Faculty Profiles - TETSUNAGA Tomoko

Papers - TETSUNAGA Tomoko

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Assessment of the Concordance Rate between Intraoperative Pathological Diagnosis and the Final Pathological Diagnosis of Spinal Cord Tumors.

Sosuke Muraoka, Kentaro Yamane, Haruo Misawa, Tomoyuki Takigawa, Tomoko Tetsunaga, Yoshiaki Oda, Kazuo Nakanishi, Toshifumi Ozaki, Takehiro Tanaka

Acta medica Okayama 75 ( 4 ) 455 - 460 2021.8

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

The intraoperative pathological diagnosis (IPD) plays an important role in determining the optimal surgical treatment for spinal cord tumors. The final pathological diagnosis (FPD) is sometimes different from the IPD. Here, we sought to identify the accuracy of the IPD of spinal cord tumors compared to the FPD. We retrospec-tively analyzed the cases of 108 patients with spinal cord tumors treated surgically in our institute; the IPD, FPD, mismatched cases, and concordance rate between the IPD and FPD were investigated. Five cases involved a mismatch between the IPD and FPD. The overall concordance rate was 95.4%, with 90.9% for extra-dural lesions, 98.5% for intradural extramedullary lesions, 84.2% for intramedullary lesions, and 100% for dumbbell-type tumors. The concordance rate of intramedullary lesions tended to be lower than that of other lesions (p = 0.096). A lower concordance rate was revealed for intramedullary lesions compared to the other lesions. Despite the IPD clearly remaining a valuable tool during operative procedures, surgeons should recog-nize the limitations of IPDs and make comprehensive decisions about surgical treatments.

DOI： 10.18926/AMO/62397

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Evaluation of the labrum on postoperative magnetic resonance images: a predictor of acetabular development in developmental dysplasia of the hip. International journal

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 2021.4

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

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

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Maximal Resection of Intramedullary Lipoma Using Intraoperative Ultrasonography: A Technical Note.

Haruo Misawa, Yoshiaki Oda, Kentaro Yamane, Tomoko Tetsunaga, Toshifumi Ozaki

Acta medica Okayama 75 ( 2 ) 239 - 242 2021.4

Language：English

One of the problems during surgery for intramedullary lipoma is the ambiguous boundary between the lipoma and the spinal cord, resulting in either incomplete resection or damage to the spinal cord. We report a case of intramedullary lipoma resection on a 61-year-old man in which the boundary between the tumor and spinal cord was repeatedly visualized with intraoperative ultrasonography. We focused on the distinctive features of fat as hyperechoic, in contrast to low-echo neural tissue. Subtotal resection of the tumor was achieved without any aggravation of neurological symptoms. Intraoperative ultrasonography may be useful for confirming tumor boundaries during intramedullary lipoma resection.

DOI： 10.18926/AMO/61907

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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 2021.2

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

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

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Quantification of patellar tendon reflex using portable mechanomyography and electromyography devices. International journal

Hironori Tsuji, Haruo Misawa, Tomoyuki Takigawa, Tomoko Tetsunaga, Kentaro Yamane, Yoshiaki Oda, Toshifumi Ozaki

Scientific reports 11 ( 1 ) 2284 - 2284 2021.1

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

Deep tendon reflexes are one of the main components of the clinical nervous system examinations. These assessments are inexpensive and quick. However, evaluation can be subjective and qualitative. This study aimed to objectively evaluate hyperreflexia of the patellar tendon reflex using portable mechanomyography (MMG) and electromyography (EMG) devices. This study included 10 preoperative patients (20 legs) who had a pathology that could cause bilateral patellar tendon hyperreflexia and 12 healthy volunteers (24 legs) with no prior history of neurological disorders. We attached MMG/EMG sensors onto the quadriceps and tapped the patellar tendon with maximal and constant force. Our results showed a significantly high amplitude of the root mean square (RMS) and low frequency of the mean power frequency (MPF) in the rectus femoris, vastus medialis, and vastus lateralis muscles in both EMG and MMG with both maximal and constant force. Especially in the patients with cervical and thoracic myelopathy, the receiver operating characteristic (ROC) curve for diagnosing hyperreflexia of the patellar tendon showed a moderate to very high area under the curve for all EMG-RMS, EMG-MPF, MMG-RMS, and MMG-MPF values. The use of EMG and MMG for objectively quantifying the patellar tendon reflex is simple and desirable for future clinical applications and could help diagnose neurological disorders.

