研究者詳細 - 山田　和希

論文 - 山田　和希

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Mechanical stretching induces calcification and cartilage matrix metabolism, causing degeneration of the acetabular labrum. 査読国際誌

Yoshi Kawamura, Tomonori Tetsunaga, Kazuki Yamada, Tomoaki Sanki, Yoshihiro Sato, Aki Yoshida, Takayuki Furumatsu, Toshifumi Ozaki

Hip international : the journal of clinical and experimental research on hip pathology and therapy 11207000211044675 - 11207000211044675 2021年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: The acetabular labrum plays an important role in joint lubrication, and damage to this structure leads to osteoarthritis. This study aimed to histologically classify the degree of degeneration of the acetabular labrum and to investigate the changes in gene expression induced by mechanical stretching. METHODS: We obtained acetabular labrum cells from patients with hip osteoarthritis during total hip arthroplasty (n = 25). The labrum was stained with safranin O, and images were histologically evaluated using a new parameter, the red/blue (R/B) value. The samples were divided into the degenerated group (D group: n = 18) and the healthy group (H group: n = 7) in accordance with the Kellgren-Lawrence (KL) grade. The cultured acetabular labral cells were subjected to loaded uniaxial cyclic tensile strain (CTS). After CTS, changes in gene expression were examined in both groups. RESULTS: Spearman's correlation analysis revealed that the R/B value was significantly correlated with the KL grade and the Krenn score. The expression levels of genes related to cartilage metabolism, osteogenesis and angiogenesis significantly increased after CTS in the H group, while gene expression in the D group showed weaker changes after CTS than that in the H group compared to the nonstretched control group. CONCLUSIONS: The degree of labral degeneration could be classified histologically using the R/B value and the KL grade. Mechanical stretching caused changes in gene expression that support the pathological features of labral degeneration.

DOI： 10.1177/11207000211044675

変形性肩関節症とCCN3発現上昇との相関について

廣瀬一樹, 中田英二, 服部高子, 鉄永智紀, 山田和希, 佐藤嘉洋, 桑原実穂, 滝川正春, 久保田聡, 尾崎敏文

日本整形外科学会雑誌 95 ( 8 ) S1506 - S1506 2021年8月

Femoral head collapse rate among Japanese patients with pre-collapse osteonecrosis of the femoral head. 査読国際誌

Ryuta Asada, Hiroyasu Abe, Hidetoshi Hamada, Yusuke Fujimoto, Hyonmin Choe, Daisuke Takahashi, Shusuke Ueda, Yutaka Kuroda, Takaki Miyagawa, Kazuki Yamada, Takeyuki Tanaka, Juji Ito, Satoshi Morita, Michiaki Takagi, Tomonori Tetsunaga, Ayumi Kaneuji, Yutaka Inaba, Sakae Tanaka, Shuichi Matsuda, Nobuhiko Sugano, Haruhiko Akiyama

The Journal of international medical research 49 ( 6 ) 3000605211023336 - 3000605211023336 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: In this study, we aimed to elucidate the relationship between the duration from diagnosis to femoral head collapse and the collapse rate among patients with pre-collapse osteonecrosis of the femoral head (ONFH). METHODS: In this retrospective, observational, multicenter study, we analyzed 268 patients diagnosed with ONFH and classified them using the Japanese Investigation Committee classification. The primary endpoint was duration from the time of diagnosis to femoral head collapse for each type of ONFH. RESULTS: The 12-, 24-, and 36-month collapse rates among participants were 0%, 0%, and 0% for type A, respectively; 0%, 2.0%, and 10.8% for type B, respectively; 25.5%, 40.8%, and 48.5% for type C-1, respectively; and 57.4%, 70.3%, and 76.7% for type C-2 ONFH, respectively. A comparison of unilateral and bilateral ONFH, using Kaplan-Meier survival curves demonstrated similar collapse rates. CONCLUSIONS: The lowest collapse rate was observed for ONFH type A, followed by types B, C-1, and C-2. Additionally, a direct association was observed between the collapse rate and location of the osteonecrotic lesion on the weight-bearing surface.

