Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Multicenter, prospective cohort study. OBJECTIVE: The current study aimed to identify the incidence of residual paresthesias after surgery for degenerative cervical myelopathy (DCM), and to demonstrate the impact of these symptoms on clinical outcomes and patient satisfaction. SUMMARY OF BACKGROUND DATA: Surgery for DCM aims to improve and/or prevent further deterioration of physical function and quality-of-life (QOL) in the setting of DCM. However, patients are often not satisfied with their treatment for myelopathy when they have severe residual paresthesias, even when physical function and QOL are improved after surgery. MATERIALS AND METHODS: The authors included 187 patients who underwent laminoplasty for DCM. All patients were divided into two groups based on their visual analog scale score for paresthesia of the upper extremities at one year postoperatively (>40 vs. ≤40 mm). Preoperative factors, changes in clinical scores and radiographic factors, and satisfaction scales at one year postoperatively were compared between groups. The authors used mixed-effect linear and logistic regression modeling to adjust for confounders. RESULTS: Overall, 86 of 187 patients had severe residual paresthesia at one year postoperatively. Preoperative patient-oriented pain scale scores were significantly associated with postoperative residual paresthesia ( P =0.032). A mixed-effect model demonstrated that patients with severe postoperative residual paresthesia showed significantly smaller improvements in QOL ( P =0.046) and myelopathy ( P =0.037) than patients with no/mild residual paresthesia. Logistic regression analysis identified that residual paresthesia was significantly associated with lower treatment satisfaction, independent of improvements in myelopathy and QOL (adjusted odds ratio: 2.5, P =0.010). CONCLUSION: In total, 45% of patients with DCM demonstrated severe residual paresthesia at one year postoperatively. These patients showed significantly worse treatment satisfaction, even after accounting for improvements in myelopathy and QOL. As such, in patients who experience higher preoperative pain, multidisciplinary approaches for residual paresthesia, including medications for neuropathic pain, might lead to greater clinical satisfaction. LEVEL OF EVIDENCE: 3.

DOI： 10.1097/BRS.0000000000004907

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

This retrospective cohort study established malnutrition's impact on mortality and neurological recovery of older patients with cervical spinal cord injury (SCI). It included patients aged ≥ 65 years with traumatic cervical SCI treated conservatively or surgically. The Geriatric Nutritional Risk Index was calculated to assess nutritional-related risk. Overall, 789 patients (mean follow-up: 20.1 months) were examined and 47 had major nutritional-related risks on admission. One-year mortality rate, median survival time, neurological recovery, and activities of daily living (ADL) at 1 year post-injury were compared between patients with major nutrition-related risk and matched controls selected using 1:2 propensity score matching to adjust for age, pre-traumatic neurological impairment, and activity. In the Kaplan-Meier analysis, the median survival times were 44.9 and 76.5 months for patients with major nutrition-related risk and matched controls, respectively (p = 0.015). Matched controls had more individuals with a neurological improvement of American Spinal Injury Association Impairment Scale ≥ 1 grade (p = 0.039) and independence in ADL at 1 year post-injury than patients with major nutrition-related risk (p < 0.05). In conclusion, 6% of older patients with cervical SCI had major nutrition-related risks; they showed a significantly higher 1 year mortality rate, shorter survival time, poorer neurological improvement, and lower ADL at 1 year post-injury than matched controls.

DOI： 10.1038/s41598-024-56527-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: To reduce the healthcare burden, the clinical results of arthroscopic rotator cuff repair and the cost of the implants used have recently been focused upon. This study compared implant cost, surgical time, short-term clinical results, and cuff repair integrity 2 years postoperatively between arthroscopic transosseous rotator cuff repair using lateral cortical augmentation (TOA) and arthroscopic transosseous-equivalent suture bridge (TOE). METHODS: This study included 220 patients with rotator cuff repairs performed by a single surgeon between December 2013 and December 2018. Overall, 70 TOA and 68 TOE cases met the inclusion criteria. The same surgeon performed the procedures at two different hospitals, and the techniques differed between the facilities. A total of 42 TOA patients were matched with 42 TOE patients. The patients were matched using a propensity score analysis by gender, age, and cuff tear size. The minimum follow-up period was 2 years. Implant cost and surgical time were compared between the two methods. The range of motion, clinical outcomes, and visual analog scale were evaluated. Magnetic resonance imaging was performed to examine cuff repair integrity 2 years postoperatively. RESULTS: The follow-up rate was 81% (112/138 patients). Implant cost was significantly lower with TOA ($1,396 vs. $2,165; p < 0.001) than with TOE. The average surgical time in the TOA method was significantly shorter than that in the TOE method (82 vs. 109 min; p = 0.001). At a minimum 2-year follow-up, the mean active elevation, abduction, and clinical outcomes improved with both methods, although no improvements in external and internal rotations were observed with either method. There were no significant differences in the postoperative variables and retear rate (TOA, 12%; TOE, 19%; p = 0.548) between the two methods. CONCLUSIONS: TOA and TOE achieved comparable clinical results; however, TOA was more cost-effective and had a shorter surgical time than TOE. LEVEL OF EVIDENCE: Level Ⅲ, retrospective matched control study.

DOI： 10.1016/j.jos.2023.02.003

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. SUMMARY OF BACKGROUND DATA: The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. METHODS: Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. RESULTS: In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age (R=-0.358, P=0.002), preoperative JOA score (R=0.286, P=0.021), preoperative PCS (R=0.603, P<0.001), C2-C7 lordotic angle (R=-0.284, P=0.017), stenosis severity (R=-0.271, P=0.019), and Goutallier classification at the C7 level (R=-0.268, P=0.021). In multiple linear regression analysis, sex (β=-0.334, P=0.002), age (β=-0.299, P=0.013), preoperative PCS (β=0.356, P=0.009), and Goutallier classification at the C7 level (β=-0.280, P=0.018) were significantly related to 2-year postoperative PCS. CONCLUSIONS: Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. LEVEL OF EVIDENCE: Level III.

DOI： 10.1097/BSD.0000000000001585

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Hydroxyapatite-coated, triple-tapered, shorter-length stems with a medial collar have been reported with good results for a few years. We investigated whether contact between the medial collar and femoral neck affects clinical outcomes and changes in bone mineral density (BMD) in patients who have this type of stem in their total hip arthroplasty construct. METHODS: This was a retrospective, single-center study involving 62 patients scheduled for unilateral total hip arthroplasty using a hydroxyapatite-coated, triple-tapered, shorter-length stem who were followed for at least 1 year postoperatively. All patients had a Dorr type B femoral canal shape. Contact between the medial collar and the femoral neck was evaluated by computed tomography at the third postoperative month, and patients were classified into 2 groups. Postoperative clinical outcomes were investigated by the Western Ontario and McMaster Universities Arthritis Index and the Japanese Orthopaedic Association scores; radiological evaluation included stem fixation, spot welds and cortical hypertrophy, postoperative 3-dimensional stem alignment, and periprosthetic BMD changes. RESULTS: There were 51 patients in the Contact + group (collar and neck contact) and 11 in the Contact-group (no contact). There were no differences between the 2 groups in the improvement of Western Ontario and McMaster Universities Arthritis Index and Japanese Orthopaedic Association scores, stem fixation, occurrence of cortical hypertrophy, or 3-dimensional stem alignment. Radiolucent lines were present in zones 3, 4, and 5 in 6 patients (12%) in the Contact + group only, who had no statistical difference between the 2 groups. Bone mineral density (BMD) decreased most in zone 7 in both groups, with no difference between the 2 groups. CONCLUSIONS: The presence or absence of contact between the medial collar and femoral neck did not affect postoperative BMD changes or radiological or clinical results. LEVEL OF EVIDENCE: Therapeutic Level III.

