Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We retrospectively investigated the mid-term outcomes of arthroplasty using the AVANTA silicone implant for thumb metacarpophalangeal (MCP) joints with boutonniere deformity in patients with rheumatoid arthritis (RA). This study involved 36 thumbs of 33 RA patients with a mean follow-up period of 5.1 years (range, 2.0-13.3). Postoperatively, the mean extension was significantly increased and the mean flexion was significantly decreased (p<0.001, p<0.001, respectively), resulting in the mean arc of range of motion (ROM) shifting in the direction of extension after surgery. Implant fracture was observed in 10 thumbs (28%), and 4 of these (11%) underwent revision surgery. The survivorship with implant fracture and revision surgery as endpoints were 73.4% and 91.8% at 5 years, respectively. The preoperative arc of ROM and the postoperative flexion range of the implant-fracture group were significantly greater than those in the no-implant-fracture group (p=0.039, 0.034, respectively). These results suggest the importance of patient education and careful rehabilitation to prevent excessive flexion. Overall, the AVANTA silicone implant showed a relatively high rate of implant fracture at our institute.

DOI： 10.18926/AMO/66673

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the effects of a Tankyrase (TNKS-1/2) inhibitor on mechanical stress-induced gene expression in human chondrocytes and examined TNKS-1/2 expression in human osteoarthritis (OA) cartilage. Cells were seeded onto stretch chambers and incubated with or without a TNKS-1/2 inhibitor (XAV939) for 12 h. Uni-axial cyclic tensile strain (CTS) (0.5 Hz, 8% elongation, 30 min) was applied and the gene expression of type II collagen a1 chain (COL2A1), aggrecan (ACAN), SRY-box9 (SOX9), TNKS-1/2, a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS-5), and matrix metalloproteinase-13 (MMP-13) were examined by real-time PCR. The expression of ADAMTS-5, MMP-13, nuclear translocation of nuclear factor-κB (NF-κB), and β-catenin were examined by immunocytochemistry and Western blotting. The concentration of IL-1β in the supernatant was examined by enzyme-linked immunosorbent assay (ELISA). TNKS-1/2 expression was assessed by immunohistochemistry in human OA cartilage obtained at the total knee arthroplasty. TNKS-1/2 expression was increased after CTS. The expression of anabolic factors were decreased by CTS, however, these declines were abrogated by XAV939. XAV939 suppressed the CTS-induced expression of catabolic factors, the release of IL-1β, as well as the nuclear translocation of NF-κB and β-catenin. TNKS-1/2 expression increased in mild and moderate OA cartilage. Our results demonstrated that XAV939 suppressed mechanical stress-induced expression of catabolic proteases by the inhibition of NF-κB and activation of β-catenin, indicating that TNKS-1/2 expression might be associated with OA pathogenesis.

DOI： 10.3390/ijms25031443

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Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Objective: Precise assessment of spinal instability is critical before and after radiotherapy (RT) for evaluating the effectiveness of RT. Therefore, we retrospectively evaluated the efficacy of RT in spinal instability over a period of 6 months after RT, utilizing the spinal instability neoplastic score (SINS) in patients with painful spinal metastasis. We retrospectively evaluated 108 patients who received RT for painful vertebral metastasis in our institution. Mechanical pain at metastatic vertebrae, radiological responses of irradiated vertebrae, and spinal instability were assessed. Follow-up assessments were done at the start of and at intervals of 1, 2, 3, 4, and 6 months after RT, with the pain disappearing in 67%, 85%, 93%, 97%, and 100% of the patients, respectively. The median SINS were 8, 6, 6, 5, 5, and 4 at the beginning and after 1, 2, 3, 4, and 6 months of RT, respectively. Multivariate analysis revealed that posterolateral involvement of spinal elements (PLISE) was the only risk factor for continuous potentially unstable/unstable spine at 1 month. In conclusion, there was improvement of pain, and recalcification results in regaining spinal stability over time after RT although vertebral body collapse and malalignment occur in some irradiated vertebrae. Clinicians should pay attention to PLISE in predicting continuous potentially unstable/unstable spine.

DOI： 10.1177/10732748241250219

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Other Link： https://journals.sagepub.com/doi/full-xml/10.1177/10732748241250219

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Contrast-enhanced ultrasound (CEUS) shows different enhancement patterns depending on the time after administration of the contrast agent. The aim of this study was to evaluate the diagnostic performance of liver nodule characterization using our proposed deep learning model with input of nine CEUS images. METHODS: A total of 181 liver lesions (48 benign, 78 hepatocellular carcinoma (HCC), and 55 non-HCC malignant) were included in this prospective study. CEUS were performed using the contrast agent Sonazoid, and in addition to B-mode images before injection, image clips were stored every minute up to 10 min. A deep learning model was developed by arranging three ResNet50 transfer learning models in parallel. This proposed model allowed inputting up to nine datasets of different phases of CEUS and performing image augmentation of nine images synchronously. Using the results, the correct prediction rate, sensitivity, and specificity between "benign" and "malignant" cases were analyzed for each combination of the time phase. These accuracy values were also compared with the washout score judged by a human. RESULTS: The proposed model showed performance superior to the referential standard model when the dataset from B-mode to the 10-min images were used (sensitivity: 93.2%, specificity: 65.3%, average correct answer rate: 60.1%). It also maintained 90.2% sensitivity and 61.2% specificity even when the dataset was limited to 2 min after injection, and this accuracy was equivalent to or better than human scoring by experts. CONCLUSION: Our proposed model has the potential to identify tumor types earlier than the Kupffer phase, but at the same time, machine learning confirmed that Kupffer-phase Sonazoid images contain essential information for the classification of liver nodules.

DOI： 10.1007/s10396-023-01390-z

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Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms &gt;12 months between the control and rehabilitation groups at the final follow-up.

DOI： 10.3390/jcm12227187

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Publisher：金原出版  

DOI： 10.18888/se.0000002707

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Total wrist arthroplasty is a challenging procedure for wrist joints severely destroyed by rheumatoid arthritis. The most common postoperative complication of total wrist arthroplasty is the loosening of the carpal component. Revision surgeries for failed total wrist arthroplasties can be complicated owing to severe bone loss and concomitant soft-tissue problems. Here we report a case (68-year-old woman with a history of rheumatoid arthritis for 24 years) of severe aseptic loosening of semi-constrained total wrist arthroplasty and its salvage surgery. During the primary arthroplasty procedure, severe instability at the second through fifth carpometacarpal joints was observed, and arthrodesis of these joints was required. The radiographs obtained nine months after surgery showed loosening of the carpal component. Subsequently, she suffered a stroke, resulting in a loss of follow-up, and higher stress was loaded on her upper extremities during standing and walking. In the radiograph taken at her revisit 25 months after the primary surgery, the subsidence of the carpal component progressed, and loosening of the radial component was observed. Total wrist arthrodesis was performed using a bulk bone allograft of the femoral head, combined with a penetrating Wrist Fusion Rod®. Rapid bone union was achieved without soft tissue irritation. We conclude that wrist arthrodesis with a bulk bone allograft combined with an intramedullary nail is a reasonable option for failed total wrist arthroplasty.

DOI： 10.1093/mrcr/rxad048

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We retrospectively reviewed the records of rheumatoid arthritis (RA) patients who underwent orthopaedic surgery to examine the influence of the perioperative use of Janus kinase (JAK) inhibitors on early postoperative complications. PATIENTS AND METHODS: Thirty-two patients with RA under disease control with JAK inhibitors who underwent 49 orthopaedic procedures were included in the study. Patient records after surgery were investigated for surgical site infection (SSI), delayed wound healing (DWH), flare-up of the disease, pre-and postoperative absolute lymphocyte counts (ALCs), venous thromboembolism and other postoperative complications. RESULTS: JAK inhibitors were continued during the perioperative period in 31 procedures. In the remaining 18 procedures, JAK inhibitors were discontinued perioperatively with a mean discontinuation period of 2.4 days. No instances of SSI were identified in any patient during at least 90 days' follow-up, while DWH was seen in one patient. Disease flare-up was noted in two patients after 3 and 9 days of discontinuation of JAK inhibitors, respectively. The ALCs significantly decreased on postoperative Day 1 (P < 0.0001) and there was a significant correlation between pre- and post-one day ALCs (r = 0.75, P < 0.0001). CONCLUSION: JAK inhibitors seem to be safe during the perioperative period of orthopaedic surgery.

DOI： 10.1093/mr/road047

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Rupture of the extensor pollicis longus (EPL) tendon is a known complication after undisplaced distal radius fracture (DRF). However, no report has revealed the relationship between EPL tendon rupture and the fracture pattern. Thus, this study aimed to investigate the characteristics of fractures at risk of EPL tendon rupture using fracture line mapping of undisplaced DRFs. This study used computed tomography imaging data of undisplaced DRFs with (n=18) and without EPL tendon rupture (n=52). Fracture lines obtained from 3D reconstruction data were drawn manually after matching with a 2D template wrist model. Fracture maps represented the fracture line distribution by superimposing the fracture lines of all 70 patients. Heat maps showed the relative frequency of the fracture lines as a gradual color change. Fracture lines of cases with EPL tendon rupture were concentrated in the proximal border of Lister's tubercle. By contrast, fracture lines of cases without EPL tendon rupture were relatively dispersed.

DOI： 10.18926/AMO/65147

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Spinal metastases are common in patients with advanced stages of cancer and frequently cause vertebral body collapse (VBC). Although conventional radiotherapy (RT) is used for spinal metastases, the rates of occurrence of new VBC and progression of VBC at RT initiation have not been fully investigated. The present retrospective study assessed VBC and its associated risk factors after RT over time and evaluated new VBC and progression of VBC in patients who presented with VBC at RT initiation. The study evaluated 177 patients who received RT for vertebral metastases without paralysis between July 2012 and November 2016. Radiological responses of the irradiated vertebrae were assessed using computed tomography. Follow-up assessments were performed at RT initiation and 1, 2, 3, 4 and 6 months after RT. New VBC occurred in 12% of patients with no prior VBC within 1 month of RT. Multivariate analysis revealed that numeric rating scale (NRS) score (≥4) [relative risk (RR), 27.1; 95% confidence interval (CI), 1.86 to 394.9; P=0.016] was associated with the occurrence of new VBC at the 1 month follow-up time point. VBC progression occurred in 51% of the patients with collapse at RT initiation. Multivariate analysis revealed that bone quality (lytic metastases) (RR, 3.1; 95% CI, 1.28 to 7.70; P=0.013), NRS score (≥4) (RR, 3.0; 95% CI, 1.18 to 7.45; P=0.021) and tumor involvement of posterolateral elements of the spine (RR, 2.7; 95% CI, 1.03 to 7.29; P=0.04) were associated with the progression of VBC at the 1 month follow-up time point. The current study findings suggested that clinicians should pay attention to the factors that predict the occurrence of new VBC and VBC progression to ensure proper evaluation of conservative treatment effectiveness and facilitate the determination of patients who need close monitoring.

DOI： 10.3892/ol.2023.13695

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: There are concerns regarding complications and longevity of total elbow arthroplasty (TEA) in young patients, and the few previous publications are mainly limited to reports on linked elbow devices. We investigated the clinical outcome of unlinked TEA for patients aged less than 50 years with rheumatoid arthritis (RA). METHODS: We retrospectively reviewed the records of 26 elbows of 21 patients with RA who were aged less than 50 years who underwent primary TEA with an unlinked elbow prosthesis. The mean patient age was 46 years (35 to 49), and the mean follow-up period was 13.6 years (6 to 27). Outcome measures included pain, range of motion, Mayo Elbow Performance Score (MEPS), radiological evaluation for radiolucent line and loosening, complications, and revision surgery with or without implant removal. RESULTS: The mean MEPS significantly improved from 47 (15 to 70) points preoperatively to 95 (70 to 100) points at final follow-up (p < 0.001). Complications were noted in six elbows (23%) in six patients, and of these, four with an ulnar neuropathy and one elbow with postoperative traumatic fracture required additional surgeries. There was no revision with implant removal, and there was no radiological evidence of loosening around the components. With any revision surgery as the endpoint, the survival rates up to 25 years were 78.1% (95% confidence interval 52.8 to 90.6) as determined by Kaplan-Meier analysis. CONCLUSION: The clinical outcome of primary unlinked TEA for young patients with RA was satisfactory and comparable with that for elderly patients. A favourable survival rate without implant removal might support the use of unlinked devices for young patients with this disease entity, with a caution of a relatively high complication rate regarding ulnar neuropathy.Level of Evidence: Therapeutic Level IVCite this article: Bone Jt Open 2023;4(1):19-26.

DOI： 10.1302/2633-1462.41.BJO-2022-0151.R1

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本皮膚科学会-西部支部  

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Language：English  

DOI： 10.1016/j.jos.2022.09.017

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: We examined the relationship between The Japanese version of Patient-Related Elbow Evaluation (PREE-J) and other established subjective and objective outcome measures in Japanese patients with rheumatoid arthritis (RA) who underwent total elbow arthroplasty (TEA). PATIENTS AND METHODS: This study involved 46 elbows of 40 RA patients. We collected clinical data one year after surgery, including the PREE-J, the Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder, and Hand (DASH), and Hand20. The correlation and responsiveness to PREE-J were evaluated compared with other outcome measures pre-and postoperatively. RESULTS: Almost all outcome measures were improved significantly after surgery. Preoperative PREE-J was significantly correlated with preoperative DASH, Hand20, and MEPS. Interestingly, postoperative PREE-J did not correlate with postoperative MEPS. Multiple regression analyses revealed that preoperative grip strength (B = -0.09; 95% CI -0.17 to -0.01, p = 0.03) and preoperative Hand20 (B = 0.31, 95% CI 0.03 - 0.58, p = 0.03) were significant factors those might influenced the postoperative PREE-J. CONCLUSIONS: The PREE-J was shown to correlate well with other preoperative outcome measures among the RA patients included in the current study. The postoperative PREE-J after TEA was influenced by the preoperative grip strength and function of the hand.

