Faculty Profiles - TETSUNAGA Tomoko

Papers - TETSUNAGA Tomoko

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Could the Trabecular Bone Score Be a Complementary Tool for Evaluating Degenerative Lumbar Vertebrae?

Shinichiro Takao, Koji Uotani, Haruo Misawa, Tomoko Tetsunaga, Kensuke Shinohara, Kentaro Yamane, Yoshiaki Oda, Hironori Tsuji, Yuya Kajiki, Toshifumi Ozaki

Acta medica Okayama 79 ( 1 ) 39 - 45 2025.2

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

Evaluating vertebral bone mass and quality in the elderly poses challenges due to degenerative changes. This study aims to elucidate the usefulness of the trabecular bone score (TBS) by examining the relationship between bone mineral density (BMD), TBS, and Hounsfield unit (HU) values. A retrospective analysis of 599 vertebrae from 152 patients (mean age 69.0 years; range 44-89; 74 males and 78 females) undergoing dual-energy X-ray absorptiometry (DXA) and CT scans was conducted. Vertebrae were categorized into three grades based on the degree of degeneration. The TBS was calculated from DXA images, and the HU value was measured by placing a region of interest on an axial image of the vertebral mid-body. One-way analysis of variance and Pearson's correlation tests were employed to investigate the relationship between BMD and TBS or HU values. While lumbar BMD significantly increased (p<0.01) with degenerative changes, TBS and HU values showed no significant differences. The correlations between lumbar BMD and TBS values, and between BMD and HU values, were stronger without degenerative changes than with degenerative changes. Significantly different HU values were observed between the right and left sides of severely degenerated vertebrae. Severe degenerative changes, particularly those associated with sclerosis, may impact HU values. TBS exhibits greater potential than HU values as a complementary tool.

DOI： 10.18926/AMO/68360

Curve Progression After the Termination of Bracing for Adolescent Idiopathic Scoliosis: Usefulness of Combining the Proximal Femur Maturity Index (PFMI) and Risser Staging

Hisakazu Shitozawa, Haruo Misawa, Koji Uotani, Tomoko Tetsunaga, Kensuke Shinohara, Yoshiaki Oda, Masataka Ueda, Ryo Takatori, Kazutaka Yamashita, Toshifumi Ozaki

Cureus 2024.11

Accuracy of Cup Alignment in Total Hip Arthroplasty: A Comparison Between Portable Navigation and Goniometer. International journal

Tomonori Tetsunaga, Tomoko Tetsunaga, Kazuki Yamada, Takashi Koura, Tomohiro Inoue, Ryuichiro Okuda, Yasutaka Masada, Sho Muguruma, Yuki Okazaki, Toshifumi Ozaki

Cureus 16 ( 11 ) e74176 2024.11

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

Background Navigation systems, including portable navigation systems, used for total hip arthroplasty (THA) are useful for achieving higher cup alignment accuracy. NAVBIT, a newly available portable navigation system, uses a unique registration method, the table tilt registration. However, its accuracy is unclear. This retrospective study aimed to investigate whether THA with a portable navigation system in the lateral position with the flip technique is more accurate than THA with a cup goniometer in the supine or lateral positions. Methodology This study included 96 consecutive patients (77 women, 19 men) who underwent primary cementless THA using either a portable navigation system in the lateral position with the flip technique or a cup goniometer in the supine or lateral positions. The average age of the patients was 66.8 years (range = 29-91) and the average body mass index was 24.6 kg/m2 (range = 17.5-39.9). The accuracy of cup orientation was compared among the three groups. Results The absolute values of the difference in cup inclination and anteversion with the NAVBIT (2.1 ± 1.7°, 2.0 ± 1.4°) were smaller than that with the cup goniometer in the supine (3.4 ± 2.4°, 3.4 ± 2.2°) and lateral decubitus positions (3.4 ± 2.5°, 5.0 ± 3.5°). Overall, 91%, 64.5%, and 56.3% were within 5° of the target angles in the navigation, supine goniometer, and lateral goniometer groups, respectively. Conclusions The accuracy of cup alignment with the portable navigation system using the flip technique was significantly higher than that with the cup goniometer in the supine and lateral decubitus positions.

DOI： 10.7759/cureus.74176

Insomnia among patients with chronic pain: A retrospective study

Masataka Ueda, Tomoko Tetsunaga, Tomonori Tetsunaga, Keiichiro Nishida, Ryo Takatori, Hisakazu Shitozawa, Koji Uotani, Kennsuke Shinohara, Yoshiaki Oda, Toshifumi Ozaki

Medicine 103 ( 32 ) e39113 - e39113 2024.8

Publishing type：Research paper (scientific journal) Publisher：Ovid Technologies (Wolters Kluwer Health)

Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (−) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.

