研究者詳細 - 鉄永　倫子

論文 - 鉄永　倫子

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Efficacy of tramadol-acetaminophen tablets in low back pain patients with depression.

Tomoko Tetsunaga, Tomonori Tetsunaga, Masato Tanaka, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 20 ( 2 ) 281 - 6 2015年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Tramadol-acetaminophen tablets are currently used to treat pain, including that of degenerative lumbar disease. Although there are many reports on tramadol-acetaminophen tablets, treatment outcomes in low back pain (LBP) patients with depression remain uncertain. This study investigated the outcomes of LBP patients with depression treated with tramadol-acetaminophen tablets. METHODS: Of 95 patients with chronic LBP, 70 (26 men, 44 women; mean age 64 years) who were judged as having depression by the Self-Rating Depression Scale (SDS) were included in this study. In this trial, patients received one of two randomly assigned 8-week treatment regimes: tramadol-acetaminophen (Tramadol group, n = 35) and non-steroidal anti-inflammatory drugs (NSAIDs) (NSAID group, n = 35). In addition to completing self-report questionnaires, patients provided demographic and clinical information. All patients were assessed using a Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), SDS, and Pain Catastrophizing Scale (PCS). RESULTS: After 8 weeks' treatment, the NRS and SDS scores were lower in the Tramadol group than in the NSAID group (p < 0.05). There were no significant differences in the ODI, PDAS, and PCS scores between the groups (p = 0.47, 0.09, 0.47). Although there was no difference in the anxiety component of the HADS between the groups (p = 0.36), the depression component was lower in the Tramadol group than in the NSAID group (p < 0.05). There was no significant difference between groups in the percentage of patients with treatment-associated adverse events. CONCLUSIONS: This investigation found that tramadol-acetaminophen is effective for reducing LBP and provided a prophylactic antidepressant effect in chronic LBP patients with depression.

DOI： 10.1007/s00776-014-0674-4

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CBTスクリュー刺入部の3次元解析

瀧川朋亨, 田中雅人, 杉本佳久, 荒瀧慎也, 鉄永倫子, 尾崎敏文

Journal of Spine Research 5 ( 10 ) 1452 - 1455 2014年10月

記述言語：日本語出版者・発行元：(一社)日本脊椎脊髄病学会

本研究の目的はCBTスクリューの挿入可能な角度とスクリュー長、そのCT値を求めることである。64椎体の腰椎CTデータを用いて、4.5mm径の仮想スクリューが刺入可能な角度、スクリュー長およびスクリュー挿入部位のCT値を解析した。腰椎CBTスクリューは下位になるほどより尾外側方向で、より長いスクリューが刺入可能であった。CBTスクリュー挿入部位のCT値は椎弓根スクリューの約2倍であった。(著者抄録)

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岡山大学病院における難治性慢性痛に対する新しい試み痛みリエゾン外来

鉄永倫子, 田中雅人, 尾崎敏文, 西江宏行, 石川慎一, 溝渕知司, 井上真一郎, 小田幸治, 流王雄太, 宮脇卓也, 太田晴之

中国・四国整形外科学会雑誌 26 ( 1 ) 23 - 29 2014年4月

記述言語：日本語出版者・発行元：中国・四国整形外科学会

当院では平成24年4月から痛みリエゾン外来(難治性慢性痛に対する多角的集学的外来)を開設した。その概要を紹介し、これまでに診療した32例の短期成績を報告した。32例の内訳は腰痛11例、下肢痛5例、頸部痛5例、全身痛5例、足底部痛2例、前胸部痛2例、腋窩部痛1例、背部痛1例で、成績の評価指標は「Pain Disability Assessment Scale(PDAS)」「Pain Catastrophizing Scale(PCS)」「Hospital Anxiety Depression Scale(HADS)」「日本整形外科学会腰痛疾患質問票(JOABPEQ)」「日本整形外科学会頸部脊髄症評価質問票(JOACMEQ)」とした。PDASの得点は、初診時平均29.7±13.5点、1ヵ月後25.6±12.9点、3ヵ月後25.3±12.8点であり、有意な改善は認められなかった。PCSは初診時39.7±8.1点、1ヵ月後33.7±9.0点、3ヵ月後34.7±9.9点であり、有意な改善が認められた。HADSの抑うつスコアは初診時11.2±4.7点、1ヵ月後9.8±5.5点、3ヵ月後12.0±4.5点で有意な改善は認められず、不安スコアは初診時11.6±5.7点、1ヵ月後9.2±5.1点、3ヵ月後8.6±4.9点で有意な改善が認められた。JOABPEQは初診時46.3±35.1点、1ヵ月後37.5±28.5点、3ヵ月後35.5±28.5点で有意な改善が認められた。JOACMEQは全ての項目において有意な改善は認められなかった。

