Faculty Profiles - OZAKI Toshifumi

Papers - OZAKI Toshifumi

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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 2021.7

Authorship：Last author 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

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A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis. International journal

Hideki Ohashi, Keiichiro Nishida, Yoshihisa Nasu, Kenta Saiga, Ryuichi Nakahara, Masahiro Horita, Shunji Okita, Toshifumi Ozaki

International journal of environmental research and public health 18 ( 14 ) 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (-0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

DOI： 10.3390/ijerph18147520

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Cement augmentation of internal fixation for trochanteric fracture: a systematic review and meta-analysis. International journal

Norio Yamamoto, Takahisa Ogawa, Masahiro Banno, Jun Watanabe, Tomoyuki Noda, Haggai Schermann, Toshifumi Ozaki

European journal of trauma and emergency surgery : official publication of the European Trauma Society 48 ( 3 ) 1699 - 1709 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

PURPOSE: This study aimed to determine the efficacy and safety of cement augmentation for internally fixed trochanteric fractures through a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS: We searched the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs, published until July 2020 that examined the effects of cement augmentation of internal fixation of trochanteric fractures. The primary outcomes were reoperation and Parker Mobility Score, whereas the secondary outcomes were 1-year mortality rate, EuroQol 5 Dimension, fixation failures, and adverse events. We conducted meta-analyses of the outcome measures using the random-effects models. We evaluated the certainty of evidence based on the Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS: We included three RCTs (326 participants). No significant effect was observed in favor of cement augmentation on all these outcomes. The certainty of evidence for fixation failures was very low and that for the other outcomes was low. The overall risk of bias for each outcome was high or of some concern in all included studies. CONCLUSIONS: The effect of cement augmentation of internal fixation of trochanteric fractures was uncertain for the clinical outcomes due to the low certainty of evidence. Further RCTs with a low risk of selection bias may present convincing conclusions on the efficacy and safety of cement augmentation. LEVEL OF EVIDENCE: Level 1.

DOI： 10.1007/s00068-021-01746-5

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Postoperative external tibial rotation is correlated with inferior meniscal healing following pullout repair of a medial meniscus posterior root tear. International journal

Takaaki Hiranaka, Takayuki Furumatsu, Yuki Okazaki, Keisuke Kintaka, Yusuke Kamatsuki, Ximing Zhang, Haowei Xue, Toshifumi Ozaki

Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

PURPOSE: The purpose of this study was to evaluate the influence of tibial rotation on the postoperative healing status of the medial meniscus (MM) following pullout repair of the MM posterior root tear (MMPRT). METHODS: Ninety-one patients (68 women and 23 men; mean age 63.3 ± 8.8 years) who had undergone transtibial pullout repair of MMPRT were enrolled in the study. The tibial external rotation angle (ERA) in each patient was measured postoperatively using computed tomography in the extended knee position. The meniscal healing status following transtibial pullout repair was assessed by second-look arthroscopy (mean postoperative period 12 months) using a previously published scoring system (range 0-10). The association between the ERA and the meniscal healing score was investigated using univariate linear regression models. The ERA cut-off for improved meniscal healing score (≥ 7) was determined using receiver-operating characteristic analysis. RESULTS: The ERA and the meniscal healing score were significantly associated, confirming that increased ERAs were correlated with worse meniscal healing status (R = - 0.28; P < 0.001). The optimum ERA cut-off value was 0.5°, with a sensitivity of 68% and a specificity of 63%. The mean meniscal healing scores were 7.3 and 6.2 among patients with ERAs < 0.5° and those with ERAs ≥ 0.5°, respectively (P < 0.001). CONCLUSION: This study demonstrated that the ERA was significantly correlated with the postoperative meniscal healing status. Postoperative tibial rotation could be one of the factors affecting postoperative outcomes of pullout repair of MMPRT. Controlling the tibial rotation may possibly improve meniscal healing. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-021-06656-y

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Spinopelvic fixation with retention of external fixation in a lateral position for unstable pelvic fracture. International journal