DOI： 10.1016/j.arth.2024.02.011

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: This study aimed to evaluate the meniscal size of asymptomatic discoid lateral meniscus (DLM) and compare it with that of normal lateral meniscus (LM) and to compare changes in meniscal dimensions with age among patients with asymptomatic DLM and those with normal LM using magnetic resonance imaging (MRI). MATERIALS AND METHODS: We retrospectively reviewed the medical records, including MRI data, of patients with asymptomatic DLM (DLM group) or normal LM (control group). Width and extrusion of both DLM and normal LM and tibial length were measured and compared using mid-coronal and mid-sagittal MR images. Meniscal size and sagittal and coronal meniscal ratio according to age, as well as differences between DLM and normal menisci, were also evaluated. RESULTS: Thirty-four knees were included in the DLM group, whereas the control group comprised of 50 patients. The DLM group showed significantly less meniscal extrusion, greater coronal width, posterior capsule distance, sagittal meniscal length, and sagittal meniscal ratio than the control group (DLM: 0.1 ± 0.3 mm, 23.3 ± 2.2 mm, 5.4 ± 2.4 mm, 25.1 ± 2.8 mm, 61 ± 6%, and control: 0.4 ± 0.4 mm, 9.5 ± 2.3 mm, 2.5 ± 1.2 mm, 30.2 ± 2.6 mm, 71 ± 4%, respectively). The coronal meniscal ratio decreased with age in both the control (p = 0.001) and DLM (p = 0.037) groups. The sagittal meniscal ratio (p = 0.001) and minimum height (p = 0.04) decreased and the anterior capsule distance (p = 0.035), posterior capsule distance (p = 0.026), and entire sagittal length (p = 0.005) increased with age in the DLM group, while the distance between the meniscal inner margins (p = 0.019) increased with age in the control group. CONCLUSIONS: The meniscal ratio in the sagittal plane of the DLM group was significantly lower than that of the control group. The sagittal meniscal ratio of asymptomatic DLM decreased with age, indicating that the size of asymptomatic DLM does not change with age. LEVEL OF EVIDENCE: III: Retrospective comparative study.

DOI： 10.1007/s00402-023-05084-6

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Level 3 retrospective cohort case-control study. PURPOSE: This study aimed to investigate the risk factors for distal junctional kyphosis (DJK) caused by osteoporotic vertebral fractures following spinal reconstruction surgery, with a focus on the sagittal stable vertebra. OVERVIEW OF LITERATURE: Despite the rarity of reports on DJK in this setting, DJK was reported to reduce when the lower instrumented vertebra (LIV) was extended to the sagittal stable vertebra in the posterior corrective fixation for Scheuermann's disease. METHODS: This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. RESULTS: The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. CONCLUSIONS: Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term.

DOI： 10.31616/asj.2023.0174

PubMed

International / domestic magazine：International journal  

DOI： 10.1007/s00402-023-05157-6

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

INTRODUCTION: Osteoporotic vertebral fractures (OVFs) are a significant problem among older patients who are undergoing spine surgery. This study examined the influence of incident OVFs on clinical outcomes and spinal alignment 5 years following short-segment fusion (SSF) for lumbar spinal stenosis. METHODS: We studied 88 patients who underwent SSF (≤2-disc level) for lumbar spinal stenosis with instability and were followed up for more than 5 years postoperatively. Those with prior OVFs were excluded. We evaluated incident OVFs with plain whole-spine lateral radiography preoperatively (before) and at 5 years postoperatively (after). Using preoperative lumbar computed tomography, Hounsfield unit (HU) values were evaluated. The patients were classified into two groups according to the presence of incident OVFs. Repeated-measures analysis of variance was utilized to compare the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and the 36-item Short-Form Health Survey (SF-36), and spinal parameters were recorded before and after. Multiple linear regression analyses were employed to investigate the association between the incident OVFs and the clinical scores and spinal alignment recorded after. RESULTS: In the fracture group, the clinical course of low back pain score on the JOABPEQ, physical component summary SF-36 score, and spinal alignment including C7 sagittal vertical axis (SVA), thoracic kyphosis (TK), and pelvic tilt were significantly worse. Multiple linear regression revealed a significant correlation between incident OVFs and worse 5-year postoperative spinal alignment, which includes SVA and TK. The optimal threshold for the HU values for predicting the incidence of OVFs within 5 years postoperatively was 83.0 (area under the curve 0.701). CONCLUSIONS: Incident OVFs in patients following SSF were significantly correlated with the 5-year clinical outcomes and spinal alignment. Patients at risk of OVFs, especially those with HU values below 83, must take preventive measures against OVFs, as this could prevent deteriorating midterm postoperative clinical outcomes and spinal alignment. LEVEL OF EVIDENCE: 3.

DOI： 10.22603/ssrr.2023-0160

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Dislocation is a major complication of reverse total shoulder arthroplasty (RSA). The humeral liner may be changed to a constrained type when stability does not improve by increasing glenosphere size or lateralization with implants, and patients, particularly women with obesity, have risks of periprosthetic instability that may be secondary to hinge adduction on the thorax, but there are few reports on its impact on the range of motion (ROM). This study aimed to determine the influence of humeral liner constraint on impingement-free ROM and impingement type using an RSA computer simulation model. METHODS: A virtual simulation model was created using 3D measurement software for conducting a simulation study. This study included 25 patients with rotator cuff tears and rotator cuff tear arthropathy. Impingement-free ROM and impingement patterns were measured during flexion, extension, abduction, adduction, external rotation, and internal rotation. Twenty-five cases with a total of 4 patterns of 2 multiplied by 2, making a total of 100 simulations: glenosphere (38 mm normal type vs. lateralized type) and humeral liner constraint (normal type vs. constrained type). There were 4 combinations: normal glenosphere and normal humeral liner, normal glenosphere and constrained humeral liner, lateralized glenosphere and normal humeral liner, and lateralized glenosphere and constrained humeral liner. RESULTS: Significant differences were found in all impingement-free ROM in 1-way analysis of variance (abduction: P = .01, adduction: P < .01, flexion: P = .01, extension: P = .02, external rotation: P < .01, and internal rotation: P < .01). Tukey's post hoc tests showed that the impingement-free ROM was reduced during abduction, external rotation, and internal rotation with the combination of the normal glenosphere and constrained humeral liner compared with the other combinations, and improved by glenoid lateralization compared with the combination of the lateralized glenosphere and constrained humeral liner. In the impingement pattern, the Pearson χ2 test showed significantly greater proportion of impingement of the humeral liner into the superior part of the glenoid neck in abduction occurring in the combination of the normal glenosphere and constrained humeral liner group compared with the other groups (P < .01). Bonferroni post hoc tests revealed that the combination of the normal glenosphere and constrained humeral liner was significantly different from that of the lateralized glenosphere and constrained humeral liner (P < .01). Using constrained liners resulted in early impingement on the superior part of the glenoid neck in the normal glenosphere, whereas glenoid lateralization increased impingement-free ROM. CONCLUSION: This RSA computer simulation model demonstrated that constrained humeral liners led to decreased impingement-free ROM. However, using the lateralized glenosphere improved abduction ROM.

DOI： 10.1016/j.jse.2023.06.038

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIM: This study aimed to assess the relationship between the three-dimensional (3D) alignment of short tapered-wedge cementless stems and bone mineral density (BMD) changes in patients followed up for 5 years after total hip arthroplasty (THA). METHODS: We retrospectively analysed the hips of 52 patients who underwent THA using short tapered-wedge cementless stems at our institution from 2013 to 2016 with complete 5-year follow-up data. We evaluated the relationship between stem alignment, measured using a 3D-templating software, and BMD changes in the 7 Gruen zones. RESULTS: After 1 year, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD in zones 3 and 4 were noted. After 5 years, significant negative correlations between varus insertion and a decrease in BMD in zone 7 and between flexed insertion and decreases in BMD zones 2, 3, and 4 were observed. With increased amounts of varus/flexion stem alignment, the amount of BMD loss decreased. There was no correlation between anteverted stem insertion and changes in BMD levels. CONCLUSIONS: Our data showed that stem alignment affects BMD based on 5-year follow-up data after surgery. Careful observation is necessary, especially when using short tapered-wedge cementless stems, as stem alignment may affect changes in BMD levels more than 5 years after surgery.

