Faculty Profiles - NAKADA Eiji

Papers - NAKADA Eiji

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Predicting acetabular growth in developmental dysplasia of the hip following open reduction after walking age.

Takamasa Miyake, Tomonori Tetsunaga, Hirosuke Endo, Kazuki Yamada, Tomoaki Sanki, Kazuo Fujiwara, Eiji Nakata, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 ( 2 ) 326 - 331 2019.3

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

BACKGROUND: Acetabular dysplasia of the hip following open reduction can complicate the treatment of developmental dysplasia of the hip (DDH). The purposes of this retrospective study were to investigate the long-term results of open reduction performed via an extensive anterolateral approach for DDH after walking age and to predict acetabular development using postoperative radiographs and arthrograms. METHODS: From 1973 to 2001, we performed open reduction for 131 hips in 119 pediatric patients with DDH after failed closed reduction. Of these, 85 hips of 73 patients who underwent arthrography at 5 years old were followed-up radiologically until skeletal maturity. Mean age at the time of surgery was 17 ± 4.6 months (range, 10-33 months), and mean age at final survey was 19 ± 5.7 years (range, 14-33 years). Mean follow-up time was 17.7 ± 5.8 years (range, 13-32 years). Groups with satisfactory outcomes (66 hips) and unsatisfactory outcomes (19 hips) according to the Severin classification were compared. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. RESULTS: Univariate analysis showed a significant between-group difference in acetabular index (AI) at 2 months postoperatively, and in center-edge (CE) angle, cartilaginous AI (CAI), and cartilaginous CE angle at 5 years old (p < 0.05 each). In multiple logistic regression analysis, CAI at 5 years old represented a predictor of acetabular development after open reduction for DDH (odds ratio, 1.81; 95% confidence interval (CI), 1.04-3.13; p < 0.05). Area under the receiver operating characteristic curve for CAI at 5 years old was 0.93 (95%CI, 0.85-1.0), and the optimal cut-off was 10° (81.8% sensitivity, 92% specificity). CONCLUSIONS: A CAI ≥10° on hip arthrograms at 5 years old may offer a useful indicator of the need for corrective surgery following open reduction after walking age.

DOI： 10.1016/j.jos.2018.09.015

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Mini-open excision of osteoid osteoma using intraoperative O-arm/Stealth navigation.

Tomohiro Fujiwara, Toshiyuki Kunisada, Ken Takeda, Joe Hasei, Eiji Nakata, Yusuke Mochizuki, Masahiro Kiyono, Aki Yoshida, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 ( 2 ) 337 - 341 2019.3

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

BACKGROUND: Although osteoid osteomas have traditionally been treated by surgical excision, radiofrequency ablation (RFA) has gained favor as a less invasive procedure. However, RFA is contraindicated for osteoid osteomas close to the skin or crucial neurovascular structures, and is not covered by national health insurance in Japan. The aim of the present study was to evaluate the efficacy of surgical excision of osteoid osteomas using intraoperative navigation. METHODS: We performed a retrospective review of five patients with osteoid osteoma who underwent a mini-open excision using O-arm/Stealth navigation at our institution. The osteoid osteomas were excised using a cannulated cutter or curetted out with the assistance of navigation. RESULTS: Complete excision was achieved in all patients, which was confirmed by pathological examination. The mean skin incision was 2.1 cm (range, 1.5 to 3.0 cm) and the mean duration required for setup three-dimensional image was 15 min (range, 12 to 20 min). Although the mean visual analog scale score was 7 (range, 4 to 8) before surgery, all patients experienced relief from their characteristic pain immediately after surgery, with the mean scores of 2.2 (range, 1 to 3) and 0 at 2 days and 4 weeks after surgery, respectively. There was no intra-operative complication related to the navigation and no recurrence was observed during the mean follow-up period of 25 months (range, 13 to 33 months). CONCLUSIONS: Mini-open excision using intraoperative O-arm/Stealth navigation is a safe and accurate procedure for patients with osteoid osteoma, which could cover the limitation of RFA.

DOI： 10.1016/j.jos.2018.09.017

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Early response assessment of re-ossification after palliative conventional radiotherapy for vertebral bone metastases.

