n.

整形外科、整形

関: orthopaedic、orthopaedic surgery、orthopaedics、orthopedic、orthopedic surgery、trimming

WordNet

the branch of medical science concerned with disorders or deformities of the spine and joints (同)orthopaedics
a decoration or adornment on a garment; "the trimming on a hat"; "the trim on a shirt" (同)trim, passementerie
the act of adding decoration; "the children had to be in bed before it was time for the trimming of the tree"
of or relating to orthopedics; "orthopedic shoes" (同)orthopaedic, orthopedical

PrepTutorEJDIC

(服などの)飾り / (料理などの)添え物,つま
整形外科,整形術

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/25 22:32:31」(JST)

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This fracture of the lower cervical vertebrae, known as a "teardrop fracture", is one of the conditions treated by orthopedic surgeons and neurosurgeons.

This image, taken in September 2006, shows extensive repair work to the right acetabulum 6 years after it was carried out (2000). Further damage to the joint is visible due to the onset of arthritis - a bone/joint disease.

Orthopedic surgery or orthopedics (also spelled orthopaedic surgery and orthopaedics in British English) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

Nicholas Andry coined the word "orthopaedics" in French as orthopedie, derived from the Greek words orthos ("correct", "straight") and paideion ("child"), when he published Orthopedie (translated as Orthopaedia: or the Art of Correcting and Preventing Deformities in Children) in 1741. The correction of spinal and bony deformities became the cornerstone of orthopedic practice.

In the US orthopedics is standard, although the majority of college, university and residency programs, and even the American Academy of Orthopaedic Surgeons, still use the spelling with the Latinate digraph ae. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; orthopaedics usually prevails in the rest of the British Commonwealth, especially in the UK.

History

Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm)

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopaedic surgeon in consideration of the establishment of his hospital and for his published methods(7).

Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851. Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint. Traction and splinting developed during World War I. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center in Seattle group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. With no equipment he was confronted with crippling conditions of unhealed, infected, and malaligned fractures. With the help of the local bicycle shop he devised ring external fixators tensioned like the spokes of a bicycle. With this equipment he achieved healing, realignment and lengthening to a degree unheard of elsewhere. His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods.

Ruth Jackson became the first female Board-certified Orthopaedic Surgeon in the U.S in 1937. Orthopedics continues to be a male-dominated field. In 2006, 12.4% of orthopedics residents were women.^[1]

David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament (ACL) of the knee. This common and serious injury in skiers, field athletes, and dancers invariably brought an end to their athletics due to permanent joint instability. Working with injured football players, Dr MacIntosh devised a way to re-route viable ligament from adjacent structures to preserve the strong and complex mechanics of the knee joint and restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.

Modern orthopedic surgery and musculoskeletal research has sought to make surgery less invasive and to make implanted components better and more durable.

Training

In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school. Subsequently, these medical school graduates undergo residency training in orthopedic surgery. The five-year residency consists of one year of general surgery training followed by four years of training in orthopedic surgery.

Selection for residency training in orthopedic surgery is very competitive. Approximately 700 physicians complete orthopedic residency training per year in the United States. About 10 percent of current orthopedic surgery residents are women; about 20 percent are members of minority groups. There are approximately 20,400 actively practicing orthopedic surgeons and residents in the United States.^[2] According to the latest Occupational Outlook Handbook (2011–2012) published by the United States Department of Labor, between 3–4% of all practicing physicians are orthopedic surgeons.

Many orthopedic surgeons elect to do further training, or fellowships, after completing their residency training. Fellowship training in an orthopedic subspecialty is typically one year in duration (sometimes two) and sometimes has a research component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the United States are:

Hand surgery
Shoulder and elbow surgery
Total joint reconstruction (arthroplasty)
Pediatric orthopedics
Foot and ankle surgery
Spine surgery
Musculoskeletal oncology
Surgical sports medicine
Orthopedic trauma

These specialty areas of medicine are not exclusive to orthopedic surgery. For example, hand surgery is practiced by some plastic surgeons and spine surgery is practiced by most neurosurgeons. Additionally, foot and ankle surgery is practiced by board-certified Doctors of Podiatric Medicine (D.P.M.) in the United States. Some family practice physicians practice sports medicine; however, their scope of practice is non-operative.