Norio Yamamoto, Hisanori Ikuma, Tomoyuki Noda, Tomoo Inoue, Keisuke Kawasaki, Toshifumi Ozaki

Orthopaedics & traumatology, surgery & research : OTSR 103008 - 103008 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

Anterior external fixation (EF), as the primary treatment for unstable pelvic fractures, is performed with patients in the supine position. In most cases, however, definitive surgery for posterior fixation is performed first in the prone position without EF. We report the case of a patient with unilateral and vertically unstable pelvic fracture whom we had treated with minimally invasive spinopelvic fixation, with retention of the anterior EF in a lateral position. Reduction of the residual displacement was performed with percutaneous spinal instrumentation, and acceptable reduction was achieved. At the 13-month follow-up, the functional outcome, calculated using the Majeed Score, was 87 points. The plain radiograph showed good bone union, except for the right superior pubic ramus. The radiological outcome, measured using the Matta rating, was excellent. Thus, retaining the EF facilitates safe and accurate reduction without major surgical complications and may offer surgeons an additional management option for such fractures.

DOI： 10.1016/j.otsr.2021.103008

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Symptomatic Venous Thromboembolism in Patients with Malignant Bone and Soft Tissue Tumors: A Prospective Multicenter Cohort Study

Shintaro Iwata, Akira Kawai, Takafumi Ueda, Takeshi Ishii, Tsukasa Yonemoto, Tsukasa Yonemoto, Hiroto Kamoda, Yoshihisa Suzuki, Kazutaka Kikuta, Jungo Imanishi, Taketo Okubo, Yasuo Yazawa, Tsukasa Sotobori, Hiroaki Murata, Toshifumi Ozaki, Toshiyuki Kunisada, Tomohiro Fujiwara, Shigeki Kakunaga, Koji Hiraoka, Tetsuya Hamada, Kotaro Matsuda, Takashi Yanagawa, Kenichi Saito, Hirofumi Namba, Motohiro Kawasaki, Shunji Nishimura, Kazuhiko Hashimoto, Takeshi Okamoto, Ukei Anazawa, Itsuo Watanabe, Michiyuki Hakozaki, Yoshinori Imura, Yoshinori Imura, Eisuke Kobayashi, Koichi Ogura, Taketoshi Yasuda, Kayo Suzuki, Toru Akiyama, Masami Hosaka, Munenori Watanuki, Kou Hayashi, Toshiharu Shirai, Ryu Terauchi, Hisaki Aiba, Hiroaki Kimura, Kunihiro Asanuma, Tomoki Nakamura, Tomohito Hagi, Satoshi Abe, Kenji Sato, Yukihiro Yoshida, Yoshiyuki Suehara, Keisuke Akaike, Hiroaki Hiraga, Tamotsu Soma, Hiroshi Kobayashi, Yusuke Shinoda, Ryoko Sawada

ANNALS OF SURGICAL ONCOLOGY 28 ( 7 ) 3919 - 3927 2021.7

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

Background A prospective cohort study was conducted to determine the incidence and risk factors of symptomatic venous thromboembolism (sVTE) during the perioperative period in patients with malignant bone and soft tissue tumors. Methods Patients with newly diagnosed primary malignant bone and soft tissue tumors for whom definitive surgery was planned were consecutively registered among 27 tertiary hospitals specializing in musculoskeletal oncology. Clinicopathological information on each patient was collected prospectively, and careful follow-up was conducted for 6 months after surgery. The study endpoint was the occurrence of sVTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Results Eleven of 929 patients developed sVTE, including 8 patients with DVT, 2 with PE, and 1 with both, making the incidence of sVTE 1.18%. The median time until the development of sVTE after tumor resection was 11 days, ranging from - 7 to 95 days. Multiple logistic regression analyses revealed that ischemic heart disease as a comorbidity, maximum tumor diameter exceeding 8 cm, and elevated preoperative platelet count were independent risk factors for sVTE. Conclusions The incidence of sVTE in this series of patients with bone and soft tissue sarcomas was 1.18%, which was relatively lower than in previous retrospective studies. We identified the risk factors for sVTE specific to patients with malignant bone and soft tissue tumors, and these included ischemic heart disease, tumor size, and elevation of the preoperative platelet count.