DOI： 10.1093/mr/roab100

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Background: Identification of the risk factors for surgical site infection (SSI) can be a straightforward and cost-effective measure to reduce or prevent the occurrence of SSI. However, there are no studies that revealed risk factors for SSI for traumatic upper extremity amputation. The aim of this study is to investigate the risk factors that promote SSI after surgery for traumatic upper extremity amputation using a large nationwide database. Methods: We used data from the Japan Trauma Data Bank. Diagnoses were defined using the Abbreviated Injury Scale code. We applied multivariate logistic regression to evaluate the infection risk factor. We chose age, sex, vital signs, cause and type of trauma, concomitant injury, diabetes, amputation level, Glasgow coma scale, Injury Severity Score (ISS) and blood transfusion within 24 hours following hospital arrival as confounders. Receiver operating characteristic (ROC) curve analysis was adopted to identify thresholds for change in infection risk. We also applied propensity score (PS) matching to adjust for confounding factors that may affect the outcome. Results: A total of 1,150 patients (967 males, 183 females) had traumatic upper extremity amputation. The mean patient age was 46.5 years. A total of 21 patients (1.8%) suffered from SSI. ISS, blood transfusion, systolic blood pressure (BP) and the upper extremity amputation except for finger were identified as the independent significant risk factors for SSI occurrence by the multivariate analysis (p < 0.05, p < 0.005, p < 0.05 and p < 0.005, respectively). ROC modelling revealed that patients with ISS of over 9 or systolic BP of over 160 had a risk for SSI. After PS matching, the patients with blood transfusion or systolic BP of over 160 had a significantly higher risk of infection (OR 9.0; p = 0.01 and OR 7.0; p = 0.03, respectively). Conclusions: In treating patients with these risk factors, we must be especially careful in performing thorough debridement and wound care. Level of Evidence: Level II (Therapeutic).

DOI： 10.1142/S2424835522500709

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Authorship：Lead author   Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: It has been reported that levels of soluble CD30 in serum and joint fluid are significantly elevated in patients with rheumatoid arthritis (RA). This study aimed to investigate whether CD30 could be a therapeutic target for RA. METHODS: The expression and localization of CD30 were examined by immunohistochemical and double immunofluorescence staining on synovial tissue samples obtained from patients with RA or osteoarthritis (OA) during surgery. Changes in CD30 expression of fibroblast-like synoviocytes (FLS) from RA patients with or without TNFα and IL-1β stimulation were examined by the polymerase chain reaction (PCR) and flow cytometry. Collagen antibody-induced arthritis (CAIA) was created in DBA/1 mice, and the therapeutic effect of brentuximab vedotin (BV) was examined by clinical score, histological findings and measurement of serum levels of SAA, IL-6, and TNFα. RESULTS: CD30 expression was significantly higher in samples from patients with RA than from those with OA. Double immunofluorescence showed a low rate of co-localization of CD30 with CD20 or CD90, but a high rate of co-localization of CD30 and CD138. CD30 mRNA expression was upregulated 11.7-fold in FLS following stimulation by inflammatory cytokines. The clinical scores of CAIA mice were significantly lower following both BV treatments, however, the histological scores of CAIA mice were significantly lower only following treatment with high dose BV (70 mg/kg). CONCLUSIONS: CD30 was expressed on immunocompetent cells in synovial tissue from RA patients and in cytokine-stimulated FLS in vitro. High dose BV (70 mg/kg) showed significant therapeutic effects in ameliorating inflammation and joint destruction in CAIA mice, but low dose BV (30 mg/kg) was insufficient.

DOI： 10.1007/s00011-021-01537-z

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass correlates to bone mineral density (BMD). The psoas muscle index (PMI), measured as the L3 cross-sectional areas of the right and left psoas divided by the square of height, has a positive correlation with the total volume of skeletal muscle in the body. This study aimed to evaluate relationships between PMI and BMD and fracture risk estimated by the Fracture Risk Assessment Tool (FRAX). METHODS: Preoperatively acquired, plain computed tomography images at the L3 level were used to measure PMI in 87 people with degenerative spinal diseases. We evaluated the correlation between PMI and BMD and fracture risk estimated by FRAX. RESULTS: PMI was significantly correlated with BMD in the entire lumbar spine and femoral neck (r = 0.413 and 0.525, both P < 0.001). People with osteoporosis showed significantly lower PMI than those without (P < 0.05). PMI was also significantly correlated with FRAX score (r = -0.545, P < 0.001). Furthermore, based on the recommendation of osteoporosis treatment, participants were divided into two groups: FRAX ≥15% (R group) and FRAX <15% (C group). The R group showed significantly lower PMI than the C group (P < 0.001). Receiver operating characteristic curve analysis revealed that PMI has moderate accuracy in diagnosing osteoporosis and FRAX ≥15%. CONCLUSIONS: PMI was significantly associated with BMD and fracture risk. PMI measurement is straightforward and may increase the diagnosis rate of osteoporosis and fracture risk.

DOI： 10.1016/j.nut.2021.111428

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Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Purpose

We investigated objective and patient-reported outcomes after resection arthroplasty or shortening oblique osteotomy (SOO) of the lesser metatarsals combined with arthrodesis of the first metatarsophalangeal (MTP) joint for severe rheumatoid forefoot deformities.

Methods

17 feet from 14 women (mean age, 67.8 years) underwent resection arthroplasty of the lesser metatarsal heads (MTH resection group), while 13 feet from nine women and two men (mean age, 68.7 years) underwent SOO of the lesser metatarsals (MTH preservation group). Arthrodesis of the first MTP joint was performed in all cases. Mean follow-up in the MTH resection and preservation groups was 25.0 and 21.3 months, respectively. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q) scores.

Results

Mean total JSSF scale significantly improved from 53.4 to 76.4 in the MTH resection group ( p &lt; .001) and from 50.1 to 74.2 in the MTH preservation group ( p = .002). Pain and pain-related and shoe-related SAFE-Q subscale scores significantly improved after surgery in both groups. In the MTH resection group, recurrence of painful callosities and claw toe deformity was observed in four and three feet, respectively. In the MTH preservation group, one patient experienced recurrence of painful callosities and one underwent revision surgery for IP joint dislocation.

Conclusion

Resection arthroplasty or SOO of the lesser metatarsals combined with arthrodesis of the first MTP joint achieved significant improvement with respect to pain relief, deformity correction, and footwear comfort.

DOI： 10.1177/10225536221117903

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/10225536221117903

Language：English   Publishing type：Research paper (scientific journal)  

We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.

DOI： 10.1053/j.jfas.2021.06.008

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Publishing type：Research paper (international conference proceedings)  

DOI： 10.1117/12.2608065

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Other Link： https://dblp.uni-trier.de/db/conf/micad/micad2022.html#NakazawaHHNO22

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Fatigue is an important factor for muscle strengthening in rehabilitation medicine. Frequency analysis has been regarded as the gold standard for muscle fatigue assessment in surface electromyography (EMG). However, there are no experiments quantifying fatigue with grouped discharge (GD), which is one of the historical phenomena observed in patients having fatigue, by using high sampling rate recording of EMG. OBJECTIVE: To investigate the effect of fatigue, which is induced by repeated posterior tongue lift movement (TLM), on the occurrence of GD peaks, thus, to provide possible basis as a parameter for future fatigue evaluation. METHODS: Nineteen healthy adults (9 men and 10 women) participated in this study. The muscle fatigue protocol consisted of repetitive posterior TLM and maximum voluntary contractions (MVC). Bilateral N-EMG (Neck surface EMG for measuring the muscle activity of the posterior tongue) was recorded. RESULTS: Subjective tongue fatigue at the end of the protocol was significantly higher than at beginning throughout the muscle fatigue protocol (p < .01). The frequency of occurrence of GD peaks was 0.9 ± 1.2 (per second) at the baseline in 33 of 38 subject sides, and significantly increased depending on fatigue progression (p < .01). CONCLUSION: It was shown that fatigue due to repetitive posterior tongue lifting resulted in significant increase in the frequency of occurrence of GD peaks. Especially, the nature of GD, showing very few occurrences at non-fatigue condition, might work as an advantageous property for its use in future absolute evaluation of fatigue phenomena.

DOI： 10.1111/joor.13258

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Publisher：Research Square Platform LLC  

Abstract

Only few reports have assessed the characteristics and oncological and functional outcomes of forearm soft tissue sarcomas (STS). Then, we aimed to investigate the clinical features and survival-related factors for forearm STS who underwent surgical excision at our institution. There were 38 patients. Fourteen patients (41%) were referred to our institution after an unplanned excision and tumor size and grade were significantly associated with the receipt of it. The postoperative median Musculoskeletal Tumor Society rating scale (MSTS) score was 28. Bone resection or major nerve palsy was the only factor influencing the postoperative MSTS score (P &lt; 0.001). There was no significant difference in MSTS scores according to the reconstruction procedures (the use of flap or tendon reconstruction). The 5-year local recurrence-free survival (LRFS) rate was 86%. Univariate analysis revealed that the histological diagnosis of myxofibrosarcoma was the only factor that influenced LRFS (P = 0.047). The 5-year metastasis-free survival rate was 77%. The 5-year overall survival (OS) rate was 94%. Age was the only factor that influenced OS (P = 0.01). In conclusion, reconstruction of the skin and tendon can compensate for function. Careful follow-up is important, especially in patients with myxofibrosarcoma, due to its likelihood of local recurrence.

DOI： 10.21203/rs.3.rs-1028963/v1

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS. METHOD: Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months postoperatively. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement. RESULTS: The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6-12 months, r = 0.67; 0-12 months, r = 0.60) and DASH (0-12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6-12 months, r = - 0.33; 0-12 months, r = - 0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below. CONCLUSION: NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.

DOI： 10.1186/s12891-021-04771-y

PubMed

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Authorship：Lead author   Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the effects of adipose-derived extract (AE) on cultured chondrocytes and in vivo cartilage destruction. AE was prepared from human adipose tissues using a nonenzymatic approach. Cultured human chondrocytes were stimulated with interleukin-1 beta (IL-1β) with or without different concentrations of AE. The effects of co-treatment with AE on intracellular signaling pathways and their downstream gene and protein expressions were examined using real-time PCR, Western blotting, and immunofluorescence staining. Rat AE prepared from inguinal adipose tissues was intra-articularly delivered to the knee joints of rats with experimental osteoarthritis (OA), and the effect of AE on cartilage destruction was evaluated histologically. In vitro, co-treatment with IL-1β combined with AE reduced activation of the p38 and ERK mitogen-activated protein kinase (MAPK) pathway and nuclear translocation of the p65 subunit of nuclear factor-kappa B (NF-κB), and subsequently downregulated the expressions of matrix metalloproteinase (MMP)-1, MMP-3, MMP-13, a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4, IL-6, and IL-8, whereas it markedly upregulated the expression of IL-1 receptor type 2 (IL-1R2) in chondrocytes. Intra-articular injection of homologous AE significantly ameliorated cartilage destruction six weeks postoperatively in the rat OA model. These results suggested that AE may exert a chondroprotective effect, at least in part, through modulation of the IL-1β-induced inflammatory signaling pathway by upregulation of IL-1R2 expression.

DOI： 10.3390/ijms22189781

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本臨床リウマチ学会  

【目的】関節リウマチ(RA)患者におけるボディイメージ・アセスメントツール(BIAT)の信頼性と有効性を検証すること。【方法】本研究は横断的観察研究である。外来通院中(非手術群)および入院中(手術群)のRA患者265例および健常人62名を対象にBIAT質問用紙への回答を依頼した。信頼性の評価として、内部一貫法にはRA患者265例のbaselineのデータを、再テスト法には健常群62名のbaseline・3週後、および非手術群76例のbaseline・半年・1年後のデータを用いた。既存の評価法としてBDI-II(Beck Depression Inventory-II、ベック抑うつ質問票)を用いてBIATの臨床評価としての妥当性を検討した。RA患者265例をDAS28-CRPに基づき、寛解、低疾患活動性、中疾患活動性、高疾患活動性に群別し、BIATとの関連を検討した。さらに非手術群と手術群でBIATに差があるかどうかを検討した。【結果】BIATは全体の評価でも各構成概念の評価でもα係数は0.8以上を示しており、高い一貫性を有していた。再テスト法ではBIAT全体平均において、健常群のbaselineと3週後で相関係数0.75、非手術群のbaselineと半年後および1年後で相関係数0.79および0.78であり、比較的高い信頼性が確認できた。BIAT全体スコアはBDI-IIと有意な負の相関(r=-0.64、P<0.001)を示した。BIATは疾患活動性が高いほど低値となる傾向があることが示された。手術群でのbaselineの平均BIATの値はいずれの構成概念においても非手術群よりも有意に低値であった。【結論】RA患者に対するBIATは、高い一貫性、安定性を有する評価ツールであることが確認された。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (-0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

DOI： 10.3390/ijerph18147520

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Psychological distress is common in patients with soft tissue and bone tumors. We first investigated its frequency and the associated risk factors in patients with pre-operative bone and soft tissue tumors. Participants included 298 patients with bone and soft tissue tumors who underwent surgery in our institution between 2015 and 2020. Psychological distress was evaluated by the Distress and Impact Thermometer (DIT) that consists of two types of questions (questions about the severity of the patient's distress (DIT-D) and its impact (DIT-I)). We used a cut-off point of 4 on the DIT-D and 3 on the DIT-I for screening patients with psychological distress. We therefore investigated: (1) the prevalence of psychological distress as assessed with DIT or distress thermometer (DT), which can be decided by DIT-D ≥ 4, (2) what are the risk factors for the prevalence of psychological distress, and (3) what is the number of patients who consulted a psychiatrist for psychological distress in patients with pre-operative bone and soft tissue tumors. With DIT and DT, we identified 64 patients (21%) and 95 patients (32%), respectively, with psychological distress. Multivariate logistic regression revealed that older age, sex (female), malignancy (malignant or intermediate tumor), a lower Barthel Index, and higher numeric rating scale were risk factors for psychological distress. Two patients (3%) consulted a psychiatrist after surgery. In conclusion, careful attention to psychological distress is needed, especially for female patients, older patients, and those with malignant soft or bone tissue tumors who have more than moderate pain.

