Faculty Profiles - TETSUNAGA Tomoko

Papers - TETSUNAGA Tomoko

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多職種連携による痛みリエゾン外来

鉄永倫子

更年期と加齢のヘルスケア 17 ( 1 ) 31 - 35 2018.6

Language：Japanese Publisher：更年期と加齢のヘルスケア学会((NPO)更年期と加齢のヘルスケア)

慢性難治性疼痛を有する患者の治療は、その心理的合併症のために病態が複雑化して困難なものである。さらに、このような患者にとって、医療費および痛みによる一時的な休職などによる経済的損失は相当なものである。慢性難治性疼痛の患者を治療するためには、ヨーロッパで開発された集学的アプローチが効果的であることが示されている。このような集学的アプローチは、近年日本でも実施されており、いくつかの報告が見られる。慢性痛患者を支援するために、2012年に当院でも痛みを総合的に評価し治療する、痛みリエゾン外来を開設した。このアプローチは、医療者と患者の目標を明確にし、異なる分野の専門家がより効率的かつ効果的な方法で医療を提供することを可能にする。今回我々は、当院の痛みリエゾン外来を紹介し、その短期成績を報告する。(著者抄録)

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【慢性疼痛に対するトラマドール製剤の適切な使用法】リウマチ・炎症性疾患やその他の病態の慢性疼痛に対するトラマドール製剤使用

神崎浩孝, 鉄永倫子

日本医事新報 ( 4900 ) 38 - 45 2018.3

Language：Japanese Publisher：(株)日本医事新報社

＜Point＞▼リウマチ性疾患の遷延する痛みは、器質的疼痛(侵害受容性疼痛、神経障害性疼痛)と非身体器質的疼痛によって複雑化した複合型疼痛であり、薬剤選択には痛みのスクリーニングが重要である▼トラマドール製剤は侵害受容性疼痛、神経障害性疼痛に第二選択以降として用いられ、適合者の見きわめは慎重に行うべきであるが、リウマチ性疾患における疼痛治療薬の一選択肢として重要な位置にある▼トラマドール製剤の効果を最大化し、最適化するためには、副作用マネジメントを重要視し、アドヒアランスの維持に努める必要がある(著者抄録)

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Calcar Femorale in Patients with Osteoarthritis of the Hip Secondary to Developmental Dysplasia. International journal

Tomonori Tetsunaga, Kazuo Fujiwara, Hirosuke Endo, Tomoko Tetsunaga, Naofumi Shiota, Toru Sato, Toshifumi Ozaki

Clinics in orthopedic surgery 9 ( 4 ) 413 - 419 2017.12

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

Background: We investigated whether the calcar femorale, a cortical septum in the region of the lesser trochanter of the femur, correlates with results of femoral stem implantation in patients with osteoarthritis of the hip secondary to developmental dysplasia using computed tomography. Methods: This retrospective study included 277 hips (41 males and 236 females; age, 37 to 92 years) of patients who had presented to Okayama Medical Center with hip pain. Of these, a total of 219 hips (31 males and 188 females) had previously undergone total hip arthroplasty. According to the Crowe classification, 147 hips were classified as Crowe grade I, 72 hips as Crowe grade II-IV, and 58 hips as normal. Results: The calcar femorale was identified in 267 hips (96.4%). The calcar femorale was significantly shorter and more anteverted in Crowe grade II-IV hips than in Crowe grade I or normal hips. Significant differences in the shape of the calcar femorale were found according to the severity of hip deformity. Three stem designs were analyzed: single-wedge (59 hips), double-wedge metaphyseal filling (147 hips), and modular (13 hips). Single-wedge stems were inserted more parallel to the calcar femorale rather than femoral neck anteversion, while other types of stems scraped the calcar femorale. Conclusions: The angle of the calcar femorale differs according to the severity of hip deformity, and the calcar femorale might thus serve as a more useful reference for stem insertion than femoral neck anteversion in total hip arthroplasty using a single-wedge stem.