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Outcomes of pregabalin in lumbar-disease patients with depression.

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

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 19 ( 2 ) 229 - 234 2014年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The anti-seizure drug pregabalin is currently used for peripheral neuropathic pain, including degenerative lumbar disease with a neuropathic component. Although there are many reports associated with pregabalin, treatment outcome in low back pain (LBP) patients with depression remains uncertain. This study investigated the outcomes of pregabalin in LBP patients with depression. METHODS: We assessed 64 patients (29 men and 35 women) using a Visual Analogue Scale, a Self-Rating Depression Scale (SDS) and the Oswestry Disability Index (ODI). Mean age was 63.3 years (range 20-81), and mean duration of disease was 69.8 months (range 3-576). The patients were divided into two groups according to SDS: normal (n = 37) and depressed group (n = 27). RESULTS: Pregabalin significantly reduced both SDS and ODI in the depressed group (p < 0.05). Effect size was larger for both SDS and ODI in the depressed group than in the normal group. Pain was significantly relieved, even in the depressed group (p < 0.01). Pain reduction was achieved by the direct effect of pregabalin, as well as indirect effects attributed to change in depressive symptoms. Although both somnolence and dizziness were detected, the use of hypnotic agents was decreased in half of cases. Somnolence did not influence the analgesic effects of the drug or psychotic state. CONCLUSIONS: This investigation indicated that pregabalin is safe and effective for reducing both LBP and mood disturbance in patients with depression.

DOI： 10.1007/s00776-013-0529-4

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痛みリエゾン外来(集学的慢性痛診療チーム)クリニカルパスの作成

西江宏行, 大倉和代, 鉄永倫子, 井上真一郎, 太田晴之, 小田幸治, 日下亜依, 宮脇卓也, 福永亜沙美, 石川慎一, 好長香織, 馬場華奈己

日本クリニカルパス学会誌 16 ( 1 ) 23 - 27 2014年3月

記述言語：日本語出版者・発行元：(一社)日本クリニカルパス学会

慢性痛は、患者を苦しめるのみならず、医療経済、社会経済へも大きな損失をもたらすため、早急な対策が必要である。慢性痛は、心理・社会的な要因を含み複雑になるため、集学的に診療することが勧められている。しかし日本の医療体制では各科の壁を取り除いたチーム医療を行うのは困難な場合が多い。我々は、麻酔科、整形外科、精神科、総合リハビリテーション部、歯科麻酔科、看護部等で診察やカンファレンスを行い、診断治療を行う「痛みリエゾン外来」を2012年4月から開始した。痛みリエゾン外来は、複数の医療者で診療し、運動療法を通じて生活の質の向上を目指す外来である。しかし、複数での診療体制は複雑であり、患者、医療者側ともに混乱を生じた。そこで、「痛みリエゾン外来クリニカルパス」を作成した。クリニカルパスを通じて、痛みリエゾン外来の意義、診療の流れ、役割、目標などが明確になり、スムーズな診療ができるようになった。クリニカルパスは慢性痛の診療にも有効であると考える。(著者抄録)

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岡山大学病院における難治性慢性痛に対する集学的治療脱落症例の検討

鉄永倫子, 田中雅人, 杉本佳久, 荒瀧慎也, 瀧川朋亨, 尾崎敏文, 西江宏行, 石川慎一, 井上真一郎, 小田幸治, 太田晴之

日本整形外科学会雑誌 88 ( 3 ) S786 - S786 2014年3月

Intra-articular loose body caused by avascular necrosis of the femoral head in children. 国際誌