DOI： 10.3390/healthcare9050566

PubMed

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Authorship：Lead author   Language：Japanese   Publisher：(株)インナービジョン  

人工知能(AI)技術は非常に速い速度で進化しており、自動翻訳や音声認識などの、日常で利用可能なAIも出現している。医療領域でもAI研究は進んでおり、2019年には医療AIソフトウエア(MRI・脳動脈瘤検出)が医薬品医療機器総合機構(PMDA)により認可され、今後さらに普及が進むと予想されている。本稿では、運動器領域における超音波画像診断のAI利用について概説する。(著者抄録)

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

BACKGROUND: This study aimed to assess the use of 33 MHz ultra-high-frequency ultrasonography (33MHz-UHFUS) for evaluating axillary sweat glands with osmidrosis in comparison with histological techniques. Axillary osmidrosis is a common problem in Asian societies, and the number and size of apocrine sweat glands have a strong relationship with osmidrosis severity. Currently, there are no methods to evaluate sweat gland distribution non-invasively. METHODS: In this study, 35 skin specimens from 10 fresh human cadavers without osmidrosis and retrospective ultrasonographic images from 20 patients with osmidrosis were used. Skin specimens were embedded in paraffin, thinly sliced, and finally stained with hematoxylin and eosin. Histologically, the apocrine and eccrine glands were evaluated, and the top and bottom depths of follicles were measured from the skin surface. In 33 MHz ultrasonography images, the depths of sweat glands were measured, and the mean grey value was calculated using Image J. RESULTS: Compared to histological data, 33MHz-UHFUS could be used to identify sweat glands as a hyperechoic structure between the dermis and fat layer. Furthermore, it could evaluate sweat gland distribution but could not distinguish between types of sweat glands. CONCLUSIONS: The distribution of sweat glands in the axilla can be non-invasively evaluated via 33MHz-UHFUS.

DOI： 10.1371/journal.pone.0251600

Web of Science

PubMed

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：岡山医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00175&link_issn=&doc_id=20210419150008&doc_link_id=130008034823&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130008034823&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Many histological, mechanical, and clinical studies have been performed on the medial meniscus posterior root attachment, as it often tears in patients with osteoarthritic knee. Medial meniscal root repair is recommended in clinical situations; however, to date, no studies have examined the differences between meniscal root and horn cells. The aim of this study was, therefore, to investigate the morphology, reaction to cyclic tensile strain, and gene expression levels of medial meniscal root and horn cells. METHODS: Meniscal samples were obtained from the medial knee compartments of 10 patients with osteoarthritis who underwent total knee arthroplasty. Root and horn cells were cultured in Dulbecco's modified Eagle's medium without enzymes. The morphology, distribution, and proliferation of medial meniscal root and horn cells, as well as the gene and protein expression levels of Sry-type HMG box 9 and type II collagen, were determined after cyclic tensile strain treatment. RESULTS: Horn cells had a triangular morphology, whereas root cells were fibroblast-like. The number of horn cells positive for Sry-type HMG box 9 and type II collagen was considerably higher than that of root cells. Although root and horn cells showed similar levels of proliferation after 48, 72, or 96 h of culture, more horn cells than root cells were lost following a 2-h treatment with 5% and 10% cyclic tensile. Sry-type HMG box 9 and α1(II) collagen mRNA expression levels were significantly enhanced in both cells after 2- and 4-h cyclic tensile strain (5%) treatment. CONCLUSIONS: Medial meniscal root and horn cells have distinct morphologies, reactions to mechanical stress, and cellular phenotypes. Our results suggest that physiological tensile strain is important to activate extracellular matrix production in horn cells.

DOI： 10.1016/j.jos.2020.02.015

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In Japan, microsurgical skill development and a system to transfer patients to an appropriate hospital for upper extremity amputation have been promoted; however, information about trends of replantation is limited. Therefore, the aim of this study was to clarify the trends in the treatment for upper extremity amputation using the Japan Trauma Data Bank (JTDB). METHODS: Data derived from JTDB (2004-2015) were used to quantify trends in the volume of replantation for upper extremity amputation including finger amputation. Trauma was diagnosed based on the Abbreviated Injury Scale code; a subgroup of patients who underwent replantation was delineated. We investigated patient demographics, infection rate, and characteristics of treating facilities. RESULTS: A total of 1240 patients underwent upper extremity amputation. Among these, 510 (41.1%) underwent replantation, and the rate of replantation did not change over the study period. The average age of patients who underwent or did not undergo replantation was 45.5 and 47.2 years, respectively. The proportion of the patients who were transferred to another hospital for treatment significantly decreased between 2004 (28.5%) and 2015 (16.3%) (P < 0.01). Time taken for transfer from the accident site to hospitals increased. The rate of patients who underwent replantation differed among different hospitals; however, higher-volume hospitals were more likely to perform replantation. CONCLUSION: The rate of patients transferred to another hospital decreased between 2004 and 2015; however, the rate of patients who underwent replantation remained unchanged. This suggests that the number of patients who were transported directly from the accident site to an appropriate hospital has increased, whereas the indication for care in each hospital remains unchanged. Common criteria for amputations are needed to address the differing rates of replantation among hospitals.

DOI： 10.1016/j.jos.2020.03.006

PubMed

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

J-GLOBAL

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本リウマチ学会  

J-GLOBAL

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

＜文献概要＞人工知能(artificial intelligence;AI)技術の発展は技術だけの問題ではなく経済も含めた複合的な現象である。AIを中心としたデータ処理が得意なGAFA企業は世界の株式時価総額のトップを占めるようになった。AIの中心技術である深層学習は画像処理能力を飛躍的に伸ばしただけでなく,言語や音声などの解析能力も伸ばした。またGPUの進歩,大規模データセットの進化などの要因がAIの発展を支えている。本稿ではこれらのAI技術の進歩にまつわる歴史を概説する。

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BACKGROUND: Dedifferentiated liposarcoma (DDLPS) is a rare malignancy that transitions from an atypical lipomatous tumor to a sarcoma with a variable morphologic appearance. The behavior of this tumor in the retroperitoneum is aggressive, but the behavior of DDLPS in the extremities is less well-defined because it is rare. Few reports have assessed the imaging features and clinical outcomes of primary DDLPS in the extremities. QUESTIONS/PURPOSES: In patients with primary DDLPS of the extremity, we asked the following questions: (1) How frequently do additional primary malignancies occur in patients with DDLPS? (2) What is the rate of overall survival, metastases, and local recurrence in DDLPS? (3) What factors are associated with metastasis-free survival and local recurrence in DDLPS? METHODS: We defined DDLPS as a biphasic neoplasm that transitions from an atypical lipomatous tumor (ALT) to a sarcoma of variable morphologic appearance and histologic grades. We retrospectively evaluated the medical records of patients with DDLPS of the extremities who underwent surgery in our institution between 2003 and 2017. During that time, 16 patients were treated for this diagnosis; one was excluded from this study because the patient did not have an MRI, leaving 15 patients (nine men, six women; their median [range] age was 67 years [42 to 87]) for evaluation. All had a minimum of 2 years follow-up (median [range] 54 months [25 to 136]); 14 of 15 have been seen in the last 5 years (one patient, who was doing well at the time, was lost after 9 years of follow-up). In 11 patients, MRI demonstrated two components: an ALT component with high intensity on both T1-weighed and T2-weighted sequences and a dedifferentiated component low-to-intermediate intensity on T1-weighed and heterogeneous hyperintensity on T2-weighted sequence. Nine patients were evaluated using 2-deoxy-2-18F-fluoro-D-glucose positron emission tomography (FDG-PET) combined with CT (PET/CT). PET/CT showed a biphasic pattern with a close relationship to MRI findings. The dedifferentiated component presented with high FDG uptake (median [range] maximum standardized uptake value 5.1 [1.9 to 22.6]), while the atypical lipomatous tumor component showed almost no FDG uptake. In all patients, immunohistochemical studies of p16 and cyclin-dependent kinase-4 (CDK4) were investigated. Positive staining for both p16 and CDK4 were seen in 13 of 15 patients.We retrospectively evaluated the electronic medical records of all patients in our institution for the presence of additional primary malignancies, local recurrence-free survival, metastasis-free survival, and overall survival. The survival rate was estimated using the Kaplan-Meier method. The Wilcoxon exact test was used to determine the prognostic importance of the following survival variables: age, sex, maximum tumor size, radiotherapy, and surgical margin. RESULTS: Seven additional primary malignancies developed in five of 15 patients (two lung cancers, two sarcomas, one renal cell cancer, one uterine cancer, and one non-Hodgkin lymphoma). The 3- and 5-year metastasis-free survival rates were 86% (95% CI 0.67 to 1.00) and 75% (95% CI 0.49 to 1.00), respectively. With the numbers available, we found no factors associated with metastasis-free survival. The 3- and 5-year overall survival rates were 100% (95% CI 1.00 to 1.00) and 88% (95% CI 0.65 to 1.00), respectively. Three of 15 patients had local recurrence. The 3- and 5-year local recurrence-free survival rates were 86% (95% CI 0.67 to 1.00) and 75% (95% CI 0.49 to 1.00), respectively. Large (> 15 cm) tumors were more likely to have a local recurrence (p = 0.04). CONCLUSIONS: In this small series, we found that the extremities are a favorable site for DDLPS compared with the retroperitoneum, although we did not directly compare the two sites. This rare tumor has a relatively high likelihood of being associated with other malignancies. We believe patients should be assessed and monitored carefully for this possibility. In the future, larger studies are needed to better define predictors of local recurrence, although the tumor's size may be associated with a greater propensity for local recurrence. LEVEL OF EVIDENCE: Level II, prognostic study.

DOI： 10.1097/CORR.0000000000001338

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

The effect of nivolumab and the relation between bone response and tumor control in patients with non-small-cell lung cancer (NSCLC) with bone metastases are not clear. The outcome of nivolumab monotherapy was investigated, and whether the response of bone metastases is useful as an early predictor of tumor control in patients with NSCLC with bone metastases was examined. The participants included 15 patients who received nivolumab monotherapy for NSCLC with bone metastases in our institution between 2015 and 2017. Tumor control was defined using Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST1.1). Response of bone metastases was assessed by the MD Anderson response criteria (MDA criteria). Responses according to RECIST1.1 and the MDA criteria were classified as responder (complete response or partial response) and non-responder [progressive disease (PD) or stable disease]. Progression-free survival (PFS) was investigated using the Kaplan-Meier method. With RECIST1.1, the overall response rate was 20%. Multivariate analysis showed that the MDA criteria were the only risk factor for patients with PD (RECIST1.1). Median PFS was 1.9 months, with PFS of 20% at 6 months. Univariate analysis showed that being a non-responder according to the MDA criteria was the only risk factor for PFS. In patients who were responders (MDA criteria) within 3 months, PFS was 83 and 50% at 3 and 6 months, respectively, though all non-responder (MDA criteria) patients converted to PD (RECIST1.1) within 3 months. Response according to RECIST1.1 was significantly correlated with response according to the MDA criteria (P<0.05). In patients who were both responders according to RECIST1.1 and the MDA criteria, time to response with the MDA criteria (1.4-2.0 months) was earlier than with RECIST1.1 (2.8-3.0 months) in all patients. In conclusion, application of the MDA criteria within 2 months of nivolumab monotherapy is useful for early prediction of response and prognosis in patients with NSCLC with bone metastases.

DOI： 10.3892/ol.2020.11856

PubMed

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)医学書院  

＜文献概要＞深層学習(deep learning)と呼ばれる人工知能(artificial intelligence)AI技術の発達により,AI画像診断研究が劇的に発展している.それを支えているのがAIプログラムの無料公開文化だ.AI学者が再利用可能な形でAIプログラムを公開してくれるため,公開されたAI技術を組み合わせることで医療AIの開発が可能となった.整形外科領域におけるAI開発もその例外ではなく,骨折診断領域を中心に様々なAI技術を組み合わせて開発を行われている.本稿ではAI技術の発展にフォーカスしてAI画像診断研究について概説する.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01554&link_issn=&doc_id=20200818220008&doc_link_id=40022329174&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40022329174&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)南江堂  

＜文献概要＞はじめに 近年,画像認識や自動翻訳などで人工知能(artificial intelligence:AI)が急速に発展している.その中心にあるのは深層学習(deep learning)と呼ばれるAI技術である.医療界でも爆発的な勢いでAI研究が増えており,PubMedで"deep learning"で検索される論文は2012年には12件にすぎなかったが,2019年には3,919件にまで増えている(図1).医療AI研究は放射線科の画像分野ではじまり,さまざまな領域に医療AI研究は拡大している.整形外科領域でも骨折のAI画像診断を中心にAI研究が広がりをみせている.本項ではそのようなAI論文の読み解き方とAI研究のはじめ方について概説する.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00764&link_issn=&doc_id=20200605260045&doc_link_id=issn%3D0030-5901%26volume%3D71%26issue%3D6%26spage%3D725&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0030-5901%26volume%3D71%26issue%3D6%26spage%3D725&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

Malignant spinal cord compression (MSCC) is a serious complication of cancers. The present study aimed to establish a multidisciplinary treatment system for urgent magnetic resonance imaging (MRI) and referral to orthopedists in order to prevent neurological deficits caused by MSCC. In the present study, the extent to which this system achieved early diagnosis and treatment and prevented MSCC-caused neurological deficits was examined. The records from patients with neurological deficits caused by MSCC before (between April 2007 and March 2012; group A) and after (between April 2012 and March 2017; group B) the establishment of the multidisciplinary system at the Shikoku Cancer Center (Ehime, Japan) were retrospectively evaluated. The numbers of patients with neurological deficits were 38 and 7 in groups A and B, respectively. All patients received radiotherapy. The incidence of neurological deficits was 13.2 and 3.4% in groups A and B, respectively (P<0.001). The proportion of patients with improvement in the severity of neurological deficits was 5.3 and 28.6% in groups A and B, respectively (P<0.001). The interval between physicians' recognition of a neurological deficit and MRI and the start of treatment, the number of cases, and the severity of neurological deficits were evaluated in groups A and B. The median interval between recognition of a neurological deficit by physicians and MRI was 3 and 0 days in groups A and B, respectively (P<0.001). The median interval between physicians' recognition of a neurological deficit and the start of treatment was 3 and 0 days in groups A and B, respectively (P<0.001). By using a multidisciplinary treatment system, the incidence and severity of neurological deficits following treatment were significantly improved. Therefore, the multidisciplinary treatment system used in the present study may be useful for early diagnosis, treatment and prevention of MSCC in patients with bone metastases.