DOI： 10.1177/11207000231178984

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To repair peripheral nerve defects and seek alternatives for autografts, nerve conduits with various growth factors and cells have been invented. Few pieces of literature report the effect of nerve conduits plus platelet-rich fibrin (PRF). This study aimed to investigate the effectiveness of nerve conduits filled with PRF. METHODS: The model of a 10 mm sciatic nerve gap in a rat was used to evaluate peripheral nerve regeneration. The thirty rats were randomly divided into one of the following three groups (n = 10 per group). Autogenous nerve grafts (autograft group), conduits filled with phosphate-buffered saline (PBS) (PBS group), or conduits filled with PRF group (PRF group). We assessed motor and sensory functions for the three groups at 4, 8, and 12 weeks postoperatively. In addition, axon numbers were measured 12 weeks after repair of the peripheral nerve gaps. RESULTS: Significant differences in motor function were observed between the autograft group and the other two groups at 12 weeks postoperatively. In the test to evaluate the recovery of sensory function, there were significant differences between the PBS group and the other two groups at all time points. The most axon number was found in the autograft group. The axon number of the PRF group was significantly more extensive than that of the PBS group. CONCLUSIONS: The nerve conduit filled with PRF promoted the axon regeneration of the sciatic nerve and improved sensory function.

DOI： 10.1016/j.clineuro.2023.108051

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Although Grammont-style reverse total shoulder arthroplasty (RSA) showed excellent clinical results in Europe, its utility for Asian populations remains unclear. This study aimed to compare the French and Japanese populations in terms of range of motion (ROM), functional outcomes, and scapular notching rates in patients who underwent standard Grammont-style RSA. We hypothesized that RSA for the Japanese population may not provide as good ROM and functional results at the final follow-up as that for the French population. METHODS: A total of 25 Japanese patients undergoing RSA were propensity score matched to 25 French patients undergoing RSA. The patients were matched for four different covariates using a propensity score analysis. The minimum follow-up period was 2 years. We investigated differences between the populations with respect to body size and shoulder joint ROM and Constant score (CS) measured preoperatively and at the final follow-up. Scapular notching was examined using radiographs at the final follow-up. RESULTS: The average height and weight of the French and Japanese patients were 164 cm and 70 kg and 152 cm and 56 kg, respectively. Anterior elevation (AE), external rotation (ER) at the side, internal rotation (IR), and CS total changed from 101° to 145°, 17° to 15°, 4.5 points to 5.5 points, and 36 points to 72 points, respectively, in the French population and from 63° to 119°, 8.5° to 13°, 4.6 points to 4 points, and 28 points to 58 points, respectively, in the Japanese population. AE improved in both the groups; ER and IR remained unchanged before and after surgery. The frequency of scapular notching (>grade 1) was higher in the Japanese population (56%) than in the French population (20%) (p = 0.019). CONCLUSIONS: Grammont-style RSA improved AE and CS in both the populations, but AE and CS were significantly higher in the French population than in the Japanese population at the final follow-up. Scapular notching frequently occurs in the Japanese population.

DOI： 10.1016/j.jos.2022.11.008

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: There are numerous reports of bone adaptation observed on plain radiography studies after the use of cementless short stems in reverse shoulder arthroplasty. However, reports on changes in bone mineral density (BMD) around the stem using dual-energy X-ray absorptiometry (DEXA) are prominently absent. In the present study, we measured BMD around the stem using DEXA and investigated changes over time from postoperative year 1 to year 2. Additionally, the relationship between BMD changes, filling ratio, and stem alignment was examined. METHODS: Forty-seven patients with short cementless stems who could be assessed via DEXA at 1-2 years postoperatively were included. After dividing the zones around the stem into 5, the BMD in each zone was measured, in addition to BMD changes and amount of change from postoperative year 1 to year 2. The relationship between filling ratio and stem alignment on postoperative plain radiography was assessed. RESULTS: A significant decrease in BMD in zone 3 was observed between postoperative year 1 and year 2 (P = .02). Regarding filling ratio and stem alignment, a negative correlation between valgus stem alignment and BMD change observed in zone 1 (r = -0.470, P < .01). In addition, stem valgus greater than 6° correlated with a significant decrease in BMD in zone 1. (P = .01). No significant differences were found in the other zones. Furthermore, there was no correlation between filling ratio and BMD change. CONCLUSION: In reverse shoulder arthroplasty cementless short stems, changes that that occurred between postoperative year 1 to year 2 demonstrated a decrease in BMD in zone 3. In addition, a decrease in BMD in zone 1 was observed with a stem alignment of valgus 6° or higher, suggesting that stem alignment within valgus 6° is required to prevent a decrease in BMD.

DOI： 10.1016/j.jseint.2023.08.015

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Hounsfield Unit (HU) value has been associated with future osteoporotic fractures and postoperative complications. However, no studies on the impact of low HU values on mid-term clinical outcomes following lumbar spine surgery have been reported. We aimed to evaluate the usefulness of preoperative HU values for 5-year clinical outcomes following lumbar spine surgery. METHODS: We enrolled 200 patients who underwent lumbar surgery (≤ 3-disc levels) for lumbar spinal stenosis. HU values were assessed using preoperative lumbar computed tomography as part of routine preoperative planning for lumbar surgery. Patients were divided into two groups based on the cutoff value of the HU values obtained from the receiver operating characteristic curve for the incidence of vertebral fractures within five years postoperatively. Clinical scores preoperatively and 1, 2, and 5 years postoperatively, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were compared using a mixed-effects model. RESULTS: Comparative analysis indicated that all domains of JOABPEQ, except for lumbar function, and the physical component summary of the SF-36 were significantly worse in the low HU group than in the high HU group. Using multiple regression analysis, low HU values were significantly correlated with worse 5-year postoperative scores in all domains of JOABPEQ and SF-36. CONCLUSION: Low preoperative HU values are a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. HU values are not only a valuable tool for analyzing bone mineral density but also may be a valuable poor prognostic factor of postoperative clinical outcomes.

DOI： 10.1007/s00586-023-07995-9

PubMed

International / domestic magazine：International journal  

Delayed union and non-union of distal radial fractures (DRFs) are rare, and there are a few reports of delayed union and nonunion of DRFs after palmar locking plate (PLP) fixation. A 68-year-old female patient presented to our hospital with left-sided wrist pain. Radiographs and computed tomography revealed a displaced DRF and ulnar styloid fracture. We performed open reduction and internal fixation with a PLP for the DRF and tension band wiring for the ulnar styloid fracture. However, bone union was not completed three months after the operation. We initiated low-intensity pulsed ultrasound (LIPUS) to achieve fracture healing. Complete bone union was confirmed radiographically five months after LIPUS. There have been few case reports on the delayed union or nonunion of DRFs after PLP fixation treated with LIPUS. LIPUS might be an effective option for the delayed union of DRFs after PLP fixation.

