨折(AO分類23C2-3 (図-1))の一例の経験から, その治療方針について考察した","subitem_description_type":"Abstract"}]},"item_2_publisher_32":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"北海道整形外科外傷研究会"}]},"item_2_source_id_7":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0914-6083","subitem_source_identifier_type":"ISSN"}]},"item_2_version_type_15":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"辻, 英樹"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"土田, 芳彦"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"川上, 亮一"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"籏本, 恵介"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"平岩, 哲郎"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2018-07-21"}],"displaytype":"detail","filename":"n091460832086.pdf","filesize":[{"value":"189.1 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"n091460832086.pdf","url":"https://sapmed.repo.nii.ac.jp/record/10278/files/n091460832086.pdf"},"version_id":"440b8cc7-48f3-40d7-891d-0b7a4d57d672"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"Distal radius fracture","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Widely comminuted","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Intramedullary fixation","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Double-plating fixation","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"橈骨遠位端骨折","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"広範囲粉砕","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"髄内固定","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"二枚プレート固定","subitem_subject_language":"ja","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"橈骨遠位骨幹端部広範囲粉砕骨折(AO分類23C2-3)の一例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"橈骨遠位骨幹端部広範囲粉砕骨折(AO分類23C2-3)の一例","subitem_title_language":"ja"}]},"item_type_id":"2","owner":"15","path":["1738"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2009-06-18"},"publish_date":"2009-06-18","publish_status":"0","recid":"10278","relation_version_is_last":true,"title":["橈骨遠位骨幹端部広範囲粉砕骨折(AO分類23C2-3)の一例"],"weko_creator_id":"15","weko_shared_id":-1},"updated":"2023-12-13T04:45:25.815476+00:00"}