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Beck Depression Inventory-IIについての一考察

This is a very large compilation of growth data with an extremely wide coverage of population groups, many of which will be completely unknown to all but the professional ethnographer. There is, however, a disappointingly narrow coverage of variables (length, weight, body widths, circumferences and proportions, skinfold thicknesses, and maturity). Many of the findings are relevant to an important question: should one set of growth reference data be used throughout the world, thus allowing ready comparability between groups, or should there be separate sets for each major racial group or even a multitude of local sets? The studies summarized in this volume indicate many population groups have similar potentials for growth in major body dimensions. For example, the narrower range of means among European than among African groups that range from "tribal" to well-off indicates the range of variation in growth would be reduced greatly if the environmental circumstances allowed

Worldwide Variation in Human Growth

Scientific studies have been conducted to quantify attributes that may be important in the creation of more functional and comfortable lower-limb prostheses. The prosthesis socket, a human-machine interface, has to be designed properly to achieve satisfactory load transmission, stability, and efficient control for mobility. The biomechanical understanding of the interaction between prosthetic socket and the residual limb is fundamental to such goals. The purpose of this paper is to review the recent research literature on socket biomechanics, including socket pressure measurement, friction-related phenomena and associated properties, computational modeling, and limb tissue responses to external mechanical loads and other physical conditions at the interface. There is no doubt that improved biomechanical understanding has advanced the science of socket fitting. However, the most recent advances in the understanding of stresses experienced at the residual limb have not yet led to enough clinical consensus that could fundamentally alter clinical practice. Efforts should be made to systematically identify the major discrepancies. Further research should be directed to address the critical controversies and the associated technical challenges. Developments should be guided to offer clinicians the quantification and visualization of the interaction between the residual limb and the prosthetic socket. An understanding of comfort and optimal load transfer as patterns of socket interface stress could culminate in socket design expert systems.

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State-of-the-art research in lower-limb prosthetic biomechanics-socket interface: a review.

Background: The aim of this study was to radiographically analyze the long-term glenoid migration patterns following total shoulder arthroplasty to better understand the factors responsible for loosening.

Methods: Complete radiographic follow-up of more than five years was available for 518 total shoulder arthroplasties performed for primary glenohumeral osteoarthritis with use of an anatomically designed prosthesis with a cemented, all-polyethylene, keeled glenoid component. Radiographs were assessed for humeral head subluxation, periprosthetic radiolucent lines, and shifting of the position of the glenoid component. The type of migration of the glenoid was defined according to the direction of tilt, or as subsidence in the case of medial migration.

Results: Definite radiographic evidence of glenoid loosening was observed in 166 shoulders (32%) and was characterized by radiolucency of ≥2 mm over the entire bone-cement interface in thirty shoulders and by a migration of the glenoid component (shift or subsidence) in 136 shoulders. Three predominant patterns of migration of the glenoid component were observed: superior tilting in fifty-two shoulders (10%), subsidence in forty-one shoulders (7.9%), and posterior tilting in thirty-three shoulders (6.4%). Superior tilting of the glenoid was associated with three risk factors: low positioning of the glenoid component, superior tilt of the glenoid component on the immediate postoperative coronal plane radiographs, and superior subluxation of the humeral head (p < 0.05 for all). Subsidence of the glenoid component was associated with the use of reaming to optimize the seating and positioning of the glenoid component (p < 0.001). Posterior tilting of the glenoid component was associated with preoperative posterior subluxation (i.e., a Walch type-B glenoid) and with excessive reaming (p < 0.01 for both).

Conclusions: The three patterns of migration observed in this study underscore the potential importance of the supporting bone beneath the glenoid component. In some shoulders, use of a keel or pegs to provide fixation of a polyethylene component in the absence of good support from subchondral bone may not be sufficient to resist compressive and eccentric forces, resulting in loosening. Preserving subchondral bone may be important for long-term longevity of the glenoid component.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patterns of loosening of polyethylene keeled glenoid components after shoulder arthroplasty for primary osteoarthritis: results of a multicenter study with more than five years of follow-up.