DOI： 10.7759/cureus.51468

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Ulnar shortening osteotomy using various osteotomy sites, osteotomy methods, and surgical techniques with a variety of implants has been reported, but nonunion rates and the duration of bone healing are not uniform by the authors. The purpose of this study was to investigate the duration of bone healing and nonunion ratio in patients who underwent ulnar shortening osteotomy by a 5-hole nonlocking plate with a simple transverse osteotomy for ulnar impaction syndrome and to determine the correlation between the gap length of the osteotomy site and the duration of bone healing. METHODS: We assessed patients who underwent ulnar shortening osteotomy for ulnar impaction syndrome using a 5-hole nonlocking plate fixation followed by a simple transverse osteotomy between July 2012 and October 2021. This study was a case series study, and the level of evidence was IV. RESULTS: A total of 80 patients were included. The mean age of the patients was 46.7 years, and 46 patients were men. The average bone union period was 41.8 ± 18.7 weeks. The correlation between the gap length of the osteotomy site and the duration of bone union of the osteotomy site was not significant. The nonunion ratio of our method was 2.5%. CONCLUSION: The nonunion rate of our ulnar shortening osteotomy with a simple transverse osteotomy and a 5-hole nonlocking plate was comparable to that in previous reports, but our method required slightly longer periods for bone union. There was no correlation between the gap length of the osteotomy and the duration of bone union. LEVEL OF EVIDENCE: Level IV (Case series).

DOI： 10.1177/15589447231218402

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: This study evaluated the differences in meniscal sizes and occupancy between symptomatic and asymptomatic patients diagnosed with discoid lateral meniscus (DLM) using magnetic resonance imaging (MRI) to understand how these variations relate to the presence of symptoms and the patients' age. METHODS: A retrospective review of 98 patients with DLM was conducted, excluding those with meniscal displacement. Both the width and extrusion of DLM and the percentage of the meniscus to the tibia were measured using mid-coronal and mid-sagittal MRI and compared between symptomatic and asymptomatic DLM groups. The relationships among each parameter, meniscal size, and patient age were evaluated. Symptomatic cases were divided into those with and without horizontal tears on MRI to compare the differences in meniscal morphology. RESULTS: A total of 92 knees from 74 patients were included. Sixty-one knees required surgical intervention for symptomatic DLM, while 31 were asymptomatic and included the contralateral side of symptomatic knees. The symptomatic group exhibited larger morphological variations than the asymptomatic group. Moreover, the sagittal meniscal ratio reduced with age in the asymptomatic group (r = - 0.54, p = 0.002) but remained constant in the symptomatic group. The symptomatic cases with horizontal tears demonstrated larger meniscal dimensions and smaller posterior capsule distances than those without tears. CONCLUSION: Symptomatic patients with DLM had larger knee morphological changes than asymptomatic ones. Age affected the meniscal occupancy in the sagittal plane only in asymptomatic patients. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-023-07650-2

PubMed

橈骨遠位端骨折に対する掌側ロッキングプレート(palmer locking plate:PLP)であるDual Loc Radiiシステム(メイラ社)のV3はV7よりも遠位に設置可能であるため,V3使用症例では術後に手根管症候群(carpal tunnel syndrome:CTS)の発症がV7使用症例よりも危惧される.本研究の目的は,橈骨遠位端骨折に対してV7またはV3を用いて内固定を行った症例の術後CTS発症オッズを比較することである.2019年12月から2022年5月にV7またはV3を用いて手術加療を行った患者を後ろ向きに調べた.V7群とV3群はそれぞれ128例,70例で,術後CTS発症数はV7群で6例,V3群で3例であった.多変量ロジスティック回帰分析で,V7群とV3群でCTS発症オッズに有意差はなかった.術後CTS発症率はV7群,V3群ともに4～5%で,過去のPLP術後CTS発症率の報告と同等の発症頻度であった.(著者抄録)

THAの術前にMyHipを用いてPatient specific instrument(PSI)を作成し、術中にこのPSIを利用して大腿骨頸部骨切りを行った68例の骨切り精度を評価した。評価方法は、手術計画で設定した「骨切り面から大腿骨頭最近位部の距離」と、手術中に実際に切り出された大腿骨頭を計測した「大腿骨頸部骨切り面と大腿骨頭最近位部の距離」を比較した。結果、「大腿骨頸部骨切り面と大腿骨頭最近位部の距離」は、手術計画で45.2±4.6mm、実際の計測値で45.3±5.0mmであった。ボーンソーの刃の厚みが1.27mmであることから、精度としては1.4±2.2mm、絶対値誤差は1.9±1.7mmとなった。症例個々にみると、手術計画との骨切りレベル誤差2mm以内で骨切りできたのは68例中42例(62%)、誤差3mm以内は53例(78%)であった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To determine the effect of saucerization surgery on knee joint morphology associated with a complete discoid lateral meniscus (DLM) using magnetic resonance (MR) imaging. METHODS: This retrospective study included cases had undergone saucerization surgery for symptomatic DLM between 2007 and 2022. All cases were divided into two by age group: < 12 (U13) and > 13 (O13). The cases in the match group were randomly selected from preoperative cases in the O13 group matched with the age at the final follow-up (F/U) of cases in the U13 group. The following morphological parameters were evaluated using MR images preoperatively and at the final postoperative F/U in each group: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), and the lowest point of the lateral femoral condyle (LPLFC). Each parameter was compared between the U13 preoperative (pre-OP) group and the O13 pre-OP group, the preoperative and final follow-up in the U13, and the U13 group at the final F/U and the match group preoperatively. RESULTS: A total of 77 cases were evaluated. 31 cases were in the U13 pre-OP group and 46 were in the O13 pre-OP group. With a minimal F/U of 2 years, 27 cases in the U13 group and 36 in the O13 group were included. The mean F/U period was 4.6 years in the U13 group and 3.2 years in the O13 group. 32 cases were included in the match group. In the match group, the inclination of the POLTP was significantly larger (P = 0.042) and the LPLFC was more lateral (P = 0.0034) than at the final F/U in the U13 group. CONCLUSIONS: Saucerization surgery for DLM in juvenile patients can prevent progression to the characteristic bone morphology DLM. These results could help the surgeon making the decision when the surgery would be performed for symptomatic DLM patients. LEVEL OF EVIDENCE: Retrospective comparative study; level of evidence, 3.

DOI： 10.1007/s00402-023-04999-4

PubMed

International / domestic magazine：International journal  

Isolated injury to the deep motor branch of the ulnar nerve caused by stabbing is sporadic, with only one reported case in the English-language literature. We report one such case treated successfully using nerve grafting. A 33-year-old patient had sustained a stab wound to the right hypothenar eminence and showed a claw hand deformity. Needle electromyography study revealed denervation potentials with no voluntary motor unit action potentials (MUAPs) in the first dorsal interosseous (FDI) muscles. Nerve exploration revealed a neuroma-in-continuity in the intrinsic motor branch of the ulnar nerve. Intraoperative nerve stimulation confirmed the absence of compound muscle action potentials in the FDI. The damaged scarred nerve was resected, and the 15-mm defects were reconstructed with cable autografting. Two years and 5 months after the surgery, voluntary MUAPs were observed in the FDI. The pinch strengths recovered. Laceration of the deep branch of the ulnar nerve caused by stabbing can sometimes remain hidden as the hand sensation remains intact. Pre- and intraoperative electrophysiological examination is essential to assess the severity of the injured nerve and determine an appropriate surgical option. Even nerve grafting can facilitate satisfactory results as target intrinsic muscles are quite close to the repair site.