DOI： 10.1097/md.0000000000039113

骨接合術を行い椎間可動域の温存を試みたが椎体間固定術を要した椎弓根骨折の1例

小田孔明, 三澤治夫, 鉄永倫子, 魚谷弘二, 志渡澤央和, 植田昌敬, 鷹取亮, 尾崎敏文

中国・四国整形外科学会雑誌 36 ( 1 ) 93 - 97 2024.4

椎体に浸潤した非小細胞肺癌に対する根治的手術の治療成績

鷹取亮, 三澤治夫, 鉄永倫子, 魚谷弘二, 篠原健介, 小田孔明, 志渡澤央和, 植田昌敬, 尾崎敏文

日本整形外科学会雑誌 98 ( 3 ) S1294 - S1294 2024.3

AIを用いた単純CTによる転移性脊髄圧迫のスクリーニングの可能性

魚谷弘二, 鷹取亮, 植田昌敬, 志渡澤央和, 小田孔明, 篠原健介, 鉄永倫子, 尾崎敏文

日本整形外科学会雑誌 98 ( 3 ) S749 - S749 2024.3

思春期特発性側彎症に対する脊椎後方固定術において術中低体温は入院期間を延長させる

篠原健介, 三澤治夫, 魚谷弘二, 小田孔明, 鉄永倫子, 志渡澤央和, 植田昌敬, 鷹取亮, 尾崎敏文

西日本脊椎研究会抄録集 98回 21 - 21 2023.11

椎体に浸潤した非小細胞肺癌に対し、根治的手術を行った3例

鷹取亮, 三澤治夫, 鉄永倫子, 魚谷弘二, 篠原健介, 小田孔明, 志渡澤央和, 植田昌敬

西日本脊椎研究会抄録集 98回 19 - 19 2023.11

骨接合術を行い椎間可動域を温存しえた椎弓根骨折の1例

小田孔明, 三澤治夫, 鉄永倫子, 魚谷弘二, 志渡澤央和, 植田昌敬, 鷹取亮, 尾崎敏文

中国・四国整形外科学会雑誌 35 ( 3 ) 407 - 407 2023.11

腰部脊柱管狭窄症と併存した脊髄動静脈奇形の一例

志渡澤央和, 三澤治夫, 鉄永倫子, 魚谷弘二, 小田孔明, 植田昌敬, 鷹取亮, 尾崎敏文

中国・四国整形外科学会雑誌 35 ( 3 ) 342 - 342 2023.11

Index of postural stability(IPS)を用いた思春期特発性側彎症患者における動的姿勢制御能力の検討

小田孔明, 三澤治夫, 鉄永倫子, 魚谷弘二, 志渡澤央和, 植田昌敬, 山脇諒子, 尾崎敏文

日本整形外科学会雑誌 97 ( 8 ) S1839 - S1839 2023.8

Lenke type 1思春期特発性側彎症におけるHybrid法とSegmental Pedicle screw法による治療効果の検討

魚谷弘二, 三澤治夫, 鉄永倫子, 小田孔明, 志渡澤央和, 植田昌敬, 尾崎敏文

Journal of Spine Research 14 ( 3 ) 283 - 283 2023.4

骨粗鬆症治療を導入すべき脊椎手術を受ける患者の現状

高尾真一郎, 三澤治夫, 小田孔明, 魚谷弘二, 鉄永倫子, 山根健太郎, 竹内一裕, 尾崎敏文, 中原進之介

Journal of Spine Research 14 ( 3 ) 651 - 651 2023.4

Malignant spinal Cord Compression(MSCC)を伴う転移性脊椎腫瘍患者に対する手術介入は生命予後を改善するのか

志渡澤央和, 魚谷弘二, 三澤治夫, 鉄永倫子, 小田孔明, 植田昌敬, 尾崎敏文

Journal of Spine Research 14 ( 3 ) 243 - 243 2023.4

Malignant spinal cord compression(MSCC)を伴う転移性脊椎腫瘍患者に対する手術介入は生命予後に影響するか

志渡澤央和, 魚谷弘二, 三澤治夫, 鉄永倫子, 小田孔明, 植田昌敬, 尾崎敏文

日本整形外科学会雑誌 97 ( 2 ) S287 - S287 2023.3

Association of phase angle with sarcopenia in chronic musculoskeletal pain patients: a retrospective study. International journal

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

Journal of orthopaedic surgery and research 18 ( 1 ) 87 - 87 2023.2

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

BACKGROUND: In chronic musculoskeletal pain patients, detection of sarcopenia is of significant clinical interest. Phase angle, which can be measured through bioelectrical impedance analysis (BIA), can detect sarcopenia; however, the evidence in chronic musculoskeletal pain patients is limited. This study aimed to assess the relationship between phase angle and sarcopenia in patients with chronic musculoskeletal pain. Our hypothesis was that phase angle would be a useful indicator to identify sarcopenia in patients with chronic musculoskeletal pain. METHODS: A total of 190 patients (51 men and 139 women) with chronic musculoskeletal pain were included in this retrospective cross-sectional study. Patient data of backgrounds, numeric rating scale score for pain, skeletal muscle index, and phase angle assessed using BIA were retrospectively reviewed. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. RESULTS: A total of 51 patients (26.7%), including 10 men (19.6%) and 41 women (29.5%), were diagnosed with sarcopenia. Phase angle, sarcopenia-related factors, age, and body mass index (BMI) differed significantly in patients with and without sarcopenia. On multiple logistic regression analysis, the prevalence of sarcopenia was significantly correlated with phase angle and BMI. The areas under the curve exhibited high accuracy in discriminating sarcopenia in men and moderate accuracy in both sexes and in women. CONCLUSIONS: Phase angle may be a valid discriminator of sarcopenia in patients with chronic musculoskeletal pain.

DOI： 10.1186/s13018-023-03567-1

後期高齢者頸椎損傷の急性期手術介入のタイミングにコロナ禍は影響したか

魚谷弘二, 植田昌敬, 志渡澤央和, 小田孔明, 鉄永倫子, 三澤治夫, 尾崎敏文

西日本脊椎研究会抄録集 96回 21 - 21 2022.12

運動器慢性疼痛患者において生理的インピーダンス法における位相角はサルコペニア検出に有用である

辻寛謙, 鉄永倫子, 鉄永智紀, 高尾真一郎, 西田圭一郎, 尾崎敏文

Journal of Musculoskeletal Pain Research 14 ( 4 ) S49 - S49 2022.10

慢性疼痛患者を対象とした集学的治療における活動能力の継時的推移の類型化に関する検討

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

運動器理学療法学 2 ( Suppl. ) O - 28 2022.10

岡山大学病院における頸椎損傷の急性期手術介入のタイミングに関する検討

魚谷弘二, 植田昌敬, 志渡澤央和, 小田孔明, 鉄永倫子, 三澤治夫, 尾崎敏文

中国・四国整形外科学会雑誌 34 ( 3 ) 437 - 437 2022.10

不全四肢麻痺を呈し,観血的整復固定を要した環軸椎回旋位固定の一例

植田昌敬, 魚谷弘二, 志渡澤央和, 小田孔明, 鉄永倫子, 三澤治夫

中国・四国整形外科学会雑誌 34 ( 3 ) 439 - 439 2022.10

Factors influencing caregiver burden in chronic pain patients: A retrospective study. International journal

Hironori Tsuji, Tomoko Tetsunaga, Tomonori Tetsunaga, Haruo Misawa, Yoshiaki Oda, Shinichiro Takao, Keiichiro Nishida, Toshifumi Ozaki

