研究者詳細 - 鉄永　倫子

論文 - 鉄永　倫子

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Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia. 国際誌

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

Hip international : the journal of clinical and experimental research on hip pathology and therapy 29 ( 5 ) 535 - 542 2019年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Adequate initial stability of the acetabular cup is essential for total hip arthroplasty (THA). However, changes in the alignment of the acetabular component caused by screw fixation are concerning in patients with inadequate bone stock. This study aimed to investigate the effects of screw fixation on the alignment of the acetabular component in THA patients with hip dysplasia. METHODS: We retrospectively examined 256 hips (range 28-87 years) that underwent THA using a navigation system. Patients were divided into 2 groups based on the presence or absence of changes in the alignment of the intraoperative acetabular cup, and univariate and multivariate analyses were performed to identify factors that were predictive of changes in acetabular component alignment after screw fixation in 2 dimensions: inclination and anteversion. RESULTS: Screw fixation led to a mean change in inclination of 1.6° (range 0-10°) and a mean change in anteversion of 1.4° (range 0-14°). The Crowe classification, the presence of bone cysts, and the use of an inferior quadrant screw were identified as factors that correlated with acetabular cup alignment changes in inclination (odds ratios, 6.01, 5.94 and 0.03, respectively). Only the Crowe classification was identified as a factor that correlated with intraoperative alignment changes in anteversion (odds ratio, 2.08). CONCLUSIONS: Screw fixation altered the acetabular cup alignment. The inclination changes were related to the extent of the dysplasia, and the risk was reduced when the inferior quadrant screw was used. Surgeons should use caution during screw fixation in THAs performed on severely dysplastic hips.

DOI： 10.1177/1120700019828708

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【患者さんが笑顔で過ごせるためにあなたが解決!痛みとしびれみんなの対応法を一挙公開!】治療後も痛みが残存するときのケア共感・傾聴の姿勢と心構え

鉄永倫子

整形外科看護 24 ( 8 ) 806 - 806 2019年8月

【患者さんが笑顔で過ごせるためにあなたが解決!痛みとしびれみんなの対応法を一挙公開!】治療後も痛みが残存するときのケア心理面へのアプローチ

鉄永倫子

整形外科看護 24 ( 8 ) 807 - 808 2019年8月

【患者さんが笑顔で過ごせるためにあなたが解決!痛みとしびれみんなの対応法を一挙公開!】治療後も痛みが残存するときのケア治療後の痛みの慢性化防止

鉄永倫子

整形外科看護 24 ( 8 ) 809 - 809 2019年8月

【患者さんが笑顔で過ごせるためにあなたが解決!痛みとしびれみんなの対応法を一挙公開!】治療後も痛みが残存するときのケア治療後も痛みが残存?

鉄永倫子

整形外科看護 24 ( 8 ) 802 - 803 2019年8月

【患者さんが笑顔で過ごせるためにあなたが解決!痛みとしびれみんなの対応法を一挙公開!】治療後も痛みが残存するときのケア不安への対応

鉄永倫子

整形外科看護 24 ( 8 ) 804 - 805 2019年8月

整形外科を牽引する女性医師たち-男女共同参画脊椎外科医から医療安全へそして未来へ

鉄永倫子, 鉄永智紀

臨床整形外科 54 ( 5 ) 473 - 475 2019年5月

【"ナゾ"の痛み診療ストラテジー OPQRSTで読み解く】診断と治療のストラテジー「頭の先から足の先まで」痛みのcase file 腰も足も痛いんです!

鉄永倫子, 鉄永智紀, 尾崎敏文

総合診療 29 ( 4 ) 450 - 454 2019年4月

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年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

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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【長引く痛みに向き合う】《それぞれの痛みにどうつきあうか》リウマチの痛み

鉄永倫子, 神崎浩孝, 鉄永智紀

Modern Physician 39 ( 3 ) 293 - 295 2019年3月

記述言語：日本語出版者・発行元：(株)新興医学出版社

＜ポイント＞●関節リウマチ(RA)の好発年齢は30〜50歳前後であるが近年高齢化によってEORAが増加している。●新しい薬の開発によって、active RAはコントロールできるようになったが、高齢化や高額薬価によって、新たな問題(治療上の制約)も生じている。●RA治療の目的は、臨床症状の緩和と関節破壊や身体機能障害の防止であり、疾患活動性の制御と寛解を目標とした治療(Treat to Target:T2T)が勧奨されている。●RAの痛みは侵害受容性疼痛、神経障害性疼痛、非身体器質的疼痛(心因性疼痛)が複雑に関連した複合型疼痛である。●RAの痛み治療には、身体所見のみならず精神心理面、患者背景の多面的な評価が重要であり、そのうえで手術の適応やタイミング、薬剤の調整を行う必要がある。(著者抄録)