DOI： 10.1055/s-0042-1749442

PubMed

DOI： 10.1007/s00586-022-07431-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Accurate deltoid muscle assessment after reverse shoulder arthroplasty (RSA) is difficult using magnetic resonance imaging due to metal artifacts. We hypothesized that measuring the deltoid muscle area (DA) in the middle part of the deltoid's total length postoperatively would reduce metal artifacts and allow for an accurate assessment. This study aimed to assess the reliability and reproducibility of magnetic resonance imaging and evaluate its impact on postoperative outcomes. METHODS: The DA in the middle part of the muscle's total length was measured twice by four examiners using pre and postoperative magnetic resonance imaging in 60 patients who underwent RSA (22 men, 38 women; mean age: 77.4 years). The DA at the greater tuberosity was measured preoperatively, and its correlation with the middle part of the deltoid's total length was evaluated. The Constant-Murley Score was measured at 2 years postoperatively, and its correlation with the DA in the middle part of the deltoid's total length pre- and postoperatively was assessed. RESULTS: Intraclass correlation coefficients for intraobserver measurements of preoperative and postoperative DA in the middle part of the deltoid's total length were almost perfect, with mean values of 0.98 and 0.97, respectively. The intraclass correlation coefficients for interobserver reliability regarding the first and second DA measurements in the middle part of the deltoid's total length were 0.95 and 0.95 (preoperatively) and 0.89 and 0.90 (postoperatively). The Constant-Murley Score was assessed at 2 years postoperatively in 51 patients. Muscle strength was weakly and moderately correlated with preoperative DA (r = 0.33, P = .02) and postoperative DA (r = 0.49, P < .01), respectively. CONCLUSION: DA measurement in the middle part of the deltoid's total length after RSA was not affected by metal artifacts and had excellent reproducibility. This measurement method positively correlated with postoperative muscle strength, suggesting its usefulness for predicting postoperative muscle strength.

DOI： 10.1016/j.jseint.2023.08.002

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: The prognosis of metastatic and inoperable sarcomas is extremely poor, and intensive chemotherapy-based treatment is typically administered to prolong survival. Currently, pazopanib, eribulin, and trabectedin are key drugs used in patients with these sarcomas. The aim of the study was to identify prognostic factors for metastatic and inoperable bone and soft tissue sarcomas. PATIENTS AND METHODS: Clinicopathological data of 46 patients with metastatic and inoperable sarcomas treated with pazopanib, eribulin, and trabectedin between January 2013 and February 2022 at our institution were retrospectively analyzed. Age, sex, primary tumor location, adverse effects, history of doxorubicin and radiation therapy, performance status scores, maximum tumor response, and survival duration were evaluated. The significant prognostic factors were identified using Cox proportional hazards models. Moreover, the 5-year survival rate was evaluated using the Kaplan-Meier method. RESULTS: The median survival duration after treatment was 13.3 months, where the 5-year overall survival rate was estimated to be 9.85%. Both univariate and multivariate analyses revealed significant relationships among patient prognosis, performance status, and tumor response. CONCLUSION: Performance status scores and tumor response were significantly associated with patient prognosis. Therefore, regardless of age, sex, primary tumor location, adverse effects, and history of doxorubicin and radiation therapy, use of cutting-edge drugs, such as pazopanib, eribulin, and trabectedin, may be advantageous in patients with advanced sarcomas, if their drug response and performance status scores are good.

DOI： 10.21873/invivo.13371

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: It is preferable to reduce postoperative excessive rotational mismatch between the femur and tibia that causes poor clinical results following total knee arthroplasty (TKA). The aim of this study is to compare postoperative rotational mismatches and clinical outcomes with mobile- and fixed-bearing prostheses. MATERIALS AND METHODS: This study classified 190 TKAs into two groups equally by propensity score matching: mobile-bearing group (n = 95) and fixed-bearing group (n = 95). Computed tomography images of the whole leg were taken at 2 weeks postoperatively. The component alignments, rotational mismatches between the femur and tibia, and rotations among components were measured three-dimensionally. The knee range of motion, New Knee Society Score (KSS) subjective sores, and Forgotten Joint Score (FJS-12) were assessed at the final follow-up. RESULTS: Rotational mismatch between the femur and tibia was significantly less in the mobile- (- 0.8° ± 7.3°) than in the fixed-bearing (3.3° ± 8.5°, p < 0.001) group. New KSS functional activity score was significantly poorer in patients with excessive rotational mismatch (61.3 ± 21.4) than in those without it (49.5 ± 20.6, p = 0.02). Comparing mobile-bearing prosthesis, the use of fixed-bearing prosthesis was a risk factor for postoperative excessive rotational mismatch (odds ratio: 2.32, p = 0.03). CONCLUSION: When compared to a fixed-bearing prosthesis, TKA using a mobile-bearing prosthesis could suppress the postoperative rotational mismatch between the femur and tibia that causes poor subjective functional activity score. However, since this study was conducted for PS-TKA, the results might not be applicable to other models.

DOI： 10.1007/s00402-023-04971-2

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To identify the effects of multidisciplinary approaches (MAs) to improve social functioning (SF) on 1-year surgical outcomes in patients with cervical myelopathy. SUMMARY OF BACKGROUND DATA: Despite significant improvement in cervical myelopathy, a patient's quality of life (QOL) sometimes does not improve postoperatively. A previous study revealed that SF, rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy. PATIENTS AND METHODS: This study compared two prospective cohorts in Japan. Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the MA cohort. Patients in the control cohort were treated with a standard care protocol, and those in the MA cohort were treated with a multidisciplinary protocol that focused on SF improvement. The changes in the total Japanese Orthopedic Association (JOA) score and in the domains of the JOA scores (upper limb function, lower limb function, upper limb sensory, and lower limb sensory) from preoperatively to 1 year postoperatively were compared between the control and MA cohorts using a mixed-effect model. RESULTS: The control and MA cohorts comprised 140 and 31 patients, respectively. The improvement in the JOA score was significantly better in the MA cohort than in the control cohort ( P = 0.040). In analyses of each JOA score domain, the improvement of upper limb function was significantly better in the MA cohort than in the control cohort ( P = 0.033). Similarly, the MA cohort demonstrated significantly higher patient-reported outcomes for upper extremity function than the control cohort ( P < 0.001). In addition, the self-care domain of QOL score at 1 year postoperatively was significantly higher in the MA cohort than in the control cohort ( P = 0.047). CONCLUSION: MAs to improve/rebuild a patient's SF were effective in improving cervical myelopathy and the self-care domain of QOL. This study is the first to demonstrate the effectiveness of postoperative MAs in patients with cervical myelopathy. LEVEL OF EVIDENCE: Level 3.

DOI： 10.1097/BRS.0000000000004764

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Progressive fatty infiltration and muscle atrophy after rotator cuff tears lead to tendon repair failure and poor outcomes. Fibro-adipogenic progenitors (FAPs) are involved in fatty infiltration and muscle homeostasis of skeletal muscle. Inducing FAP differentiation into brown adipocyte-like "beige adipocytes" suppresses fatty infiltration and muscle atrophy. HYPOTHESIS: Parathyroid hormone (PTH) suppresses fatty infiltration and muscle atrophy after rotator cuff tears in a rat model by browning of FAPs. STUDY DESIGN: Controlled laboratory study. METHODS: PTH was administered subcutaneously for 4 or 8 weeks to a rotator cuff tear model in rats. After treatment, fatty infiltration of supraspinatus muscles was assessed using Oil Red O staining and muscle atrophy using wet muscle weight and muscle fiber cross-sectional area. Costaining of platelet-derived growth factor receptor α (FAP marker) and uncoupling protein 1 (browning marker) was performed to confirm FAP browning by PTH. Mouse-isolated FAPs were cultured with PTH and evaluated for browning-related gene expression and adipogenic differentiation using BODIPY staining. Myogenic differentiation of C2C12 myoblasts was evaluated using coculture of PTH-treated browning FAPs with C2C12. RESULTS: PTH inhibited fatty infiltration after rotator cuff tear at 8 weeks. Rotator cuff wet muscle loss of PTH-treated rats was inhibited at 4 and 8 weeks. Furthermore, PTH-treated rats demonstrated larger myofiber cross-sectional area than did untreated rats at 4 and 8 weeks. Costaining indicated colocalization of platelet-derived growth factor receptor α and uncoupling protein 1 and promoted PTH-induced FAP browning. PTH increased the expression of browning-related genes in FAPs and suppressed fat droplet accumulation in vitro. Coculture with PTH-treated FAPs promoted C2C12 cell differentiation into myotubes. CONCLUSION: PTH induced FAP-derived beige adipocytes by upregulating browning-related gene expression, and the browning effect of PTH on FAPs inhibited fatty infiltration and muscle atrophy in the rat rotator cuff tear model. PTH might have potential as a therapeutic drug for fatty infiltration and muscle atrophy after rotator cuff tears. CLINICAL RELEVANCE: PTH may expand treatment options for rotator cuff tears by reducing fatty infiltration and muscle atrophy after rotator cuff tears by browning of FAPs.