Medicine 101 ( 39 ) e30802 2022.9

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

Chronic pain coexists with disability, anxiety, depression, and sleep disturbances, which are factors of pain chronicity in the fear-avoidance model. Self-efficacy for managing pain plays a protective role against pain chronicity. For chronic pain sufferers, social support from caregivers is important. However, such caregivers face enormous physical and mental burdens. This study aimed to assess how self-efficacy and factors related to the fear-avoidance model affect caregiver burden. Participants were 135 chronic pain patients and their caregivers who visited our outpatient pain special clinic. In clinical assessments, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), Athens insomnia scale (AIS), pain disability assessment scale (PDAS), pain self-efficacy questionnaire (PSEQ) for the patients and Zarit Burden Interview (ZBI) for their caregivers were evaluated. Participants were divided into 2 groups (L group ZBI < 24 points and H group ZBI ≥ 24 points) and compared. Regression analyses were conducted to identify factors correlated with the ZBI scores. Compared to L group, H group showed significantly higher NRS and HADs depression scores, and lower PSEQ scores. In univariate regression analysis, ZBI scores were significantly correlated with NRS, PCS, HADS anxiety, HADS depression, PDAS and PSEQ. Multiple linear regression analysis revealed that ZBI scores were significantly correlated with PSEQ. The caregivers who perceived high caregiver burden had significantly higher patients' pain intensity, depression, and lower self-efficacy than those who perceived low caregiver burden. Caregiver burden correlated with the pain intensity, pain catastrophizing, anxiety, depression, disability, and self-efficacy of chronic pain patients. Among these factors, self-efficacy was the most negatively correlated with caregiver burden. Treatments focused on increasing self-efficacy for managing pain have the potential to reduce caregiver burden.

DOI： 10.1097/MD.0000000000030802

慢性疼痛患者を対象とした集学的治療における活動能力の継時的推移の類型化に関する検討

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

Journal of Musculoskeletal Pain Research 14 ( 3 ) 171 - 181 2022.9

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

慢性疼痛患者における集学的治療が6ヵ月間可能であった集団の治療経過における継時的推移について,活動能力を指標に潜在プロフィール分析(Latent Profile Analysis:LPA)を用い集団を類型化すること,類型化された各集団の特徴について検討することである。結果,慢性疼痛患者において,活動能力の継時的推移は4つの集団に類型化できること,その治療経過は開始時の身体的パフォーマンスの状態で異なる治療経過を辿る可能性を明らかにした。(著者抄録)

Evaluation of SARC-F and SARC-CalF for sarcopenia screening in patients with chronic musculoskeletal pain: A prospective cross-sectional study. International journal

Hironori Tsuji, Tomoko Tetsunaga, Tomonori Tetsunaga, Haruo Misawa, Yoshiaki Oda, Shinichiro Takao, Keiichiro Nishida, Toshifumi Ozaki

Medicine 101 ( 29 ) e29568 2022.7

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

OBJECTIVES: Early sarcopenia detection using screening tools, such as SARC-F and SARC-CalF, has been proven reliable. However, the relationship between chronic musculoskeletal pain with sarcopenia is unknown. This study assessed sarcopenia morbidity as well as the reliability of sarcopenia screening with SARC-F and SARC-CalF in patients with chronic musculoskeletal pain. METHODS: Overall, 172 patients with chronic musculoskeletal pain were included in this cross-sectional study. All participants completed the SARC-F, SARC-CalF, numeric rating scale (NRS), and pain disability assessment scale (PDAS) assessments. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. Correlations between SARC-F and SARC-CalF scores and each measured variable were evaluated using univariate and multiple linear regression analyses. A receiver operating characteristic curve analysis was conducted, and reliabilities of SARC-F and SARC-CalF scores for diagnosing sarcopenia were compared. RESULTS: Thirty-nine patients were diagnosed with sarcopenia. Among these, 10 patients were <65 years old, and 29 were >65 years old. Both SARC-F and SARC-CalF scores significantly correlated with grip power, gait speed, skeletal mass index, numeric rating scale score, and PDAS score. In multiple linear regression analysis, SALC-F and SALC-CalF scores significantly correlated with PDAS score, skeletal mass index, and gait speed. The area under the curve were 0.70 for SARC-F and 0.88 for SARC-CalF; SARC-CalF had a significantly higher area under the curve than SARC-F. DISCUSSION: Sarcopenia was diagnosed in patients aged <65 years with chronic musculoskeletal pain. SALC-F and SARC-CalF scores showed a significant correlation with disability due to pain and were reliable sarcopenia screening tools for chronic musculoskeletal pain. SARC-CalF was more reliable than SARC-F.

DOI： 10.1097/MD.0000000000029568

【整形外科画像診断・評価の進歩】CT CTによる大腰筋評価と骨密度,骨折リスクとの関連

梶木裕矢, 辻寛謙, 三澤治夫, 鉄永倫子, 中原龍一, 尾崎敏文

整形外科 73 ( 6 ) 566 - 571 2022.5

Language：Japanese Publisher：(株)南江堂

＜文献概要＞はじめに高齢者の寝たきり率の増加は先進国の医学的,社会経済的問題となっている.この問題の原因として加齢による骨格筋の減少と骨粗鬆症性骨折があげられる.骨格筋量は40歳をすぎると毎年約1%減少すると報告されている.またサルコペニアは進行性の加齢に伴う骨格筋量と筋力の低下として定義され,日常生活動作の低下,生活の質の低下,死亡などの有害なアウトカムに関連している.European Working Group on Sarcopenia in Older People(EWGSOP)は,サルコペニアの診断に二重エネルギーX線吸収法(DXA)または生体電気インピーダンス分析(BIA)を使用し骨格筋指数を評価することを推奨している.一方,骨格筋量評価およびサルコペニアの診断にはCTの使用が有用であるとされ,CTベースのアプローチの一つであるL3椎体レベルでの骨格筋の総断面積を身長の二乗で除して求められる骨格筋指数は全身の骨格筋量と相関があることが報告されている.また最近の研究で,大腰筋指数(PMI)がより簡便な骨格筋量評価の方法として報告されている.これはL3椎体レベルでの左右の大腰筋面積の和を身長の二乗で除して測定される骨格筋指数であり,総骨格筋量と正の相関があり,サルコペニアの診断に有用であるとされている.骨粗鬆症は50歳以降の骨折の主要な原因の一つで,重篤で複雑な併存疾患を引き起こす可能性があり,骨量の減少,骨組織劣化,骨強度低下を特徴とする.骨粗鬆症の診断は主に骨塩量(BMD)に基づいて行う.BMDはDXAによって測定される単位面積当たりの骨に存在するミネラル成分の量であり,低BMDは骨強度の低下と脆弱性の増加による骨粗鬆症と骨折リスクの増加と相関している.世界保健機関(WHO)の基準によると,骨粗鬆症はTスコア(若年者の平均BMD標準値が0で標準偏差が1の指標)が-2.5以下の場合に診断される.骨折リスク評価ツール(FRAX)は,10年以内の骨粗鬆症性骨折および股関節骨折のリスクを予測するための国固有のアルゴリズムであり,2008年にWHOによって開発された.骨粗鬆症性骨折のリスクが15%以上の場合は予防的治療を開始することが推奨されている.近年DXAおよびBIAによって測定された骨格筋指数がBMDと正の相関関係があることが示されている.しかしながらCTで計測された骨格筋量とBMD,骨折リスクとの関連は明らかとなっていない.本研究の目的は,PMIとBMD,FRAXによって推定された骨折リスクとの相関を検討することである.

