研究者詳細 - 中田　英二

論文 - 中田　英二

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CCN3 (NOV) Drives Degradative Changes in Aging Articular Cartilage. 国際誌

Miho Kuwahara, Koichi Kadoya, Sei Kondo, Shanqi Fu, Yoshiko Miyake, Ayako Ogo, Mitsuaki Ono, Takayuki Furumatsu, Eiji Nakata, Takako Sasaki, Shogo Minagi, Masaharu Takigawa, Satoshi Kubota, Takako Hattori

International journal of molecular sciences 21 ( 20 ) 2020年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Aging is a major risk factor of osteoarthritis, which is characterized by the degeneration of articular cartilage. CCN3, a member of the CCN family, is expressed in cartilage and has various physiological functions during chondrocyte development, differentiation, and regeneration. Here, we examine the role of CCN3 in cartilage maintenance. During aging, the expression of Ccn3 mRNA in mouse primary chondrocytes from knee cartilage increased and showed a positive correlation with p21 and p53 mRNA. Increased accumulation of CCN3 protein was confirmed. To analyze the effects of CCN3 in vitro, either primary cultured human articular chondrocytes or rat chondrosarcoma cell line (RCS) were used. Artificial senescence induced by H2O2 caused a dose-dependent increase in Ccn3 gene and CCN3 protein expression, along with enhanced expression of p21 and p53 mRNA and proteins, as well as SA-β gal activity. Overexpression of CCN3 also enhanced p21 promoter activity via p53. Accordingly, the addition of recombinant CCN3 protein to the culture increased the expression of p21 and p53 mRNAs. We have produced cartilage-specific CCN3-overexpressing transgenic mice, and found degradative changes in knee joints within two months. Inflammatory gene expression was found even in the rib chondrocytes of three-month-old transgenic mice. Similar results were observed in human knee articular chondrocytes from patients at both mRNA and protein levels. These results indicate that CCN3 is a new senescence marker of chondrocytes, and the overexpression of CCN3 in cartilage may in part promote chondrocyte senescence, leading to the degeneration of articular cartilage through the induction of p53 and p21.

DOI： 10.3390/ijms21207556

【肉腫-基礎・臨床の最新知見-】肉腫の外科的治療切除ナビゲーションサージェリー

国定俊之, 中田英二, 長谷井嬢, 尾崎敏文

日本臨床 78 ( 増刊5 肉腫 ) 315 - 320 2020年10月

Early response of bone metastases can predict tumor response in patients with non-small-cell lung cancer with bone metastases in the treatment with nivolumab. 国際誌

Eiji Nakata, Shinsuke Sugihara, Yoshifumi Sugawara, Toshiyuki Kozuki, Daijiro Harada, Naoyuki Nogami, Ryuichi Nakahara, Takayuki Furumatsu, Tomonori Tetsunaga, Toshiyuki Kunisada, Toshifumi Ozaki

Oncology letters 20 ( 3 ) 2977 - 2986 2020年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

がんロコモ

中田英二, 尾崎敏文

臨床栄養 137 ( 2 ) 140 - 143 2020年8月

【がんロコモ:がん診療のニューフロンティア】(Part7)オートメーションのニューフロンティア(がんロコモ診療のオートメーション化) 脊椎転移による麻痺の予防レッドフラッグ

中田英二, 国定俊之, 杉原進介, 尾崎敏文

Bone Joint Nerve 10 ( 3 ) 447 - 457 2020年7月

整形トピックス骨肉腫に対する抗PD-1抗体の効果増強をめざした腫瘍融解ウイルス併用複合免疫療法の開発

望月雄介, 田澤大, 出宮光二, 久禮美穂, 長谷井嬢, 中田英二, 国定俊之, 浦田泰生, 藤原俊義, 尾崎敏文

整形外科 71 ( 7 ) 786 - 786 2020年6月

【整形外科臨床研究の手引き-適切に行い,正しく読み解くために】臨床研究の準備と適正実施臨床研究の資金の獲得

中田英二, 尾崎敏文

整形外科 71 ( 6 ) 685 - 687 2020年5月

記述言語：日本語出版者・発行元：(株)南江堂

＜文献概要＞はじめに国民の健康を増進・維持するためには,疾病に対する有効な診断法,治療法,予防法のシーズ探索から臨床開発に向けた臨床研究がきわめて重要である.医療分野の研究開発には多額の費用が必要であり,研究資金の獲得が欠かせない.臨床研究は公的資金だけでなく,企業の寄附金や助成金を使用して行われているものも多い.本稿では,これらの臨床研究の資金の提供を行っている組織の事業について紹介する.