DOI： 10.1177/03635465231190389

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Previous reports using cadaveric knees and musculoskeletal computer simulation have shown that kinematically aligned (KA) total knee arthroplasty (TKA) provides more natural and physiological tibiofemoral kinematic patterns than mechanically aligned (MA) TKA. These reports suggested that the modification of joint line obliquity improve the knee kinematics. This study aimed to determine whether joint line obliquity change the intraoperative tibiofemoral kinematics in TKA candidates with knee osteoarthritis. METHODS: Thirty consecutive knees with varus osteoarthritis that underwent TKA using a navigation system were evaluated. Two types of trial components were prepared: (1) MA TKA model: component trial in which articulating surface was parallel to the bone cut surface (2) KA TKA model: the femoral component trial, which mimicked the KA TKA method of Dossett et al. was designed 3° valgus and 3° internal rotation to the femoral bone cut surface, and the tibial component trial was designed 3° varus to the tibial bone cut surface. These two trials were set on the same knees during the operation, and the tibiofemoral rotational kinematics and varus-valgus laxity were measured from 0° to 120° of knee flexion using a navigation system. RESULTS: The joint gap was 20 ± 2 mm and 3° ± 1° varus in extension and 20 ± 2 mm and 3° ± 1°varus in flexion. The differences in femoral component rotation between KA TKA and MA TKA were not statistically significant for any knee flexion angle. The differences in varus-valgus laxity between KA TKA and MA TKA were also not statistically significant for any knee flexion angle. CONCLUSION: Although the degree of joint line obliquity varies widely in various KA TKA methods, this study, which mimicked the method of Dossett et al. showed that the modification of joint line obliquity did not change the tibiofemoral kinematics and stability of the knee joint in TKA candidates with knee osteoarthritis.

DOI： 10.1007/s00402-023-04899-7

PubMed

84歳女、5年前に近医で貧血を指摘され、当院血液内科の精査で寒冷凝集素症と診断された。今回、左変股症の症状が増悪したため、人工股関節置換術を施行した。周術期の寒冷曝露を避けるため、室温を30℃に設定するとともに、術中は温風式加温装置を用い、輸液や洗浄液も加温水を使用した。その結果、急激な溶血を起こすことなく安全に手術を施行できた。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Osteoporotic vertebral fractures (OVFs) can hinder physical motor function, daily activities, and the quality of life in elderly patients when treated conservatively. Vertebral augmentation, which includes vertebroplasty and balloon kyphoplasty, is a commonly used procedure for OVFs. However, there have been reports of complications. Although serious complications are rare, there have been instances of adjacent vertebral fractures, cement dislocation, and insufficient pain relief due to cement failure, sometimes necessitating revision surgery. This narrative review discusses the common risks associated with vertebral augmentation for OVFs, such as cement leakage and adjacent vertebral fractures, and highlights the risk of revision surgery. The pooled incidence of revision surgery was 0.04 (0.02-0.06). The risks for revision are reported as follows: female sex, advanced age, diabetes mellitus, cerebrovascular disease, dementia, blindness or low vision, hypertension, hyperlipidemia, split type fracture, large angular motion, and large endplate deficit. Various treatment strategies exist for OVFs, but they remain a subject of controversy. Current literature underscores the lack of substantial evidence to guide treatment strategies based on the risks of vertebral augmentation. In cases with a high risk of failure, other surgeries and conservative treatments should also be considered as treatment options.

DOI： 10.14245/ns.2346560.280

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Dexmedetomidine (DEX) provides a unique conscious sedation without respiratory depression. We examined the usefulness of intravenous (IV) DEX sedation combined with brachial plexus block for long-duration upper extremity surgery without an anesthesiologist. METHODS: We retrospectively reviewed 90 limbs of 86 patients and measured the actual operative time course in detail. The adverse events and the patient-reported outcomes regarding intraoperative pain and depth of sedation were evaluated. RESULTS: The mean total time of the operation, tourniquet use, and the IV DEX sedation were 150 min, 132 min, and 117 min, respectively. The mean time between discontinuation of IV DEX sedation and completion of the operation was 51 min. The intraoperative adverse events involved bradycardia (21%), hypotension (18%), and oxygen desaturation (3%). The mean visual analog scale scores of pain during brachial plexus block, surgical site pain, tourniquet pain, and depth of the sedation were 23.4 mm, 0.14 mm, 4.2 mm, and 6.6 mm, respectively. Furthermore, 96% patients expressed a preference for receiving anesthesia as brachial plexus block with IV DEX sedation. CONCLUSIONS: Long-duration upper extremity surgery, even longer than 2 h, was feasible under brachial plexus block combined with IV DEX sedation without an anesthesiologist. For patients with low blood pressure and/or low heart rate, it is recommended to adjust the continuous infusion of IV DEX to less than 0.4 µg/kg/h. To ensure that the patients are able to promptly leave the operating room fully awake, IV DEX infusion should be stopped at least 30 min before finishing the operation.

DOI： 10.1016/j.bjps.2023.05.040

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Shoulder disorders occasionally cause intractable pain. Central sensitization (CS) may be involved in such pain. Identifying risk factors associated with CS is crucial for effective pain control. This study aimed to determine the effects of shoulder osteoarthritis and rotator cuff tears (RCT) on CS and associated factors. This study included patients evaluated for CS using the Central Sensitization Inventory (CSI) before surgery for shoulder osteoarthritis, RCT, or cuff tear arthropathy. Patients with a CSI score of 40 or higher were defined as having CS. The relationships between glenohumeral osteoarthritis (GHOA), RCT size, and CS were statistically analyzed. Multiple regression analysis was performed to examine the factors affecting CSI scores. Subjects included 167 patients: 131 patients had RCT without GHOA, 23 had GHOA with RCT, and 13 had GHOA without RCT. The GHOA group had a significantly higher CSI score (27.5 [10.8-40.5] vs. 18.0 [10.0-27.5]) and CS prevalence (27.8% vs. 8.4%) than the RCT without GHOA group. There was no significant correlation between RCT size and CSI scores. Multiple regression analysis showed that female sex, severe pain, and long pain duration were associated with higher CSI scores. Considering the risk factors for CS might be helpful in shoulder treatment.

DOI： 10.3390/jcm12175633

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: We compared subtotal meniscectomy and saucerization with stabilization for osteocartilaginous damage based on injured location and further examined the factors related to osteocartilaginous damage in juvenile discoid lateral meniscus (DLM) with peripheral tear after a follow-up period of at least 5 years. MATERIALS AND METHODS: We retrospectively reviewed juvenile DLM patients with peripheral tear who underwent arthroscopic surgery with more than 5 years of follow-up. Osteocartilaginous damage, which was identified by osteochondritis dissecans (OCD) development and the whole-organ magnetic resonance imaging score (WORMS) of cartilage grade ≥ 3, was compared between subtotal meniscectomy and saucerization with stabilization. A subgroup analysis examining the location of the tear site was performed. Factors for osteocartilaginous damage were analyzed between the damaged and non-damaged groups. RESULTS: Forty-one patients, including 29 who underwent saucerization with stabilization and 12 who underwent subtotal meniscectomy, were included in this study. Seven patients developed OCD lesions; six patients showed cartilage WORMS of more than grade 3. Overall, there was a significant difference in the total cartilage and meniscus WORMS between the two groups at the final follow-up. The subgroup analysis demonstrated more severe osteocartilaginous damage developed in posterior subtotal meniscectomy than in posterior stabilization following saucerization. The damaged group showed significant difference compared to the non-damaged group in terms of age (p = 0.003), sex (p = 0.036), and posterior subtotal meniscectomy (p < 0.001). CONCLUSIONS: Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile DLM with peripheral tear over a minimum follow-up period of 5 years.