STUDY DESIGN: The authors undertook a three-part study to better understand the impact of perioperative nutritional status on postoperative complications in patients undergoing spinal surgery. In preliminary Parts I and II, the authors targeted two groups of patients who are particularly nutritionally challenged. In Part III, they studied a large group of consecutive patients undergoing routine lumbar spinal fusion. OBJECTIVES: To determine whether preoperative nutritional status was a significant predictor of postoperative complications in patients undergoing elective lumbar spinal fusion. SUMMARY OF BACKGROUND DATA: In Part I, 27 patients treated surgically for vertebral osteomyelitis were divided into two groups based on their preoperative nutritional status. Twenty-four of the 26 postoperative complications were in the malnourished group (P < 0.001). In Part II, 15 (75%) of 20 patients treated surgically for spinal cord injury were found to become malnourished in the postoperative period. Seventeen complications were noted, all in the malnourished group (P = 0.001). METHODS: One hundred fourteen consecutive patients undergoing selective lumbar decompression and fusion were identified and their records reviewed. In addition to preoperative nutritional status, data gathered included age, sex, height, weight, past medical history, steroid use, alcohol use, tobacco use, type of bone graft (allograft vs. autograft), history of previous lumbar surgery, number of levels fused, and use of spinal instrumentation. RESULTS: Eleven of 13 postoperative infectious complications (10 deep wound infections) were noted in the malnourished group (P < 0.001). By stepwise logistic regression analysis, preoperative nutritional status was an extremely significant independent predictor of postoperative complications in patients undergoing elective lumbar spinal fusion (P = 0.0018). CONCLUSIONS: The prevalence data in our study population suggest that a large number (25%) of patients undergoing elective lumbar spine surgery are nourished inadequately at surgery. This number is higher (42%) in older patients. The authors recommend that close attention be paid to the perioperative nutritional status of patients undergoing lumbar spinal surgery. Patients with suboptimal nutritional parameters should be supplemented and replenished before elective surgery.

Perioperative nutrition and postoperative complications in patients undergoing spinal surgery.

A method of recording a residual limb indentation stiffness map was developed for possible use as an aid in calculating prosthetic socket rectifications. The method was tested to determine the level of repeatability attainable. A hand-held, pencil-like device was used, with an air-driven piston that indented the tissue 10 times per second. The indentor tip contained an electromagnetic digitizer element that sensed position and orientation 120 times per second. The examiner moved the device around the limb; sampling was variable in density, and typically concentrated on critical areas. An interactive visual display of sampled data quality was used to guide sampling. The indentation maps typically contained approximately 4,000 locations, in a cylindrical coordinate system, with sampling locations spaced every 3.2 mm vertically, and every 0.087 radians tangentially. The behavior of the system was characterized using six test subjects on whom recorded indentations ranged from 1.5 to 21 mm. The largest range of indentations (i.e., worst disagreement) recorded at a single location was 5.4 mm. The average standard deviation on repeated measurement ranged from 7 to 15%, and averaged 0.67 mm in absolute terms. Many of the structurally significant anatomical features of the limbs were visible, including the patella and patellar tendon, fibular head, shin, biceps femoris tendon, semitendinosus, and popliteal area.

A method of residual limb stiffness distribution measurement.

One hundred patients with a diagnosis of congenital scoliosis were reviewed with regard to their urologic history, chemistries, and excretory urography. A 40% incidence of urologic abnormality was found in these asymptomatic patients. Twenty-five additional patients were evaluated by excretory urography and ultrasonography. Of six patients identified by ultrasonography as having abnormalities five had results confirmed by excretory urography. Urologic evaluation of all patients with congenital scoliosis is recommended; however, diagnostic ultrasonographic evaluations of the urinary tract have proven to be an acceptable alternative as an initial screening modality.

Congenital Scoliosis and Urinary Tract Abnormalities: Are Intravenous Pyelograms Necessary?