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00764&link_issn=&doc_id=20200605260036&doc_link_id=10.15106%2Fj_seikei71_685&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_seikei71_685&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

【脊椎脊髄疾患に対する分類・評価法】(第5章)腫瘍脊椎腫瘍のWeinstein-Boriani-Biagini分類

三澤治夫, 中田英二, 尾崎敏文

脊椎脊髄ジャーナル 33 ( 4 ) 409 - 412 2020年4月

記述言語：日本語出版者・発行元：(株)三輪書店

＜文献概要＞はじめに Weinstein-Boriani-Biagini分類(WBB分類)は,原発性脊椎腫瘍を腫瘍学的に取り扱うために考案された分類である.四肢の骨軟部腫瘍に対してはAJCC(the American Joint Committee on Cancer)のTNM分類やEnneking分類が使用されることが多く,病期や術式の選択,実際の切除縁など決定して治療成績が報告されてきた.脊椎腫瘍に対する根治的切除としての椎体切除は1971年にStenerらが報告している.当時,腫瘍学的な原則に基づいた治療方法の選択のために統一された基準はなく,切除という言葉は論文ごとに別の意味で使用されていた.この問題点に対しEnneking分類を巨細胞腫などの原発性脊椎腫瘍に適応させようという試みが行われ,1997年にWBB分類が提唱された.腫瘍学的に不十分あるいは不適切な切除により局所再発が増加し,生存期間が短くなるというエビデンスがあり,脊椎腫瘍においても腫瘍学的な選択を十分考慮すべきである.本稿ではWBB分類について述べる.

Multidisciplinary treatment system for bone metastases for early diagnosis, treatment and prevention of malignant spinal cord compression. 国際誌

Eiji Nakata, Shinsuke Sugihara, Yoshifumi Sugawara, Ryuichi Nakahara, Takayuki Furumatsu, Tomonori Tetsunaga, Toshiyuki Kunisada, Kazuo Nakanishi, Yoshiteru Akezaki, Toshifumi Ozaki

Oncology letters 19 ( 4 ) 3137 - 3144 2020年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

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

乳がん術後患者におけるリハビリテーション介入の実施による短期間の推移 1症例の検討

菊内祐人, 明崎禎輝, 中田英二, 冨永律子, 黒河英彰, 濱田麻紀子, 濱田和範, 大倉三洋, 青儀健二郎, 大住省三, 杉原進介

保健医療学雑誌 11 ( 1 ) 40 - 47 2020年4月

記述言語：日本語出版者・発行元：保健医療学学会

本研究では,乳がん術後患者を対象に入院中のリハビリテーション介入および退院後の自宅での運動療法指導の実施による肩関節可動域,体組成,Quality of lifeの推移について1症例を対象に検討した.症例は40代の女性で乳がん診断後,当院にてリンパ節郭清を伴う乳房切除術を施行した.肩関節屈曲,外転の関節可動域は,術後1週,1ヵ月で低下を認めたが,術後2ヵ月で改善を示した.体脂肪量,体脂肪率は,退院後2ヵ月まで増加傾向であった.術側上肢筋量は,術後1週と比較して術後1ヵ月では低下を示し,術後2ヵ月では改善傾向を示したが,術後1週よりも低値であった.Quality of lifeは症状尺度の全ての項目が,術後2ヵ月経過後も改善を認めなかった.これらのことから,乳がん術後患者のリハビリテーションでは,上肢機能に加えて体組成,Quality of lifeについて評価し適切に介入する必要性が示唆された.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J06406&link_issn=&doc_id=20200422360006&doc_link_id=10.15563%2Fjalliedhealthsci.11.40&url=https%3A%2F%2Fdoi.org%2F10.15563%2Fjalliedhealthsci.11.40&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Risk factors for early postoperative psychological problems in breast cancer patients after axillary lymph node dissection.