DOI： 10.1038/s41598-021-81874-5

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Chronic Pain Has Little Effect on Physical Condition During the COVID-19 Pandemic in Japan: A Web-based Cross-Sectional Survey Reviewed

Tomoko Tetsunaga, Tomonori Tetsunaga, Haruo Misawa, Hironori Tsuji, Toshifumi Ozaki, Takahiro Tabuchi

Res Square 2021.1

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Research Square Platform LLC

<title>Abstract</title>
<bold><italic>Background</italic></bold> Chronic pain affects people negatively, both mentally and physically. It is unclear how chronic pain affects people during social isolation and remote work due to the COVID-19 pandemic. The aim of this study was to analyze the effect of chronic pain on life during the COVID-19 pandemic.<bold><italic>Methods</italic></bold> This retrospective study included 4,972 matched-participants with or without chronic pain (2,311 males, 2,661 females; mean age, 53.8 years). The participants were divided into a chronic pain group (<italic>n</italic>=2,486) and a control group (<italic>n</italic>=2,486). Participants with chronic pain for three months or more were classified into the chronic pain group. All participants completed self-reported questionnaires. Factors related to physical condition during the COVID-19 pandemic were identified by univariate and multivariate analyses.<bold><italic>Results</italic></bold> Significant differences were found between participants with and without chronic pain for the pain that developed during the COVID-19 pandemic, lifestyle, interpersonal relationships, psychological factors related to COVID-19, and deterioration of physical condition. Multiple logistic regression analysis identified insomnia, poor work/study/housework performance, and anxiety/depression as factors related to deterioration of physical condition. Chronic pain was not identified as factor related to deterioration of physical condition.<bold><italic>Conclusions </italic></bold>The effect of chronic pain on lifestyle and physical condition during the COVID-19 pandemic was limited. The factors related to deterioration of the physical condition were insomnia, poor work/study/housework performance, and anxiety/depression.

DOI： 10.21203/rs.3.rs-138931/v1

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Other Link： https://www.researchsquare.com/article/rs-138931/v1.html

【整形外科医の職業被曝】整形外科診療における被曝の現状と低減対策脊髄造影検査と神経根ブロック Reviewed

山根健太郎, 三澤治夫, 小田孔明, 鉄永倫子, 尾崎敏文

整形・災害外科 64 ( 6 ) 765 - 770 2021

Language：English Publishing type：Research paper (scientific journal) Publisher：金原出版(株)

＜文献概要＞脊椎外科医は日常診療において脊髄造影検査,神経根ブロック,手術などで職業被曝を受ける機会がある。それぞれの手技を施行する頻度や割合によって個人の放射線被曝量は大きく異なってくるため,被曝量を普遍化することは困難である。したがって,脊椎外科医各々の職業被曝に対する意識に応じて被曝量の低減化対策を行っているのが現状である。被曝の形態としては,いずれの手技中においても手が最も多く被曝を受ける「末端部被曝」であることを理解する必要がある。胸部や頭頸部線量計による被曝測定では末端部被曝を正しく測定することは困難である。脊髄造影検査,神経根ブロックそれぞれにおける検者被曝量の指標を示した。職業被曝量の低減化に対して脊椎外科医各々の意識改革と継続的な努力が求められる。

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慢性疼痛患者を対象とした痛みリエゾン外来における活動能力の帰結の類型化に関する検討 Reviewed

太田晴之, 齋藤圭介, 原田和宏, 京極真, 鉄永倫子, 西田圭一郎, 千田益生

日本保健科学学会誌 23 ( 4 ) 176 - 186 2021

【運動器疼痛】運動器疼痛を対象とした医療体制腰痛に対するチームアプローチ Reviewed

鉄永倫子, 鉄永智紀, 西田圭一郎

ペインクリニック 42 ( 別冊春 ) 247 - 254 2021

整形外科医師を対象とした就業状況の現状と健康に関する調査

土屋明大, 伊藤淳二, 堀井恵美子, 石原陽子, 大川淳, 金谷貴子, 田中奈津美, 鉄永倫子, 新関祐美, 早川和恵, 堀籠圭子, 三上容司, 村岡真理, 山内かづ代, 日本整形外科学会男女共同参画・働き方改革委員会

日本整形外科学会雑誌 94 ( 10 ) 907 - 917 2020.10

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

日本整形外科学会正会員25139名(2019年11月1日現在)を対象として、労働環境の現状ならびにその健康への影響との関連、今後の対応などに関する調査を行った。質問票は男女共同参画・働き方改革委員会で作成し、質問内容は勤務状況や労働条件に対する現時点での状況、取り組みの例などのほか、アウトカムとして簡易抑うつ症状尺度と日本版Burn out scaleの質問も含めた。その結果、10052名から総労働時間、夜間当直とオンコール、有給休暇取得日数、自己研鑽、他院での労働時間、女性医師の勤務状況、生活習慣やアウトカムに関する回答が得られ、整形外科医師の就労状況と現状が精神状態に及ぼす影響などが明らかとなった。