Tomoko Tetsunaga, Hirofumi Akazawa, Tomonori Tetsunaga

Journal of pediatric orthopedics. Part B 23 ( 1 ) 44 - 8 2014年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

In children, avascular necrosis of the femoral head occurs easily because of the difference in the domination of blood flow compared with that in adults. Here we report a rare case of a 12-year-old girl who sustained a femoral neck fracture. The femoral head collapsed after open reduction and internal fixation. The hip developed into subluxation because of the gradually enlarged loose body in association with avascular necrosis. These results might be explained by the fact that blood circulation from the ligamentum teres temporarily increases during the ages of 8-12 years.

DOI： 10.1097/01.bpb.0000434244.41569.6b

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難治性慢性腰痛症例に対する集学的治療の有効性痛みリエゾン外来

鉄永倫子, 西江宏行, 尾崎敏文

Locomotive Pain Frontier 2 ( 2 ) 92 - 97 2013年10月

慢性痛に対する痛みリエゾン外来パスの修正(入院を含めて)

大倉和代, 福永亜沙美, 好長香織, 西江宏行, 石川慎一, 溝渕知司, 鉄永倫子, 太田晴之, 日下亜衣, 胡重やす子

日本クリニカルパス学会誌 15 ( 4 ) 397 - 397 2013年10月

痛みリエゾン外来クリニカルパスにおける脱落症例の検討

西江宏行, 大倉和代, 井上真一郎, 小田幸治, 福島倫子, 日下亜依, 鉄永倫子, 石川慎一, 太田晴之, 好長香織

日本クリニカルパス学会誌 15 ( 4 ) 412 - 412 2013年10月

Posterior buttress plate with locking compression plate for Hoffa fracture.

Tomonori Tetsunaga, Toru Sato, Naofumi Shiota, Masahiro Yoshida, Yusuke Mochizuki, Tomoko Tetsunaga, Arubi Teramoto, Yoshiki Okazaki, Kazuki Yamada

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 18 ( 5 ) 798 - 802 2013年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Many difficulties are associated with treating fractures of the posterior condyle of the femur (Hoffa fractures). Anatomical reduction and internal fixation are optimum for such intra-articular fractures. Some surgeons use anteroposterior screws to achieve direct stability. However, screw fixation is not adequate in some cases. To increase stability, we treat Hoffa fractures with a posterior buttress plate; we use a twisted, 1/3 tubular plate at the posterior surface and a supplementary, locking compression plate (LCP) for additional stability. METHODS: Patients who had sustained Hoffa fractures between January 2006 and March 2009 were included in this study. Patients comprised three males and two females with a mean age of 73.6 years at the time of surgery. A 3.5-mm 1/3 tubular plate was twisted and applied to the posterolateral aspect of the distal femur. This was combined with an LCP on the distal femur to achieve a rafting effect. RESULTS: All fractures were healed within 15 weeks. There were no instances of nonunion, infection, or implant removal. The mean range of motion was -3° to 121°. Four patients had no pain in the treated limb and one had mild pain on weight bearing. The average Oxford Knee Score was 44.6 points. All patients achieved satisfactory joint function and regained their walking ability with good clinical results. CONCLUSIONS: Improved stability associated with this technique enables patients to begin range-of-motion training and return to their normal activities sooner; this resulted in good outcome.

DOI： 10.1007/s00776-013-0410-5

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【肩関節傷害診療の真髄】肩(関節)の痛みの病態

牛田享宏, 鉄永倫子

MEDICAL REHABILITATION ( 157 ) 1 - 6 2013年5月

記述言語：日本語出版者・発行元：(株)全日本病院出版会

肩周囲に痛みを生ずる頻度は非常に高く、2010年に全国で実施した1万人規模のアンケート調査でも、腰、頸の痛みに続いて肩周囲の痛みが慢性疼痛の発生部位として有病率が非常に高いことが判明した。このように肩周辺に痛みを引き起こしやすい解剖学的な要因としては、肩関節が体幹と腕をつなぐ要の部分であること、可動域が他の関節に比べて非常に大きい関節であるということなどが挙げられる。肩関節の痛みの病態としては、(1)関節およびその周囲組織の炎症状態、(2)過度の動きなど動的な要因の関与、(3)これらの結果、起こってきた関節の可動域低下による運動制限、(4)筋力の問題がある。特に神経メカニズムや筋腱のメカニズムは痛みの発生や持続に関与し、肩関節の痛みには様々な要因が単独もしくは組み合わせで関係している。(著者抄録)

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The clinical manifestations of lumbar disease are correlated with self-rating depression scale scores.