DOI： 10.1177/03000605211023336

Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip. 査読国際誌

Tomonori Tetsunaga, Tomoko Tetsunaga, Hirofumi Akazawa, Kazuki Yamada, Takayuki Furumatsu, Toshifumi Ozaki

Hip international : the journal of clinical and experimental research on hip pathology and therapy 11207000211004917 - 11207000211004917 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Residual acetabular dysplasia of the hip after open reduction can complicate the treatment of developmental dysplasia of the hip (DDH) due to the potential need for corrective surgery. This retrospective study aimed to determine the predictive factors for acetabular development using postoperative radiographs and magnetic resonance imaging (MRI). METHODS: We retrospectively investigated 74 hips of patients with DDH who underwent open reduction after reaching walking age and were followed up radiologically until skeletal maturity. We evaluated the cartilaginous acetabulum and labrum using a new method that measures the cartilaginous and labral landmarks on coronal and axial MR T2*-weighted images in patients aged 5 years. The mean age at the time of surgery was 22 months and that at the final survey was 20 years. Severin classification was determined at the final follow-up. Groups with good (53 hips) and poor (21 hips) outcomes were compared using the postoperative radiographic and MRI parameters recorded at 5 years of age. Factors predicting acetabular development were identified using univariate and multiple logistic analyses. RESULTS: There were no significant differences in the bony-acetabular index (AI) and centre-edge (CE) angle between the good and poor outcome groups. However, the poor outcome group had significantly larger cartilaginous- and labral-AIs but significantly smaller cartilaginous- and labral-CE angles than the good outcome group (both p < 0.05). Multiple logistic regression analysis showed that labral-AI and labral-CE angle were predictors of acetabular development after open reduction for DDH, and their optimal cut-offs were 4° (77% sensitivity, 76% specificity) and 37° (68% sensitivity, 85% specificity), respectively. DISCUSSION: Normal cartilaginous acetabulum development occurs in childhood, and evaluation using only radiographs is difficult. However, labral-AI ⩾4° and labral-CE angle <37° on MRI at 5 years of age offer useful indications for corrective surgery in patients with DDH.

DOI： 10.1177/11207000211004917

Osteosynthesis for Geriatric Acetabular Fractures: An Epidemiological and Clinico-Radiological Study Related to Marginal or Roof Impaction. 査読

Madoka Inoue, Tomoyuki Noda, Takenori Uehara, Tomonori Tetsunaga, Kazuki Yamada, Taichi Saito, Yasunori Shimamura, Yasuaki Yamakawa, Toshifumi Ozaki

Acta medica Okayama 75 ( 2 ) 177 - 185 2021年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

This retrospective study sought to elucidate the incidence rates of roof impaction (RI) and marginal impaction (MI) and radiological and clinical outcomes of open reduction and internal fixation (ORIF) for RI and MI in geriatric acetabular fractures. The cases of 68 patients aged ≥ 65 years (mean 71 years) treated with ORIF were analyzed. MI was present in 12 fractures (67%) and an RI of the weight-bearing surface was present in 24 (46%) of the potential fracture types. Regarding the reduction quality, 54% of the reductions were graded as anatomical, 37% as imperfect, and 9% as poor. In the clinical evaluations of the 45 patients who had > 1-year follow-up (follow-up rate: 66.2%), 18% were graded as excellent, 53% as good, 16% as fair, and 13% as poor. An anatomic reduction was strongly associated with good or excellent clinical and radiological outcomes. CT was superior to radiographs for detecting the residual displacement postoperatively. Postoperative deep infection occurred in four patients. Three patients (6.7%) underwent a total hip arthroplasty conversion due to secondary osteoarthritis of the hip. We recommend ORIF as the preferred surgical treatment option for displaced acetabular fractures in elderly patients.