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Avulsion fracture of the ischial tuberosity treated with the suture bridge technique: a case report. 国際誌

Tomonori Tetsunaga, Hirosuke Endo, Tomoko Tetsunaga, Kazuki Yamada, Takayuki Furumatsu, Toshifumi Ozaki

BMC musculoskeletal disorders 20 ( 1 ) 9 - 9 2019年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: In cases of avulsion fracture of the ischial tuberosity in which the bone fragments are substantially displaced, nonunion may cause pain in the ischial area. Various surgical procedures have been reported, but achieving sufficient fixation strength is difficult. CASE PRESENTATION: We treated a 12-year-old male track-and-field athlete with avulsion fracture of the ischial tuberosity by suture anchor fixation using the suture bridge technique. The boy felt pain in the left gluteal area while running. Radiography showed a left avulsion fracture of the ischial tuberosity with approximately 20-mm displacement. Union was not achieved by conservative non-weight-bearing therapy, and muscle weakness persisted; therefore, surgery was performed. A subgluteal approach was taken via a longitudinal incision in the buttocks, and the avulsed fragment was fixed with five biodegradable suture anchors using the suture bridge technique. CONCLUSIONS: Although the majority of avulsion fractures of the ischial tuberosity can be treated conservatively, patients with excessive displacement require surgical treatment. The suture bridge technique provided secure fixation and enabled an early return to sports activities.

DOI： 10.1186/s12891-018-2377-z

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【腰痛治療の最前線】腰痛の治療腰痛のリエゾン療法

鉄永倫子, 西田圭一郎, 鉄永智紀, 尾崎敏文

関節外科 37 ( 12 ) 1350 - 1356 2018年12月

記述言語：日本語出版者・発行元：(株)メジカルビュー社

腰痛に対する保存療法、薬物療法、手術療法が進歩するなかで、認知行動学的な集学的治療の重要性も昨今認識されてきている。そこで、腰痛のリエゾン療法についての効果・限界・今後の展望について紹介する。(著者抄録)

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【慢性運動器疼痛整形外科のペインマネジメント徹底解説】慢性運動器疼痛治療における薬学管理の実践ポイント! 慢性運動器疼痛治療薬の副作用マネジメント

神崎浩孝, 鉄永倫子, 西田圭一郎, 千堂年昭

薬局 69 ( 12 ) 3361 - 3367 2018年11月

記述言語：日本語出版者・発行元：(株)南山堂

＜Key Points＞◎慢性疼痛の治療は、個人差の大きいことから、その背景を十分に理解した上で、個別化した治療(医療)を提供する必要がある。◎慢性疼痛治療の目標は、「ADLとQOLの改善」であり、「痛みゼロ」を最重要目標としていない点でがん性疼痛治療と大きく異なっている。◎薬物療法マネジメントにおいて、薬剤使用の見極め(減量、中止や別の薬への変更)と副作用の発現リスクへの配慮が重要である。◎副作用マネジメントにおいて、漫然とした処方継続の回避と定期的な血液検査の奨励が必須である。◎高齢で慢性疼痛を呈する患者も多く、高齢者は副作用リスクも高いことから注意が必要である。(著者抄録)

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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年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

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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プレガバリンの処方実態調査腎機能と用法・用量を基にした適正使用に関する考察

神崎浩孝, 鉄永倫子, 田中雄太, 槇田崇志, 西原茂樹, 鉄永智紀, 北村佳久, 西田圭一郎, 千堂年昭

Journal of Musculoskeletal Pain Research 10 ( 3 ) S153 - S153 2018年11月

岡山大学病院における運動器慢性痛患者に対する復職支援の取り組み

鉄永倫子, 西田圭一郎, 鉄永智紀, 井上真一郎, 松崎孝, 太田晴之, 神崎浩孝, 大倉和代, 石橋京子, 宮本和子

Journal of Musculoskeletal Pain Research 10 ( 3 ) S74 - S74 2018年11月

Drug dependence in patients with chronic pain: A retrospective study. 国際誌

Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Hirotaka Kanzaki, Haruo Misawa, Tomoyuki Takigawa, Yasuyuki Shiozaki, Toshifumi Ozaki