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20220527300013&doc_link_id=10.15106%2Fj_seikei73_566&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_seikei73_566&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Mechanical Study of Various Pedicle Screw Systems including Percutaneous Pedicle Screw in Trauma Treatment. International journal

Yoshiaki Oda, Tomoyuki Takigawa, Yasuo Ito, Haruo Misawa, Tomoko Tetsunaga, Koji Uotani, Toshifumi Ozaki

Medicina (Kaunas, Lithuania) 58 ( 5 ) 2022.4

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

Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction.

DOI： 10.3390/medicina58050565

脊椎手術を受ける患者から骨粗鬆症治療が必要な患者を見つけ出す

高尾真一郎, 三澤治夫, 鉄永倫子, 魚谷弘二, 小田孔明, 尾崎敏文

中部日本整形外科災害外科学会雑誌 65 ( 春季学会 ) 111 - 111 2022.4

慢性疼痛はコロナ禍における身体機能低下に与える影響は少ない

鉄永智紀, 鉄永倫子, 三澤治夫, 魚谷弘二, 小田孔明, 高尾真一郎, 梶木裕矢, 井上忠俊, 尾崎敏文, 田淵貴大

日本整形外科学会雑誌 96 ( 3 ) S781 - S781 2022.3

慢性疼痛はコロナ禍における身体機能低下に与える影響は少ない

鉄永智紀, 鉄永倫子, 三澤治夫, 魚谷弘二, 小田孔明, 高尾真一郎, 梶木裕矢, 井上忠俊, 尾崎敏文, 田淵貴大

日本整形外科学会雑誌 96 ( 3 ) S781 - S781 2022.3

三次元動作解析でみた2ステップテストと下肢体幹可動域の関連性

小田孔明, 三澤治夫, 鉄永倫子, 魚谷弘二, 高尾真一郎, 梶木裕矢

日本整形外科学会雑誌 96 ( 3 ) S900 - S900 2022.3

関節リウマチ患者における胸腰椎手術後の術後合併症および再手術の検討

三澤治夫, 小田孔明, 魚谷弘二, 鉄永倫子, 高尾真一郎, 梶木裕矢, 尾崎敏文

Journal of Spine Research 13 ( 3 ) 672 - 672 2022.3

骨密度と腸腰筋の各パラメーターとの関連 CT画像データを用いた検討

高尾真一郎, 三澤治夫, 鉄永倫子, 魚谷弘二, 小田孔明, 尾崎敏文, 梶木裕矢

日本整形外科学会雑誌 96 ( 3 ) S919 - S919 2022.3

単純CTによる脊椎転移脊柱管内進展の早期発見の可能性について

魚谷弘二, 三澤治夫, 梶木裕矢, 高尾真一郎, 小田孔明, 鉄永倫子, 尾崎敏文

Journal of Spine Research 13 ( 3 ) 299 - 299 2022.3

2ステップテストにおける体幹と下肢の三次元動作解析

小田孔明, 三澤治夫, 鉄永倫子, 魚谷弘二, 高尾真一郎, 梶木裕矢, 尾崎敏文

Journal of Spine Research 13 ( 3 ) 318 - 318 2022.3

CT画像における腸腰筋評価と最大握力 DXAによる骨密度、骨折リスクとの関連

梶木裕矢, 三澤治夫, 鉄永倫子, 魚谷弘二, 小田孔明, 高尾真一郎, 尾崎敏文

Journal of Spine Research 13 ( 3 ) 568 - 568 2022.3

Psoas muscle index predicts osteoporosis and fracture risk in individuals with degenerative spinal disease. International journal

Yuya Kajiki, Hironori Tsuji, Haruo Misawa, Ryuichi Nakahara, Tomoko Tetsunaga, Kentaro Yamane, Yoshiaki Oda, Shinichiro Takao, Toshifumi Ozaki

Nutrition (Burbank, Los Angeles County, Calif.) 93 111428 - 111428 2022.1

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

OBJECTIVES: Skeletal muscle loss and osteoporosis are major medical and socioeconomic concerns as the global population ages. Studies have reported that skeletal muscle mass correlates to bone mineral density (BMD). The psoas muscle index (PMI), measured as the L3 cross-sectional areas of the right and left psoas divided by the square of height, has a positive correlation with the total volume of skeletal muscle in the body. This study aimed to evaluate relationships between PMI and BMD and fracture risk estimated by the Fracture Risk Assessment Tool (FRAX). METHODS: Preoperatively acquired, plain computed tomography images at the L3 level were used to measure PMI in 87 people with degenerative spinal diseases. We evaluated the correlation between PMI and BMD and fracture risk estimated by FRAX. RESULTS: PMI was significantly correlated with BMD in the entire lumbar spine and femoral neck (r = 0.413 and 0.525, both P < 0.001). People with osteoporosis showed significantly lower PMI than those without (P < 0.05). PMI was also significantly correlated with FRAX score (r = -0.545, P < 0.001). Furthermore, based on the recommendation of osteoporosis treatment, participants were divided into two groups: FRAX ≥15% (R group) and FRAX <15% (C group). The R group showed significantly lower PMI than the C group (P < 0.001). Receiver operating characteristic curve analysis revealed that PMI has moderate accuracy in diagnosing osteoporosis and FRAX ≥15%. CONCLUSIONS: PMI was significantly associated with BMD and fracture risk. PMI measurement is straightforward and may increase the diagnosis rate of osteoporosis and fracture risk.

DOI： 10.1016/j.nut.2021.111428

麻痺性側彎側彎症を伴う重症脳性麻痺児のQOL評価

小田孔明, 三澤治夫, 鉄永倫子, 魚谷弘二, 赤澤啓史, 青木清, 尾崎敏文

日本小児整形外科学会雑誌 30 ( 3 ) S19 - S19 2021.11

Cognitive factors associated with locomotive syndrome in chronic pain patients: A retrospective study.