DOI： 10.1245/s10434-020-09308-6

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Treatment for postoperative infection of pathological femoral fracture after radiotherapy: two case reports and review of the literature. International journal

Minami Matsuhashi, Taichi Saito, Tomoyuki Noda, Takenori Uehara, Yasunori Shimamura, Toshifumi Ozaki

Archives of orthopaedic and trauma surgery 141 ( 7 ) 1139 - 1148 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Radiation-induced pathological fractures show high nonunion and infection rates. Successful treatment of postoperative infections of these fractures without limb amputation is extremely rare. METHODS: We report two cases of postoperative infection of pathological femoral fracture after radiation therapy for soft tissue tumors. Considering the poor condition of the irradiated site, a two-staged operation was selected to create the optimal situation for bone union. The treatment involved the Masquelet technique, latissimus dorsi (LD) flap, and a free vascularized fibula graft (FVFG). In the first stage, we drastically resected the necrotic bone and the surrounding infected tissue and placed antibiotic polymethylmethacrylate space on the bone gap according to the Masquelet technique. Next, we used an Ilizarov external fixator as a temporizing stabilizer and performed the LD flap. Six weeks later, in the second stage, we changed the external fixation to plate fixation; packed the artificial bone (β-TCP) and autograft bone to the induced membrane; and performed FVFG on the other side of the plate. As postoperative therapy, toe touch was allowed immediately, and partial weight bearing was started 2 months after second surgery. RESULTS: Both patients achieved bone union and were able to walk without postoperative complications. At the 2-year follow-up, there was no recurrence of infection. CONCLUSION: Our treatment is effective for controlling postoperative infection of radiation-induced pathological fracture.

DOI： 10.1007/s00402-020-03493-5

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Clinical prediction model for postoperative ambulatory ability outcomes in patients with trochanteric fractures. International journal

Yosuke Tomita, Norio Yamamoto, Tomoo Inoue, Tomoyuki Noda, Keisuke Kawasaki, Toshifumi Ozaki

Injury 52 ( 7 ) 1826 - 1832 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Regaining independent ambulatory ability is one of the primary goals of treatment in patients with trochanteric fractures. This study aimed to develop and evaluate the discriminative accuracy of a clinical prediction model for ambulatory ability outcomes 3 months after surgery for trochanteric fractures. METHODS: This retrospective cohort study included 346 patients treated with intramedullary nailing for trochanteric fractures who had independent ambulatory ability before their injury. Multiple regression models with preoperative and postoperative factors were used to predict ambulatory ability outcomes at 3 months. A clinical prediction model (CPM) was created based on a decision tree developed using a chi-square automatic interaction detector technique. RESULTS: Three months after surgery, 263 (76.0%) and 83 (24.0%) patients regained and lost independent ambulatory ability, respectively. Univariate analysis showed that the Barthel index (BI) total score at 2 weeks predicted the ambulatory ability outcome at 3 months with good discriminative accuracy (area under the receiver operating characteristic curve [AUROC]: 0.819; 95% confidence interval [CI]: [0.769, 0.868], cut-off value: 22.5; sensitivity: 69.5%; specificity: 82.3%). Multiple logistic regression analysis showed that preoperative factors (residence before injury, diagnosis of dementia, and serum albumin at admission) and postoperative factors (BI total score at 2 weeks) predicted ambulatory ability outcomes at 3 months (AUROC: 0.710; 95%CI: [0.636, 0.783]; sensitivity: 91.3%; specificity: 41.8%). The CPM with the BI total score at 2 weeks (≤10; 10<, ≤50; >50 points) and dementia status (present; absent) had a moderate discriminative accuracy (AUROC: 0.676; 95%CI: [0.600, 0.752]; sensitivity: 94.7%; specificity: 40.5%). CONCLUSIONS: We developed a CPM with moderate accuracy to predict ambulatory ability outcomes in patients 3 months after surgery for trochanteric fractures. Our results demonstrate the importance of the BI score measured soon after surgery and dementia status for the prediction of postoperative ambulation.

