Faculty Profiles - OZAKI Toshifumi

Papers - OZAKI Toshifumi

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Regeneration of the Fibula with Unidirectional Porous Hydroxyapatite. International journal

Koji Demiya, Toshiyuki Kunisada, Eiji Nakata, Joe Hasei, Toshifumi Ozaki

Case reports in orthopedics 2019 9024643 - 9024643 2019

Language：English

A fibula graft is one of the most common orthopedic procedures for reconstruction of a bone defect, and some complications related to persistent defects of the fibula have been reported previously. We believe that regeneration of the fibula may be critical for postoperative function and prevention of complications. This report describes a 9-year-old female with Ewing sarcoma of the pelvis who was treated with the double-barrel fibula grafts for pelvic bone defect following tumor resection. The defect after fibular resection was filled with unidirectional porous hydroxyapatite (UDPHAp) implants. A plain radiograph revealed new bone formation and a callus-like structure at one month after surgery and bony union between each UDPHAp implant 5 months after surgery. Resorption of implanted UDPHAp was identified, and partial remodeling of the bone marrow cavity could be seen 1 year 2 months after surgery. A radiograph at final follow-up (5 years 10 months after surgery) demonstrated almost complete absorption of the implanted UDPHAp and clear formation of the cortex and bone marrow in the resected part of the fibula. The patient is able to walk well without any walking supports and to take part in sports activities.

DOI： 10.1155/2019/9024643

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Difference between the Right and Left Phrenic Nerve Conduction Times, Latency, and Amplitude. Reviewed

Katayama Y, Senda M, Kaneda D, Ozaki T

Acta medica Okayama 72 ( 6 ) 563 - 566 2018.12

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

We studied phrenic nerve conduction times in 90 phrenic nerves of 45 normal subjects. The phrenic nerve was stimulated at the posterior border of the sternomastoid muscle in the supraclavicular fossa, just above the clavicle, with bipolar surface electrodes. For recording, positive and negative electrodes were placed on the xiphoid process and at the eighth intercostal bone-cartilage transition, respectively. We studied both the right and left sides to determine whether there was any difference between the two sides. The mean onset latency (± SD) of the right compound muscle action potentials (CMAPs) (5.99±0.39 msec) was significantly shorter than that of the left CMAPs (6.45±0.50 msec). The mean peak latency was significantly shorter in the right CMAPs (10.22±1.33 msec) than the left CMAPs (12.48±2.02 msec). The mean (± SD) amplitude was significantly lower in the left CMAPs (0.42±0.11 mV) than the right CMAPs (0.49±0.10 mV). The difference between the length of the nerve on the right and left sides might have affected the difference in latency between the two sides.

DOI： 10.18926/AMO/56373

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Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction. Reviewed International journal

Kodama Y, Furumatsu T, Hino T, Kamatsuki Y, Ozaki T

Knee surgery & related research 30 ( 4 ) 348 - 355 2018.12

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

Purpose: To evaluate the clinical effects of using anatomical bony landmarks (Parsons' knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction. Materials and Methods: We performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes. Results: Use of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes. Conclusions: Use of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

DOI： 10.5792/ksrr.18.024

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Identification of Circulating Exosomal Marker in Synovial Sarcoma

Suguru Yokoo, Tomohiro Fujiwara, Aki Yoshida, Masahiro Kiyono, Yusuke Mochizuki, Koji Demiya, Joe Hasei, Toshiyuki Kunisada, Yusuke Yoshioka, Koji Ueda, Takahiro Ochiya, Toshifumi Ozaki

CANCER SCIENCE 109 570 - 570 2018.12

【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

Intraoperative O-arm-navigated resection in musculoskeletal tumors. Reviewed

Fujiwara T, Kunisada T, Takeda K, Hasei J, Nakata E, Nakahara R, Yoshida A, Ozaki T

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 23 ( 6 ) 1045 - 1050 2018.11