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

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 26 ( 5 ) 896 - 901 2021.9

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

BACKGROUND: Prevention and treatment for locomotive syndrome (LS) are important for extending healthy life expectancy. The 25-question geriatric locomotive function scale (GLFS-25) was developed to diagnose LS. The Fear-Avoidance model was proposed to explain pain chronicity. LS and chronic pain decrease activities of daily living; however, the relationships between LS and factors related to chronic pain in the Fear-Avoidance model are unknown. Objective of the current study was to assess the prevalence of LS and examine the factors of the Fear-Avoidance model and the GLFS-25 that affect the prevalence of LS in patients with chronic pain. METHODS: Participants included 281 patients (99 men, 182 women) aged over 40 years with chronic pain who visited our outpatient clinic for chronic pain. All participants completed the GLFS-25, numeric rating scale (NRS), pain catastrophizing scale (PCS), hospital anxiety and depression scale (HADS), and Athene insomnia scale (AIS). According to a GLFS-25 cutoff point, participants were divided into three groups (LS-2; GLFS-25 ≥ 16, LS-1; 7 ≤ GLFS-25 < 16, and non-LS; GLFS-25 < 7 points) and each parameter was compared among the groups, followed by multiple logistic regression analysis. Next, multiple linear regression analysis was performed to determine the factors associated with the GLFS-25. RESULTS: Of all 281 patients, 241 (85.8%) patients were diagnosed with LS-2. Univariate analysis revealed there were significant differences in NRS, PCS, HADS anxiety, HADS depression, and AIS among groups. Multiple logistic regression analyses showed PCS was significantly associated with LS-2 prevalence. The GLFS-25 was positively correlated with NRS, HADS depression, AIS in multiple linear regression analysis. CONCLUSIONS: We found that patients with chronic pain in our outpatient clinic had a significant rate of LS-2. The prevalence of LS-2 was significantly correlate with pain catastrophizing, and the GLFS-25 was significantly correlated with higher pain intensity, depression, and insomnia.

DOI： 10.1016/j.jos.2020.08.007

Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. International journal

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

Hip international : the journal of clinical and experimental research on hip pathology and therapy 31 ( 5 ) 603 - 608 2021.9

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

BACKGROUND: The accuracies of various navigation systems in total hip arthroplasty (THA) have been described; however, the accuracy of cup orientation with an accelerometer-based navigation system has not been reported. The purpose of this study was to compare the accuracies of computed tomography (CT)- and accelerometer-based navigation systems for cup orientation in THA. METHODS: In this prospective study, 30 patients who underwent cementless THA via anterolateral approach in the lateral decubitus position were analysed. A CT-based navigation system (30 hips) and an accelerometer-based navigation system (30 hips) were used simultaneously. The accuracy of cup orientation (absolute difference between intraoperative vs. postoperative measurements) was compared between the navigation systems using postoperative CT. RESULTS: The accuracy of cup inclination was 3.2 ± 2.4° in the CT-based navigation group and 4.1 ± 3.7° in the accelerometer-based navigation group (p = 0.3035). The accuracy of cup anteversion was 3.0° ± 2.5° in the CT-based navigation group and 6.8° ± 4.8° in the accelerometer-based navigation group. Cup anteversion was significantly more accurate with the CT-based navigation system than with accelerometer-based navigation (p = 0.0009). Multiple regression analysis demonstrated that the malposition in cup anteversion was positively correlated with the change in pelvic tilt and loosening of the reference antenna. CONCLUSIONS: Although, these results are only true for this specific accelerometer system, cup positioning was significantly more accurate with the CT-based navigation system than an accelerometer-based navigation in the lateral decubitus position. This is because of considerable discrepancies in the sagittal pelvic tilt, resulting in variability in cup anteversion angle with the use of an accelerometer-based navigation system.

DOI： 10.1177/1120700020904940

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

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

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

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

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

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

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。

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。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01133&link_issn=&doc_id=20201102090031&doc_link_id=%2Ffj2ortho%2F2020%2Fs09410%2F012%2F0907-0917%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj2ortho%2F2020%2Fs09410%2F012%2F0907-0917%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02438&link_issn=&doc_id=20200602230030&doc_link_id=%2Fcm4ortho%2F2020%2F003201%2F030%2F0143-0145%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcm4ortho%2F2020%2F003201%2F030%2F0143-0145%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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

Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia. International journal

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 2019.9

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

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

【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 2019.8

【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 2019.8

【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 2019.8

【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 2019.8

【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 2019.8

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 2019.5

【"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 2019.4

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 2019.3

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

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

【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 2019.3

Language：Japanese Publisher：(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)

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

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

BMC musculoskeletal disorders 20 ( 1 ) 9 - 9 2019.1

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

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

【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 2018.12

【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 2018.11

Language：Japanese Publisher：(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)

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 2018.11

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

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

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 2018.11

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 2018.11

Drug dependence in patients with chronic pain: A retrospective study. International journal

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

Medicine 97 ( 40 ) e12748 2018.10

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

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

【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 2018.10

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 2018.9

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 2018.8

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

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

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)

【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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01024&link_issn=&doc_id=20180328070005&doc_link_id=%2Faf9mdcla%2F2018%2F004900%2F014%2F0038-0045%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faf9mdcla%2F2018%2F004900%2F014%2F0038-0045%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02438&link_issn=&doc_id=20171010020026&doc_link_id=%2Fcm4ortho%2F2017%2F002902%2F026%2F0297-0300%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcm4ortho%2F2017%2F002902%2F026%2F0297-0300%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

【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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05881&link_issn=&doc_id=20171024170005&doc_link_id=%2Feg5undok%2F2017%2F000902%2F008%2F0170-0175%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feg5undok%2F2017%2F000902%2F008%2F0170-0175%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05881&link_issn=&doc_id=20170707070001&doc_link_id=%2Feg5undok%2F2017%2F000901%2F004%2F0007-0014%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Feg5undok%2F2017%2F000901%2F004%2F0007-0014%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05962&link_issn=&doc_id=20170523180001&doc_link_id=%2Fai1locoe%2F2017%2F000601%2F001%2F0005-0013%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai1locoe%2F2017%2F000601%2F001%2F0005-0013%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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

岡山大学病院における脊椎関連難治性疼痛に対する集学的治療ドロップアウト症例の検討

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)

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

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の検討

鉄永倫子, 西田圭一郎, 鉄永智紀, 尾崎敏文, 西江宏行, 太田晴之, 井上真一郎, 小田幸治, 龍野耕一, 宮脇卓也, 神崎浩孝

日本整形外科学会雑誌 90 ( 2 ) S39 - S39 2016.3

成人脊柱変形におけるsacral alar iliac screwのentry pointとtrajectoryの検討

渡邉典行, 瀧川朋亨, 小田孔明, 魚谷弘二, 篠原健介, 鉄永倫子, 荒瀧慎也, 杉本佳久, 田中雅人, 尾崎敏文

Journal of Spine Research 7 ( 3 ) 319 - 319 2016.3

思春期特発性側彎症Lenke1、2に対する選択的胸椎後方固定術後の胸腰椎/腰椎カーブおよび冠状面バランスはどのように推移するのか?