Tomoko Tetsunaga, Haruo Misawa, Masato Tanaka, Yoshihisa Sugimoto, Tomonori Tetsunaga, Tomoyuki Takigawa, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 18 ( 3 ) 374 - 9 2013年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Depression can exacerbate symptoms of chronic pain and worsen disability. The symptoms of lumbar disease may be particularly sensitive to psychological state, but statistical associations between low back pain (LBP) severity and mental health status have not been established. METHODS: Of the 151 patients with LBP, 122 completed questionnaires probing depressive symptoms, LBP severity, and degree of disability. In addition to completing self-report questionnaires, patients provided demographic and clinical information. A self-rating depression scale (SDS) was used to screen for depression. Pain and disability were assessed by the visual analog scale (VAS) and the Roland-Morris disability questionnaire (RDQ), respectively. Overall clinical severity was assessed using the Japanese Orthopaedic Association (JOA) score. Kendall's tau correlation coefficients were calculated to examine the relationships among these variables. RESULTS: Ninety-four patients (77 %) were in a depressive state as indicated by SDS score ≥40, including mild depression group (47 patients, SDS score from 40 to 49) and depression group (47 patients, SDS score ≥50). There were only 28 patients in the no depression group (SDS score ≤39). There was no significant difference in both age and pain duration among the three groups. The mean VAS score in the depression group (70 ± 19 mm) was higher than both no depression (41 ± 24 mm) and mild depression groups (52 ± 21 mm). The mean JOA score in the no depression group (14 ± 5.0 points) was higher than both mild depression (12 ± 4.0 points) and depression groups (10 ± 6.0 points). The mean RDQ in the depression group (15.1 ± 6.0 points) was higher than both no depression (6.4 ± 5.0 points) and mild depression groups (10.9 ± 5.4 points). Factors significantly correlated with SDS score included VAS, JOA score, and RDQ score. In contrast, SDS did not correlate with patient age or pain duration. CONCLUSIONS: The majority of chronic LBP patients examined were in a depressed state and the severity of depression correlated with pain severity, degree of self-rated disability, and clinical severity.

DOI： 10.1007/s00776-013-0363-8

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T-reflex studies in human upper limb muscles during voluntary contraction: normative data and diagnostic value for cervical radiculopathy. 国際誌

Tomoko Tetsunaga, Toshikazu Tani, Masahiko Ikeuchi, Kenji Ishida, Kazunobu Kida, Nobuaki Tadokoro, Masahiro Ichimiya, Noriaki Nakajima, Hideshi Tsuboya, Shinichirou Taniguchi

Archives of physical medicine and rehabilitation 94 ( 3 ) 467 - 73 2013年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

OBJECTIVE: To evaluate the diagnostic utility of the T reflexes elicited from the upper limb muscles during standardized volitional contraction monitored by a real-time integrating electromyographic analyzer. DESIGN: Prospective descriptive study. SETTING: Department of orthopedic surgery at a university hospital. PARTICIPANTS: Healthy subjects (n=80) evenly distributed across decades of age from 21 to 79 years, and 12 consecutive patients with a single cervical root lesion based on clinical and magnetic resonance imaging studies and diagnostic block. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Using a special hammer, which externally triggers the sweep on skin contact, we evoked T reflexes in the biceps (C5), brachioradialis (C6), triceps (C7), and the first dorsal interosseous muscles (C8). RESULTS: Simultaneous regression analyses yielded clinically useful upper limits of normative values for latencies, side-to-side differences, and amplitude ratios adjusted to age and arm span. Comparison of the T reflexes between the 2 sides localized the solitary root lesions with a high sensitivity (92%), specificity (81%), and accuracy (83%). T-reflex studies proved helpful to localize the lesion even in patients who solely complained of upper limb pain. CONCLUSIONS: The T reflexes with a standardized facilitation of the upper limb muscles provide a clinically useful, noninvasive measure to localize the C5 to C8 radiculopathies. This study contributes in reassessing the currently underused T reflex as an electrodiagnostic technique.