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

BACKGROUND: Although emerging evidence has suggested that computer-assisted navigation allows surgeons to plan the optimal level of resection without compromising the surgical margins, the precise accuracy of the procedures has been unclear. The aim of this study was to investigate the accuracy and safety of the musculoskeletal tumor resection using O-arm/Stealth intraoperative navigation assistance. METHODS: A retrospective study of six patients with bone and soft tissue tumors who underwent surgical resection using O-arm/Stealth navigation system was performed. The histological diagnosis was osteosarcoma, metastatic bone tumor, leiomyosarcoma, undifferentiated sarcoma, and synovial sarcoma, respectively. Tumor resection was performed according to planned osteotomy planes determined on O-arm/Stealth three-dimensional intraoperative images. The resection accuracy, length of time for the procedures, surgical margins, and perioperative complications were evaluated. RESULTS: The distances between the entry and exit points for the planned and actual cuts were 1.5 ± 0.3 mm and 2.3 ± 0.3 mm, respectively, and the mean discrepancy of the osteotomy angle was 2.8 ± 1.2°. The mean length of time required for navigation was 14 min. A histological examination revealed clear margins in all patients. There were no complications related to navigation, and no patients developed local recurrence during a mean follow-up of 30.6 months. CONCLUSIONS: The O-arm/Stealth intraoperative CT navigation system provides safe and accurate osteotomy in musculoskeletal tumor resections. However, surgeons should keep in mind and be careful of minimal errors during osteotomy, which are around 2 mm from the planned line.

DOI： 10.1016/j.jos.2018.06.012

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Early response assessment of palliative conventional radiotherapy for painful uncomplicated vertebral bone metastases. Reviewed

Nakata E, Sugihara S, Kataoka M, Yamashita N, Furumatsu T, Takigawa T, Tetsunaga T, Ozaki T

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

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骨形成不全症大腿骨骨折を繰り返し治療に難渋している骨形成不全症の1例

三喜知明, 遠藤裕介, 野田知之, 鉄永智紀, 尾崎敏文, 高橋欣吾, 武田健

日本整形外科学会雑誌 92 ( 11 ) 918 - 921 2018.11

Language：Japanese Publisher：(公社)日本整形外科学会

症例は13歳男児で、出生時に多発骨折(左上腕骨、左腓骨、第2〜4肋骨)を認め、骨形成不全症(Sillence分類IV型)と診断された。8歳時に転倒し、右大腿骨骨幹部骨折に対し当院でギプス加療を行った。左大腿骨は骨幹部骨折を生後3ヵ月時と6歳時に生じ、10歳時に転倒し左大腿骨顆上骨折を受傷したが、転位は軽度でギプス固定による保存的加療により骨癒合が得られていた。その後も骨折を繰り返し、13歳時に車いすで転倒しそうになった際に左股関節に違和感があり左大腿骨頸部不全骨折を生じ、LCPプレート孔より4.5mm CCSと5.0mmロッキングスクリューを挿入し、前方より6.5mm CCS1本の計3本で追加固定を施行されている。最終術後2ヵ月時の単純X線像では骨折転位は認めておらず、移動は車いすで自立している。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01133&link_issn=&doc_id=20181204100016&doc_link_id=%2Ffj2ortho%2F2018%2F009211%2F018%2F0918-0921%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj2ortho%2F2018%2F009211%2F018%2F0918-0921%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Composition of Cell Clusters in Torn Menisci and Their Extracellular Matrix Components. Reviewed

Kodama Y, Furumatsu T, Maehara A, Ozaki T

Acta medica Okayama 72 ( 5 ) 499 - 506 2018.10

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

Cell clusters, or groups of cells sharing a single chondron-like structure, are frequently found in degenerated areas of the osteoarthritic (OA) meniscus. However, little is known about these meniscal clusters in humans. The aim of our study was to determine the composition of the extracellular matrix deposition around cell clusters in human OA menisci. Twenty-six menisci were obtained through total knee arthroplasty from patients with OA knee joints. The specimens were subjected to safranin O staining and immunostaining for Sry-type HMG box 9 (SOX9), type II collagen, and aggrecan. Their signal density after staining was assessed using ImageJ software. Five regions of interest were analyzed within each tissue sample. The SOX9, type II collagen, and aggrecan densities were considerably higher in cluster areas than in intact superficial layers of the meniscus. In addition, a substantial difference was detected between cluster areas and degenerative areas without cell clusters. We demonstrated that cell clusters localized near fissures and clefts showed remarkable uniformity in menisci exposed to a broad range of injuries. In addition, the chondrogenic proteins SOX9, type II collagen, and aggrecan were highly expressed in these tissues.