荒瀧慎也, 田中雅人, 杉本佳久, 瀧川朋亨, 鉄永倫子, 篠原健介, 渡邉典行, 魚谷弘二, 小田孔明, 森田卓也, 宇川諒, 尾崎敏文

Journal of Spine Research 7 ( 3 ) 266 - 266 2016.3

低侵襲側方進入椎体間固定術の合併症について

荒瀧慎也, 田中雅人, 杉本佳久, 瀧川朋亨, 鉄永倫子, 篠原健介, 渡邉典行, 小田孔明, 小松原将, 森田卓也, 尾崎敏文

日本整形外科学会雑誌 90 ( 3 ) S879 - S879 2016.3

腸腰筋の位置に対する腰椎アライメントの影響

小田孔明, 荒瀧慎也, 瀧川朋亨, 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 90 ( 3 ) S1074 - S1074 2016.3

思春期特発性側彎症Lenke5Cに対する術後肩バランスの検討

荒瀧慎也, 田中雅人, 杉本佳久, 瀧川朋亨, 鉄永倫子, 篠原健介, 渡邉典行, 魚谷弘二, 小田孔明, 小松原将, 宇川諒, 尾崎敏文

Journal of Spine Research 7 ( 3 ) 647 - 647 2016.3

成人脊柱変形における腰椎側彎と大腰筋の位置の関係

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

Journal of Spine Research 7 ( 3 ) 312 - 312 2016.3

【運動器疼痛性疾患に対する薬物療法update】運動器疾患に対する非ステロイド性抗炎症薬(NSAIDs)の使い方

鉄永倫子, 鉄永智紀

整形・災害外科 59 ( 2 ) 155 - 162 2016.2

Combination Therapy with Continuous Three-in-One Femoral Nerve Block and Periarticular Multimodal Drug Infiltration after Total Hip Arthroplasty. International journal

Tomonori Tetsunaga, Tomoko Tetsunaga, Kazuo Fujiwara, Hirosuke Endo, Toshifumi Ozaki

Pain research & management 2016 1425201 - 1425201 2016

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

Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.

DOI： 10.1155/2016/1425201

Microgeodic Disease Affecting the Fingers and Toes in Childhood: A Case Report. International journal

Tomonori Tetsunaga, Hirosuke Endo, Kazuo Fujiwara, Tomoko Tetsunaga, Toshifumi Ozaki

The open orthopaedics journal 10 500 - 504 2016

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

Microgeodic disease is a disease of unknown etiology that affects the fingers and toes of children, with ≥ 90% of cases involving the fingers alone. We present a rare case of microgeodic disease affecting an index finger and two toes simultaneously in a 7-year-old girl. X-ray and magnetic resonance imaging (MRI) showed multiple small areas of osteolysis in the middle phalanges of the left index finger, hallux, and second toe. Microgeodic disease was diagnosed from X-ray and MRI findings, and conservative therapy involving rest and avoidance of cold stimuli was provided. Although pathological fractures occurred in the course of conservative treatment, the affected finger healed under splinting without any deformity of the finger.

Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain. International journal

Tomoko Tetsunaga, Tomonori Tetsunaga, Masato Tanaka, Keiichiro Nishida, Yoshitaka Takei, Toshifumi Ozaki

Pain research & management 2016 7458534 - 7458534 2016

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

Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP.

DOI： 10.1155/2016/7458534

The Effect of Guidance regarding Home Exercise and ADL on Adolescent Females Suffering from Adverse Effects after HPV Vaccination in Japanese Multidisciplinary Pain Centers Reviewed

Takahiro Ushida, Masahiko Shibata, Masaki Kitahara, Shoji Yabuki, Masahiko Sumitani, Takanori Murakami, Masako Iseki, Masako Hosoi, Hiroaki Shiokawa, Tomoko Tetsunaga, Hiroyuki Nishie, Sei Fukui, Motohiro Kawasaki, Sinsuke Inoue, Makoto Nishihara, Shuichi Aono, Tatunori Ikemoto, Takashi Kawai, Young-Chang Arai

Pain Research and Management 2016 1 - 6 2016

Language：English Publishing type：Research paper (scientific journal) Publisher：Hindawi Limited

<italic>Background</italic>. Two prophylactic papillomavirus (HPV) vaccines have been available for primary prevention of cervical cancer. Although serious adverse effects (AE) were rare, more than 230 women have been suffering from severe AEs such as persistent pain and headache in Japan. Our research group started to treat adolescent females suffering from the AEs.<italic>Objective</italic>. To survey the characteristics of and the effects of cognitive behavioral therapy on adolescent female suffering from the AEs in Japanese multidisciplinary pain centers.<italic>Methods</italic>. One hundred and forty-five patients suffering from the AEs were reviewed retrospectively and 105 patients of them were provided guidance on home exercise and activities of daily living based partially on a cognitive-behavioral approach. The intensity of pain was rated by the patients using a numerical rating scale (NRS). Furthermore, the Hospital Anxiety and Depression Scale (HADS) and the Pain Catastrophizing Scale (PCS) were used.<italic>Results</italic>. Eighty out of the 105 patients who received the guidance were followed up, 10 displayed a marked improvement, and 43 showed some improvement.<italic>Conclusions</italic>. Guidance on home exercise and activities of daily living based on a cognitive-behavioral approach alleviated the AEs that women suffered from after HPV vaccination in Japan.

DOI： 10.1155/2016/3689352

Other Link： http://downloads.hindawi.com/journals/prm/2016/3689352.xml

Four-Year Results of Summit Stems for Total Hip Arthroplasty in Japanese Patients Reviewed

Tomonori Tetsunaga, Toru Sato, Naofumi Shiota, Tomoko Tetsunaga, Yoshiki Okazaki, Kazuki Yamada

HIP International 25 ( 6 ) 553 - 556 2015.11

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

<sec><title>Purpose</title> A retrospective study to evaluate the clinical and radiographic outcome of the Summit primary total hip arthroplasty (THA) at a minimum follow-up of 4 years.