Yoshiteru Akezaki, Eiji Nakata, Masato Kikuuchi, Ritsuko Tominaga, Hideaki Kurokawa, Makiko Hamada, Kenjiro Aogi, Shozo Ohsumi, Shinsuke Sugihara

Breast cancer (Tokyo, Japan) 27 ( 2 ) 284 - 290 2020年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The purpose of this study was to investigate the factors related to early postoperative psychological conditions in breast cancer patients with axillary lymph node dissection 3 months after the surgery. METHODS: The subjects of this study were 200 consecutive patients who underwent axillary lymph node dissection for breast cancer at our hospital. Age, body mass index, surgical side, work, marriage, presence of children, presence of co-resident household members, resection of the pectoralis minor muscle, preoperative chemotherapy, postoperative chemotherapy, postoperative hormonal therapy, postoperative radiotherapy, shoulder range of motion, upper limb function (Disabilities of the Arm, Shoulder and Hand; DASH), and psychological conditions were evaluated. In this study, a Distress and Impact Thermometer was used to classify patients with adjustment disorders, depression, or major depression and suicidal ideation into a group with psychological problems and the remaining patients into a group with no psychological problems. RESULTS: Logistic regression analysis showed that only DASH was statistically significantly associated with psychological conditions (p < 0.05). Using receiver operating characteristic curve analysis, a DASH score of 18 or greater was found to be very specific for predicting psychological conditions. CONCLUSIONS: The observation that somatic symptoms and disability of upper limb function are related to psychological conditions may indicate the importance of postoperative rehabilitation in breast cancer patients with axillary lymph node dissection.

DOI： 10.1007/s12282-019-01020-y

骨肉腫X線画像の読影を目指した人工知能の開発

長谷井嬢, 中田英二, 国定俊之, 尾崎敏文

日本CAOS研究会・日本最小侵襲整形外科学会プログラム・抄録集 14回・26回 135 - 135 2020年3月

Factors Affecting the Discharge Destination of Patients With Spinal Bone Metastases. 国際誌

Yoshiteru Akezaki, Eiji Nakata, Masato Kikuuchi, Shinsuke Sugihara

Annals of rehabilitation medicine 44 ( 1 ) 69 - 76 2020年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To investigate the factors affecting the discharge destination of patients with spinal bone metastases. METHODS: We reviewed the medical records of patients admitted to our institute with a diagnosis of skeletalrelated events secondary to malignant disease. Exclusion criteria comprised decreased cognitive function and hypercalcemia, brain metastasis, peritoneal dissemination, and pleural dissemination. The factors examined included the discharge destination, age, sex, the Barthel Index (BI) at admission and discharge, pain at admission and discharge, number of co-resident household members, length of hospital stay, treatment strategy, spinal instability neoplastic score, vertebral body collapse, spinal level of bone metastases, and motor paralysis. For the discharge destination, patients at discharge were grouped into two categories. The home group included patients discharged to their own homes, and the non-home group included patients discharged to other hospitals. RESULTS: Of 140 patients, the home group comprised 120 patients and the non-home group comprised 20 patients. Activities of daily living (ADL) and pain at rest and during motion improved significantly in the home group, whereas only pain at rest and during motion improved significantly in the non-home group. The results indicated that discharge BI and motor paralysis were the best predictors of the discharge destination; a BI cut-off value of 72.5 predicted discharge to home. CONCLUSION: This study showed that the ADL level on discharge and motor paralysis affected the discharge destination of patients with spinal bone metastases. These results are likely to be helpful in predicting the discharge destination of patients with spinal bone metastases.

DOI： 10.5535/arm.2020.44.1.69

Bilateral Anterior Cruciate Ligament Tear Combined with Medial Meniscus Posterior Root Tear.