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運動器慢性痛を診る身体と心をサポート

鉄永倫子, 鉄永智紀, 尾崎敏文

日本整形外科学会雑誌 94 ( 9 ) 593 - 600 2020.9

Short-term outcomes of mirogabalin in patients with peripheral neuropathic pain: a retrospective study. International journal

Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Haruo Misawa, Tomoyuki Takigawa, Kentaro Yamane, Hironori Tsuji, Yoshitaka Takei, Toshifumi Ozaki

Journal of orthopaedic surgery and research 15 ( 1 ) 191 - 191 2020.5

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

BACKGROUND: Mirogabalin, which is approved for the treatment of peripheral neuropathic pain in Japan, is a ligand for the α2δ subunit of voltage-gated calcium channels. Both pregabalin and mirogabalin act as nonselective ligands at the α2δ-1 and α2δ-2 subunits. Mirogabalin has a unique binding profile and long duration of action. Pregabalin has been reported to produce intolerable adverse effects in some patients. This study investigated outcomes associated with mirogabalin administration in patients with peripheral neuropathic pain who ceased treatment with pregabalin. METHODS: We retrospectively assessed peripheral neuropathic pain using the neuropathic pain screening questionnaire (NeP score) in 187 patients (58 men, 129 women) who were treated with mirogabalin. All patients had switched from pregabalin to mirogabalin due to lack of efficacy or adverse events. Differences in the treatment course (i.e., numeric rating scale (NRS) scores) were compared using one-way analysis of variance with Bonferroni post hoc tests. RESULTS: The mean age of the patients was 72.3 years (range, 30-94 years), and the mean duration of disease was 37 months (range, 3-252 months). After treatment with mirogabalin for 1 week, NRS scores significantly decreased compared with baseline and continued to decrease over time. After 8 weeks, NRS scores improved by ≥ 30% from baseline in 113 patients (69.3%). Twenty-four patients (12.8%) stopped mirogabalin treatment due to adverse events. Somnolence (26.7%), dizziness (12.3%), edema (5.9%), and weight gain (0.5%) were noted as adverse events of mirogabalin. CONCLUSIONS: The results of this investigation indicate that mirogabalin is safe and effective for reducing peripheral neuropathic pain.

DOI： 10.1186/s13018-020-01709-3

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An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position. International journal

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

Journal of orthopaedic surgery and research 15 ( 1 ) 147 - 147 2020.4

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

BACKGROUND: Inadequate acetabular component orientation is associated with postoperative impingement, dislocation, and accelerated polyethylene wear. Computed tomography (CT)-based navigation systems provide accuracy for total hip arthroplasty (THA) but are not available in all facilities. Accelerometer-based navigation systems are inexpensive, but their accuracy remains undetermined. This study compares the accuracy of cup orientation in THA using CT-based and accelerometer-based navigation systems. METHODS: This retrospective study included 35 consecutive patients (11 males, 24 females; mean age, 65 years) who underwent primary cementless THA via an anterolateral approach in the supine position. Both CT-based and accelerometer-based navigation systems were used simultaneously. The accuracy of cup orientation was compared between the two systems using postoperative CT. RESULTS: The accuracy of cup inclination was 2.7° ± 2.0° in the CT-based group and 3.3° ± 2.4° in the accelerometer-based group. The accuracy of cup anteversion was 2.8° ± 2.6° in the CT-based group and 3.4° ± 2.2° in the accelerometer-based group. No significant difference was observed in cup inclination (p = 0.29) or cup anteversion (p = 0.34) between CT-based and accelerometer-based navigation. CONCLUSIONS: The accuracy of cup positioning did not differ significantly between CT-based and accelerometer-based navigation systems.

DOI： 10.1186/s13018-020-01673-y

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運動器疼痛患者における食事が及ぼす影響

廣瀬一樹, 鉄永倫子, 鉄永智紀, 尾崎敏文

中国・四国整形外科学会雑誌 32 ( 1 ) 143 - 145 2020.4

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

3ヵ月以上運動器疼痛が持続する200例を対象に、食事が規則正しくバランス良く摂取されている27例(良好群)、普通に摂取できている144例(普通群)、規則正しく摂取できていない29例(不良群)に分類した。3群間でBMI、痛みの評価としてNRS、意欲低下の評価としてApathy Scale、疼痛生活障害評価としてPDAS、不安抑うつ評価としてHADS、破局的思考評価としてPCSを比較した。その結果、BMIとApathy Scaleは良好群が不良群に比べ有意に低かった。NRSは良好群が他群に比べ有意に低かった。PDAS、HADS、PCSは有意な群間差がなかった。規則正しい食事が摂取できていない運動器疼痛患者は意欲が低下し、軽度肥満で、痛みが強い傾向にあると考えられた。疼痛の危険因子である肥満を改善するための規則正しい食事の指導、意欲低下の改善を図るための薬物療法や生活面へのアプローチが必要と思われた。