DOI： 10.1016/j.injury.2021.04.043

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Reduction quality and nail fixation ratio as bone-implant stability factors associated with reoperation for trochanteric fractures. International journal

Norio Yamamoto, Yosuke Tomita, Tomoyuki Noda, Tomoo Inoue, Yusuke Mochizuki, Toshifumi Ozaki

Injury 52 ( 7 ) 1813 - 1818 2021.7

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Geriatric trochanteric fractures are a major global issue, and their incidence is steadily rising. Bone quality, fracture type, fracture reduction quality, implant selection, and implant placement affect bone-implant stability in osteoporotic fractures. Our aim in this study was to evaluate the association between bone-implant stability factors, including nail construct, and the rate of reoperation in a more extensive case series with comprehensive variables. METHODS: This was a retrospective cohort study of 390 patients with trochanteric fractures aged ≥60 years and treated with intramedullary nailing. The primary outcome was the rate of reoperation due to any cause. Univariate and multivariable logistic regression analyses were used to identify factors associated with reoperation. RESULTS: In this study, 15 patients (3.8%) required reoperation. Univariate analysis showed that the following variables were significantly different between patients who required reoperation and those who did not: T-score at the total hip and lumbar spine, cortical thickness index, fracture type, and reduction quality. Multivariable logistic regression analysis showed that the odds ratio (OR) for A3 fracture type was 2.76 (95% confidence interval [CI], 0.77-9.76; p=0.116) and that for inadequate reduction, assessed by computed tomography, was 2.94 (95% CI, 0.89-9.69; p=0.076). These were independent predictors of reoperation. There was only one case (6.7%) of reoperation among patients with a distal femoral fragment fixation ratio (FR) >0.8. Considering the intraoperative decision-making process, the combination of inadequate reduction and an FR ≤0.8 were associated with the highest reoperation at a rate of 9.3% (OR, 3.327; 95% CI, 1.091-10.142; p=0.043). CONCLUSIONS: Risk factors on bone-implant stability for reoperation were the reduction quality and fracture type. Regarding the intraoperative decision-making process, the selection of a nail length with an FR >0.8 is a better option when the intramedullary reduction has been maintained intraoperatively.