DOI： 10.3892/ol.2020.11415

PubMed

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

＜文献概要＞・医療AIの研究が急速に発展している。さまざまな医療AI企業が生まれ,米国を中心に医療AIの臨床利用が開始された。・無料のAI開発環境が公開され誰でもAI研究が可能となったため,外傷領域でもAI研究は進んでいる。・AIはAI特有の誤認識を犯すことも分かってきたため,AIの臨床利用のためにはAIの利点だけではなく,問題点の研究も重要である。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00282&link_issn=&doc_id=20200414180029&doc_link_id=10.18885%2FJJS.0000000282&url=https%3A%2F%2Fdoi.org%2F10.18885%2FJJS.0000000282&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：岡山医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：中国・四国整形外科学会  

症例1は93歳女性で、右膝痛による体動困難を主訴とした。CT、超音波で右股関節包内前方に水腫と石灰化像を認め、超音波ガイド下に股関節穿刺吸引を施行した。関節液の検査結果は比重1.015、尿酸結晶(-)、CPPD結晶(+)、細胞数46325/μL(分画:Stab1%、Seg85%、Mono13%、Lymph1%)、糖77mg/dL、塗抹菌体(-)であり、股関節偽痛風と診断した。穿刺の際にキシロカインを投与し、症状が速やかに改善した。症例2は81歳女性で、誘因のない右股関節痛を主訴とした。CT、超音波で右股関節包内前方に水腫と石灰化像を認め、超音波ガイド下に股関節穿刺吸引を施行した。関節液の検査結果は比重1.020、尿酸結晶(-)、CPPD結晶(+)、細胞数20800/μL(分画:Stab0%、Seg82%、Mono13%、Lymph8%)、糖155mg/dL、塗抹菌体(-)であり、股関節偽痛風と診断した。穿刺の際にキシロカインを投与し、症状が速やかに改善した。以後、2例とも疼痛の再燃を認めなかった。

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

関節エコーは単純X線画像では検出困難な滑膜炎や微小な骨びらんの検出が可能である。早期診断・薬効判定・寛解基準に有用であるだけでなく,関節穿刺にも用いることができ,安価で低侵襲であるため関節リウマチ診療においてなくてはならない検査となった。(著者抄録)

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: To reveal trends in bone microarchitectural parameters with increasing spatial resolution on ultra-high-resolution computed tomography (UHRCT) in vivo and to compare its performance with that of conventional-resolution CT (CRCT) and micro-CT ex vivo. METHODS: We retrospectively assessed 5 tiger vertebrae ex vivo and 16 human tibiae in vivo. Seven-pattern and four-pattern resolution imaging were performed on tiger vertebra using CRCT, UHRCT, and micro-CT, and on human tibiae using UHRCT. We measured six microarchitectural parameters: volumetric bone mineral density (vBMD), trabecular bone volume fraction (bone volume/total volume, BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), and connectivity density (ConnD). Comparisons between different imaging resolutions were performed using Tukey or Dunnett T3 test. RESULTS: The vBMD, BV/TV, Tb.N, and ConnD parameters showed an increasing trend, while Tb.Sp showed a decreasing trend both ex vivo and in vivo. Ex vivo, UHRCT at the two highest resolutions (1024- and 2048-matrix imaging with 0.25-mm slice thickness) and CRCT showed significant differences (p ≤ 0.047) in vBMD (51.4 mg/cm3 and 63.5 mg/cm3 versus 20.8 mg/cm3), BV/TV (26.5% and 29.5% versus 13.8 %), Tb.N (1.3 l/mm and 1.48 l/mm versus 0.47 l/mm), and ConnD (0.52 l/mm3 and 0.74 l/mm3 versus 0.02 l/mm3, respectively). In vivo, the 512- and 1024-matrix imaging with 0.25-mm slice thickness showed significant differences in Tb.N (0.38 l/mm versus 0.67 l/mm, respectively) and ConnD (0.06 l/mm3 versus 0.22 l/mm3, respectively). CONCLUSIONS: We observed characteristic trends in microarchitectural parameters and demonstrated the potential utility of applying UHRCT for microarchitectural analysis.

DOI： 10.1186/s41747-019-0135-0

PubMed

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Language：Japanese   Publisher：(株)全日本病院出版会  

関節リウマチ(RA)手の障害は、スワンネック変形・ボタン穴変形・尺側偏位など多彩であり、一つの手に複数の変形が混在している。その中でも、中手指節(MCP)関節は早期から罹患率が高く関節変形が生じやすく、進行例ではシリコン製インプラントによるMCP人工関節置換術での良好な成績が報告されている。当院では、MCP人工関節置換術に対しては、スタンダードパスを用いて術後療法を行っている。しかし、RA手指においては隣接関節の障害や伸筋腱皮下断裂を伴っていることも多く、進行例の変形では必要に応じて追加手術が同時に実施される。本稿では、通常のMCP人工関節置換術からスワンネック変形・ボタン穴変形・若年者の関節変形の術後リハビリテーションについて概説する。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本関節病学会  

当院でRA(関節リウマチ)に対しMCP関節人工関節置換術を施行した72例(手術時平均年齢61.8歳±11.9歳)を対象に、術中に手関節背側部の腱剥離術を要した症例について検討した。その結果、術中に手関節背側部の腱剥離術を要した症例は12例(16.7%)であった。更に手関節部での手術歴を有している症例では、15例中6例(40.0%)で術中に腱剥離術の追加が必要であった。手関節手術歴のある例ではEDCの癒着が多い傾向にあり、手術歴のない例では全例でEDMの癒着がみられた。腱剥離(+)群、腱剥離(-)群ともにHAND20、DASHは術後改善傾向を示し、改善量は両群間で有意差は認められなかった。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本臨床リウマチ学会  

RA診療における外科的治療として、2006年以降より肩・肘・股・膝関節の人工関節の手術件数は減少傾向にあるなか、手・足の手術件数は増加傾向にあった。術後リハビリテーション医療を行う際には、術前・術後に執刀医と綿密な連携をとることや、病棟看護師との連携の必要性が報告されている。本稿では、当院での作業療法士の立場からみた他職種連携について紹介する。当院での外科的治療におけるリハビリテーション医療は入院から外来と長期間に渡って行われ、計画的に入院中の術前評価から外来での術後3ヵ月・6ヵ月・1年と定期的に評価を行い患者の状況把握に努めている。入院期間中は主治医と手術に対して共通認識がもてるように、整形外科手術カンファレンス・回診、症例報告、超音波検査によって連携をとっている。また、上肢・手の手術でも移動能力に問題があれば、リハ医・理学療法士と、入院中のADLに関しては、病棟看護師と連携している。また、退院後も各術式による時期別の機能回復を意識しながら、術後評価を行い主治医と連携しながらフォローアップしている。多職種間で意思疎通しやすい環境構築を意識しながら診療を行うこが重要である。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the prevalence of and risk factors for the progression of upper cervical lesions (UCLs) in patients with rheumatoid arthritis (RA). A retrospective analysis of 49 patients with RA (4 males, 45 females) was conducted. The UCLs included atlanto-axial subluxation and vertical subluxation. We investigated the clinical factors including the Disease Activity Score 28 based on C-reactive protein (DAS28-CRP) and the modified Health Assessment Questionnaire-Disability Index as well as radiographic changes between the baseline (at May 2010 to April 2013) and final follow-up. Forty patients (81.6%) were classified as the non-progressive group, and the other 9 patients (18.4%) comprised the progressive group. The progressive group's final CRP values, baseline or final MMP-3 levels, DAS28-CRP, and rate of pre-existing lesions at baseline were all significantly higher than those of the non-progressive group (p=0.017, p=0.043, p=0.002, p=0.008, p<0.001, and p=0.008 respectively). A multivariate logistic regression analysis demonstrated that DAS28-CRP at baseline was a risk factor for radiographic progression (p=0.018, odds ratio: 2.54, 95% confidence interval: 1.17-5.51). Our findings indicate that higher disease activity might influence the progression of UCLs in patients with RA.

DOI： 10.18926/AMO/56866

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Language：Japanese   Publisher：日本運動器科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The incidence rate of bladder rupture associated with pelvic ring fractures is reported to be about 5-10%, mostly occurring at the time of injury. Fragility pelvic ring fractures are reported to increase fracture displacement or become nonunion if they are treated inadequately. Few case reports on bladder rupture associated with fragility pelvic ring fracture have been published. We report a rare case of delayed bladder rupture associated with a fragility fracture of the pelvis. A 65-year-old female felt right hip pain without sustaining any trauma. She was diagnosed with a right pubic rami fracture. However, her pain deteriorated, and a sacral fracture was identified one month later. She was prescribed teriparatide, but her pain worsened and she was referred to our hospital. She was diagnosed with fragility fracture of the pelvis (Rommens classification type IVb) and was treated operatively. During the surgery, her thin bladder wall, which was compressed by a displaced pubic fragment, was torn and repaired. This is the first report describing a fragility fracture of the pelvis associated with a bladder rupture. Our treatment led to a successful result.

DOI： 10.1016/j.tcr.2019.100169

PubMed

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Authorship：Lead author   Language：Japanese   Publisher：(株)南江堂  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/14397595.2018.1427431

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although emerging evidence has suggested that computer-assisted navigation allows surgeons to plan the optimal level of resection without compromising the surgical margins, the precise accuracy of the procedures has been unclear. The aim of this study was to investigate the accuracy and safety of the musculoskeletal tumor resection using O-arm/Stealth intraoperative navigation assistance. METHODS: A retrospective study of six patients with bone and soft tissue tumors who underwent surgical resection using O-arm/Stealth navigation system was performed. The histological diagnosis was osteosarcoma, metastatic bone tumor, leiomyosarcoma, undifferentiated sarcoma, and synovial sarcoma, respectively. Tumor resection was performed according to planned osteotomy planes determined on O-arm/Stealth three-dimensional intraoperative images. The resection accuracy, length of time for the procedures, surgical margins, and perioperative complications were evaluated. RESULTS: The distances between the entry and exit points for the planned and actual cuts were 1.5 ± 0.3 mm and 2.3 ± 0.3 mm, respectively, and the mean discrepancy of the osteotomy angle was 2.8 ± 1.2°. The mean length of time required for navigation was 14 min. A histological examination revealed clear margins in all patients. There were no complications related to navigation, and no patients developed local recurrence during a mean follow-up of 30.6 months. CONCLUSIONS: The O-arm/Stealth intraoperative CT navigation system provides safe and accurate osteotomy in musculoskeletal tumor resections. However, surgeons should keep in mind and be careful of minimal errors during osteotomy, which are around 2 mm from the planned line.

DOI： 10.1016/j.jos.2018.06.012

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本リウマチリハビリテーション研究会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本リウマチリハビリテーション研究会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本足の外科学会  

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Authorship：Lead author   Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(一社)日本骨・関節感染症学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(公社)日本リハビリテーション医学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

＜画像診療のポイント＞●関節リウマチ診療においては、それぞれの画像検査の特徴と使いどころを知ることが重要である。●単純X線検査は最も基本的な画像検査であり、定期的に撮影すれば微小な変化の検出に役立つ。●MRIは骨髄浮腫や滑膜炎の診断が可能であるが、コストが高く造影剤投与が必要であるため、超音波検査との使い分けが必要である。●超音波検査は近年注目されている画像検査であり、外来で簡便に関節評価が可能であるため、使い方に習熟すべきである。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We investigated the clinical outcomes of resection and joint-preserving arthroplasty for forefoot deformities in patients with rheumatoid arthritis. METHODS: Sixteen feet of 14 women (average age, 67.1 years; range, 53-82) underwent resection arthroplasty of the metatarsal head (resection group), and 18 feet of 15 women (average age, 61.3 years; range, 40-73) underwent a metatarsophalangeal joint-preserving procedure with shortening oblique metatarsal osteotomies of the lesser toes (joint preservation group). The mean disease duration in the resection and joint preservation groups was 23.6 and 19.1 years, and the average follow-up period was 37.3 and 33.5 months, respectively. The classification of Larsen was used to assess the severity of destruction of the metatarsophalangeal (MTP) joint. Preoperative and postoperative clinical evaluation included Japanese Society for Surgery of the Foot (JSSF) score and postoperative complications. RESULTS: The number of preoperative radiographic destruction of the MTP joints (Larsen grade II, III, IV, and V) was 0, 29, 39, and 12 joints in the resection group and 13, 67, 9, and 1 joints in the joint preservation group. The mean JSSF score improved significantly from 61.3 to 83.9 points in the resection group ( P < .001) and from 62.2 to 90.8 points in the joint preservation group ( P < .001). In the resection group, recurrence of callosities and claw toe deformity was observed in 6 and 3 feet, respectively. In the joint-preserving group, recurrence of callosities and hammer toe deformity was observed in 1 foot each. CONCLUSION: The resection arthroplasty and joint-preserving procedure showed satisfactory clinical outcomes. However, whether both procedures can maintain the good clinical results without the recurrence of forefoot deformity will require longer follow-up. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

DOI： 10.1177/1071100717743996

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Authorship：Lead author   Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本関節病学会  