Eiji Nakata, Shinsuke Sugihara, Masaaki Kataoka, Natsumi Yamashita, Takayuki Furumatsu, Tomoyuki Takigawa, Tomoko Tetsunaga, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 ( 2 ) 332 - 336 2019.3

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

BACKGROUND: To evaluate the therapeutic outcomes in patients with bone metastases receiving radiotherapy (RT), it is important to use objective radiological response criteria. The aim of this study was to investigate the changes in pain and re-ossification after RT for painful vertebral bone metastases without paralysis by malignant spinal cord compression. METHODS: The participants included 55 patients who received RT for painful vertebral bone metastases without paralysis in our institution between 2012 and 2016. Bone modifying agents (BMAs) were administered in all patients. Follow-up assessments were done just before the start of RT and at 1, 2, 3, 4, and 6 months after RT. Radiological responses of irradiated vertebrae by RT were assessed by computed tomography (CT) using MD Anderson response classification criteria (MDA criteria) and the pain response was assessed by Numeric Rating Scale (NRS). Response was classified as complete response (CR), partial response (PR), progressive disease (PD), and stable disease (SD). RESULTS: The rates of CR were 2%, 7%, 20%, 30%, and 56% at 1, 2, 3, 4, and 6 months, respectively. The rates of CR or PR were 15%, 49%, 77%, 91%, and 91% at 1, 2, 3, 4, and 6 months, respectively. The rates of CR or PR were significantly higher in patients with breast cancer than in patients with lung cancer (p = 0.043). At one month, there was an association between the NRS and radiological response assessed by MDA criteria. There was a significant trend that, with a better response, there were more patients without pain (p = 0.021). CONCLUSIONS: Under BMAs administration, successful RT for vertebral bone metastases decreased pain and caused re-ossification. The MD Anderson criteria could be useful for assessment of radiological responses of irradiated vertebrae.

DOI： 10.1016/j.jos.2018.08.018

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Injury patterns of medial meniscus posterior root tears. International journal

Takayuki Furumatsu, Yuki Okazaki, Yoshiki Okazaki, Tomohito Hino, Yusuke Kamatsuki, Shin Masuda, Shinichi Miyazawa, Eiji Nakata, Joe Hasei, Toshiyuki Kunisada, Toshifumi Ozaki

Orthopaedics & traumatology, surgery & research : OTSR 105 ( 1 ) 107 - 111 2019.2

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

INTRODUCTION: Medial meniscus posterior root tear (MMPRT) can occur in middle-aged patients who have a posteromedial painful popping during light activities. MMPRTs are more common in patients with increased age, female gender, sedentary lifestyle, obesity, and varus knee alignment. However, injury mechanisms of minor traumatic MMPRTs are still unclear. We hypothesized that high flexion activities are the major cause of MMPRTs. The aim of this study was to clarify injury patterns of MMPRTs. MATERIALS AND METHODS: One hundred patients were diagnosed having MMPRTs after posteromedial painful popping episodes. Details of posteromedial painful popping episode, situation of injury, and position of injured leg were obtained from the patients by careful interviews. Injury patterns were divided into 8 groups: descending knee motion, walking, squatting, standing up action, falling down, twisting, light exercise, and minor automobile accident. RESULTS: A descending knee motion was the most common cause of MMPRTs (38%) followed by a walking injury pattern (18%) and a squatting action related to high flexion activities of the knee (13%). The other injury patterns were less than 10%. DISCUSSION: Descending knee motions associated with descending stairs, step, and downhill slope are the most common injury pattern of MMPRTs. High flexion activities of the knee are not the greatest cause of MMPRTs. Our results suggest that the descending action with a low knee flexion angle may trigger minor traumatic MMPRTs. LEVEL OF EVIDENCE: IV, retrospective cohort study.