After completion of specialty residency/registrar training, an orthopedic surgeon is then eligible for board certification by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists. Certification by the American Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopedic Surgery means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the Board.^[3]^[4] The process requires successful completion of a standardized written exam followed by an oral exam focused on the surgeon's clinical and surgical performance over a 6-month period. In Canada, the certifying organization is the Royal College of Physicians and Surgeons of Canada; in Australia and New Zealand it is the Royal Australasian College of Surgeons.

In the United States, specialists in hand surgery and orthopedic sports medicine may obtain a Certificate of Added Qualifications (CAQ) in addition to their board primary certification by successfully completing a separate standardized examination. There is no additional certification process for the other subspecialties.

Practice

According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are as follows^[5]:

Knee arthroscopy and meniscectomy
Shoulder arthroscopy and decompression
Carpal tunnel release
Knee arthroscopy and chondroplasty
Removal of support implant
Knee arthroscopy and anterior cruciate ligament reconstruction
Knee replacement
Repair of femoral neck fracture
Repair of trochanteric fracture
Debridement of skin/muscle/bone/fracture
Knee arthroscopy repair of both menisci
Hip replacement
Shoulder arthroscopy/distal clavicle excision
Repair of rotator cuff tendon
Repair fracture of radius (bone)/ulna
Laminectomy
Repair of ankle fracture (bimalleolar type)
Shoulder arthroscopy and debridement
Lumbar spinal fusion
Repair fracture of the distal part of radius
Low back intervertebral disc surgery
Incise finger tendon sheath
Repair of ankle fracture (fibula)
Repair of femoral shaft fracture
Repair of trochanteric fracture

A typical schedule for a practicing orthopedic surgeon involves 50–55 hours of work per week divided among clinic, surgery, various administrative duties and possibly teaching and/or research if in an academic setting. According to the AMGA Medical Group compensation and financial Survey, an Orthopedic surgeon's median salary is around $500,672.^[6]

Arthroscopy

The use of arthroscopic techniques has been particularly important for injured patients. Arthroscopy was pioneered in the early 1950s by Dr. Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. Arthroscopy helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, 'open' surgery. It is a very popular technique. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today and is often combined with meniscectomy or chondroplasty. The majority of orthopedic procedures are now performed arthroscopically.^{[citation needed]}

Arthroplasty

The modern total hip replacement was pioneered by Sir John Charnley in England in the 1960s.^[7] He found that joint surfaces could be replaced by metal or high density polyethylene implants cemented to the bone with methyl methacrylate bone cement. Since Charnley, there have been continuous improvements in the design and technique of joint replacement (arthroplasty) with many contributors, including W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant.

Knee replacements using similar technology were started by McIntosh in rheumatoid arthritis patients and later by Gunston and Marmor for osteoarthritis in the 1970s developed by Dr. John Insall in New York utilizing a fixed bearing system, and by Dr. Frederick Buechel and Dr. Michael Pappas utilizing a mobile bearing system.^[8]

Uni-compartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, is an alternative to a total knee replacement in a select patient population.

Joint replacements are available for other joints on a limited basis, most notably shoulder, elbow, wrist, ankle, spine, and fingers.

In recent years, surface replacement of joints, in particular the hip joint, have become more popular amongst younger and more active patients. This type of operation delays the need for the more traditional and less bone-conserving total hip replacement, but carries significant risks of early failure from fracture and bone death.

One of the main problems with joint replacements is wear of the bearing surfaces of components. This can lead to damage to surrounding bone and contribute to eventual failure of the implant. Use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). The plastic (actually ultra high-molecular-weight polyethylene) can also be altered in ways that may improve wear characteristics.

References

^ Day CS, Lage DE, Ahn CS. Diversity Based on Race, Ethnicity, and Sex Between Academic Orthopaedic Surgery and Other Specialties: A Comparative Study. J Bone Joint Surg Am. 2010: 92:2328-2335
^ American Board of Orthopaedic Surgery
^ American Board of Orthopaedic Surgery
^ "AOBOS 2012 Candidate Handbook". American Osteopathic Board of Orthopedic Surgery. 2012. http://www.aobos.org/mm/files/Candidate-Handbook-Master.pdf. Retrieved 19 September 2012.
^ *Garrett, WE, et al. American Board of Orthopaedic Surgery Practice of the Orthopedic Surgeon: Part-II, Certification Examination. The Journal of Bone and Joint Surgery (American). 2006;88:660-667.
^ [1]
^ Wroblewski, B.M. (2002). "Professor Sir John Charnley (1911–1982)". Rheumatology (The British Society for Rheumatology via Oxford Journals) 41 (7): 824–825. doi:10.1093/rheumatology/41.7.824. PMID 12096235. http://rheumatology.oxfordjournals.org/cgi/content/full/41/7/824. Retrieved 2008-04-28.
^ Hamelynck, K.J. (2006). "The history of mobile-bearing total knee replacement systems". Orthopedics 29 (9 Suppl): S7–12. PMID 17002140. http://www.ncbi.nlm.nih.gov/pubmed/17002140. Retrieved 2008-04-28.

