関節固定術、関節固定

WordNet

the surgical fixation of a joint which is intended to result in bone fusion

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/10 10:06:58」(JST)

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Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones via surgery. This is done to relieve intractable pain in a joint which cannot be managed by pain medication, splints, or other normally-indicated treatments. The typical causes of such pain are fractures which disrupt the joint, and arthritis. It is most commonly performed on joints in the spine, hand, ankle, and foot. Historically, knee and hip arthrodeses were also performed as pain relieving procedures, however with the great successes achieved in hip and knee arthroplasty, arthrodesis of these large joints has fallen out of favour as a primary procedure, and now are only used as procedures of last-resort in some failed arthroplasties.^{[citation needed]}

It can be done in several ways:

A bone graft can be created between the two bones using a bone from elsewhere in the person's body (autograft) or using donor bone (allograft) from a bone bank.^{[citation needed]}
- Bone autograft is generally preferred by surgeons because, as well as eliminating the risks associated with allografts, bone autograft contains native bone-forming cells (osteoblasts), so the graft actually forms new bone itself (osteoinductive), as well as acting as a matrix or scaffold to new bone growing from the bones being bridged (osteoconductive). The main drawback of bone autograft is the limited supply available for harvest.^{[citation needed]}
- Bone allograft has the advantage of being available in far larger quantities than autograft; however, the treatment process the bone goes through following harvest, which usually involves deep-freezing and may also involve demineralization, irradiation and/or freeze-drying, kills living bone or bone marrow cells. This significantly reduces the immunogenicity (risk of graft rejection) such that no anti rejection drugs are needed and, combined with appropriate donor screening practices, these processing and preservation practices can significantly reduce the risk of disease transmission. In spite of all of this processing, cancellous allograft bone retains its osteoconductive properties. Furthermore, certain processing practices have been shown to also retain the acid-stable osteoinductive proteins in cortical bone grafts, so that many bone allografts can be considered both osteoconductive and osteoinductive.^{[citation needed]}
A variety of synthetic bone substitutes are commercially available. These are usually hydroxyapatite or tricalcium phosphate based granules formed into a coralline or trabecular structure to mimic the structure of cancellous bone. They act solely as an osteoconductive matrix. Some manufacturers have recently begun supplying these products with soluble bone-forming factors such as bone morphogenetic protein to attempt to create a synthetic product with osteoinductive properties.^{[citation needed]}
Metal implants can be attached to the two bones to hold them together in a position which favors bone growth.
A combination of the above methods is also commonly employed to facilitate bony fusion.^{[citation needed]}

At the completion of surgery and healing, which takes place over a period of several weeks to over a year, the two adjoining bones are fused and no motion takes place between them. This can have the effect of actually strengthening the bones, as in anterior cervical fusion.^{[citation needed]}

References

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1. 外反母趾変形（バニオン） hallux valgus deformity bunion
2. 全人工膝関節置換術 total knee arthroplasty
3. 骨肉腫：術前評価、組織学的分類、および外科的マネージメントの原則 bone sarcomas preoperative evaluation histologic classification and principles of surgical management
4. 全人工股関節置換術 total hip arthroplasty
5. 人工関節感染の治療 treatment of prosthetic joint infections

English Journal

Molded arthrodesis of the hallux metatarsophalangeal joint using the crossed-screw technique: Surgical technique, results and functional outcomes.

Mohammed R, Gadgil A.SourceHywel Dda NHS Trust, West Wales General Hospital, Carmarthen SA31 2AF, United Kingdom.
Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.Foot Ankle Surg.2012 Jun;18(2):132-5. Epub 2011 Jun 12.
BACKGROUND: We describe the surgical technique, results and functional outcomes of molded arthrodesis of hallux metatarsophalangeal (MTP) joint using crossed-screw fixation.METHODS: 23 Toes in 21 consecutive patients operated between September 2007 and January 2010 were included for the retrospectiv
PMID 22444002

Headless compression screw fixation prevents symptomatic metalwork in arthroscopic ankle arthrodesis.

Odutola AA, Sheridan BD, Kelly AJ.SourceTrauma and Orthopaedic Directorate, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol BS2 8HW, United Kingdom.
Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.Foot Ankle Surg.2012 Jun;18(2):111-3. Epub 2011 May 8.
BACKGROUND: Arthroscopic ankle arthrodesis (AAA) is a recognised salvage procedure for end-stage arthritis. Its reported disadvantages include a high rate of re-operation for symptomatic prominence of metalwork. We propose that the use of a headless screw would reduce this re-operation rate.METHODS:
PMID 22443997