DOI： 10.1016/j.otsr.2018.10.001

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Regeneration of the Fibula with Unidirectional Porous Hydroxyapatite. International journal

Koji Demiya, Toshiyuki Kunisada, Eiji Nakata, Joe Hasei, Toshifumi Ozaki

Case reports in orthopedics 2019 9024643 - 9024643 2019

Language：English

A fibula graft is one of the most common orthopedic procedures for reconstruction of a bone defect, and some complications related to persistent defects of the fibula have been reported previously. We believe that regeneration of the fibula may be critical for postoperative function and prevention of complications. This report describes a 9-year-old female with Ewing sarcoma of the pelvis who was treated with the double-barrel fibula grafts for pelvic bone defect following tumor resection. The defect after fibular resection was filled with unidirectional porous hydroxyapatite (UDPHAp) implants. A plain radiograph revealed new bone formation and a callus-like structure at one month after surgery and bony union between each UDPHAp implant 5 months after surgery. Resorption of implanted UDPHAp was identified, and partial remodeling of the bone marrow cavity could be seen 1 year 2 months after surgery. A radiograph at final follow-up (5 years 10 months after surgery) demonstrated almost complete absorption of the implanted UDPHAp and clear formation of the cortex and bone marrow in the resected part of the fibula. The patient is able to walk well without any walking supports and to take part in sports activities.

DOI： 10.1155/2019/9024643

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Early response assessment of palliative conventional radiotherapy for painful uncomplicated vertebral bone metastases.

Nakata E, Sugihara S, Kataoka M, Yamashita N, Furumatsu T, Takigawa T, Tetsunaga T, Ozaki T

J Orthop Sci 2018.11

Early response assessment of palliative conventional radiotherapy for painful uncomplicated vertebral bone metastases.

Eiji Nakata, Shinsuke Sugihara, Masaaki Kataoka, Natsumi Yamashita, Takayuki Furumatsu, Tomoyuki Takigawa, Tomoko Tetsunaga, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 ( 6 ) 912 - 917 2018.11

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

BACKGROUND: Radiation therapy (RT) is the common treatment for painful vertebral bone metastases without paralysis by malignant spinal cord compression. However, no studies have focused on the time course of pain after RT. Then, we investigated the change of pain after RT for painful vertebral bone metastases without paralysis. METHODS: Participants included 101 patients who received RT for painful vertebral bone metastases without paralysis in our institution between 2012 and 2016. All patients received RT and pain response was evaluated by Numeric Rating Scale (NRS). Follow-up assessments were performed just before the start of RT and every month for six months after RT. Pain response was classified as complete response (CR), partial response (PR), pain progression (PP), and indeterminate response (IR) based on the response criteria of International Bone Metastases Consensus Working Party. Responders were classified as either CR or PR, and non-responders as either PP or IR. RESULTS: Median NRS scores for pain were 5 before RT, decreasing to 0 by one month after RT and remaining zero until last follow-up, representing a significant decrease over time (P < 0.001). The rate of responders at each month from one to six months was 93, 96, 95, 100, 98, and 96%, respectively. Multivariate analysis revealed that Spinal Instability Neoplastic Score (SINS) was the only risk factor for response to RT at one month. At one month pain disappeared in 88% of the patients with spinal stability (SINS < 7), although pain disappeared 58% of the patients with spinal instability (SINS ≥ 7), which was significant (P = 0.002). CONCLUSIONS: Pain decreased significantly over time and 93% of patients were classified as responders as early as one month after RT in patients with painful vertebral bone metastases without paralysis. Pretreatment SINS could be a predictor of pain response to RT.

DOI： 10.1016/j.jos.2018.07.007

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Intraoperative O-arm-navigated resection in musculoskeletal tumors.

Tomohiro Fujiwara, Toshiyuki Kunisada, Ken Takeda, Joe Hasei, Eiji Nakata, Ryuichi Nakahara, Aki Yoshida, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 ( 6 ) 1045 - 1050 2018.11