DOI： 10.18926/AMO/56248

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A high incidence of extensor pollicis brevis insertion into the distal phalanx in rheumatoid arthritis patients who required the surgical reconstruction for thumb boutonnière deformity. Reviewed International journal

Okita S, Nishida K, Ohtsuka A, Ozaki T

Modern rheumatology 29 ( 6 ) 1 - 15 2018.10

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

Objectives: The aim of the current study was to investigate the pattern of extensor pollicis brevis (EPB) insertion macroscopically and histologically using cadaveric thumbs, and to compare the incidence of different insertions with that of thumb boutonnière deformity in rheumatoid arthritis (RA) patients who required surgical reconstruction.Methods: We examined 103 thumbs of 58 adult cadavers with no evidence of RA, and reviewed the surgical records of 28 thumbs of 23 RA patients who underwent surgical reconstruction for thumb boutonnière deformity. The incidence of different insertion patterns of the cadaveric thumbs and the RA thumbs were compared using the Fisher's exact test.Results: Macroscopic and histologic examination revealed that the insertion patterns of EPB could be divided into three groups: insertion into the base of the proximal phalanx (Type P1), integration of EPB into the dorsal fibrocartilage of the MCP joint (Type P2), and insertion into the distal phalanx (Type D). The incidence of Type D was significantly higher in RA patients with thumb boutonnière deformity (64%) than that in the non-RA cadavers (29%; P < .05).Conclusion: EPB is inserted into the distal phalanx more frequently in RA patients who require surgery for thumb boutonnière deformity than non-RA cadavers, suggesting an additional possible mechanism of this deformity.

DOI： 10.1080/14397595.2018.1532484

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

Tetsunaga T, Tetsunaga T, Nishida K, Kanzaki H, Misawa H, Takigawa T, Shiozaki Y, Ozaki T

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

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Thymol turbidity test is associated with the risk of cyclops syndrome following anterior cruciate ligament reconstruction. Reviewed International journal

Kodama Y, Furumatsu T, Hino T, Kamatsuki Y, Okazaki Y, Masuda S, Okazaki Y, Ozaki T

BMC musculoskeletal disorders 19 ( 1 ) 367 - 367 2018.10

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

BACKGROUND: Cyclops nodule formation is a serious complication after anterior cruciate ligament (ACL) reconstruction. The purpose of our study was to investigate whether an increase in thymol turbidity test (TTT) values is involved in the development of cyclops nodule formation or cyclopoid scar formation following ACL reconstruction. METHODS: Between 2011 and 2014, 120 cases underwent outside-in ACL reconstruction. Forty-seven patients who had high TTT values were individually matched for age, sex, body mass index, and meniscus injury to a low TTT value group of 47 patients. The primary outcome was the occurrence of cyclops nodule formation or cyclopoid scar formation. All 94 patients were divided into 3 groups using surgical records and intra-operative video to enable a sub-analysis. The groups were a no-cyclops group, a cyclopoid group, and a cyclops group. Blood examinations, including TTT, and knee range of motion evaluations were performed before surgery, 3 months after surgery, and 1 year after surgery. RESULTS: There were no differences in preoperative demographic data between the two groups. TTT values did not significantly influence cyclopoid scar formation (OR, 1.67; 95% CI, 0.62 to 4.66; p = 0.362). However, patients with cyclops nodule formation showed significantly higher TTT values than the control patients. (OR, 9.34; 95% CI, 1.94 to 90.3; p = 0.002). Knee extension loss was observed in the cyclopoid and cyclops groups 3 months after reconstruction. In the cyclops group, arthroscopic resection of the cyclops nodule was performed 3 months after reconstruction. Eventually, almost full range of motion was restored in all patients. CONCLUSIONS: High TTT values before ACL reconstruction were an indicator of cyclops nodule formation. Furthermore, cyclopoid scar formations may not be the result of an individual's immune reaction but that of extension loss in the early post-reconstruction phase.