健常者8名(男性6名、女性2名、20歳代)を対象とし、2種類の計測法によって関節可動域(ROM)を計測した。理学療法士(PT)により角度計を用いて徒手的にROM計測を行った(徒手計測法)。考案した新しい計測法として、3Dスキャナーによって体表の撮像を行い、そこから得られた三次元データを用いてコンピューター上でROM計測を行った(3Dスキャナー計測法)。被験者ごとのROMの標準偏差は、全ての関節肢位において3Dスキャナー計測法では徒手計測法と比較し検者間における標準偏差は有意に小さかった。平均最大測定値差は、標準偏差と同様に全ての関節肢位において3Dスキャナー計測法では徒手計測法と比較して有意に小さかった。徒手計測法、3Dスキャナー計測法の級内相関係数(ICC)は、全ての関節において3Dスキャナー計測法のほうが高く、検者間誤差は小さかった。平均計測時間は、肘関節、足関節ともに3Dスキャナー計測法のほうが有意に計測に時間を要した。

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To investigate whether janus kinase (JAK) inhibitor exhibits a chondro-protective effect against mechanical stress-induced expression of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) and matrix metalloproteinase (MMPs) in human chondrocytes. MATERIALS AND METHODS: Normal human articular chondrocytes were seeded onto stretch chambers and incubated with or without tofacitinib (1000 nM) for 12 h before mechanical stimulation or cytokine stimulation. Uni-axial cyclic tensile strain (CTS) (0.5 Hz, 10% elongation, 30 min) was applied and the gene expression levels of type II collagen α1 chain (COL2A1), aggrecan (ACAN), ADAMTS4, ADAMTS5, MMP13, and runt-related transcription factor 2 (RUNX-2) were examined by real-time polymerase chain reaction. Nuclear translocation of RUNX-2 and nuclear factor-κB (NF-κB) was examined by immunocytochemistry, and phosphorylation of mitogen-activated protein kinase (MAPK) and signaling transducer and activator of transcription (STAT) 3 was examined by western blotting. The concentration of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α in the supernatant was examined by enzyme-linked immunosorbent assay. RESULTS: COL2A1 and ACAN gene expression levels were decreased by CTS, but these catabolic effects were canceled by tofacitinib. Tofacitinib significantly down-regulated CTS-induced expression of ADAMTS4, ADAMTS5, MMP13, and RUNX2, and the release of IL-6 in supernatant by chondrocytes. Tofacitinib also reduced CTS-induced nuclear translocation of RUNX-2 and NF-κB, and phosphorylation of MAPK and STAT3. CONCLUSION: Tofacitinib suppressed mechanical stress-induced expression of ADAMTS4, ADAMTS5, and MMP13 by human chondrocytes through inhibition of the JAK/STAT and MAPK cascades.

DOI： 10.1007/s00011-017-1083-x

PubMed

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00282&link_issn=&doc_id=20170323100003&doc_link_id=10.18885%2FJ00282.2017203068&url=https%3A%2F%2Fdoi.org%2F10.18885%2FJ00282.2017203068&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the long-term clinical results of total elbow arthroplasty (TEA) by cementless fixation of alumina ceramic unlinked elbow prostheses (J-alumina ceramic elbows: JACE) for the reconstruction of elbow joints with rheumatoid arthritis (RA). Seventeen elbows in 17 patients (aged 44-72 years, average 54.8) replaced by JACE TEA without bone cement were investigated. The average follow-up period was 10.7 (range, 1.0-19.3) years. Clinical conditions of each elbow before and after surgery were assessed according to the Mayo Elbow Performance Index (MEPI). Radiographic loosening was defined as a progressive radiolucent line of more than 1 mm that was completely circumferential around the intramedullary stem. The average MEPI significantly improved from 46.8 points preoperatively to 66.8 points at final follow-up (p=0.0226). However, aseptic loosening was noted in 10 of 17 elbows (58.8%) and revision surgery was required in 7 (41.2%). Most loosening was observed on the humeral side. With radiographic loosening and revision surgery defined as the end points, the likelihoods of prosthesis survival were 41.2% and 51.8%, respectively, up to 15 years by Kaplan-Meier analysis. The clinical results of JACE implantation without bone cement were disappointing, with high revision and loosening rates of the humeral component.

DOI： 10.18926/AMO/54824

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Language：English   Publishing type：Research paper (scientific journal)  

The metatarsophalangeal (MTP) joints are often and predominantly affected in rheumatoid arthritis. The aim of the current study was to describe surgical techniques of shortening oblique osteotomy for lesser metatarsal bone with screw fixation at the osteotomy site, and to investigate the short-term clinical outcomes of our procedure. Twenty-seven feet (78 toes) of 24 RA patients underwent the shortening oblique osteotomy for the correction of deformity at the lesser MTP joints. The average Japanese Society of Surgery of the Foot (JSSF) standard rating system for the RA foot and ankle scale improved significantly from 59.6 points preoperatively to 88.3 points postoperatively (p＜0.001). Twenty-four feet (89% ) were free from metatarsalgia and symptomatic callosities at the lesser MTP joint after surgery. Our present findings showed satisfactory early clinical outcomes of the shortening oblique osteotomy of the metatarsal bone with screw fixation for RA forefoot.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本小児整形外科学会  

小児上腕骨顆上骨折は、小児肘関節周囲骨折の中で最も高頻度に発生し、合併症が多い疾患である。上腕骨顆上骨折後にVolkmann拘縮を来した1例を経験したので報告する。7歳男児、ジャングルジムより墜落して受傷。前医で上腕骨顆上骨折と診断され、当日創外固定術を施行された。術後徐々に手指の屈曲傾向が進行し、当科紹介となった。Volkmann拘縮と診断し、装具加療や徹底したリハビリの後、屈筋腱解離術を施行した。手術所見としては、屈筋群深層筋線維に変性像を認め、正中・尺骨神経剥離術、屈筋群剥離・前進術を施行した。術後6ヵ月時、DIP関節の屈曲拘縮が残存するも全指伸展位保持可能となり、術後7年時生活に支障のない状態まで回復した。小児上腕骨顆上骨折の合併症であるVolkmann拘縮は、重篤な後遺症を残す。本骨折に対していかなる治療方法を選択しても、阻血性障害への注意が重要である。(著者抄録)

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Although a 0.3 Bangerter filter, which reduces visual acuity, is frequently used for treating moderate amblyopia, the effects on gross stereopsis are not well known. This study quantitatively evaluated whether gross stereopsis is degraded by a Bangerter filter. Seven healthy subjects (median age: 29 years) participated in this psychophysical study. Targets with crossed disparities of 1°, 2°, 3°, 4°, and 5° were randomly presented on a three-dimensional television display. The subjects indicated the point at which the targets popped out from the television screen (matching method). The distance from the screen to the point was defined as the degree of stereopsis. This experiment was performed with and without a 0.3 Bangerter filter. The corrected monocular visual acuities were decreased to about 20/63 by the filter in all subjects. No significant difference was observed for any of the disparities (1°-5°), between the degree of stereopsis visualized with and without filters for either the dominant or the non-dominant eye. The degree of stereopsis was not degraded by the reduced visual acuity induced by the use of 0.3 Bangerter filters. In this regard, the use of 0.3 Bangerter filters may be considered safer than occlusion eye patches for the patients with normal binocular vision.

PubMed

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本人工関節学会  

症例は発熱を主訴とする69歳女性で、右股関節痛が増悪、歩行困難となり前医に入院した。血液培養にて大腸菌が検出され、股関節の切開洗浄、デブリードマン、セメントビーズ留置が行われた。しかし、右股関節痛は軽快せず、X線像では末期股関節症の状態で、前医において後方アプローチから骨頭切除し、セメントビーズ留置が行われた。骨頭切除6週間後に人工股関節置換術を施行した。後方アプローチでセメントビーズを抜去して再度郭清し、ナビゲーション下に抗菌薬含有セメントCobalt G-HVを用いてセメントカップを設置、ステムを挿入した。術後は神経麻痺などの合併症はなく、術後6ヵ月には屋内は杖なし歩行可能で、X線上は問題なく、JOAスコアは術前12点から64点に改善した。

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本関節病学会  

人工肩関節置換術を行った15例16肩(全例女性、平均70.6歳)の治療成績について検討した。疾患は変形性肩関節症5肩、関節リウマチ11肩、観察期間は平均3.0年であった。平均値でJOAスコアは39.9点→80.3点、上肢障害評価表(DASH)は70.1点→56.0点、肩関節可動域は屈曲が68.7度→104度、伸展が37度→69度、外転が52度→82度、外旋が15度→36度、内旋が高位臀部→L3高位に改善した。X線学的評価では弛みやコンポーネントの脱転をきたした症例はなかった。腱板の状態はintact:5肩、thin:8肩、torn:3肩であり、腱板機能残存群(intact)と腱板機能不全群(thin・torn)に分けた成績は、JOAスコアの各項目の改善度に有意差はなく、可動域では残存群で屈曲、外転、外旋が不全群に比べ有意に改善度が高かった。Acromio-head distanceは不全群で術後に狭小化する傾向であった。術前DASHと術後JOAスコアとの間に強い負の相関を認めた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05177&link_issn=&doc_id=20150113270009&doc_link_id=130005145710&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130005145710&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本関節病学会  

関節リウマチに対しSwansonおよびAVANTAインプラントを用いてMP人工指関節置換術を行い、半年以上経過観察し得た34例118指について治療成績を検討した。Swanson群は48指、AVANTA群は70指であった。治療成績として、MP関節可動域、握力、ピンチ力、health assessment questionnaire、Hand20、Disabilities of the Arm, Shoulder and Handを調査した。また、画像評価として、インプラント周囲の骨透亮像と硬化像を計測し、更に尺側偏位、破損等についても検討を行なった。その結果、術後の臨床成績においてAVANTA群が優れる傾向にあったが、明らかな有意差はなかった。インプラント破損をSwanson群の3指に認めたが、シリコンインプラントの耐久性として経過観察期間(Swanson群60.7±20.5ヵ月、AVANTA群21.3±9.1ヵ月)の影響が考えられた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05177&link_issn=&doc_id=20140813110010&doc_link_id=130005093433&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130005093433&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: We aimed to evaluate the early clinical results of the reconstruction of problematic elbow joints due to rheumatoid arthritis (RA) using a PROSNAP linked elbow prosthesis (Kyocera Medical, Osaka, Japan) for total elbow arthroplasty. METHODS: Seventeen elbows in 14 RA patients were replaced with a PROSNAP elbow with cement fixation. The patients comprised 1 man and 13 women, with a mean age of 63.9 years (range, 52-83 years) at the time of surgery. The preoperative conditions of the elbows were arthritis mutilans (n = 10), an ankylosed or stiff elbow with a preoperative range of motion of 45° or less (n = 4), and loosening of a primary total elbow arthroplasty (n = 3). The mean follow-up period was 47.7 months (range, 32-69 months), with a 100% follow-up rate. The clinical outcome of the elbows was evaluated by the Mayo Elbow Performance Index (maximum, 100 points). RESULTS: The mean postoperative Mayo Elbow Performance Index score improved from 57.6 points to 97.1 points. Preoperatively, 3 of the 17 elbows were judged as good, 7 as fair, and 7 as poor; at final follow-up, 16 elbows were judged as excellent and 1 as good. Complications were noted in 1 elbow (6%), which had undergone a postoperative fracture. CONCLUSIONS: The PROSNAP elbow prosthesis can be safely implanted through a relatively easy procedure and provides satisfactory short-term clinical outcomes for the reconstruction of severely damaged RA elbows. LEVEL OF EVIDENCE: Level IV, case series, treatment study.

DOI： 10.1016/j.jse.2013.12.031

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本リウマチリハビリテーション研究会  

当院で2009年4月?2012年7月にTEA(全人工肘関節置換術)を施行したRA患者のうち術後約1年経過している24例を対象とし、術前後でROM(伸展・屈曲・arc)とDASHスコアを比較した。結果、術前のROMは伸展が-36.7±21.6°、屈曲が112.9±34.6°、arcが76.3±40.7°、術後は伸展-27.3±13.9°、屈曲130.6±13.7°、arc103±20.5°であり、3指標とも有意に改善していた。DASHスコアは術前56.9±19.7、術後44.2±24.5で有意に改善していた。術前後のROM変化率とDASH変化率との相関性について検討した結果、屈曲・arcはDASHと有意な相関を示し、伸展は有意な相関を示さなかった。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本リウマチリハビリテーション研究会  

当院で2009?2012年にMP人工指関節置換術を施行したRA患者のうち術後6ヵ月以上観察しえた26例を対象とし、術前後の「Hand20」「DASH」「HAQ」スコアについて調査した。結果、Hand20は術前49.4±23.2、術後42.4±18.5、DASHは術前39±18.3、術後33.3±16.9、HAQは術前0.8±0.6、術後0.9±0.6であった。Hand20の項目別にみると、術前平均値と術後平均値の変化量が1以上の項目は[両手で洗顔する][わるい方の手でコインを拾う][わるい方の手で蛇口をひねる][両手で髪を洗う][わるい方の手を人前に出しても美容的に気にならない]であった。DASHの項目別にみると、術前後の変化量が0.5以上の項目は[重労働の家事をする][ベッドメーキングまたは布団を敷く][肩・腕や手に筋力を必要とするか、それらに衝撃のかかるレクリエーション活動をする][腕を自由に動かすレクリエーション活動をする][腕・肩・手の障害のために、自分の能力に自信がないとか、使いづらいと思っている]であった。

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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DOI： 10.3109/14397595.2013.874758

PubMed

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(有)科学評論社  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

当院では、仙腸関節脱臼骨折および仙骨骨折に対しiliosacral(IS)screwを挿入する場合、3Dナビゲーションを使用しており、その安全性について検討した。2011年4月?2012年12月の期間、IS screw手技を用いた5症例(男性2例、女性3例)・7本を対象とした。平均年齢は43歳であった。全例、術後1週以内にCTでスクリュー位置を調査した。セッティング時間を除いた挿入時間は1本につき平均20分であった。全例、脊柱管・神経管への迷入や前方骨皮質穿破はなく、スクリュー位置は良好であった。通常透視下でのIS screw挿入は、神経管への迷入や前方骨皮質穿破などの危険があり、安全性には限界がある。3DナビゲーションでのIS screw挿入は、被曝量を軽減しつつ、脊柱管・神経管を確認しながらスクリュー挿入方向と深度を決定でき、正確で安全性が高く有用であった。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メディカ出版  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J05810&link_issn=&doc_id=20131120160002&doc_link_id=40019898364&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40019898364&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：(一社)日本関節病学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)ライフ・サイエンス  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

CT撮影した平均年齢86.2歳の日本人解剖屍体下腿28肢のデータを、脛骨近位外側骨形状を中心に計測し、脛骨近位外側用プレートと比較検討した。脛骨近位外側カーブ形状には様々なバリエーションが存在し、その中でも典型パターンと非典型パターンが存在した。また5種類の脛骨近位外側用プレートと比較すると、どのプレートも合わない脛骨近位外側カーブ形状も存在した。脛骨近位外側カーブ形状にはバリエーションが多く、単一の脛骨近位外側用プレートですべての脛骨近位外側カーブ形状に対応することは不可能である。プレートの設置不良が予想される場合、プレートベンディングや三次元テンプレートはその対策として有用と考える。(著者抄録)

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Most blood vessels contain elastin that provides the vessels with the resilience and flexibility necessary to control hemodynamics. Pathophysiological hemodynamic changes affect the remodeling of elastic components, but little is known about their structural properties. The present study was designed to elucidate, in detail, the three-dimensional (3D) architecture of delicate elastic fibers in small vessels, and to reveal their architectural pattern in a rat model. The fine vascular elastic components were observed by a newly developed scanning electron microscopy technique using a formic acid digestion with vascular casts. This method successfully visualized the 3D architecture of elastic fibers in small blood vessels, even arterioles and venules. The subendothelial elastic fibers in such small vessels assemble into a sheet of meshwork running longitudinally, while larger vessels have a higher density of mesh and thicker mesh fibers. The quantitative analysis revealed that arterioles had a wider range of mesh density than venules; the ratio of density to vessel size was higher than that in venules. The new method was useful for evaluating the subendothelial elastic fibers of small vessels and for demonstrating differences in the architecture of different types of vessels.