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側彎を有する成人脊柱変形患者における腰椎CTハンスフィールド値の検討

山根健太郎, 三澤治夫, 瀧川朋亨, 鉄永倫子, 村岡聡介, 辻寛謙, 高尾真一郎, 尾崎敏文

Journal of Spine Research 11 ( 3 ) 504 - 504 2020.3

運動器慢性痛に対する多面的アプローチ Reviewed

鉄永倫子, 鉄永智紀, 西田圭一郎

Journal of Musculoskeletal Pain Research 12 ( 3 ) 248 - 250 2020

The factors driving self-efficacy in intractable chronic pain patients: a retrospective study. International journal

Hironori Tsuji, Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Haruo Misawa, Toshifumi Ozaki

Journal of orthopaedic surgery and research 14 ( 1 ) 473 - 473 2019.12

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

BACKGROUND: The fear-avoidance model is a theoretical paradigm for explaining acute and chronic pain. In this model, pain catastrophizing plays an important role. On the other hand, self-efficacy influences whether patients view their pain optimistically, ultimately preventing the conversion of pain into intractable pain. The aim of the present study was to evaluate the factors that influence self-efficacy in patients with chronic pain. METHODS: Study participants included 147 outpatients (35 men, 112 women) with intractable chronic pain who visited our hospital between September 2014 and July 2015. Their mean age was 71.0 (range 32-92) years. Pain sites were as follows: low back, 97 patients; knee, 71 patients; shoulder, 34 patients; and hip, 15 patients. All patients were assessed using the following measures: Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), and Pain Self-Efficacy Questionnaire (PSEQ). All participants were further divided into two groups based on median PSEQ scores (group L: PSEQ of 35 points or less, n = 74; group H: PSEQ greater than 35 points, n = 73). The factors that influenced self-efficacy in these patients were analyzed using univariate and multiple linear regression analyses. RESULTS: Significant differences were observed in gender; pain duration; and NRS, PDAS, HADS, and PCS scores between group L and group H. Multiple linear regression analysis revealed that self-efficacy was correlated with PDAS score, HADS depression score, and pain duration. CONCLUSIONS: Patients with longer pain duration indicated greater self-efficacy and patients with higher pain disability and depression exhibited lower self-efficacy.

DOI： 10.1186/s13018-019-1535-9

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The Early Arthroscopic Pullout Repair of Medial Meniscus Posterior Root Tear Is More Effective for Reducing Medial Meniscus Extrusion.

Yusuke Kamatsuki, Takayuki Furumatsu, Shinichi Miyazawa, Yuya Kodama, Tomohito Hino, Yoshiki Okazaki, Shin Masuda, Yuki Okazaki, Tomoyuki Noda, Yasuaki Yamakawa, Tomoko Tetsunaga, Toshifumi Ozaki

Acta medica Okayama 73 ( 6 ) 503 - 510 2019.12

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

Clinical studies have demonstrated that transtibial pullout repair led to favorable midterm outcomes in patients with medial meniscus posterior root tears (MMPRTs) although medial meniscal extrusion (MME) continued to be present. It has been unclear whether these residual postoperative MMEs existed after the pullout repair or had progressed at the very short-term evaluation after surgery. We sought to determine which characteristics of patients with MMPRTs influence the incidence of postoperative MME. The cases of 23 patients whose date of injury was known were analyzed. All patients underwent MMPRT pullout fixation. Preoperative and 3-month postoperative magnetic resonance imaging (MRI) examinations were performed. MME was retrospectively assessed on the mid-coronal plane of MRI scans. The preoperative and postoperative MME values were 4.2±1.2 mm and 4.3±1.5 mm, respectively (p=0.559). Pullout repair surgery was performed significantly earlier after the MMPRT-specific injury in patients whose postoperative MME improved compared to the patients whose MME did not improve (p<0.001). Our findings demonstrated that an early transtibial pullout repair of an MMPRT was more effective in reducing MME than a late repair. Surgeons should not miss the optimal timing for the pullout repair of an MMPRT, considering the period from the injury and the preoperative MME.

DOI： 10.18926/AMO/57714

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私の処方運動器慢性痛患者に対するセロトニン・ノルアドレナリン再取り込み阻害薬(SNRI)

鉄永倫子, 鉄永智紀

Modern Physician 39 ( 12 ) 1166 - 1166 2019.12

女性整形外科医の勤務実状と勤務環境改善に向けて第1回整形外科領域における女性医師の現状に関するアンケート調査の中間報告

堀籠圭子, 冨士武史, 堀井恵美子, 金谷貴子, 田中奈津美, 鉄永倫子, 早川和恵, 村岡真理, 山内かづ代, 石井政次, 公益社団法人日本整形外科学会男女共同参画・働き方改革委員会

日本整形外科学会雑誌 93 ( 11 ) 921 - 923 2019.11

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