A retrospective analysis of 96 patients who underwent an epiphysiodesis procedure for leg length discrepancy was performed. Forty patients were identified who had an open Phemister-type epiphysiodesis. Fifty-six patients underwent a percutaneous epiphysiodesis procedure. All patients' medical records and radiographs were reviewed for complications. No angular deformities or epiphysiodesis failures occurred in the open group; however, one deep infection requiring intravenous antibiotics and serial surgical debridement was successfully treated. Five complications occurred in the percutaneous group. The complications included two superficial infections, two failures of physeal arrest, and one postoperative angular deformity. The occurrence of complications in the two groups was not statistically significant. Regular follow-up and radiographic evaluation of patients who have undergone a percutaneous epiphysiodesis is essential. Failure of physeal arrest and angular deformities are rare in this patient population, but they can occur.

Leg length inequality and epiphysiodesis: Review of 96 cases

Fifty-two nonambulatory totally-involved cerebral palsy patients with spinal deformity who had barium swallow examinations of their gastroesophageal tract as part of their preoperative evaluation were retrospectively reviewed. Thirty-six patients (69%) were identified with abnormalities of their swallowing mechanism. Subnormal nutritional indices were identified as well in 41 patients (79%). Ten of 38 patients undergoing spinal surgery developed significant postoperative complications. Nine of the 10 complications occurred in patients in whom gastroesophageal or nutritional abnormalities were identified but not addressed before spinal surgery. We recommend gastroesophageal and nutritional evaluation of all patients with cerebral palsy before spinal surgery.

Gastroesophageal evaluation in totally involved cerebral palsy patients

Background: Fibular deficiency results in a small, unstable foot and ankle as well as a limb-length discrepancy. The purpose of this study was to assess outcomes in adults who, as children, had had amputation or limb-lengthening, commonly used treatments for fibular deficiency.

Methods: Retrospective review of existing data collected since 1950 at six pediatric orthopaedic centers identified 248 patients with fibular deficiency who were twenty-one years of age or older at the time of the review. Excluding patients with other anomalies and other treatments (with the excluded group including six who had had lengthening and then amputation), we identified ninety-eight patients who had had amputation or limb-lengthening for the treatment of isolated unilateral fibular deficiency. Sixty-two patients (with thirty-six amputations and twenty-six lengthening procedures) completed several questionnaires, including one asking general demographic questions, the Beck Depression Inventory-II, the Quality of Life Questionnaire, and the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire including the Short Form-36. A group of twenty-eight control subjects completed the Beck Depression Inventory-II and the Quality of Life Questionnaire.

Results: There were forty men and twenty-two women. The average age at the time of the interview was thirty-three years. There were more amputations in those with fewer rays and less fibular preservation. Lengthening resulted in more surgical procedures (6.3 compared with 2.4 in patients treated with amputation) and more days in the hospital (184 compared with sixty-three) (both p < 0.0001). However, when we compared treatment outcomes we did not find differences between groups with regard to education, employment, income, public assistance or disability payments, pain or use of pain medicine, sports participation, activity restriction, comfort wearing shorts, dislike of limb appearance, or satisfaction with treatment. No patient who had been treated for fibular deficiency reported signs of depression. The only significant difference between treatment groups shown by the Quality of Life Questionnaire was in the scores on the Job Satisfiers content scale, with the amputees scoring better than the patients treated with lengthening (p = 0.015). The American Academy of Orthopaedic Surgeons Lower Limb Module did not demonstrate differences in health-related quality of life or physical function.

Conclusions: The patients who were treated with lengthening had started out with more residual foot rays and more fibular preservation than the amputees. They also required more surgical intervention than did those with an amputation. While patients with an amputation spent less of their childhood undergoing treatment, they were found to have a better outcome in terms of only one of seventeen quality-of-life parameters. Both groups of patients who had had treatment of fibular deficiency were functioning at high levels, with an average to above-average quality of life compared with that of the normal adult population.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

David M. Drvaric

Papers

A method of residual limb stiffness distribution measurement.

Congenital Scoliosis and Urinary Tract Abnormalities: Are Intravenous Pyelograms Necessary?

Leg length inequality and epiphysiodesis: Review of 96 cases

Gastroesophageal evaluation in totally involved cerebral palsy patients

Adult outcomes following amputation or lengthening for fibular deficiency.