Takaaki Hiranaka, Takayuki Furumatsu, Yoshiki Okazaki, Yusuke Kamatsuki, Shin Masuda, Yuki Okazaki, Shota Takihira, Shinichi Miyazawa, Eiji Nakata, Toshifumi Ozaki

Acta medica Okayama 73 ( 6 ) 523 - 528 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

The case of an individual with a bilateral anterior cruciate ligament (ACL) tear combined with a medial meniscus (MM) posterior root tear is described. A 34-year-old Japanese man with bilateral ACL rupture that occurred > 10 years earlier was diagnosed with bilateral ACL tear combined with MM posterior root tear (MMPRT). We performed a transtibial pullout repair of the MMPRT with ACL reconstruction. The tibial tunnels for the MM posterior root repair and ACL reconstruction were created separately. Postoperatively, a good clinical outcome and meniscal healing were obtained. Our surgical technique may thus contribute to anatomical MM posterior root repair and ACL reconstruction.

DOI： 10.18926/AMO/57717

Transtibial Pullout Repair Reduces Posterior Extrusion of the Medial Meniscus.

Shin Masuda, Takayuki Furumatsu, Yoshiki Okazaki, Yusuke Kamatsuki, Yuki Okazaki, Yuya Kodama, Takaaki Hiranaka, Eiji Nakata, Toshifumi Ozaki

Acta medica Okayama 73 ( 6 ) 495 - 501 2019年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Medial meniscus posterior root tear causes rapid knee cartilage degradation by inducing posteromedial displacement of the medial meniscus. We evaluated medial meniscus posterior extrusion before and after pullout repair for medial meniscus posterior root tear using magnetic resonance images. Twenty-eight patients with symptomatic medial meniscus posterior root tear were included. The inclusion criteria were: acute (< 3 months) or chronic (≥3 months) medial meniscus posterior root tear after painful popping events. The exclusion criteria were: other meniscus and anterior cruciate ligament injuries. We measured medial meniscus posterior extrusion and medial meniscus anteroposterior interval at knee flexion angles of 10° and 90° preoperatively and at 3 months postoperatively. The posterior extrusion at 90° knee flexion decreased from 4.42±1.38 mm preoperatively to 3.09±1.06 mm (p<0.001) postoperatively, while at 10° knee flexion it was -4.17±1.63 mm preoperatively and -3.77±1.72mm postoperatively, showing no significant change. The anteroposterior interval at 10° knee flexion increased from 19.74±4.27 mm preoperatively to 22.15±5.10 mm postoperatively (p<0.001); at 90° knee flexion, it increased from 16.81±4.51 mm preoperatively to 19.20±4.30 mm postoperatively (p<0.001). Medial meniscus posterior extrusion and movement decreased after pullout repair. Pullout repair for medial meniscus posterior root tear improves medial meniscus posterior extrusion, especially at 90° knee flexion.

DOI： 10.18926/AMO/57713

【スポーツ診療における画像診断-医療安全上必要なコツと落とし穴-】スポーツ外傷・障害と間違えやすい病変

尾崎敏文, 中田英二, 長谷井嬢, 国定俊之

関節外科 38 ( 11 ) 1142 - 1150 2019年11月

記述言語：日本語出版者・発行元：(株)メジカルビュー社

スポーツを活発に行う年齢層が骨・軟部腫瘍の好発年齢と一致しているため,スポーツ外傷や障害と骨・軟部腫瘍との鑑別診断は重要である。それらの病変のなかには,(1)偶然発見されたX線像に写った無症候性の病変,(2)疼痛などの症状を伴い骨腫瘍疑いと紹介されてきたが骨腫瘍ではなかった病変,そして(3)骨腫瘍疑いで紹介されてきて真の治療を要する骨腫瘍であった症例などがある。スポーツ外傷・障害を診断するうえで骨腫瘍の知識は重要であるが,それに加えて,外傷,骨折,炎症性疾患など整形外科疾患全般の基本知識も重要である。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00282&link_issn=&doc_id=20191025090004&doc_link_id=10.18885%2FJ00282.2020041696&url=https%3A%2F%2Fdoi.org%2F10.18885%2FJ00282.2020041696&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

Posttraumatic cartilage degradation progresses following anterior cruciate ligament reconstruction: A second-look arthroscopic evaluation.