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

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腫瘍用人工関節KLS system術後機能回復の経過

増田翔太, 岩井賢司, 築山尚司, 堅山佳美, 中田英二, 尾崎敏文, 千田益生

日本関節病学会誌 37 ( 3 ) 272 - 272 2018.10

骨転移登録システム稼働後に発生した最近の対麻痺症例の検討

杉原進介, 魚谷弘二, 中田英二, 尾崎敏文

中部日本整形外科災害外科学会雑誌 61 ( 5 ) 1105 - 1106 2018.9

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

当院では、重篤なskeletal related event(SRE)の発生を防ぐ目的で、2009年9月に骨転移登録システムを確立し稼働している。同システムでは骨転移が確認された時点で登録され、リスクに応じて画像フォローや診察を行い、metastatic spinal cord compression(MSCC)を認めた症例において、麻痺発生リスクが高いと判断された場合には放射線照射を積極的に施行している。システム稼働後、骨折や麻痺などの重篤なSRE発生は減少しているものの、麻痺を生じて当科紹介となる症例が依然散見されている。今回、麻痺を発症し最終的に歩行不能となった最近の4症例を振り返り、問題点について検討した。4例中2例は麻痺出現前から画像上MSCCが確認可能であったが、他の2例は確認困難であった。

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骨肉腫における細胞内外microRNA-25-3p発現の機能解析

吉田晶, 藤原智洋, 魚谷弘二, 森田卓也, 清野正普, 横尾賢, 長谷井嬢, 中田英二, 国定俊之, 尾崎敏文

日本整形外科学会雑誌 92 ( 8 ) S1813 - S1813 2018.8

滑膜肉腫細胞および患者血清由来exosomeの特定と膜表面マーカーの網羅的解析

横尾賢, 藤原智洋, 吉田晶, 森田卓也, 清野正普, 出宮光二, 望月雄介, 長谷井嬢, 中田英二, 国定俊之, 尾崎敏文

日本整形外科学会雑誌 92 ( 8 ) S2045 - S2045 2018.8

骨肉腫の細胞内外microRNA-25-3p発現異常の腫瘍学的意義

吉田晶, 藤原智洋, 魚谷弘二, 森田卓也, 清野正普, 横尾賢, 長谷井嬢, 中田英二, 国定俊之, 尾崎敏文

日本整形外科学会雑誌 92 ( 6 ) S1460 - S1460 2018.6

骨転移治療に対する院内コンセンサス形成整形外科としての骨転移への関わりがん専門病院の立場から

杉原進介, 魚谷弘二, 中田英二, 尾崎敏文

日本整形外科学会雑誌 92 ( 6 ) S1509 - S1509 2018.6

【運動器画像診療の最前線】部位別・疾患別画像診療の最前線骨腫瘍の画像診療

中田英二, 国定俊之, 長谷井嬢, 藤原智洋, 尾崎敏文

関節外科 37 ( 4月増刊 ) 130 - 143 2018.4

Language：Japanese Publisher：(株)メジカルビュー社

＜画像診療のポイント＞●骨腫瘍の診療において、画像検査は鑑別診断や治療効果判定だけではなく、手術にも有用である。●鑑別診断について、初診医は一般整形外科医であることが多く、悪性を疑う所見を見逃さないことが重要である。●骨腫瘍にはそれぞれ特徴的な年齢分布や好発部位があり、年齢や既往歴などの臨床情報も踏まえ、複数の画像検査の情報を組み合わせて診断を行う。●単純X線像の読影では、腫瘍の局在と性状に注目する。●CTは、単純X線検査では評価が困難な部位の診断、微細な石灰化や骨化の有無の検出などを調べるのに適している。また、三次元的に骨病変を評価することができ、術前計画にも有用である。さらに、近年はコンピュータ支援手術により術中に短時間で高画質の2D・3D画像が取得でき、画像データをナビゲーションシステムに送信することで、より低侵襲かつ安全で確実な手術が可能となっている。●MRIは優れたコントラスト分解能をもち、腫瘍の進展や質的診断、治療効果判定などに有用である。●PET/CTは、良悪性の鑑別診断、病期診断、治療効果判定に有用である。●各画像検査には長所と短所があるため、その特徴を理解しておくことが重要である。(著者抄録)