DOI： 10.1016/j.apmr.2012.09.003

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岡山大学病院における難治性慢性痛に対する新しい試み痛みリエゾン外来

鉄永倫子, 田中雅人, 杉本佳久, 瀧川朋亨, 尾崎敏文, 太田晴之, 千田益夫, 西江宏行, 石川慎一, 溝渕知司, 井上真一郎

日本整形外科学会雑誌 87 ( 2 ) S504 - S504 2013年3月

Chiari type I malformation caused by craniometaphyseal dysplasia.

Masato Tanaka, Shinya Arataki, Yoshihisa Sugimoto, Tomoyuki Takigawa, Tomoko Tetsunaga, Toshifumi Ozaki

Acta medica Okayama 67 ( 6 ) 385 - 9 2013年

記述言語：英語掲載種別：研究論文（学術雑誌）

Craniometaphyseal dysplasia is a rare genetic condition characterized by progressive thickening of bones in the skull and metaphyseal abnormalities in the long bones. This disorder often causes progressively symptomatic cranial nerve compression, but in rare cases foramen magnum stenosis may lead to quadriplegia. Chiari I malformation with craniometaphyseal dysplasia is extremely rare. The authors report on a 25-year-old woman with myelopathy due to Chiari I malformation along with craniometaphyseal dysplasia. There are only four previous case reports of this condition. The authors present here the fifth case report of this rare condition and summarize its characteristics.

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痛みリエゾン外来パスの作成

大倉和代, 溝渕知司, 西江宏行, 石川慎一, 鉄永倫子, 太田晴之, 馬場華奈己, 高木尚江, 胡重やす子

日本クリニカルパス学会誌 14 ( 4 ) 440 - 440 2012年11月

【1からわかる脊椎圧迫骨折のすべて】保存療法脊椎圧迫骨折に対する薬剤

鉄永倫子

整形外科看護 17 ( 10 ) 981 - 985 2012年10月

岡山大学病院における難治性慢性疼痛に対する新しい試み痛み・リエゾン外来

鉄永倫子, 田中雅人, 尾崎敏文, 西江宏行, 石川慎一, 溝渕知司, 井上真一郎, 宮脇卓也, 太田晴之, 千田益夫

中国・四国整形外科学会雑誌 24 ( 3 ) 486 - 486 2012年10月

高悪性度腫瘍の脊椎転移に関する治療成績

馬崎哲朗, 田中雅人, 杉本佳久, 瀧川朋亨, 鉄永倫子, 塩崎泰之, 尾崎修平, 尾崎敏文, 国定俊之, 三澤治夫, 片岡昌樹

中国・四国整形外科学会雑誌 24 ( 2 ) 273 - 277 2012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

著者らが手術治療を行った転移性脊椎腫瘍患者78例のうち、徳橋スコアで原発巣のスコアが0点であった21例(高悪性度群:H群、男性18例、女性3例、平均年齢55歳)の治療成績を、スコアが5点であった29例(低悪性度群:L群、男性16例、女性13例、平均:年齢65歳)と比較検討した。その結果、1)術中出血量、手術時間は両群間で有意差は認められなかった。2)術後合併症はH群で肺炎による死亡、DIC、せん妄がそれぞれ1例、L群でDVT2例、DIC、創感染、局所再発がそれぞれ1例であった。3)ASIA Impairment Scaleで1段階以上の改善率はH群で61%、L群で55%、術前後での歩行能力の改善率はH群で69%、L群で78%と、両群ともにほぼ同等であった。4)術後6ヵ月未満での死亡の割合はH群で7例、L群で4例とH群で高い傾向にあったが、術後平均生存期間は両群とも12ヵ月以上であり、生存率に有意差はなかった。

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