</sec><sec><title>Methods</title> 87 hips in 84 Japanese patients underwent THA using Summit stems. 3 patients were lost to follow-up, and 4 patients were excluded because a Summit stem was judged to be inappropriate for their narrow femoral canals. The remaining 80 hips in 77 patients were evaluated. Mean age was 66 years (range, 33-86 y). Mean postoperative follow-up period was 52 months (range, 48-66 m).

</sec><sec><title>Results</title> There was no early stem subsidence after surgery. Of the 80 hips, 60 (75%) showed radiographic signs of stem osseointegration including zones 3 and 5 at final follow-up. Stress shielding occurred in 50 hips (62.5%), and third-degree stress shielding was observed in 12 hips (15%). 3 patients experienced postoperative thigh pain due to distal fixation.

</sec><sec><title>Conclusions</title> These short-term results indicate that the Summit stem achieved good initial fixation, although there were some cases of distal fixation. Careful long-term follow-up and observation will be necessary for hips in which stress shielding occurs.

</sec>

DOI： 10.5301/hipint.5000287

Other Link： http://journals.sagepub.com/doi/full-xml/10.5301/hipint.5000287

岡山大学病院における難治性慢性痛に対する薬剤師の介入意義について

神崎浩孝, 北村佳久, 千堂年昭, 鉄永倫子, 鉄永智紀, 尾崎敏文, 西江宏行, 太田晴之, 井上真一郎, 小田幸治, 流王雄太, 宮脇卓也, 西田圭一郎

Journal of Musculoskeletal Pain Research 7 ( 3 ) S71 - S71 2015.11

The effect of guidance for home exercise and activities of daily living on female adolescents experiencing adverse events after human papillomavirus vaccination in Japanese multidisciplinary pain centres. International journal

Takahiro Ushida, Masahiko Shibata, Masaki Kitahara, Shoji Yabuki, Masahiko Sumitani, Takanori Murakami, Masako Iseki, Masako Hosoi, Hiroaki Shiokawa, Tomoko Tetsunaga, Hiroyuki Nishie, Sei Fukui, Motohiro Kawasaki, Sinsuke Inoue, Makoto Nishihara, Shuichi Aono, Tatunori Ikemoto, Takashi Kawai, Young-Chang Arai

Pain research & management 2015.10

Establishment of a liaison clinic for patients with intractable chronic pain.

Tomoko Tetsunaga, Tomonori Tetsunaga, Hiroyuki Nishie, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 20 ( 5 ) 907 - 13 2015.9

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

BACKGROUND: A multidisciplinary approach has been shown to be effective for the treatment of intractable pain. However, few hospitals in Japan have established liaison clinics for such patients. In this study, we investigated the short-term results of a liaison clinic for patients with intractable chronic pain. METHODS: Study participants comprised 53 outpatients (20 men, 33 women) with intractable chronic pain who visited our hospital between April 2012 and March 2013. At baseline, patients completed a self-reported questionnaire and provided demographic and clinical information. Experts in various fields (anesthesia, orthopedic surgery, psychiatry, physical therapy, and nursing) conducted examinations of patients and attended a weekly conference during which patients' physical, psychological, and social problems were discussed and courses of treatment were determined. All patients were assessed using the Numerical Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Pain Disability Assessment Scale (PDAS). Eligibility for the pain liaison outpatient clinic was evaluated using multiple logistic regression analysis. RESULTS: After a 6-month follow-up period, no significant changes were seen in scores for the NRS, PDAS, or HADS for depression. In contrast, scores for both the PCS and HADS for anxiety were significantly reduced after 6 months of treatment (p < 0.05). HADS for anxiety was identified as a factor related to patient resistance to attending the pain liaison outpatient clinic (p < 0.05). CONCLUSIONS: This liaison clinic for patients with intractable chronic pain was able to improve patient anxiety. Severe anxiety at the initial visit represented a risk factor for dropout from the clinic.

DOI： 10.1007/s00776-015-0748-y

神経線維腫症1型に合併した頸髄髄内腫瘍の1例

渡邉典行, 荒瀧慎也, 小田孔明, 魚谷弘二, 篠原健介, 鉄永倫子, 瀧川朋亨, 杉本佳久, 田中雅人, 尾崎敏文

中国・四国整形外科学会雑誌 27 ( 3 ) 446 - 446 2015.9

Apathy scaleを用いた変形性股関節症患者と慢性腰痛患者の意欲低下の比較検討

鉄永智紀, 佐藤徹, 塩田直史, 鉄永倫子

Hip Joint 41 65 - 68 2015.8

Language：Japanese Publisher：日本股関節学会

当院整形外科を受診した慢性腰痛患者63例(以下A群)と末期変股症患者25例(B群)および健常対照群30例(C群)についてApathy scaleの測定を行い、群間比較した。また、疼痛の程度をNumerical rating scale(NRS)で測定するとともに、神経障害性疼痛スクリーニング質問票による調査、疼痛生活障害評価(Pain disability assessment scale:PDAS)、不安抑うつ評価(Hospital anxiety and depression scale:HADS)、破局的思考評価(Pain catastrophizing scale:PCS)を行い、群間比較した。結果、Apathy scaleの点数はA群とB群がC群に比べて有意に高く、A群とB群の間に有意差はなかった。NRSはA群>B群>C群の順に高く各群間に有意差を認め、神経障害性疼痛も同様であった。PDAS、HADS、PCSはA群とB群がC群に比べて有意に高値で、A群とB群の間に有意差はなかった。

処方エキスパートへの道(第2回) プレガバリン

鉄永智紀, 鉄永倫子

Loco Cure 1 ( 2 ) 150 - 154 2015.8

Comparison of Continuous Epidural Analgesia, Patient-Controlled Analgesia with Morphine, and Continuous Three-in-One Femoral Nerve Block on Postoperative Outcomes after Total Hip Arthroplasty. International journal

Tomonori Tetsunaga, Toru Sato, Naofumi Shiota, Tomoko Tetsunaga, Masahiro Yoshida, Yoshiki Okazaki, Kazuki Yamada

Clinics in orthopedic surgery 7 ( 2 ) 164 - 70 2015.6

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

BACKGROUND: Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty. METHODS: We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score. RESULTS: Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score. CONCLUSIONS: Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.