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脊椎に原発した骨肉腫の5例

塩崎泰之, 瀧川朋亨, 三澤治夫, 尾崎敏文, 中田英二, 国定俊之

中国・四国整形外科学会雑誌 30 ( 1 ) 79 - 82 2018.4

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

当院で経験した脊椎原発の骨肉腫5例(男性2例、女性3例、診断時平均年齢52歳)について検討した。発生高位はT1が1例、L2が1例、L3が1例、L5が2例であった。初診時の症状は腰椎発生の3例では全例に腰痛が認められ、2例に下肢不全麻痺が合併していた。胸椎発生の2例では、それぞれ背部痛と上肢痛を認められた。治療は全摘出術を2例、重粒子線治療を3例に行った。また、化学療法は4例に行った。予後は、治療中の2例を除き、3例は診断後平均66ヵ月で死亡していた。

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Clinical and Functional Significance of Intracellular and Extracellular microRNA-25-3p in Osteosarcoma.

Aki Yoshida, Tomohiro Fujiwara, Koji Uotani, Takuya Morita, Masahiro Kiyono, Suguru Yokoo, Joe Hasei, Eiji Nakata, Toshiyuki Kunisada, Toshifumi Ozaki

Acta medica Okayama 72 ( 2 ) 165 - 174 2018.4

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

Although there is considerable evidence indicating that the dysregulation of microRNAs (miRNAs) in malignant tumors plays a role in tumor development, the overall function of miRNAs and their clinicopathological significance are not well understood. In this retrospective analysis of 45 biopsy specimens from osteosarcoma (OS) patients, we investigated the functional and clinical significance of miR-25-3p in OS, which we previously identified as a highly expressed miRNA in OS patients' serum. We observed that miR-25-3p dysregulation in human OS tissues was negatively correlated with the clinical prognosis, whereas the expression level of its target gene, Dickkopf WNT Signaling Pathway Inhibitor 3 (DKK3), was positively correlated with the clinical prognosis. Endogenous miR-25-3p upregulation promoted tumor growth, invasion, and drug resistance, which was consistent with DKK3 silencing in OS cells. In addition, secretory miR-25-3p was embedded in tumor-derived exosomes, where it promoted capillary formation and the invasion of vascular endothelial cells. Overall, our results show that miR-25-3p has intracellular and extracellular oncogenic functions as well as clinicopathological relevance in OS, indicating its potential as a novel diagnostic and therapeutic tool for the clinical management of this disease.

DOI： 10.18926/AMO/55857

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リハビリテーション介入における病的骨折リスクマネージメントの効果病的骨折リスクの高い乳がん骨転移を伴った患者

明崎禎輝, 中田英二, 冨永律子, 黒河英彰, 菊内祐人, 濱田麻紀子, 魚谷弘二, 杉原進介

保健医療学雑誌 9 ( 1 ) 39 - 44 2018.4

Language：Japanese Publisher：保健医療学学会

今回、乳がん多発骨転移でskeletal related events発生リスクの高い患者に対し、当院で実施しているリハビリテーション中の病的骨折リスクマネージメントの効果を検討した。対象は、63歳の乳がん骨転移患者である、リハビリテーション開始前には、医師が画像と診察で病的骨折などのリスク評価を行った。また多職種カンファレンスなどで情報共有を行った。その結果、入院中に骨転移部の2ヶ所で新たに疼痛などのskeletal related eventsの発生を認めたが、円滑な情報伝達により重篤なskeletal related eventsを発症することなくリハビリテーションを継続することが可能であった。またActivities of daily livingは改善した。これらのことから、当院のシステムは、病的骨折リスクの高い骨転移患者にリハビリテーションを行う場合のマネージメントに有用であると考えられた。(著者抄録)

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Professional approaches for patients with bone metastases during rehabilitation

Yoshiteru Akezaki, Eiji Nakata, Ritsuko Tominaga, Hideaki Kurokawa, Masato Kikuuchi, Makiko Hamada, Shinsuke Sugihara

IRYO - Japanese Journal of National Medical Services 72 ( 3 ) 122 - 125 2018.3

肉腫進行例の新しい診療システムサルコーマセンター設立と腫瘍内科医との連携

国定俊之, 田端雅弘, 山根弘路, 中田英二, 長谷井嬢, 尾崎敏文

中部日本整形外科災害外科学会雑誌 61 ( 春季学会 ) 88 - 88 2018.3

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