DOI： 10.1186/s12891-018-2286-1

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Pullout Repair of the Medial Meniscus Posterior Root Tear Reduces Proton Density-Weighted Imaging Signal Intensity of the Medial Meniscus. Reviewed

Okazaki Y, Furumatsu T, Masuda S, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T

Acta medica Okayama 72 ( 5 ) 493 - 498 2018.10

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

Medial meniscus (MM) posterior root tear (PRT) results in joint overloading and degenerative changes in the knee. MM root repair is recommended to prevent subsequent cartilage degeneration following MMPRT. Favorable clinical outcomes have been reported after transtibial pullout repair of MMPRT. However, it is unclear whether pullout repair can cause compositional change in the MM posterior segment. We examined this question in 14 patients who underwent MMPRT pullout repair. Magnetic resonance imaging examinations were performed preoperatively and 3 months postoperatively at 10° knee flexion. The region-of-interest was marked along the MM posterior segment edge. Intra-meniscal signal intensity (IMSI) was expressed as the signal intensity ratio of the repaired MM to the intact lateral meniscus, which was used as a control. MMPRT pullout repair reduced IMSI from 1 to 0.915±0.096 (range, 0.760-1.074) 3 months postoperatively (p=0.006, power=0.90). Meniscal degeneration causes high proton density-weighted imaging signal intensity of the meniscal body. In our study, MMPRT pullout repair reduced IMSI contrary to other tears. This technique may decrease the MM posterior segment signal intensity by restoring the hoop tension mechanism. Measuring IMSI may be useful to assess the effect of MMPRT pullout repair on meniscal healing.

DOI： 10.18926/AMO/56247

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関節リウマチにおけるPDスコアの関節破壊予測能の検討

沖田駿治, 中原龍一, 松橋美波, 渡辺雅仁, 木曽洋平, 大橋秀基, 那須義久, 西田圭一郎, 尾崎敏文

日本関節病学会誌 37 ( 3 ) 306 - 306 2018.10

深層学習を用いた超音波画像の関節部位推定

中原龍一, 西田圭一郎, 沖田駿治, 松橋美波, 渡辺雅仁, 木曽洋平, 大橋秀基, 那須義久, 野田知之, 尾崎敏文

日本関節病学会誌 37 ( 3 ) 305 - 305 2018.10

RA手の障害に対する手指人工関節における角速度の術後経過

松山宜之, 中原龍一, 松岡玲衣, 藤岡晃, 鍋倉由佳, 小川加苗, 岡佳純, 那須義久, 堅山佳美, 西田圭一郎, 千田益生, 尾崎敏文

日本関節病学会誌 37 ( 3 ) 271 - 271 2018.10

人工手関節全置換術(TWA)を受ける関節リウマチ患者の看護

小橋靖子, 西田圭一郎, 宮地亜美, 鍋倉由佳, 藤岡晃, 那須義久, 尾崎敏文

日本関節病学会誌 37 ( 3 ) 216 - 216 2018.10

関節リウマチに対するAVANTAとAVANTA preflexによる小指MP人工指関節置換術の治療成績

松橋美波, 那須義久, 渡辺雅仁, 沖田駿治, 木曽洋平, 大橋秀基, 中原龍一, 西田圭一郎, 尾崎敏文

日本関節病学会誌 37 ( 3 ) 216 - 216 2018.10

関節リウマチに対するMCP関節人工関節置換術中に手関節部での腱処置剥離術を要した症例の検討

木曽洋平, 那須義久, 松橋美波, 渡辺雅仁, 沖田駿治, 大橋秀基, 兼田大輔, 竹下歩, 堀田昌宏, 中原龍一, 西田圭一郎, 尾崎敏文

日本関節病学会誌 37 ( 3 ) 199 - 199 2018.10

腫瘍用人工関節KLS system術後機能回復の経過

増田翔太, 岩井賢司, 築山尚司, 堅山佳美, 中田英二, 尾崎敏文, 千田益生

日本関節病学会誌 37 ( 3 ) 272 - 272 2018.10

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