DOI： 10.1017/S1431927612014341

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本手外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)先端医学社  

関節リウマチ(RA)の診断治療において、単純X線による関節病変の評価はその所見に特徴的なものが多く、また病態を反映していることなどもあり有用なツールとして広く使用されている。しかし、生物学的製剤の導入を契機に早期診断また治療効果、寛解評価のための鋭敏な検査が必須となり、単純X線のlimitationのためMRIや超音波検査など他のmodalityとの併用が提唱されている。早期診断には不向きであるが、網羅的評価に長けること、reproducibleであるなど利点も多いため単純X線の見方や評価法について熟慮しておく必要がある。多種の評価法が報告されており、どの評価法を用いるかについては各検査法の長所短所を考慮し、目的に応じた評価法の選択を検討する必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J06167&link_issn=&doc_id=20130423530009&doc_link_id=40019656669&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40019656669&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本創外固定・骨延長学会  

症例1(52歳男性)。作業中に鉄板が左足部に落ちて受傷した。X線所見より第一楔状骨粉砕を伴うリスフラン関節脱臼骨折と診断され、受傷当日に緊急手術を行い、創外固定術を施行した。だが、受傷後1ヵ月で創壊死と感染を生じたため、骨欠損部にセメントビーズを使用し感染を鎮静化した後、骨移植と有茎皮弁を行い、最終手術後6ヵ月で骨癒合が得られた。症例2(24歳男性)。交通事故にて受傷し、X線所見より第一楔状骨粉砕を伴うリスフラン関節脱臼骨折と診断され、整復徒手とシーネ固定を行い、受傷後10日で手術を施行した。術中に創外固定を併用して整復後、ロッキングプレートによる架橋プレート固定を行なったところ、術後4ヵ月で骨癒合が得られた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本創外固定・骨延長学会  

脛骨遠位部骨折に対し一時的創外固定を併用してstaged operationを行った33例の治療成績について検討した。平均年齢は59歳で、骨折型はAO分類で43のAタイプが9例、Bタイプが6例、Cタイプが18例で、うち開放骨折が10例であった。その結果、受傷?最終固定までの平均期間は13.3日、最終固定までに要した軟部組織再建は有茎皮弁が2例、遊離皮弁が1例、植皮が1例であった。6ヵ月以内に31例で骨癒合が得られたが、1例は遷延癒合、1例は深部感染から足関節固定を要した。尚、staged operation終了後の合併症は術後皮膚壊死2例、minor infectionを含む感染が3例であった。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

【目的】当科では鎖骨骨幹部骨折に対し、CT画像を元にプレベンディングしたプレートを用いたMIPO法を行い、良好な結果を得ている。遠隔地の小規模施設でも同様の手術を行うため、クラウドサーバー経由でのCTの編集画像を転送し、作成したプレートを当該施設に輸送して手術を行うシステムを構築した。【方法】健側鎖骨のCT画像からプレベンディング用の画像データを作成する。手術を行う施設で画像処理を行い、クラウドサーバーに匿名化した編集画像を転送する。データを元に当院でプレートをプレベンディングし、当該施設に輸送し、手術を行った。【結果】当該施設でのデータ編集は30分で可能であった。編集後の画像データ量は大幅に削減でき、ネットワーク上での転送に支障はなかった。【結論】当科と手術を行う病院でクラウドサーバーを構築し、低コストでカスタムメイドインプラント作成ネットワークを作り、大学病院の手術方法を他院で実現できた。(著者抄録)

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Language：Japanese   Publisher：日本最小侵襲整形外科学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)南江堂  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J04037&link_issn=&doc_id=20121102340033&doc_link_id=issn%3D0287-1645%26volume%3D31%26issue%3D62%26spage%3D175&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0287-1645%26volume%3D31%26issue%3D62%26spage%3D175&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：中国・四国整形外科学会  

著者らが経験した外傷による足部骨髄炎5例(男性4例、女性1例、平均年齢37歳)の治療成績について検討した。部位は踵骨が4例、楔状骨が1例で、治療は全例で手術治療と抗生剤投与が行われた。起因菌はMSSAが2例、MRSAが3例で、MRSAの1例は真菌との混合感染であった。感染沈静化までの期間は平均9.6ヵ月で、最終的には全例鎮静化が得られ、感染治療に続発する合併症や皮膚トラブルは特にみられなかった。尚、手術回数は平均3.2回で、自家骨移植した3例はいずれも骨癒合が得られていた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02438&link_issn=&doc_id=20121003210001&doc_link_id=130005127524&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130005127524&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

下腿骨幹部骨折術後非感染性偽関節の治療にはインプラント選択を含めた再内固定方法、骨欠損および変形への対処法など様々な問題点が存在する。当科で経験した5例を検討した。全例男性、手術時平均年齢は46歳、偽関節タイプおよび前回手術法は肥厚型3例(プレート固定1例、血管柄付き骨移植2例)、萎縮型2例(創外固定1例、髄内釘固定1例)。偽関節手術法は、髄内釘固定および髄内釘入れ替えを2例、ロッキングプレート固定を3例に実施し、偽関節部新鮮化・骨移植を4例、部分腓骨切除を併用した変形矯正を3例に行った。全例に骨癒合が得られ、矯正位は良好であった。本偽関節に対しては、適切な手術手技による髄内釘入れ替えを第一選択とし、血管柄付き骨移植後などの髄腔狭小・閉鎖例にはロッキングプレート固定を第二選択として適応し、変形や骨欠損に対する部分腓骨切除や自家骨移植などの併用により治療成績の向上が期待できる。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本股関節学会  

観血的治療を施行したfemoroacetabular impingement患者2例(症例1:34歳男、症例2:22歳男)において、術前のCTデータより3Dボーンモデルを作成し、それを参考にして臼蓋側と大腿骨側のトリミングを行った。術前のボーンモデルにおける関節可動域は外転0°回旋0°における最大屈曲角度が症例1で77°、症例2が73°であり、外転0°屈曲60°における最大内旋角度はそれぞれ20°、10°であった。術後に作成したボーンモデルによる関節可動域は最大屈曲角度が症例1で80°、症例2が76°、最大内旋角度はそれぞれ28°、14°であった。術後の両症例平均角度は屈曲で3°、内旋で5°改善した。X線評価ではCE角が術前平均37°から27°、α角は69°から43°となった。両症例とも術後6週時には可動域は術前と同程度に回復しており、安静時痛は消失してインピンジメントテストは陰性であった。術後3ヵ月からの負担の軽いスポーツ活動を許可している。

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10165-012-0599-8

PubMed

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

【目的】当院では骨折症例に対してCT画像をもとに健側鏡像の立体模型か実寸大の左右反転図を作成し、プレベンディングを行っている。この方法は骨の左右差が少ないことを前提としているが、どの程度骨の左右差があるかは不明であった。そこでCADソフトを用いてCT画像を三次元的に比較するシステムを構築し、プレベンディング法を最も利用している鎖骨を対象に左右差を検討した。【方法と対象】解剖実習で摘出した屍体の左右の鎖骨16対をCTで撮影し、CADソフトを用いて三次元的な左右差を検討した。【結果】骨幹部のカーブ形状に左右差は少なかったが、径の左右差は認められた。【考察】径の左右差はあるがカーブ形状に左右差はなかったため、鎖骨に関してプレベンディングは有用であると考えられた。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)日本評論社  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(公社)日本整形外科学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J01133&link_issn=&doc_id=20120608230005&doc_link_id=40019341553&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F40019341553&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

脛骨遠位部骨折、とりわけpilon骨折は関節内骨折の中でも治療に難渋し未解決の多い骨折である。今回我々が経験したpilon骨折を単純X線とCTにて評価し、その特徴につき検討した。症例は66例で、17?89歳(平均55歳)である。AO分類でB1が6例、B2が5例、B3が9例、C1が8例、C2が10例、C3が21例であった。腓骨骨折の形態分類が内反変形22例、外反変形25例、intact 12例であった。腓骨骨折が外反変形・intactでは、内反変形よりCTによる評価でcoronal family fracturesのY-type、V-typeに分類されるものが多くみられた。本研究により、単純X線写真と関節面の骨折型、および腓骨骨折の有無が骨折の重傷度を評価する一助となり、今後の手術治療アプローチ選択、固定法選択に有用である可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

寛骨臼複合骨折に対してmodified Stoppa approachにlateral windowを併用した前方単独進入(以下、MS+LW)による整復固定術の治療成績につき検討した。対象は24例で、骨折型は両柱:19例、前柱+半横:3例、T型:2型であった。全例MS+LWにて進入したが3例にmiddle windowの追加が必要であった。Quadrilateral surfaceのbuttress plate固定を20骨折、lag screw固定を4骨折に施行した。平均術中出血量は1593mlで、平均手術時間は4時間24分であった。術後X線評価は平均step offは0.9mm、平均gapは1.4mmで、anatomical:14例、imperfect:9例、poor:1例であった。6ヵ月以上経過観察しえた症例のJOA hip scoreは平均88点であった。術中合併症は外腸骨静脈損傷1例、閉鎖動脈損傷1例であった。術後合併症は閉鎖神経不全麻痺:4例、外腸骨動脈血栓形成1例、坐骨神経麻痺:1例、関節内スクリュー誤挿入1例、術後再転移1例などであった。本アプローチの利用は前方単独進入では従来整復困難であった転位の大きい後柱成分の整復固定が直視下に施行可能で有用である。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)インナービジョン  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：日本創外固定・骨延長学会  

症例1は33歳男で、圧挫の強い右下腿骨折に対し、創外固定術を施行した。受傷後2週に髄内釘へconversionを行ったが、受傷後2ヵ月で感染拡大により髄内釘抜去し、創外固定術を再施行した。さらに2回抗菌薬含有セメントビーズ交換を行うも感染は沈静化せず、脛骨遠位部は骨欠損状態となった。受傷後3ヵ月でデブリドマンおよび抗菌薬含有セメント髄内釘挿入、イリザロフ創外固定にて再固定した。感染が沈静化したため骨延長を行い、ドッキング部に骨移植を行った。術後2年6ヵ月、感染の再発はなく、独歩可能である。症例2は18歳女で、交通事故にて骨欠損を伴う右下腿開放骨折を受傷し、抗菌薬含有セメントビーズ充填と創外固定術を施行した。その後、軟部欠損部に対してsural flapにて被覆した。受傷後2ヵ月時、骨欠損部に腸骨より骨移植、イリザロフ創外固定を施行したところ、術後7ヵ月で骨癒合を認めた。

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Language：Japanese   Publisher：日本創外固定・骨延長学会  

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Language：Japanese   Publisher：日本肘関節学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

CT画像を基に作成した三次元実体石膏模型を用いて、寛骨臼骨折の術前計画を行った。使用するプレートの設定位置を決定し、術前にベンディングした。2例の寛骨臼骨折(37歳男性、左寛骨臼骨折AO分類:62-A3。53歳男性、左骨盤輪骨折および右寛骨臼骨折AO分類:61-C1+62-B2)に対し、術前にベンディングしたプレートを使用し、良好な結果を得た。三次元実体石膏模型は、術前計画において画像からの把握(視覚的情報)のみならず、立体像の把握(触覚的情報)を得ることができる。手術に有用な情報が得られ術者を助けるばかりでなく、術前にチーム間で骨盤立体構造をディスカッションすることで、立体解剖の認識が高まり、教育の面でも有用である。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)全日本病院出版会  

保存治療が基本とされてきた鎖骨骨折であるが、現代のニーズも加わり手術治療が選択されることが増加してきた。従来より鎖骨骨折に対する様々な手術治療法が存在するが、手術侵襲や固定性などのすべてにおいて満足できる治療法は存在しなかった。我々が行っている鎖骨骨折に対するminimally invasive plate osteosynthesis(以下、MIPO法)は、健側CT撮像、プレベンディングといった術前計画・準備を要するが、小皮切からロッキングプレートを挿入・スクリュー固定することで比較的良好な解剖学的整復位ならびに固定性が獲得され、同時に骨折部のbiabilityは温存されやすいため骨癒合においても有利である。術後早期に社会復帰が可能でもある鎖骨骨折に対するMIPO法は、従来の観血的プレート固定法と保存治療のメリットを併せ持ち、かつ両者のデメリットを最小限にとどめることが可能な優れた治療法である。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