DOI： 10.4055/cios.2017.9.4.413

PubMed

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Neurofibromatosis type 1に伴う脊柱側彎症の手術成績

宇川諒, 杉本佳久, 小田孔明, 渡邉典行, 塩崎泰之, 鉄永倫子, 瀧川朋亨, 田中雅人, 尾崎敏文

中国・四国整形外科学会雑誌 29 ( 2 ) 297 - 300 2017.9

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

Neurofibromatosis type 1に合併した脊柱側彎症に対し手術を施行した10例(男性2例、女性8例、平均年齢19歳)の治療成績について検討した。その結果、術後平均観察期間は66ヵ月、手術方法は全例で後方固定術が施行され、thoracic pedicle screw法が6例、pedicle screw densityが50%以下のhybrid法が2例、growing rod法が2例であった。初回手術における矯正率は46%で、dystrophic typeの7例中6例でdystrophic changeの進行がみられ、うち5例で骨移植の追加を要した。最終術後半年以上経過観察できた7例の検討では、全例で骨癒合が得られ、合併症は初回術後5年時で腫瘍血管からの大量出血が1例、ロッド折損が2例にみられた。

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【慢性腰痛症に対する治療法の進歩】難治性慢性腰痛症例に対する集学的治療痛みリエゾン外来

鉄永倫子, 西田圭一郎, 鉄永智紀, 尾崎敏文

Journal of Musculoskeletal Pain Research 9 ( 2 ) 170 - 175 2017.9

Language：Japanese Publisher：(一社)日本運動器疼痛学会

難治性慢性痛に対しては集学的治療が有効であるとされる。岡山大学病院では2012年4月より痛みの多角的集学的治療を目指した「痛みリエゾン外来」を行っている。我々は痛みリエゾン外来の診療体系を認知行動療法の一環と考え、痛みはあるが動ける、活動に繋げられることを目標としている。今回、我々の行っている痛みリエゾン外来の紹介を行うとともに、これまでの治療成績について検討した。慢性腰痛患者に対する6ヵ月間の短期間の治療では、不安、破局的思考、疼痛生活障害が改善された。また多重ロジスティック回帰分析により初診時の高度の抑うつは治療後に疼痛が軽快しない危険因子であることがわかった。(著者抄録)

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脊柱変形手術時の運動誘発電位モニタリングにおけるanesthetic fade現象の検討

宇川諒, 瀧川朋亨, 小田孔明, 塩崎泰之, 鉄永倫子, 杉本佳久, 三澤治夫, 田中雅人, 尾崎敏文

日本整形外科学会雑誌 91 ( 8 ) S1733 - S1733 2017.8

思春期特発性側彎症における体幹体表変形の三次元的評価

小田孔明, 瀧川朋亨, 中原龍一, 宇川諒, 塩崎泰之, 杉本佳久, 鉄永倫子, 田中雅人, 尾崎敏文

日本整形外科学会雑誌 91 ( 8 ) S1809 - S1809 2017.8

Discrimination between Malignant and Benign Vertebral Fractures Using Magnetic Resonance Imaging. International journal

Tomoyuki Takigawa, Masato Tanaka, Yoshihisa Sugimoto, Tomoko Tetsunaga, Keiichiro Nishida, Toshifumi Ozaki

Asian spine journal 11 ( 3 ) 478 - 483 2017.6

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

STUDY DESIGN: Retrospective analysis using magnetic resonance imaging (MRI). PURPOSE: To identify MRI features that could discriminate benign from malignant vertebral fractures. OVERVIEW OF LITERATURE: Discrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators. METHODS: Totally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis. RESULTS: The chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2-548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0-229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5-21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005-4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=-3.88×(i)-3.05×(ii)-3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture. CONCLUSIONS: Although each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.

DOI： 10.4184/asj.2017.11.3.478

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関節リウマチの痛みと治療アプローチ

西田圭一郎, 小橋靖子, 鉄永倫子

Journal of Musculoskeletal Pain Research 9 ( 1 ) 7 - 14 2017.6

Language：Japanese Publisher：(一社)日本運動器疼痛学会

関節リウマチ(RA)の治療は生物学的製剤の導入と新しい治療戦略により、過去14年で大きく変化した。近代のリウマチ治療は局所あるいは全身性の炎症抑制に傾注してきたが、一方で患者による全般的疾患活動性評価は、しばしば寛解達成のための障害因子であり、疼痛が最も影響を与える因子であることが知られている。RAにおける疼痛は炎症や、末梢性および中枢性の疼痛感作、抑うつ、関節の構造的変化など様々な機序によって引き起こされる。これらは疾患経過や炎症の沈静化と再燃、あるいは個人によって異なるが、それぞれに応じた適切な治療を選択しなければならない。(著者抄録)

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Short-term outcomes of patients being treated for chronic intractable pain at a liaison clinic and exacerbating factors of prolonged pain after treatment.

Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Masato Tanaka, Yoshihisa Sugimoto, Tomoyuki Takigawa, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 22 ( 3 ) 554 - 559 2017.5

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

BACKGROUND: Although a multidisciplinary approach is often recommended to treat intractable pain, this approach does not completely prevent uncontrolled pain in some patients. The aim of this retrospective study was to investigate the exacerbating factors of prolonged, intractable pain among patients being treated at a pain liaison clinic. METHODS: The participants of this study were 94 outpatients (32 men, 62 women) with chronic intractable pain who visited our hospital between April 2013 and February 2015. Demographic and clinical information was obtained from all patients at baseline. Experts in various fields, including anesthesia, orthopedic surgery, psychiatry, physical therapy, and nursing, were involved in the treatment procedures. All patients were assessed before and after a 6-month treatment period using the following measures: the Numeric Rating Scale (NRS); the Pain Catastrophizing Scale (PCS); the Hospital Anxiety and Depression Scale (HADS); the Pain Disability Assessment Scale (PDAS); and the Oswestry Disability Index (ODI). All participants were then divided into two groups based on their self-reported pain after treatment: a pain relief group (n = 70) and a prolonged pain group (n = 24). The exacerbating factors of prolonged pain after treatment in the pain liaison outpatient clinic were analyzed using univariate and multiple logistic regression analysis. RESULTS: A significant improvement in NRS scores was observed after the 6-month follow-up period. After treatment, 24 (25.5%) of the 94 patients reported having prolonged pain. Significant improvements were seen in the PCS, PDAS, and ODI scores in the pain relief group, and in the HADS depression scores in the prolonged pain group. On univariate and multiple regression analysis, HADS depression scores were identified as a factor related to prolonged pain after treatment. CONCLUSIONS: The results of the present study suggest that severe depression at the initial visit to the liaison outpatient clinic was an exacerbating factor for prolonged pain after treatment.

DOI： 10.1016/j.jos.2017.01.004

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運動器慢性痛に対するチームアプローチ立ち上げと実践、その効果

矢吹省司, 池本竜則, 高橋直人, 鉄永倫子

Locomotive Pain Frontier 6 ( 1 ) 5 - 13 2017.5

Language：Japanese Publisher：(株)メディカルレビュー社

運動器慢性痛の原因および症状は多様であり、また治療の長期化に伴って患者の生活の質(QOL)および日常生活活動(ADL)にも悪影響を与えることから、患者満足度も低くドロップアウトする症例も少なくない。実際、個々の診療科での対応では自ずと限界があり、近年は集学的アプローチが非常に注目されるようになってきた。ただ、チームアプローチを考えている施設は多いと思われるが、実際には問題が多くなかなか立ち上がらないのが実情である。そこで今回は、「運動器慢性痛に対するチームアプローチ」と題して座談会を行い、立ち上げと実践およびその効果などの経験を通して、今後チームによる集学的治療を企画されている医療者の参考に供したいと思う。(著者抄録)

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Denosumab and alendronate treatment in patients with back pain due to fresh osteoporotic vertebral fractures.

Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Masato Tanaka, Yoshihisa Sugimoto, Tomoyuki Takigawa, Yoshitaka Takei, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 22 ( 2 ) 230 - 236 2017.3

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

INTRODUCTION: Denosumab specifically inhibits the receptor activator for nuclear factor-kappa B ligand (RANKL), and prevents osteoporotic fractures. Several reports have analyzed the effects of denosumab and alendronate alone on bone mineral density (BMD) or reduction of fracture risk. The objective of this study was to analyze the effects of antiresorptive osteoporosis pharmacotherapy on pain relief in patients with fresh vertebral fracture. METHODS: This retrospective, single-center study included 80 patients (10 males, 70 females) with fresh osteoporotic vertebral fractures treated using denosumab at a dose of 60 mg subcutaneously every 6 months (40 patients) or alendronate at a dose of 35 mg orally every week (40 patients) for 6 months in our hospital. The mean age of subjects was 77 years (range, 55-92 years). The primary outcome was duration of back pain. Secondary outcomes included changes in BMD, serum type 1 collagen cross-linked N-telopeptide (NTX), and serum N-terminal propeptide of type 1 collagen (P1NP) from baseline to 6 months. Pain catastrophizing due to back pain was assessed using the Pain Catastrophizing Scale (PCS). The incidences of further vertebral fracture and adverse events were also assessed. RESULTS: Pain relief was obtained at a mean of 3.3 weeks with denosumab and 5.4 weeks with alendronate. Pain relief was achieved significantly earlier with denosumab than with alendronate. At 6 months, change in BMD was higher with denosumab (6.1%) than with alendronate (0.8%). No significant differences in changes in NTX and P1NP were observed between groups. Scores for PCS were significantly lower for denosumab than for alendronate. The incidence of further vertebral fractures was 5% with denosumab and 10% with alendronate. Adverse event rates were similar between groups. CONCLUSIONS: Denosumab enabled earlier pain relief than alendronate and avoided catastrophizing in patients with osteoporotic vertebral fractures after 6 months of treatment.