External links

Wikimedia Commons has media related to: Orthopedics

American Academy of Orthopaedic Surgeons
American Osteopathic Academy of Orthopedics
Arthroscopy Association of North America
European Federation of National Associations of Orthopaedics and Traumatology
American Orthopaedic Society for Sports Medicine
The International Society of Orthopaedic Surgery and Traumatology
The Journal of Bone and Joint Surgery, American Volume
The Journal of Bone and Joint Surgery, British Volume

UpToDate Contents

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5. 小児における上腕骨骨幹部骨折 midshaft humeral fractures in children

English Journal

Developmental expression patterns of kainate receptors in the mouse spinal cord.

Cui S, Du P, Zhou X, Wang H.SourceaDepartment of Orthopedics, Shengjing Hospital, China Medical University, Shenyang bDepartment of Neurology, Zhongshan Hospital, Fudan University, Shanghai cDepartment of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Neuroreport.Neuroreport.2012 Dec 5;23(17):1012-6. doi: 10.1097/WNR.0b013e32835a7f1e.
Kainate receptors, a subtype of ionotropic glutamate receptors, perform important functions in the spinal cord. This study aimed to examine the expression pattern of various kainate receptor subunits in the spinal cord over different stages of development. The regional distribution and levels of Gri
PMID 23076118

Age-related differences in microstructure, density and biomechanics of vertebral cancellous bone of Chinese males.

Liu GM, Xu CJ, Kong N, Zhu XM, Zhang XY, Yao Y.SourceDepartment of Orthopedics & Department of Pathology, The Second Hospital of Jilin University , Changchun , China.
The aging male : the official journal of the International Society for the Study of the Aging Male.Aging Male.2012 Dec;15(4):233-9. doi: 10.3109/13685538.2012.724739. Epub 2012 Oct 5.
The conventional lumbar separation was performed by removing soft tissue, subsidiary structures and leaving only the vertebral body. The vertebral body was cut into two halves along the median sagittal plane, keeping the upper and lower end plates of each half, which were subsequently used for biome
PMID 23035988

Mechanisms of bone anabolism regulated by statins.

Ruan F, Zheng Q, Wang J.Source*Institute of Orthopedics, The Second Hospital, Zhejiang University, Hangzhou, Zhejiang 310009, People's Republic of China.
Bioscience reports.Biosci Rep.2012 Dec 1;32(6):511-9. doi: 10.1042/BSR20110118.
Osteoporosis is a common disease in the elderly population. The progress of this disease results in the reduction of bone mass and can increase the incidence of fractures. Drugs presently used clinically can block the aggravation of this disease. However, these drugs cannot increase the bone mass an
PMID 22799752

Japanese Journal

内科,整形外科患者の慢性疼痛に対する看護介入と看護師の共感性との関連

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足部舟状骨疲労骨折を認めた脳性麻痺の1例

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脳性麻痺(痙性両麻痺)の14歳女性が右足部痛を主訴に受診し,舟状骨中央3分の1の疲労骨折と診断した.尖足歩行により舟状骨へ繰り返しもたらされる負荷が原因と考え,骨接合術に加えてアキレス腱延長術を行い,尖足を矯正した.脳性麻痺で舟状骨疲労骨折を受傷した症例は我々が文献を調べたかぎりでは報告されていない.麻痺性尖足の脳性麻痺患者が足部痛を訴えた際には舟状骨疲労骨折の可能性も考慮するべきである.
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勤労者における抑うつ症状に関わる諸因子のパス解析モデルを用いた検討

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頚椎損傷に対する後外側進入による低侵襲頚椎椎弓根スクリュー固定術 : 緊急手術としての低侵襲性

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