DOI： 10.1016/j.injury.2021.04.048

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高齢者脛骨近位部骨折の治療成績

畑利彰, 野田知之, 島村安則, 上原健敬, 吉村将秀, 福岡史朗, 佐藤浩平, 近藤宏也, 齋藤太一, 尾崎敏文

骨折 43 ( Suppl. ) S201 - S201 2021.7

寛骨臼骨折手術における術中コンピュータ支援によるスクリュー挿入精度の向上

上原健敬, 野田知之, 福岡史朗, 佐藤浩平, 畑利彰, 近藤宏也, 齋藤太一, 島村安則, 尾崎敏文

骨折 43 ( Suppl. ) S163 - S163 2021.7

後方(Burks)アプローチによる脛骨近位部骨折(後外側骨片)の整復固定手技

野田知之, 上原健敬, 島村安則, 福岡史朗, 佐藤浩平, 畑利彰, 近藤宏也, 齋藤太一, 尾崎敏文

骨折 43 ( Suppl. ) S90 - S90 2021.7

大腿骨転子部骨折患者におけるCONUTを用いた術前栄養状態と術後歩行能力の関連性の検討

佐藤浩平, 野田知之, 福岡史朗, 近藤宏也, 畑利彰, 上原健敬, 齋藤太一, 島村安則, 東原信七郎, 尾崎敏文

骨折 43 ( Suppl. ) S295 - S295 2021.7

寛骨臼骨折に対する術後臨床成績評価方法の比較 Matta scoreとJHEQの比較検討

近藤宏也, 上原健敬, 福岡史朗, 佐藤浩平, 畑利彰, 斎藤太一, 雑賀建多, 島村安則, 野田知之, 尾崎敏文

骨折 43 ( Suppl. ) S283 - S283 2021.7

大腿骨骨幹部骨折の治療成績

福岡史朗, 佐藤浩平, 畑利彰, 近藤宏也, 上原健敬, 野田知之, 尾崎敏文

骨折 43 ( Suppl. ) S257 - S257 2021.7

踵骨骨折に対する外側小切開による骨接合術の治療成績ロッキングプレート固定とスクリュー固定の比較

佐藤浩平, 野田知之, 福岡史朗, 近藤宏也, 畑利彰, 上原健敬, 横尾賢, 吉村将秀, 尾崎敏文

骨折 43 ( Suppl. ) S251 - S251 2021.7

踵骨骨折における3DCTを用いた後距踵関節面の評価

上原健敬, 野田知之, 福岡史朗, 佐藤浩平, 畑利彰, 近藤宏也, 齋藤太一, 雑賀建多, 島村安則, 尾崎敏文

骨折 43 ( Suppl. ) S248 - S248 2021.7

関節面の整復に術中3D撮影およびナビゲーションが有用であった寛骨臼骨折の2例

畑利彰, 野田知之, 島村安則, 上原健敬, 福岡史朗, 佐藤浩平, 近藤宏也, 齋藤太一, 雑賀建多, 尾崎敏文

骨折 43 ( Suppl. ) S367 - S367 2021.7

多発外傷患者における筋断面積の推移の比較

近藤宏也, 上原健敬, 福岡史朗, 佐藤浩平, 畑利彰, 斎藤太一, 雑賀建多, 島村安則, 野田知之, 尾崎敏文

骨折 43 ( Suppl. ) S371 - S371 2021.7

Subjective and Objective Outcomes of Surgery for Rheumatoid Forefoot Deformities Under the Current Treatment Paradigm. International journal

Masahiro Horita, Keiichiro Nishida, Daisuke Kaneda, Kenzo Hashizume, Yoshihisa Nasu, Ryuichi Nakahara, Kenta Saiga, Hideki Ohashi, Masahito Watanabe, Toshifumi Ozaki

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 61 ( 1 ) 53 - 59 2021.6

Authorship：Last author Language：English Publishing type：Research paper (scientific journal)

We investigated the clinical outcomes of surgical procedures for the treatment of forefoot deformities in patients with rheumatoid arthritis. Twenty feet in 16 women (mean age 62.1 years) underwent corrective osteotomy of the first metatarsal bone with shortening oblique osteotomy of the lesser metatarsophalangeal joints (joint-preservation group), while 13 feet in 12 women (mean age 67.4 years) underwent arthrodesis of the first metatarsophalangeal joint with resection arthroplasty of the lesser metatarsophalangeal joints (joint-sacrifice group); mean follow-up for each group was 25.8 and 23.8 months, respectively. The mean total Japanese Society for Surgery of the Foot (JSSF) scale improved significantly from 64.2 to 89.2 in the joint-preservation group (p < .001), and from 54.2 to 74.2 in the joint-sacrifice group (p = .003). In the joint-preservation group, the postoperative range of motion (ROM) of the joint, walking ability, and activities of daily living scores of the JSSF scale were significantly higher than those in the joint-sacrifice group (p = .001, p = .001, and p = .019, respectively). There were no differences in the subscale scores of the self-administered foot evaluation questionnaire between 2 groups either pre- or postoperatively. No differences in the postoperative complications were found between 2 groups. Although the joint-sacrificing procedure resulted in lower objective outcomes than the joint-preserving procedure regarding the ROM of the joint, the walking ability, and the level of activities of daily living, both procedures resulted in similar treatment outcomes when evaluated by the subjective measures.

DOI： 10.1053/j.jfas.2021.06.008

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