DOI： 10.18926/AMO/61895

寛骨臼回転骨切り術前後での三次元的大腿骨頭移動はADLに影響するか

鉄永智紀, 山田和希, 佐藤嘉洋, 廣瀬一樹, 鉄永倫子, 尾崎敏文

日本整形外科学会雑誌 95 ( 3 ) S972 - S972 2021年3月

発育性股関節形成不全(DDH)に対する広範囲展開法術後の関節包は菲薄化する MRIとX線学的評価による症例対照研究

山田和希, 鉄永智紀, 遠藤裕介, 三喜知明, 河村涌志, 佐藤嘉洋, 廣瀬一樹, 尾崎敏文

日本整形外科学会雑誌 95 ( 2 ) S132 - S132 2021年3月

当院で施行したACTISを用いたTHAの術後1年の成績

佐藤嘉洋, 鉄永智紀, 山田和希, 三喜知明, 河村涌志, 尾崎敏文

日本人工関節学会誌 50 ( 追補版 ) 879 - 880 2021年3月

記述言語：日本語出版者・発行元：(一社)日本人工関節学会

当院でACTISを用いてTHAを行った20例20股(男性1股、女性19股、手術時平均年齢66.9歳)を対象に、術後1年の成績を検討した。その結果、X線学的評価ではステム沈下、骨折はなく、良好な初期固定性が得られていた。zone 1、7に8例(40%)のstress shieldingが認められたが、II度以上のstress shieldingはみられなかった。また、術後合併症や再置換を要した症例はなく、JOAスコアは術前平均49.7点から最終調査時平均88.6点へ有意に改善していた。

The Thickness of the Medial Wall of the Acetabulum Prevents Acetabular Fracture during the Insertion of a Cementless Cup in Total Hip Arthroplasty: A Biomechanical Study.

Tomoaki Sanki, Tomonori Tetsunaga, Takayuki Furumatsu, Kazuki Yamada, Yoshi Kawamura, Toshifumi Ozaki

Acta medica Okayama 75 ( 1 ) 71 - 77 2021年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

Intra-operative acetabular fracture is a total hip arthroplasty complication that can occur during cementless cup insertion, especially in osteoporotic patients. We conducted this biomechanical study to investigate the impact resistance of the acetabulum with simulated bones of different density by drop-weight impact testing. Low- and high-density polyurethane foam blocks were used as osteoporotic and healthy bone models, respectively. Polyurethane blocks were used as the acetabular cancellous bone. Composite sheets were used as the acetabu-lum's medial cortex. The testing revealed that the osteoporotic bone model's impact resistance was significantly lower than that the healthy bone model'. In the healthy bone model, even thin acetabular cancellous bone with ≥ 1 mm acetabulum medial cortex was less likely to fracture. In the osteoporotic bone model, fracture was pos-sible without ≥ 1 mm medial cortex of the acetabulum and thick acetabular cancellous bone. Although impac-tion resistance differs due to bone quality, the impaction resistance in this osteoporotic bone model was equiv-alent to that healthy bone model's when a thick medial wall was present. To avoid intra-operative acetabulum fracture, surgeons should consider both the bone quality and the thicknesses of the medial cortex and acetabu-lar cancellous bone.

DOI： 10.18926/AMO/61437

Bipolar Hip Arthroplasty Using a Conjoined Tendon-preserving Posterior Approach in Geriatric Patients.

Tomonori Tetsunaga, Tomoko Tetsunaga, Kazuki Yamada, Tomoaki Sanki, Yoshi Kawamura, Toshifumi Ozaki

Acta medica Okayama 75 ( 1 ) 25 - 30 2021年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

In bipolar hemiarthroplasty (BHA), it is important to preserve soft tissue to reduce the risk of postoperative dislocation. A variety of surgical approaches for BHA are available, but extra care is needed with muscle- and tendon-preserving approaches in geriatric patients. We investigated the usefulness of BHA using a conjoined tendon-preserving posterior (CPP) approach, in which only the external obturator muscle is dissected, in geri-atric patients. We retrospectively analyzed the cases of 40 femoral neck fracture patients (10 men, 30 women) aged ≥ 80 years who underwent BHA using the CPP approach. The patients' average age was 85.8 years (80-94 years). We examined the operation time, bleeding, preservation of short external rotator muscles, complica-tions, and stem alignment and subsidence from postoperative radiographs. Although gemellus inferior muscle injury was detected in 4 patients (10%), the hip joint stability was very excellent in all cases. There was no intraoperative fracture or postoperative dislocation. On postoperative radiographs, all femoral stems were in a neutral position. There was no stem subsidence in all 40 patients. BHA using the CPP approach appeared to be useful even in geriatric patients.