Takaaki Hiranaka, Takayuki Furumatsu, Yusuke Kamatsuki, Kazuhisa Sugiu, Yoshiki Okazaki, Shin Masuda, Yuki Okazaki, Shota Takihira, Shinichi Miyazawa, Eiji Nakata, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 ( 6 ) 1058 - 1063 2019年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Several studies have demonstrated that posttraumatic knee osteoarthritis progresses even after anterior cruciate ligament reconstruction. Few reports described zone-specific cartilaginous damages after anterior cruciate ligament reconstruction. This study aimed to compare the status of articular cartilage at anterior cruciate ligament reconstruction with that at second-look arthroscopy. METHODS: This study included 20 patients (20 knees, 10 males and 10 females, mean age 22.4 years, Body mass index 24.4 kg/m2) that underwent arthroscopic anatomic double-bundle anterior cruciate ligament reconstruction and second-look arthroscopy. Mean periods from injury to reconstruction and from reconstruction to second-look arthroscopy were 3.4 and 15.3 months, respectively. Cartilage lesions were evaluated arthroscopically in the 6 articular surfaces and 40 articular subcompartments independently, and these features were graded with the International Cartilage Repair Society articular cartilage injury classification; comparisons were made between the grades at reconstruction and at second-look arthroscopy. Furthermore, clinical outcomes were assessed at reconstruction and at second-look arthroscopy, using the Lysholm knee score, Tegner activity scale, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, side-to-side difference of the KT-2000 arthrometer, and pivot shift test. RESULTS: Each compartment showed a deteriorated condition at second-look arthroscopy compared with the pre-reconstruction period. A significant worsening of the articular cartilage was noted in all compartments except the lateral tibial plateau and was also observed in the central region of the medial femoral condyle and trochlea after reconstruction. However, each clinical outcome was significantly improved postoperatively. CONCLUSIONS: Good cartilage conditions were restored in most subcompartments at second-look arthroscopy. Furthermore, posttraumatic osteoarthritic changes in the patellofemoral and medial compartments progressed even in the early postoperative period, although good knee stability and clinical outcomes were obtained. Care is necessary regarding the progression of osteoarthritis and the appearance of knee symptoms in patients undergoing anterior cruciate ligament reconstruction.

DOI： 10.1016/j.jos.2019.08.001

がん診療×整形外科「がんロコモ」がんロコモにおける骨軟部腫瘍専門医の役割

中田英二, 尾崎敏文

臨床整形外科 54 ( 10 ) 1023 - 1029 2019年10月

記述言語：日本語出版者・発行元：(株)医学書院

＜文献概要＞骨軟部腫瘍専門医ががんロコモ予防のため取り組むべき課題として,骨転移の取り組み,がんのリハビリテーションなどがあげられる.筆者らは,骨転移に対する体系的な診療システムを構築し,麻痺の予防に取り組んだ.麻痺予防のために最も重要な対処法は,脊椎転移部に痛みが出現した場合,早急に画像検査を行い,痛みの原因と考えられる椎体破壊や脊髄圧迫を認めた場合,早急に治療(放射線治療など)を行うことである(Red flag).また,多職種連携チーム医療が重要であり,カンファレンスで情報を共有し,医療従事者の早期介入によりADLを向上させることが重要である.

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01554&link_issn=&doc_id=20191017170012&doc_link_id=10.11477%2Fmf.1408201488&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408201488&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

Temporary External Fixation Can Stabilize Hip Transposition Arthroplasty After Resection of Malignant Periacetabular Bone Tumors. 国際誌

Toshiyuki Kunisada, Tomohiro Fujiwara, Joe Hasei, Eiji Nakata, Masuo Senda, Toshifumi Ozaki