DOI： 10.4055/cios.2015.7.2.164

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 2015.3

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

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

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 2014.10

Language：Japanese Publisher：(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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05510&link_issn=&doc_id=20141104100020&doc_link_id=%2Ffg7spine%2F2014%2F000510%2F021%2F1452-1455%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg7spine%2F2014%2F000510%2F021%2F1452-1455%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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 2014.4

Language：Japanese Publisher：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。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J02438&link_issn=&doc_id=20140626110004&doc_link_id=%2Fcm4ortho%2F2014%2F002601%2F004%2F0023-0029%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcm4ortho%2F2014%2F002601%2F004%2F0023-0029%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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 2014.3

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

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

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 2014.3

Language：Japanese Publisher：(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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J03567&link_issn=&doc_id=20140407510004&doc_link_id=%2Fdy9cpath%2F2014%2F001601%2F004%2F0023-0027%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdy9cpath%2F2014%2F001601%2F004%2F0023-0027%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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 2014.3

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

Tomoko Tetsunaga, Hirofumi Akazawa, Tomonori Tetsunaga

Journal of pediatric orthopedics. Part B 23 ( 1 ) 44 - 8 2014.1

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

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

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 2013.10

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 2013.10

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 2013.10

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 2013.9

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

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

【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 2013.5

Language：Japanese Publisher：(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)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J03505&link_issn=&doc_id=20130527190001&doc_link_id=%2Fap5meree%2F2013%2F000157%2F001%2F0001-0006%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fap5meree%2F2013%2F000157%2F001%2F0001-0006%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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 2013.5

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

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

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

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 2013.3

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

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

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 2013.3

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

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

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.

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 2012.11

【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 2012.10

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 2012.10

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 2012.9

Language：Japanese Publisher：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。

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2012&ichushi_jid=J02438&link_issn=&doc_id=20121003210013&doc_link_id=%2Fcm4ortho%2F2012%2F002402%2F013%2F0273-0277%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcm4ortho%2F2012%2F002402%2F013%2F0273-0277%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Efficacy of Pregabalin for Patients with Neuropathic Pain and Degenerative Lumbar Disease

Tetsunaga Tomoko, Tanaka Masato, Sugimoto Yoshihisa, Misawa Haruo, Takigawa Tomoyuki, Shiozaki Yasuyuki, Osaki Syuhei, Mazaki Tetsuro, Yamane Kentarou, Ozaki Toshifumi

The Journal of the Chugoku-Shikoku Orthopaedic Association 24 ( 2 ) 325 - 329 2012

Language：Japanese Publisher：The Chugoku-Shikoku Orthopaedic Association

The anti-seizure drug, pregabalin, is used for treatment of neuropathic pain and degenerative lumbar disease. The objective of this study was to evaluate the effect of pregabalin (150-300 mg/day) in patients with chronic lower back/leg pain. We assessed 47 patients (17 men and 30 women) with an average age of 65 years (range 20 to 81 years), and an average disease duration of 87 months (range 3 to 480 months). All patients were assessed using a visual analogue scale (VAS, 0-100 mm), the Self-Rating Depression Scale (SDS, 20-80 points), and the Oswestry Disability Index (ODI, 0-100%). After 8 weeks, pregabalin improved lower back pain, leg pain, SDS and ODI significantly (P<0.01). Pain was improved significantly in the depression group as well as the normal group (P<0.01). Accepted sleepiness (51%), dizziness (19%), weight gain (16%) and rash (5%) were detected after medication. The use of the hypnotic agent was decreased in half of the cases after medication. Pregabalin is safe and effective for decreasing lower back pain and leg pain in patients with depression.

DOI： 10.11360/jcsoa.24.325

Other Link： http://search.jamas.or.jp/link/ui/2013107559

Intradermal administration of magnesium sulphate and magnesium chloride produces hypesthesia to mechanical but hyperalgesia to heat stimuli in humans. International journal

Takahiro Ushida, Osamu Iwatsu, Kazuhiro Shimo, Tomoko Tetsunaga, Masahiko Ikeuchi, Tatsunori Ikemoto, Young-Chang P Arai, Katsutoshi Suetomi, Makoto Nishihara

Journal of neuroinflammation 6 25 - 25 2009.8

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

BACKGROUND: Although magnesium ions (Mg2+) are known to display many similar features to other 2+ charged cations, they seem to have quite an important and unique role in biological settings, such as NMDA blocking effect. However, the role of Mg2+ in the neural transmission system has not been studied as sufficiently as calcium ions (Ca2+). To clarify the sensory effects of Mg2+ in peripheral nervous systems, sensory changes after intradermal injection of Mg2+ were studied in humans. METHODS: Magnesium sulphate, magnesium chloride and saline were injected into the skin of the anterior region of forearms in healthy volunteers and injection-induced irritating pain ("irritating pain", for short), tactile sensation, tactile pressure thresholds, pinch-pain changes and intolerable heat pain thresholds of the lesion were monitored. RESULTS: Flare formation was observed immediately after magnesium sulphate or magnesium chloride injection. We found that intradermal injections of magnesium sulphate and magnesium chloride transiently caused irritating pain, hypesthesia to noxious and innocuous mechanical stimulations, whereas secondary hyperalgesia due to mechanical stimuli was not observed. In contrast to mechanical stimuli, intolerable heat pain-evoking temperature was significantly decreased at the injection site. In addition to these results, spontaneous pain was immediately attenuated by local cooling. CONCLUSION: Membrane-stabilizing effect and peripheral NMDA-blocking effect possibly produced magnesium-induced mechanical hypesthesia, and extracellular cation-induced sensitization of TRPV1 channels was thought to be the primary mechanism of magnesium-induced heat hyperalgesia.

DOI： 10.1186/1742-2094-6-25

【脊髄・末梢神経疾患】随意収縮下に誘発される上肢筋伸張反射(T波) 健常人と頸部神経根症における検討

鉄永倫子, 谷俊一, 谷口愼一郎, 石田健司, 池本竜則, 一宮正博

臨床脳波 50 ( 5 ) 257 - 264 2008.5

Language：Japanese Publisher：(株)永井書店

目的:上肢筋伸張反射を安定して記録するために随意収縮下にT波を誘発した。対象:健常者80名と片側性頸部神経根症11名であった。結果:健常者のT波検出率は、両側95%以上であった。健常者のデータをもとに症例を検討したところ左右潜時差と振幅比からの判定が有用であった。考察:上腕二頭筋ではC5根、腕橈骨筋ではC6根、上腕三頭筋ではC7根、第一背側骨間筋ではC8根の異常の判定が可能と思われた。(著者抄録)

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J01558&link_issn=&doc_id=20080508060001&doc_link_id=%2Faf2rsnhd%2F2008%2F005005%2F001%2F0257-0264%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faf2rsnhd%2F2008%2F005005%2F001%2F0257-0264%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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