DOI： 10.18926/AMO/61430

当院で施行した創外固定を用いた骨延長術の短期成績

佐藤嘉洋, 鉄永智紀, 山田和希, 三喜知明, 河村涌志, 尾崎敏文

日本小児整形外科学会雑誌 29 ( 2 ) 238 - 242 2020年12月

記述言語：日本語出版者・発行元：(一社)日本小児整形外科学会

当院の小児対象の創外固定を用いた下肢骨延長術の治療成績を報告する。対象は2008年から2018年に当院で手術加療を行った20症例34肢である。大腿骨延長15肢に単支柱型創外固定を、下腿骨延長19肢にリング型創外固定器を用いた。検討項目は骨延長距離、創外固定指数(EFI)、プレート固定追加の有無、術後合併症とした。大腿の骨延長は平均6.0cm、EFIは平均39.0日/cm、7肢でplate conversionを行った。3肢で創外固定抜去後骨折、plate conversion後1肢でプレート折損、プレート抜釘後1肢で骨折を生じた。下腿の骨延長は平均5.6cm、EFIは平均54.6日/cm、4肢でplate conversionを行った。1肢で創外固定抜去後骨折、1肢で偽関節、plate conversion後1肢で感染を生じた。当院では長期の創外固定装着を避けるためplate conversionを行っている。軟部組織の厚い大腿に比べ、軟部組織の薄い下腿のplate conversionは軟部組織トラブルを生じる危険性がある。本シリーズでも1肢で感染を生じ、また、手術回数を増やす弊害もあり、適応は慎重にすべきである。(著者抄録)

セメントレスインプラント挿入時におけるナイロンハンマーとステンレスハンマーの打ち込み力の差の検討

三喜知明, 鉄永智紀, 山田和希, 河村涌志, 佐藤嘉洋, 尾崎敏文

日本人工関節学会誌 50 697 - 698 2020年12月

記述言語：日本語出版者・発行元：(一社)日本人工関節学会

模擬骨を用いてセメントレスインプラント挿入時におけるナイロンハンマー(Nハンマー)とステンレスハンマー(Sハンマー)の打ち込み力の差を比較検討した。その結果、打ち込み力はSハンマーがNハンマーよりも有意に大きいことが明らかになった。また、術者間では打ち込み力にばらつきが示されたものの、同一術者内ではNハンマーがSハンマーの打ち込み力を上回ることはなかった。以上、今回の検討から術中骨折を回避するためには、打ち込み力の差を念頭に入れた上でハンマーを選択することが重要であると考えられた。

Preserve αステムを用いた人工股関節全置換術の1年以上経過した短期成績

河村涌志, 鉄永智紀, 山田和希, 三喜知明, 佐藤嘉洋, 尾崎敏文

日本人工関節学会誌 50 505 - 506 2020年12月

記述言語：日本語出版者・発行元：(一社)日本人工関節学会

当院でPreserve αステムを用いて人工股関節全置換術を行い、1年以上経過した20例(男性2例、女性18例、手術時平均年齢69歳)の短期成績を検討した。その結果、術中・術後の合併症はなく、JOAスコアは術前平均44.0±11.3点が術後1年時には平均79.3±6.8点へと改善が認められた。3度以上の内外反挿入例はなく、2mm以上のsubsidenceを認めた症例もみられなかった。SSは95%と高率に認められたものの、不安定性を生じた症例はなかった。また、ステム挿入時のcortical ring温存と近位部移植により、RLLの発生率は20%に抑えることが可能であった。

初回THA術後に頻回脱臼となったシャルコー関節と考えられる1例

遠藤裕介, 山田和希, 三喜知明, 河村涌志, 鉄永智紀, 尾崎敏文

日本人工関節学会誌 50 515 - 516 2020年12月

記述言語：日本語出版者・発行元：(一社)日本人工関節学会

68歳女性。両側の高度変形性股関節症に対しTHAを施行した。術後は両股とも頻回脱臼を生じたため再置換術を繰り返しており、シャルコー関節と考えられた。本症例では拘束型ライナーを使用しても再脱臼を認め、QOL維持のために慎重な経過観察と人工関節の維持に努める必要があると考えられた。

外反膝変形を伴う臀筋内脱臼に対するTHAの1例

遠藤裕介, 宮澤慎一, 山田和希, 三喜知明, 河村涌志, 鉄永智紀, 尾崎敏文

日本人工関節学会誌 50 767 - 768 2020年12月

記述言語：日本語出版者・発行元：(一社)日本人工関節学会

80歳女性。5歳時に左先天性股関節脱臼を指摘されるも未治療であった。今回、右股痛と左膝痛による歩行困難が出現し、当院へ紹介となった。歩行レベルは屋内が4点杖と伝い歩きで、屋外は車椅子を使用していた。X線像により著明な外反膝変形を伴う臀筋内脱臼と診断され、短縮骨切り術とLCPを併用した人工股関節全置換術を行い、術後2ヵ月目に人工膝関節置換術(TKA)を予定した。経過中に再脱臼を認め、再置換術を要したが、その1週後にTKAを予定通り施行することができた。その結果、術後1年経過で左膝の可動域は15〜100度で、再脱臼や疼痛はみられず、20分程度の杖歩行が可能である。