Clinical orthopaedics and related research 477 ( 8 ) 1892 - 1901 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The choice of reconstructive procedure to restore limb function is challenging after internal hemipelvectomy. Hip transposition arthroplasty, also known as resection arthroplasty, removes a malignant or aggressive tumor of the pelvis and acetabulum after which the remaining femoral head is moved proximally to the lateral surface side of the sacrum or the underside of the resected ilium after internal hemipelvectomy. It may provide reasonable functional results and have some advantages such as lowering the risk of an infected implant compared with other reconstructions because no foreign implants are used. Hip transposition is generally managed with prolonged bed rest or immobilization postoperatively to stabilize the soft tissue surrounding the remaining femur. Because enabling patients to be mobile while the soft tissues heal might be advantageous, we reviewed our experience with an external fixation for this procedure. QUESTIONS/PURPOSES: (1) Does temporary external fixation facilitate postoperative physiotherapy in patients who undergo hip transposition arthroplasty? (2) What functional Musculoskeletal Tumor Society (MSTS) scores were achieved at short term in a small series of patients treated with hip transposition and temporary external fixation? (3) What were the complications of using external fixation in a small series of patients who received it for malignant tumors? METHODS: Between 2008 and 2012, we treated seven patients (three men and four women; median age, 37 years; age range, 18-53 years) with acetabular resection for malignant bone tumors; all were managed with a hip transposition, initially stabilized using external fixation. No other types of procedures were used for this indication in this period. Minimum followup in this retrospective study was 45 months, except for one patient who died at 18 months (range of followup duration, 18-90 months; median followup, 57 months), and no patients were lost to followup. The pins for external fixation were inserted into the affected side of the femur and the healthy contralateral ilium. External fixation was removed 6 weeks postoperatively and weightbearing was started at that time. Preoperative chemotherapy was administrated in four patients, but postoperative chemotherapy was delayed since it was given after external fixation removal in three patients. The postoperative rehabilitation course and functional results were assessed by chart review, functional results were determined using MSTS scores, tallied by physiotherapists who were not part of the surgical team, and complications were ascertained through chart review. Major complications were defined as complications that were treated with additional operations, such as deep infection, or ones that could cause severe postoperative dysfunction, such as nerve injury. RESULTS: With temporary external fixation, standing next to a bed was achieved in median 7 days (range, 6-9 days) postoperatively, transferring to a wheel chair in median 8 days (range, 6-28 days), and gait training using parallel bars in median 15 days (range, 7-48 days). At most recent followup, three patients could walk without a crutch or cane, three could walk with a cane, and one could walk with a crutch. The median MSTS score at most recent followup (median, 57 months) was 63%. Two patients had complications that resulted in reoperations; one had a wound dehiscence, and one had an abdominal herniation that gradually developed, and which was reconstructed using polypropylene mesh 2 years after pelvic resection. Two patients had nerve palsies that recovered by the end of the first year. All patients had pin tract infections that resolved with nonsurgical approaches. CONCLUSIONS: Hip transposition with temporary external fixation can stabilize the bone soft tissue after pelvic resection. Although we did not have a comparison group of patients, we believe that external fixation facilitates early postoperative physiotherapy and rehabilitation and provides good functional results without major surgical complications. Because it delays the resumption of chemotherapy, more patients with longer followup are needed to determine whether this will be associated with poorer oncologic results. LEVEL OF EVIDENCE: Level IV, therapeutic study.

DOI： 10.1097/CORR.0000000000000764

リンパ節郭清を伴う乳房切除術後の乳がん患者の上肢機能の推移短期間での観察

菊内祐人, 明崎禎輝, 中田英二, 冨永律子, 黒河英彰, 濱田麻紀子, 青儀健二郎, 大住省三, 杉原進介

保健医療学雑誌 10 ( 1 ) 27 - 33 2019年4月

記述言語：日本語出版者・発行元：保健医療学学会

本研究では、リンパ節郭清を伴う乳房切除術を施行した乳がん患者144例を対象に術後上肢機能の短期間で変化を検討した。リハビリテーションは手術前後に実施した。調査項目は、Disabilities of the Arm, Shoulder and Hand(DASH)について検討した。測定は、手術前、術後3ヵ月で実施した。その結果、術後3ヵ月では、術前と比較して23項目(障害)のうち18項目に困難感の回答が多く、7項目(症状)のうち5項目で症状ありの回答が多く認められた(p<0.05)。したがって、乳がん術後患者は、退院後にも定期的な上肢機能評価やリハビリテーションが必要であることが明らかとなった。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J06406&link_issn=&doc_id=20190422490004&doc_link_id=%2Fem9allhe%2F2019%2F001001%2F004%2F0027-0033%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fem9allhe%2F2019%2F001001%2F004%2F0027-0033%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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