DOI： 10.1016/j.jos.2016.11.017

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Total hip arthroplasty after failed treatment of proximal femur fracture. International journal

Tomonori Tetsunaga, Kazuo Fujiwara, Hirosuke Endo, Tomoyuki Noda, Tomoko Tetsunaga, Toru Sato, Naofumi Shiota, Toshifumi Ozaki

Archives of orthopaedic and trauma surgery 137 ( 3 ) 417 - 424 2017.3

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

INTRODUCTION: Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures. MATERIALS AND METHODS: We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment. RESULTS: Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p < 0.0001). Postoperative complications in the trochanteric fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p < 0.0001 for both). CONCLUSIONS: Performing THA after failed treatment of trochanteric fractures requires consideration of complication risk and incorrect femoral neck anteversion.

DOI： 10.1007/s00402-017-2631-0

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Neurofibromatosis type 1に伴う脊柱側彎症の手術成績

宇川諒, 杉本佳久, 小田孔明, 塩崎泰之, 鉄永倫子, 瀧川朋亨, 田中雅人, 尾崎敏文

Journal of Spine Research 8 ( 3 ) 783 - 783 2017.3

STLを用いた特発性側彎症患者の体表変形定量化の試み

小田孔明, 瀧川朋亨, 杉本佳久, 塩崎泰之, 鉄永倫子, 渡邉典行, 宇川諒, 田中雅人, 尾崎敏文

日本整形外科学会雑誌 91 ( 2 ) S143 - S143 2017.3

思春期特発性側彎症における3次元的体表測定の試み

小田孔明, 瀧川朋亨, 中原龍一, 宇川諒, 塩崎泰之, 鉄永倫子, 杉本佳久, 田中雅人, 尾崎敏文

Journal of Spine Research 8 ( 3 ) 285 - 285 2017.3

思春期特発性側彎症患者の自己イメージ

瀧川朋亨, 小田孔明, 宇川諒, 塩崎泰之, 鉄永倫子, 杉本佳久, 田中雅人, 尾崎敏文

Journal of Spine Research 8 ( 3 ) 286 - 286 2017.3

鉄永倫子, 田中雅人, 鉄永智紀, 杉本佳久, 荒瀧慎也, 瀧川朋亨, 尾崎敏文

Journal of Spine Research 8 ( 1 ) 6 - 10 2017.1

Language：Japanese Publisher：(一社)日本脊椎脊髄病学会

岡山大学病院痛みリエゾン外来を受診した脊椎関連難治性疼痛患者45例(男性16例、女性29例)を対象とし、その治療成績を検討した。治療中にドロップアウトした症例は45例中14例(31.1%)であり、初診時不安の強い症例がリエゾン外来への抵抗性を規定する因子として算出された。不安の強い症例には更なるクリニカルパスの改定、患者教育や家族への指導の充実など難治性疼痛に対するチーム医療のシステム化が必要である。(著者抄録)

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Neurofibromatosis type 1に伴う脊柱側彎症の手術成績

宇川りょう, 杉本佳久, 瀧川朋亨, 鉄永倫子, 塩崎泰之, 渡邉典行, 小田孔明, 田中雅人, 尾崎敏文

中国・四国整形外科学会雑誌 28 ( 3 ) 465 - 465 2016.9

思春期特発性側彎症における背部体表変形の三次元的評価の試み

小田孔明, 瀧川朋亨, 中原龍一, 杉本佳久, 荒瀧慎也, 鉄永倫子, 田中雅人, 尾崎敏文

日本整形外科学会雑誌 90 ( 8 ) S1644 - S1644 2016.8

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