アナトミカルショートモジュラーネックステムの初期固定様式に関する3次元的解析

山田和希, 鉄永智紀, 三喜知明, 河村涌志, 佐藤嘉洋, 尾崎敏文

日本人工関節学会誌 50 727 - 728 2020年12月

記述言語：日本語出版者・発行元：(一社)日本人工関節学会

アナトミカルショートモジュラーネックステム(Mainstayステム)を用いて人工股関節全置換術を施行した12股(男性3股、女性9股)を対象に、ステムの初期固定様式を3次元的に解析した。その結果、全例でステム近位においては皮質骨との良好な接触が獲得されていたが、遠位においては内側・前方での接触が少ないことが明らかになった。

機械的刺激によって股関節唇の脂肪細胞分化が誘導される

河村涌志, 鉄永智紀, 山田和希, 三喜知明, 佐藤嘉洋, 廣瀬一樹, 尾崎敏文

日本整形外科学会雑誌 94 ( 8 ) S1919 - S1919 2020年9月

当院で施行したPrime-Nを用いたTHAの術後3年の成績

佐藤嘉洋, 鉄永智紀, 山田和希, 三喜知明, 河村涌志, 尾崎敏文

中国・四国整形外科学会雑誌 32 ( 2 ) 339 - 342 2020年9月

記述言語：日本語出版者・発行元：中国・四国整形外科学会

当院でPrime-Nを用いてTHAを行った29例31股を対象に、術後3年の成績を検討した。その結果、最終観察時に合併症、再置換を要した症例はなく、良好な固定性が得られていた。JOAスコアは術前平均49点が最終調査時には88点へ有意な改善を認めた。原疾患、ステムの挿入方向、ステムの髄腔占拠率により、術後JOAスコアに有意差はみられなかった。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02438&link_issn=&doc_id=20201001180024&doc_link_id=%2Fcm4ortho%2F2020%2F003202%2F024%2F0339-0342%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcm4ortho%2F2020%2F003202%2F024%2F0339-0342%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

落錘式衝撃試験による模擬骨を用いた寛骨臼の衝撃抵抗性の検討

三喜知明, 鉄永智紀, 山田和希, 河村涌志, 佐藤嘉洋, 尾崎敏文

日本整形外科学会雑誌 94 ( 8 ) S2018 - S2018 2020年9月

Acetabular depth, an early predictive factor of acetabular development: MRI in patients with developmental dysplasia of the hip after open reduction. 国際誌

Yoshi Kawamura, Tomonori Tetsunaga, Hirofumi Akazawa, Kazuki Yamada, Tomoaki Sanki, Yoshihiro Sato, Eiji Nakata, Toshifumi Ozaki

Journal of pediatric orthopedics. Part B 30 ( 6 ) 509 - 514 2020年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Early prediction of future acetabular development is important to determine an additional surgery for developmental dysplasia of the hip (DDH). The purpose of this study was to investigate the predictive factors of acetabular development using MRI. We retrospectively investigated dislocated 40 hips and 34 normal hips in 37 pediatric patients (9 males and 28 females) with DDH who underwent open reduction after walking age. We evaluated the cartilaginous acetabulum and labrum of the patients using coronal MRI T2*-weighted images at 5 years of age. The mean age at the time of surgery was 22 months, and the mean age at the final survey was 19 years. We divided patients into two groups in accordance with the Severin classification at the final follow-up. Groups with good outcomes (affected 26 hips and unaffected 27 hips) and poor outcomes (14 hips and 7 hips) were compared using the MRI parameters on each side. Predictive factors of acetabular development were identified using univariate and multiple logistic regression analyses. Using multiple logistic regression analysis, labral acetabular roof depth and labral hip center distance at 5 years of age represented predictors after open reduction (odds ratio 0.27, P = 0.035; odds ratio 3.4, P = 0.028, respectively) on the affected side, and bony hip center distance represented a predictor on the unaffected side (odds ratio 2.6, P = 0.049). Acetabular development in the unaffected side could be predicted by bony assessment, while acetabular development in the affected side had to be assessed by labrum using MRI.

DOI： 10.1097/BPB.0000000000000799

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