DOI： 10.1007/s00402-022-04747-0

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Discoid lateral meniscus (DLM) is an anatomic knee variant associated with increased tears and degeneration. This study aimed to quantify meniscal status with magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic reshaping surgery for DLM. MATERIALS AND METHODS: We retrospectively reviewed the records of patients undergoing arthroscopic reshaping surgery for symptomatic DLM with ≥ 2-year follow-up. MRI T2 mapping was performed preoperatively and at 12 and 24 months postoperatively. T2 relaxation times of the anterior and posterior horns of both menisci and of the adjacent cartilage were assessed. RESULTS: Thirty-six knees from 32 patients were included. The mean age at surgery was 13.7 years (range 7-24), and the mean follow-up duration was 31.0 months. Saucerization alone was performed on five knees and saucerization with repair on 31 knees. Preoperatively, the T2 relaxation time of the anterior horn of the lateral meniscus was significantly longer than that of the medial meniscus (P < 0.01). T2 relaxation time significantly decreased at 12 and 24 months postoperatively (P < 0.01). Assessments of the posterior horn were comparable. The T2 relaxation time was significantly longer in the tear versus non-tear side at each time point (P < 0.01). There were significant correlations between the T2 relaxation time of the meniscus and that of the corresponding area of the lateral femoral condyle cartilage (anterior horn: r = 0.504, P = 0.002; posterior horn: r = 0.365, P = 0.029). CONCLUSIONS: The T2 relaxation time of symptomatic DLM was significantly longer than that of the medial meniscus preoperatively, and it decreased 24 months after arthroscopic reshaping surgery. The meniscal T2 relaxation time of the tear side was significantly longer than that of the non-tear side. There were significant correlations between the cartilage and meniscal T2 relaxation times at 24 months after surgery.

DOI： 10.1007/s00402-023-04819-9

PubMed

International / domestic magazine：International journal  

Postprocedural peroneal nerve palsy after endovenous laser ablation (EVLA) for varicose veins is rare and is associated with poor functional recovery. There have been no reports using tibial nerve transfer for iatrogenic peroneal nerve palsy after EVLA. Herein, we present a case with peroneal nerve injury after EVLA, which was successfully treated by partial tibial nerve transfer for the first time. A 75-year-old female presented with a right foot drop immediately after EVLA of the lesser saphenous vein. The ankle and toe dorsiflexion had a muscle grade of M0 on the British Medical Research Council muscle scale, without voluntary motor unit action potentials (MUAP) in the tibialis anterior (TA) muscle on the needle electromyography. Three months after the injury, surgical nerve exploration revealed a damaged common peroneal nerve with discoloration and scarring at the fibular head. Intraoperative deep peroneal nerve stimulation confirmed the absence of compound muscle action potentials in the TA. The best functioning motor fascicles of the tibial nerve were transferred to the deep peroneal main trunk involving motor branches of the TA, extensor digitorum longus, and extensor hallucis longus (EHL) through the interosseous membrane. The postoperative course was uneventful, with no complications. After 3 months of surgery, nascent MUAP appeared in the TA. After 24 months, the patient regained the TA and EHL muscle function and ambulation without an ankle-foot orthosis and tibial nerve deficits. Thus, our procedure may serve as an alternative to nerve grafting, tendon transfer, and orthoses for better management of the major neural complications associated with EVLA.

DOI： 10.1002/micr.31023

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To determine the in vivo effectiveness of bone marrow aspirate-derived (BMA) fibrin clots for avascular meniscal defect healing in a rabbit model. METHODS: In 42 Japanese white rabbits, a 2.0-mm cylindrical defect was introduced into the avascular zone of the anterior part of the medial meniscus in the bilateral knees. The rabbits were grouped according to implantation of a BMA fibrin clot (BMA group) or a peripheral blood (PB)-derived clot (PB group) into the defect and nonimplantation (control group). Macroscopic and histological assessments were performed using a scoring system at 4 and 12 weeks after surgery. At 12 weeks after surgery, compressive stress was analyzed biomechanically. RESULTS: The meniscal score in the BMA group (12.1) was greater than that in the PB group (5.5; P = .031) and control group (4.4; P = .013) at 4 weeks. The meniscal score in the BMA group (13.1) was greater than that in the control group (6.4; BMA = 13.1; P = .0046) at 12 weeks. In the biomechanical analysis, the BMA group demonstrated significantly higher compressive strength than the PB group (6.6 MPa) (BMA = 15.4 MPa; P = .0201) and control group (3.6 MPa; BMA = 15.4 MPa; P = .007). CONCLUSIONS: Implantation of BMA fibrin clots into the meniscal defect of the avascular zone in a rabbit model improved the meniscal score at 4 weeks and strengthened the reparative meniscal tissue at 12 weeks compared with the implantation of PB fibrin clots. CLINICAL RELEVANCE: Healing in the avascular zone of the meniscus can be problematic. Approaches to improving this healing response have had variable results. This study provides additional information that may help improve the outcomes in patients with these injuries.

DOI： 10.1016/j.arthro.2022.12.013

PubMed

COVID-19アウトブレイク前後における高齢者のロコモティブシンドローム(LS)の有病率の変化とリスク因子を検討した。COVID-19パンデミック前後に5項目Geriatric Locomotive Function Scale(GLFS-5)質問票に回答が得られた65歳以上の高齢者12197名を対象に横断サーベイ研究を行った。GLFS-5に基づいて2～3点をLSステージ1、4～5点をステージ2、6点以上をステージ3と判定し、パンデミック期間中のライフスタイルの変化を評価した。LSの有病率はパンデミック前が41.3%、パンデミック後が47.1%と増加しており、パンデミック後の新規LS発症は765名(6.3%)、LS-3発症は296名であった。LS発症群と非LS群の比較では、LS群には女性および75歳超が多く、運動習慣の減少が生じていた。多重ロジスティック回帰分析では、パンデミック後のLS発症のリスク因子として高齢、女性、運動レベル低下が抽出された。また、LS-3発症群ではLS-1/2群と比較して年齢が高く、運動習慣が著明に減少しており、多重ロジスティック回帰分析では高齢と運動習慣の減少がLS-3発症と有意に関連していた。このほか、腰痛、関節痛、しびれの有病率はLSの新規発症群、LS-3発症群において有意に高値を示していた。今回の解析結果から、日本人全体ではCOVID-19パンデミック後に約200万人の高齢者がLSを新規に発症し、軽度～中等度のLS患者のうち10%ほどが重症に移行したと推測された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: No studies have compared the accuracy of acetabular cup placement in total hip arthroplasty (THA) in the supine and lateral decubitus positions using the same portable navigation system. Thus, this study aimed to compare the accuracy of acetabular cup placement using a new accelerometer-based portable navigation system combined with an infrared stereo camera and inertial measurement unit between the supine and lateral decubitus positions. MATERIALS AND METHODS: This retrospective study compared 45 THAs performed in the supine position (supine group) and 44 THAs performed in the lateral decubitus position (lateral group) using the same portable navigation system. The primary outcome was the absolute errors of cup placement angles, defined as the absolute values of the differences between cup radiographic inclination and anteversion angles displayed on the navigation system and those measured on postoperative computed tomography images. RESULTS: No significant difference in the median absolute error of the cup inclination angle (supine group 1.7° [interquartile range 0.8°-3.1°] vs. lateral group 2.1° [interquartile range 1.0°-3.7°]; p = 0.07) was found between the two groups. Similarly, no significant difference in the median absolute error of the anteversion angle (supine group 1.9° [interquartile range 0.8°-3.4°] vs. lateral group 2.1° [interquartile range 0.9°-3.1°]; p = 0.42) was found. CONCLUSION: This new accelerometer-based portable navigation system may provide high accuracy of the cup placement in THA in the lateral decubitus and supine positions.