Medicine 97 ( 40 ) e12748 2018年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Drug dependence, which can exist concurrently with chronic pain, is seen as one of the major causes of rapidly increasing medical expenses. However, drug dependence in patients with chronic pain has not been evaluated. The aim of this study was to identify the risk factors for drug dependence in patients with chronic noncancer pain.This retrospective study included 151 patients with chronic noncancer pain (43 males, 108 females; mean age, 72 years). Low back pain (LBP) occurred in 96 patients, whereas 22 had shoulder pain, 8 had hip pain, and 77 had knee pain. Patients were divided into drug dependence and nondrug dependence groups based on the Severity of Dependence Scale (SDS) scores. Patients with SDS scores ≥5 and <5 were classified into drug dependence and nondrug dependence groups, respectively. All patients completed self-report questionnaires. Factors that predict drug dependence were identified by performing univariate and multivariate analyses.Sixty (40%) of the 151 patients met the SDS criteria for drug dependence. Significant differences were found between patients with and without drug dependence for the LBP, hip pain, number of medications, and for the Numerical Rating Scale, Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale, and Pain Catastrophizing Scale (PCS) scores. Multiple regression analysis identified LBP, hip pain, PCS, and PDAS scores as factors related to drug dependence in patients with chronic noncancer pain.Drug dependence tends to differ in patients based on the location of their chronic pain. Pain catastrophizing and disability indicated a greater tendency for drug dependence. Thus, PCS and PDAS scores are useful screening tools for predicting drug dependence in patients with chronic pain.

DOI： 10.1097/MD.0000000000012748

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【しびれ・痛みに対する整形外科診療の進歩】薬物療法セロトニン・ノルアドレナリン再取り込み阻害薬の使用方法効果は抑うつの有無により影響するか

鉄永倫子, 鉄永智紀, 西田圭一郎, 尾崎敏文

別冊整形外科 ( 74 ) 23 - 26 2018年10月

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報告(2017年実施)

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, 堀籠圭子, 村岡真理, 山内かづ代, 石井政次, 日本整形外科学会男女共同参画委員会

日本整形外科学会雑誌 92 ( 9 ) 574 - 580 2018年9月

A Multidisciplinary Approach to the Management of Chronic Pain through a Self-managed Behavioral Exercise Program : A Pilot Study in Japan.

Hiroyuki Nishie, Tomoko Tetsunaga, Hirotaka Kanzaki, Koji Oda, Shinichiro Inoue, Yuta Ryuo, Haruyuki Ota, Takuya Miyawaki, Kyosuke Arakawa, Tomonori Tetsunaga, Yoshihisa Kitamura, Toshiaki Sendo, Hiroshi Morimatsu, Toshifumi Ozaki, Keiichiro Nishida

Acta medica Okayama 72 ( 4 ) 343 - 350 2018年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

We conducted this study to determine the short-term treatment outcomes of multidisciplinary approaches to chronic pain management for outpatients in Japan. We evaluated pain reduction and improvement in quality of life (QOL) after treatment. We analyzed 32 patients who had experienced intractable chronic pain for > 3 months. The patients received multidisciplinary therapeutic self-managed exercise instructions and then underwent evaluations 1 and 3 months after the treatment. We used the Pain Disability Short Form-36 (SF-36), Pain Catastrophizing Scale (PCS), and Pain Disability Assessment Scale (PDAS) to evaluate QOL. Although the pain levels were the same before and after the physical exercise program, the patients showed significant improvements in physical function on the SF-36 (48.5 vs. 54.5, 3 months vs. 1 month; p=0.0124), the magnification subscale on the PCS (6.8 vs. 5.9, 1 month vs. before; p=0.0164) and the PDAS (29.2 vs. 23.4, 3 months vs. before; p=0.0055). Chronic pain should be treated with a biopsychosocial approach, but time constraints and costs have limited the implementation of multidisciplinary and behavioral approaches to chronic pain management. Our findings demonstrate that clinical improvements are possible for patients with chronic pain, using multidisciplinary team resources widely available in Japanese clinical practice.

DOI： 10.18926/AMO/56169

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