【目的】CT画像から作製された三次元実体模型が手術に利用されるようになった。しかし、発注が煩雑で作製時間が長いことが問題であった。当院では作製過程に医師が加わることで作業効率を改善し、骨折などの緊急症例に対応可能な院内発注システムを構築したので報告する。【方法】当院には三次元プリンターが設置されており、歯科技工士が実体模型を作製していた。医師がCTデータから領域抽出を行いDICOMデータとして保存したものを、作製期限を設けてデータを蓄積し、作製期限に間に合うように一度にまとめて作製するシステムを構築した。【結果】作業効率が改善され緊急作製に対応可能となった。2009年度は緊急作製を必要とした骨折症例7例で48時間以内にプレベンディング用の健側骨の左右反転模型を作製した。【結語】領域抽出と作製を分離することで作製効率が向上し、緊急症例に対応可能となった。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

63歳女。転倒後に歩行困難となった。8年前よりアレンドロネート服用中で、先行する鼡径部?大腿部痛の訴えはなく、単純X線写真では左大腿骨骨幹部短斜骨折(AO32-A3)と骨皮質の肥厚、髄腔の狭小化を認めた。受傷後4日目に髄内釘挿入術を行った際、近位骨折部と遠位骨折部に皮質骨による閉鎖を認めたため、閉鎖部の骨組織を除去して髄内釘を挿入した。病理組織像に骨回転の上昇や低下を示唆する所見はなく、超音波骨折治療を行うも術後8ヵ月経過時点で骨癒合は得られていない。本症例ではビスホスホネート製剤の長期内服により骨代謝が抑制され、骨皮質の肥厚と骨質の脆弱性からmicrofractureの蓄積と髄腔の閉鎖をきたし、低エネルギー外傷により大腿骨骨幹部骨折を生じたと考えられた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

Roof impactionを伴う寛骨臼骨折3例の手術治療について検討した。本所見に伴う骨折型は前壁骨折1例、前柱骨折2例であった。前壁骨折に伴う1例に対してはilioinguinal approachの2nd windowから前壁骨片を翻転し陥没骨片を直視下に整復した。前柱骨折に伴う2例に対してはmodified Stoppa approachにlateral windowを併用し、1例は陥没骨片直上の骨折部から整復を、1例は骨片直上を開窓し整復した。いずれも内固定および人工骨充填によるsubchondral supportを行った。全例整復位・臨床評価ともに概ね良好な成績を得たが、うち1例はアプローチ選択に課題が残った。Roof impactionの存在は成績不良因子とされるが、個々の症例における術前の詳細な評価、アプローチ選択および整復固定法の工夫により治療成績の改善が期待できる。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：岡山医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.

DOI： 10.1007/s10165-011-0426-7

PubMed

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：日本リウマチの外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

53歳男。身長172cm、体重100kgで、2型糖尿病のためインスリンコントロールを受けていた。泌尿器科で膀胱癌に対し膀胱全摘出術を施行され、体位は砕石位で、手術時間は10時間、出血量2370mlであった。硬膜外麻酔併用下であったが、抜管後より左下腿の強い疼痛と腫脹を認めたため当科紹介となった。筋区画圧を測定したところ、前方コンパートメントが43mmHgと高値で、コンパートメント症候群と診断した。直ちに筋膜減張切開術を施行し、術直後より足趾の背屈が可能となった。血液学的検査所見ではCKが術翌日6452IU/L、3日目942IU/Lと漸減した。術後3ヵ月で左下腿に軽度のしびれを残していたが、筋力は完全に回復した。

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

高エネルギー外傷に伴う骨盤・寛骨臼骨折症例20例(平均年齢45歳)を対象に、周術期に造影CTによる下肢静脈血栓症/肺塞栓症 (DVT/PE)スクリーニングを施行し、その有用性を検討した。受傷機転は交通事故9例、高所からの転落9例、その他2例、治療の内訳は観血的整復固定術14例、創外固定のみ2例、保存的治療4例であった。造影CT施行は受傷後平均9.8日であった。その結果、DVT/PEを9例認めた。DVTは6例で、5例が総腸骨静脈から膝窩静脈の近位型、1例が膝窩静脈より末梢の遠位型であった。 PEは6例で、4例が主幹肺動脈から区域動脈の中枢型、2例が亜区域動脈以降の末梢型であった。DVT/PEの治療は9例に抗凝固療法、1例にIVCフィルター挿入を施行し、重大な副作用を生じた症例はなかった。リスク因子では、DVT/PEの有無で年齢、BMI、D-dimer値等についてMann-Whitney U testによる比較を行ったが、両群間に有意差はなかった。以上より、DVT/PEの検索に造影CTが有用と考えられた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メディカ出版  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

寛骨臼骨折を伴った外傷性股関節脱臼(中心性脱臼を除く)の治療成績と問題点につき検討した。対象は26例で受傷時平均年齢は47歳であった。寛骨臼骨折の骨折型は後壁18例、後柱+後壁1例、横+後壁5例、T型+後壁1例、前壁1例であった。坐骨神経麻痺合併3例であった。脱臼は1例を除き受傷当日に徒手整復した。骨頭骨折を8例に合併し、marginal impactionは13例に認めた。手術アプローチは後方単独18例(6例にtrochanteric flip osteotomy施行)、前方単独3例(うち2例は骨頭骨折のみ固定)、前方+後方3例であった。術後合併症として大腿骨頭壊死を7例(うち3例が圧潰)、異所性骨化3例、変形性関節症2例、深部感染1例に認めた。本損傷においては骨頭骨折の整復固定の要否、手術アプローチの選択、高率な合併症など未解決な問題が数多く存在する。本研究においても骨頭壊死など合併症発生率は高率であった。骨頭骨折に対しては前方アプローチあるいはtrochanteric flip osteotomyの併用を考慮すべきともされ、手術アプローチの選択が今後の検討課題である。(著者抄録)

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Language：Japanese   Publisher：日本結合組織学会・マトリックス研究会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)先端医学社  

関節リウマチ(rheumatoid arthritis:RA)の早期診断・早期治療の重要性が広く認識されるようになった。しかし、米国リウマチ学会(American College of Rheumatology:ACR)による1987年のRA分類基準は、早期RAに対する感度が十分ではないという問題があった。そこで、「早期にRAを診断しメトトレキサート(MTX)を開始することで、関節破壊の進行を阻止する」ことを目的に、2010年ACR/欧州リウマチ学会(European League Against Rheumatism:EULAR)RA分類基準が発表された。1つ以上の関節腫脹を認め、原因がRA以外に認められない症例を対象としている。本稿では、この新分類基準について概説する。(著者抄録)

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

症例1:63歳女。橈骨遠位端骨折(AO分類21-A3、背側転位型)に対する掌側プレート固定後2年10ヵ月で母指の屈曲障害が出現した。X線では骨折部のアライメントは良好で、プレートの浮き上がり、スクリューの突出もなかった。抜釘時、遠位列外側2穴目のscrew hole部分の露出とFPLの完全断裂を確認した。症例2:86歳女。橈骨遠位端骨折プレート固定後3年10ヵ月で示指DIP屈曲困難が出現した。CTでプレートはwatershedlineを超えない位置であった。術中所見でプレートは遠位列が露出し、FPLとII指FDSが部分断裂、II指FDPは完全断裂であった。症例3:74歳女。橈骨遠位端骨折プレート固定後7年6ヵ月で母指の屈曲障害が出現した。X線ではプレートの浮き上がりやスクリューの突出は認めなかった。抜釘時、FPLの完全断裂とII指FDPの部分断裂、断裂部直下でのプレート、screw holeの露出を認めた。全例にPLを使用した腱移植術を行った。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨・関節感染症学会  

骨折治療後に生じた長管骨骨髄炎に対して抗菌薬含有セメント髄内釘または抗菌薬含有セメントロッドによる治療を行った7例の成績を報告した。男性6例、女性1例、年齢16?81歳、罹患部位は大腿骨5例、脛骨2例、起因菌はMRSAが6例、不明1例であった。治療成績は6例(86%)で感染の沈静化が得られ、治療開始時に骨癒合していなかった5例中3例(60%)で骨癒合が得られた。代表例1例を提示した。

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s10165-010-0321-7

PubMed

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)南江堂  

2007年より鎖骨骨幹部骨折に対してプレート固定による手術的治療を行った症例は42例であった。そのうち、初期の32例に対してはanteroinferior plating法(AP法)を、2009年からの10例は、AP法を応用したminimally invasive plate osteosynthesis法(MIPO法)を施行した。AP法、MIPO法ともに全例において骨癒合が得られ、JOAスコア、DASHスコアともに良好な改善が得られた。MIPO法はAP法に比較して、早期に疼痛の軽減が得られている印象であった。AP法は従来の手術法に比べて早期に社会復帰が可能となる有用な方法であるが、さらにMIPO法はAP法のメリットに加えて整容面や骨折部の血流温存といった面でも有利であり、手術・保存的治療双方のメリットを併せ持つ優れた治療法であると考えられた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：ライフサイエンス出版(株)  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：中国・四国整形外科学会  

2005?2008年に当科と関連施設で下肢長管骨非感染性偽関節に対してロッキングプレートによる治療を行った15例の成績を報告した。男性7例、女性8例、手術時年齢21?82歳、手術部位は大腿骨骨幹部2例、大腿骨遠位部3例、脛骨近位部7例、脛骨骨幹部2例、脛骨遠位部1例であった。偽関節の種類はhypertrophic non-unionが9例、atrophic non-unionが6例であった。手術では14例に自家骨移植を併施した。治療成績は全例で骨癒合が得られた。術直後から最終観察時までのアライメント変化の度合いは、単純X線正面像で平均1.13°(0?10°)、側面像で平均0.35°(0?5°)であり、ほとんどの症例で良好なアライメントが維持されていた。術後合併症として遷延治癒を5例(33%)、矯正損失を1例(7%)に認め、感染や皮膚壊死などの軟部組織合併症は認めなかった。合併症を認めた6例中4例がatrophic non-unionであった。

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Language：Japanese   Publisher：(一社)日本肩関節学会  

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Language：Japanese   Publisher：(一社)日本肩関節学会  

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Language：Japanese   Publisher：(一社)日本肩関節学会  

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Language：Japanese   Publisher：岡山医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

NCB distal femurプレートを用いて治療を行った大腿骨遠位部骨折5例の治療成績について検討した。AO分類はA1が2例、A2、A3、C2が各1例であった。その結果、1)骨癒合期間は平均22週、関節可動域は伸展平均3°、屈曲平均119°であった。2)Neerの評価基準による治療成績評価ではexcellentが1例、satisfactoryが2例、unsatisfactryが2例であった。3)術後合併症は遷延癒合を1例に認められた。尚、Femoral angleは術直後平均83.0°、最終観察時平均82.8°、Lindahl's angleは術直後平均39.4°、最終観察時平均39.8°と術後アライメントは良好に維持されていた。

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：Japanese   Publisher：(一社)日本骨折治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We developed two new radiographic parameters-the humeral surface height ratio and ulnar surface height ratio-to precisely detect changes in the bony structure of rheumatoid elbows. Of the 59 patients with rheumatoid arthritis, 101 elbows were classified into four types (osteoarthritis, ankylosis, erosive, and resorptive) according to the radiographic appearance. Clinically, osteoarthritis type and ankylosis type were considered to be stable form, and erosive type and resorptive type were unstable form. Patients' clinical data and yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio were compared among the four types and between the two forms. There were significant differences between the two forms and among the three types except for the ankylosis type in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio. Stable and unstable forms were distinguished by a cut-off point of 0.65 and 2.58 in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and the ulnar surface height ratio, respectively. These parameters might be useful for monitoring the structural changes of the elbow joint in rheumatoid arthritis.

DOI： 10.1007/s10067-010-1381-y

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

Femoroacetabular impingement (FAI) is a condition characterized by the impingement of the femur and acetabulum. In Japan, this disorder has become recognized gradually. Here we report a rare case of surgically treated FAI, associated with an osseous protrusion on the acetabulum of a 30-year-old female. Plain computed tomography (CT) and reconstructive 3D-CT images clearly demonstrated an anterolateral bony protrusion. Hip arthroscopy showed no degeneration of the cartilage on either the femoral or acetabular side, but degeneration at the edge of labrum was observed in the region of the bony protrusion. The complete removal of the bony protrusion under hip arthroscopy was thus considered impracticable, and a small skin incision was therefore made anteriorly to approach the acetabulum. The Short-Form 36-Item Health Survey (SF-36) revealed improvement in all scores.

PubMed

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Language：Japanese   Publisher：中国・四国整形外科学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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Language：Japanese   Publisher：(一社)日本リウマチ学会  

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Language：Japanese   Publisher：(公社)日本整形外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)南江堂  

ダブルプレートで治療した脛骨近位部骨折19例(平均61歳)の成績を報告した。骨折型はAO分類41-A3が1例、C2が3例、C3が15例で、開放骨折は2例であった。初期治療として10例に膝関節架橋創外固定を施行し、ダブルプレート時の皮切は前外側と後内側に分離して作成した。術後観察期間3?30ヵ月で、骨癒合期間は平均14.2週であった。平均膝関節可動域は伸展-2.4°、屈曲133.9°で、Holh & Luckの解剖学的評価はexcellent 12例、good 6例、fair 1例、機能的評価はexcellent 15例、good 4例であった。X線学的評価でtibial angleは術直後平均91.9°から最終時92.1°に、tibial plateau angleは7.4°から7.2°となり、5°以上のアライメント変化を起こした症例はなかった。術直後の整復位不良は2例、関節面step off残存は4例、関節面再陥没は2例に認めたが、感染・創離開・創壊死などはなかった。追加手術は1例でスクリュー入れ替えを行った。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J04037&link_issn=&doc_id=20091015480030&doc_link_id=issn%3D0287-1645%26volume%3D28%26issue%3D56%26spage%3D179&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0287-1645%26volume%3D28%26issue%3D56%26spage%3D179&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：中国・四国整形外科学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)全日本病院出版会  

関節リウマチ(RA)に対する治療ガイドラインが策定され、生物学的製剤の登場やメトトレキサートの積極的使用により、早期診断、薬効評価における画像診断の重要性が大きくなりつつある。MRI画像によって得られるRAに特徴的な所見としては、滑膜炎、骨びらん、骨髄浮腫、腱鞘滑膜炎などがあり、補助診断としてRAを早期に診断し、予後不良因子などをもとに治療法を決定し、寛解・薬剤中止を目指すためのツールとしてのエビデンスが蓄積されつつある。早期診断においてはfalse positiveの除外を含めた正しい評価方法を知ることが重要であり、薬効判定においては滑膜体積や最大造影速度などを用いた定量的判定が求められている。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)へるす出版  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)メジカルビュー社  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

著者らは踵骨関節内骨折に対し、後距踵関節面を外側小切開して直視下に整復固定し、関節外アライメントについては間接的に再建する観血的整復固定術を施行してきた。今回、過去4年間に経験した37症例(平均年齢56.8歳)40足を対象に治療成績を検討した。検討項目はBoehler角、Preiss角、後距踵関節面の転位で、それぞれ受傷時、手術直後、最終調査時に測定し臨床成績と比較した。観察期間平均9.3ヵ月の結果、1)臨床成績は34例が成績良好で、合併症としてはpin刺入部感染が1例に認められた。2)治療成績に相関を認めた因子は、受傷時のBoehler角と後距踵関節面の転位、および最終調査時の後距踵関節面の転位であった。3)術前評価としてBoehler角と後距踵関節面の転位は予後予測因子であり、手術においては後距踵関節面の解剖学的整復を得ることが重要であると考えられた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

Locking compression plate(LCP)にてminimally invasive plate osteosynthesis(MIPO)法を施行した下腿遠位部骨折の治療成績を検討した。対象はLCPを用いてMIPO法で治療した下腿遠位部骨折19例(男性10例、女性9例、平均年齢65.3歳)で、受傷機転は転倒8例、転落5例、交通事故4例、その他2例であった。骨折型はAO分類で43-A1:2例、A2:4例、B1:2例、B3:1例、C1:3例、C2:2例、C3:5例で、全例でLCPを用いてMIPO法にて固定し、術後経過観察期間は平均11ヵ月であった。1)受傷から最終手術まで平均12.4日、骨癒合期間は平均15.4週、最終時の関節可動域は背屈平均17.0°、底屈平均41.7°であった。2)Burwellの評価基準ではgood:17例、fair:2例で、主観的評価は全例good、客観的評価はgood:16例、fair:3例であった。3)X線では関節面の2mm以上のstep offは認められなかったが、1例に5°以上のmalalignment、3例に遷延癒合がみられた。尚、術後合併症は表層感染2例、皮膚壊死1例が確認された。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

仙骨骨折を伴う骨盤輪損傷4例に対してM-shaped pelvic plateを用いた内固定術を行い、その術後成績について検討した。全例女性で、年齢は平均33.5歳、骨折型はAO分離でB2.1、B3.2、C2.3、C3.3が各1例であった。経過観察期間平均13ヵ月の結果、1)最終調査時、術後整復位の喪失を1例に認めたが、全例で骨癒合は得られた。2)術後1例にDVTを合併し抗凝固療法による加療を行ったが、感染や術後神経麻痺を生じた症例はなかった。3)Majeedスコアは96点満点で平均81点で、Anatomical gradingはexcellentが2例、fairが1例、poorが1例であった。4)患者側の因子としては臀部軟部組織の状態に注意が必要と考えられた。また、Mプレートのよい適応はC1.3、C2.3の仙骨骨折を含む骨折で、転位は少ないもしくは術前に矯正可能な症例が望ましいと考えられた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J00496&link_issn=&doc_id=20081017140014&doc_link_id=10026128157&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F10026128157&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

脛骨遠位部骨折に対してプレート固定術を行った28例の成績を報告した。男性14例、女性14例、年齢14?85歳(平均59.3歳)、骨折型はAO分類で43-A1 4例、A2 5例、B1 2例、B2 1例、B3 2例、C1 5例、C2 2例、C3 7例であった。手術では、軟部組織状態の悪い(または悪化が予想される高エネルギー外傷)の症例に対しては2期的に施行した。2期的手術の基本的な方法は、初回手術で腓骨の再建と最小侵襲の関節面整復・固定および脛骨の創外固定を行い、最終固定術では、可能であればMIPOを施行し、関節面の整復に大きな展開が必要な場合にはMIPOにこだわらず整復・固定を行った。2期的手術は11例に施行し、そのうち初回手術で腓骨の再建を行ったのは10例であった。治療成績は、Burwellの評価基準で解剖学的評価がgood 24例、fair 4例、主観的評価がgood 24例、fair 4例、客観的評価がgood 25例、fair 2例、poor 1例であった。X線学的評価では、5?10°のmalalignmentを2例、関節面の2mm以上のstep offを2例に認めた。術後合併症として遅延性の表層感染を2例、深部感染を1例に認めた。代表例として、2期的手術を行い成績良好であった症例と不良であった症例を各1例提示した。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(株)南江堂  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

脛骨骨幹部骨折に対する髄内釘固定(Tightly fitted unreamed nailing:TUN)の治療成績を報告した。対象は2004年以降にTUNを行った脛骨骨幹部骨折32例33肢(男性26肢、女性7肢、平均年齢48.7歳)であった。骨折型はAO分類でA1:3肢、A2:8肢、A3:5肢、B1:4肢、B2:9肢、B3:2肢、C2:1肢、C3:1肢で、うち開放骨折は18肢(Gustilo分類でI:2肢、II:7肢、IIIa:8肢、IIIb:1肢)であった。1)髄腔占拠率は平均88.9%、術後骨折部のgapは平均1.3mmであった。2)骨癒合の時期は全体で平均18.5週(閉鎖骨折で平均14.7週、開放骨折で平均22.6週)であった。3)偽関節は4肢(12.1%)に発生し、インプラント折損を3肢(9.1%)に認めた。以上、TUNはこれらのことからも手術手技が簡略であり、stabilityを確保し、gapを極力小さくすることで良好な成績が得られると考えられた。

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本骨折治療学会  

Sacroiliac Plate(SI plate)を用いた仙腸関節脱臼骨折の治療成績を検討した。患者は男性5例、女性1例、平均年齢53.3歳で、骨折型はAO分類61-C1.2のa1(仙腸関節脱臼+腸骨翼骨折):4例、a3(仙腸関節脱臼+仙骨骨折):2例であった。経過観察期間は平均17.6ヵ月であった。創外固定装着までの時間は搬入1時間以内5例、搬入3時間後1例で、平均11.8日にConversionとしてSI plateによる内固定を行った。整復位とプレート設置位置に関連性を認め、回旋位設置例では骨折部のギャップが8.4mm、上方設置例では垂直方向の転位が7.8mmであった。残る4例の転位は5mm以下でプレート設置位置も良好であった。最終観察時のADLは元職復帰4例、家庭内自立1例、車椅子使用1例であった。SI plateは本症例に対して有用な治療法であるが、手術時5mm以上の転位があるとプレート設置位置が不良になりやすいと考えられた。

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本腹部救急医学会  

ベロ毒素を産生するO157感染性腸炎は極めて重篤な転帰をとることがある。われわれは頻回の下痢や血便がなく,腹部超音波検査でtarget sign様の像をきたしていたため,診断に苦慮したO157感染性腸炎の1例を経験した。症例は20歳男性。腹痛と軟便を主訴に来院した。FOMと整腸剤を処方されたが症状が改善しないため翌日に再来院した。右下腹部に腫瘤を触知し同部位に限局性の筋性防御があり,腹部超音波検査でtarget sign様の像があり,腹部CT検査で上行結腸の腸管壁が著明に肥厚していた。便検査からO157表面抗原陽性,便培養でベロ毒素(VT1,VT2)産生大腸菌を検出したため,O157感染性腸炎と診断した。頻回の下痢や血便などの激しい消化器症状がない場合でも,画像検査で限局性の著明な腸管壁の肥厚像があった場合には,O157感染性腸炎を考慮した検査や治療を行う必要がある。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)中部日本整形外科災害外科学会  

当科で標題の髄内釘固定を行った5例の成績を報告した。男性4例、女性1例、年齢は31?56歳、受傷機転は交通事故4例、墜落事故1例、骨折型(Seinsheimer分類)はIII A型2例、III B型1例、VI型1例、V型1例であった。手術方法は全例、骨折部を最低限展開し骨性構築を得て、cerclage wireなどで仮固定してから髄内釘を挿入した。仮固定に使用したワイヤーは術後骨片が転位しないようなら抜去し、転位する場合には体内に残した。術後観察期間6?12ヵ月(平均8.4ヵ月)で股関節可動域は屈曲120?135°(平均130°)、外転25?30°(平均29°)となった。2cm以上の脚長差を認めた症例やX線上インプラントの折損、整復位の喪失を認めた症例はなかった。全体重負荷を許可するまでの期間は10?16週(平均10.4週)、最終観察時のJOAスコアは66?95点(平均84点)であった。

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Language：English   Publishing type：Research paper (scientific journal)  

We investigated the expression and localization of the receptor activator nuclear factor κB ligand (RANKL) in cartilage from patients with rheumatoid arthritis (RA) of relevance to cartilage degeneration. We also examined the role of exogenous lymphotoxin (LT)-α on RANKL expression in human chondrocytes and its effect on in vitro osteoclast differentiation. Cartilage and synovial fluid samples were obtained from 45 patients undergoing total joint replacement surgery or joint puncture, including 24 patients with osteoarthritis (OA) and 21 patients with RA. RANKL expression in articular cartilage was examined by immunohistochemistry. LT-α concentrations in synovial fluid were measured using an enzyme-linked immunosorbent assay (ELISA). Normal human chondrocytes were stimulated with LT-α, and the relative mRNA levels of RANKL, osteoprotegerin (OPG), matrix metalloproteinase-9, and vascular endothelial growth factor were examined by real-time polymerase chain reaction. Soluble RANKL protein in culture media was measured using ELISA, and membrane-bound RANKL protein in cells was examined by western blotting. Co-cultures of human chondrocytes with peripheral blood mononuclear cells (PBMCs) were stimulated with macrophage-colony stimulating factor and LT-α, and osteoclast differentiation was evaluated by staining for tartrate-resistant acid phosphatase. LT-α concentrations were higher in RA synovial fluid than in OA samples. The population of RANKL-positive chondrocytes of RA cartilage was higher than that of OA cartilage, and correlated with cartilage degeneration. Stimulation of cultured human chondrocytes by LT-α increased RANKL expression, the RANKL/OPG ratio, and angiogenic factors. Membrane-bound RANKL in chondrocytes was up-regulated after stimulation of LT-α, whereas soluble RANKL in culture medium did not increase. Co-cultures of human chondrocytes and PBMCs demonstrated that LT-α stimulated human chondrocytes to produce RANKL and induced osteoclastic differentiation of PBMCs. RANKL produced by chondrocytes may contribute to cartilage destruction during RA and LT-α could promote the expression of RANKL in human chondrocytes.

DOI： 10.1371/journal.pone.0254268

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OBJECTIVE: To investigate the prevalence and the risk factors of surgical-site infection (SSI) and delayed wound healing (DWH) in patients with rheumatoid arthritis (RA) underwent orthopedic surgery. METHODS: We reviewed the records of 1036 elective orthopedic procedures undertaken in RA patients. Risk factors for SSI and DWH were assessed by logistic regression analysis using age, body mass index, disease duration, pre-operative laboratory data, surgical procedure, corticosteroid use, co-morbidity, and use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) as variables. RESULTS: SSI and DWH were identified in 19 cases and 15 cases, respectively. One case of SSI and three cases of DWH were recorded among 196 procedures in patients using bDMARDs. Foot and ankle surgery was associated with an increased risk of SSI (odds ratio (OR), 3.167; 95% confidence interval (CI), 1.256-7.986; p = 0.015). Total knee arthroplasty (TKA; OR, 4.044; 95% CI, 1.436-11.389; p = 0.008) and disease duration (OR, 1.004; 95% CI, 1.000-1.007; p = 0.029) were associated with an increased risk of DWH. CONCLUSIONS: Our results indicated foot and ankle surgery, and TKA and disease duration as risk factors for SSI and DWH, respectively. bDMARDs was not associated with an increased risk of SSI and DWH.

DOI： 10.3109/14397595.2015.1073133

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OBJECTIVES: To retrospectively investigate the clinical and radiographic results of partial arthrodesis for the wrists with rheumatoid arthritis (RA). METHODS: Forty-one wrists with RA were treated by radiolunate (RL) or radiolunotriquetral (RLT) arthrodesis with ulnar head resection. The average follow-up period after surgery was 7.1 years. Preoperative radiographs of all wrists were classified according to Schulthess classification. We performed RL arthrodesis for all Type II (n = 26) and Type III wrists (n = 7), and RLT arthrodesis for Type III wrists (n = 8). Pre- and postoperative pain score (visual analog scale), grip strength, range of motion, and radiographic parameters were statistically compared. RESULTS: Pain scores in all groups were significantly improved at final follow-up (P < 0.05). Grip strength increased from 5.9 to 12.4 (kg) significantly in Type II wrists (P < 0.01), from 7.2 to 9.1 in Type III wrists after RLT arthrodesis, but decreased from 6.9 to 6.0 in Type III wrists after RL arthrodesis. In all groups, the arc of pronation and supination improved significantly (P < 0.05), and all radiographic parameters improved. CONCLUSIONS: RL arthrodesis for Type II wrists showed satisfactory clinical results. RLT arthrodesis would be a reliable method in case of unstable wrist joint.

DOI： 10.3109/14397595.2015.1072293

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