DOI： 10.1007/s00402-022-04675-z

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: It is clinically important to analyze the initial contact state between an implant and femoral cortical bone as it affects clinical outcomes, such as stress shielding, stem subsidence, thigh pain, and patient-reported outcomes after total hip arthroplasty. Whether the initial contact state of a double-tapered fully hydroxyapatite (HA)-coated stem is achieved with the preserved cancellous or cortical bone remains to be established. This study aimed to compare the contact area with the femoral cortical bone between a double-tapered fully HA-coated stem (HA group) and a tapered wedge cementless stem (TW group) using three-dimensional computed tomography (3DCT)-based templating software. MATERIALS AND METHODS: Forty-seven total hip arthroplasties in the HA and TW groups each were retrospectively analyzed. The contact area between the implant and femoral cortical bone in the whole stem and at each Gruen zone was measured using density mapping with 3DCT-based templating software. RESULTS: The demographic data were not significantly different between the two groups. The contact area in the whole stem area was lower in the HA group (HA 5.4 ± 1.8% vs. TW 9.0 ± 4.8%, p < 0.01). The HA group had a lower contact area in zone 2 (HA 6.7 ± 6.5% vs. TW 15.6 ± 10.8%, p < 0.01) and zone 6 (HA 1.8 ± 3.5% vs. TW 6.3 ± 3.6%, p < 0.01) than the TW group. The implant type (β = 0.41, p < 0.01) and stem coronal alignment (β = - 0.29, p < 0.01) were significant predictors of the contact area in the whole stem area in a multiple regression analysis (adjusted R2 = 0.27, p < 0.01). CONCLUSION: The contact area of the double-tapered fully HA-coated stem was significantly lower than that of the tapered wedge cementless stem.

DOI： 10.1007/s00402-022-04655-3

PubMed

International / domestic magazine：International journal  

INTRODUCTION AND IMPORTANCE: Tendon autograft is a durable solution for the sub/total meniscus; however it is still considered a temporary solution. CASE PRESENTATION: We report the case of a 17-year-old woman with history of subtotal lateral meniscectomy performed 6 years ago. We treated her with lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched bone marrow aspirate (BMA)-derived fibrin clot. T2 relaxation times of the anterior and posterior horns of both menisci and of the cartilage were assessed. CLINICAL DISCUSSION: Lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot improved clinical and radiographic outcomes at the 24-month follow-up. These findings suggest that the lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot transformed into a meniscus-like tissue and resulted in preservation of the articular cartilage. CONCLUSION: Lateral meniscus autograft transplantation using a hamstring tendon with a sandwiched BMA clot can function as a meniscal transplant after total or subtotal meniscectomy in young patients.

DOI： 10.1016/j.ijscr.2023.108444

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

In cases of suspected spinal tumors on imaging studies, a biopsy is often necessary for establishing the diagnosis. Predictive factors for tumors or malignancies may help in scheduling biopsies or avoiding unnecessary ones. However, there have been few studies on determining these factors. We aimed to determine the factors associated with the final diagnosis in cases requiring spinal biopsy. This study included 117 patients who underwent image-guided (fluoroscopy- or computed tomography [CT]-guided) needle biopsy of the spine. Data on patient demographic, pathological diagnoses, and final diagnoses were retrospectively collected from the medical records. The imaging features and location of lesions were also evaluated on CT and magnetic resonance imaging. Furthermore, factors related to tumors or malignancies were analyzed. The diagnostic accuracy of biopsy was 94.0%, and there was no difference in the diagnostic accuracy between the fluoroscopic and CT-guided biopsies. Sixty-six and fifty-six patients were diagnosed with spinal tumors and malignant tumors, respectively. Multivariate analysis revealed that a history of malignant tumors and the presence of pedicle lesions and/or extravertebral lesions were related factors for both tumors or malignancy in the final diagnosis. These findings can help determine the necessity for or timing of biopsy in patients with suspected spinal tumors.

DOI： 10.3390/jcm12134292

PubMed

インセンティブを伴うウォーキング促進プログラムの医療費削減効果について検討した。2016年10月～2018年3月に、大阪府高石市在住の40～75歳の市民16816名を対象に、毎日の歩数に応じてインセンティブが付与される歩行促進プログラムを実施した。参加希望者は市に参加登録し、自身のスマートフォンか活動量計のどちらかを選択、市内各地に設置された歩数登録端末を使用して自らの歩数を集計した。医療費データは国民健康保険のデータを使用した。プログラム参加群(1945名)と年齢・性別・医療費をマッチングさせた対照群(1945名)を設定し、年間医療費を比較した。順序ロジスティック回帰分析の結果、高石市在住者のサンプルにおいて、インセンティブを伴うウォーキング促進プログラムへの参加は1年間の医療費削減と相関していた。プログラム参加群と対照群の1年間における医療費の差は21261324円/年であった。インセンティブを伴うウォーキング促進プログラムは医療費削減の観点から有効な政策であると考えられた。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Spheroids can allow three-dimensional (3D) cell culture without scaffolds, potentially promoting the production of growth factors from adipose-derived stem cells (ADSCs). We hypothesized that ADSC spheroids exert more favourable effects on osteochondral defects than ADSCs in two-dimensional (2D) cultures. The purpose of this study was to compare the therapeutic effects of 2D and 3D cultures of ADSCs on osteochondral defects using animal models. METHODS: Rat femoral osteochondral defects were created. When creating osteochondral defects, phosphate-buffered saline, 2D ADSCs, or ADSC spheroids as a 3D culture were administered on to the lesion. At 2, 4, 6, 8, 10 and 12 weeks post-surgery, knee tissues were harvested and evaluated via histological examination. The expression of genes related to growth factors and apoptosis were compared between 2D and 3D ADSCs. RESULTS: Histologically, the repair of osteochondral defects was significantly enhanced in 3D ADSCs than in 2D ADSCs in terms of the Wakitani score and cartilage repair rate. In 3D ADSCs, TGF-β1, VEGF, HGF and BMP-2 were significantly upregulated, while apoptosis was suppressed in the early phase. CONCLUSION: The therapeutic effects of 3D ADSC spheroids on osteochondral defects were more potent than those of 2D ADSCs. The upregulated expression of growth factors and suppression of apoptosis could contribute to promoting these therapeutic effects. Overall, ADSC spheroids can help treat osteochondral defects.

DOI： 10.1016/j.knee.2023.04.017

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

INTRODUCTION: Clinical evidence shows that opioid administration in cancer patients is associated with shorter survival. This study explored the impact of opioid requirement on overall survival of patients with spinal metastases. We also evaluated the association between opioid requirement and tumor-related spinal instability. METHODS: We retrospectively identified 428 patients who had been diagnosed with spinal metastases from February 2009 to May 2017. Those with an opioid prescription during the first 1 month after the diagnosis were included in this study. Patients given opioids were divided into two groups: the opioid requirement group [≥5 mg oral morphine equivalent (OME)/day] and the nonopioid group (<5 mg OME/day). Spinal instability due to metastases was evaluated using the Spinal Instability Neoplastic Score (SINS). Cox proportional hazards analysis was performed to evaluate the relationship between opioid use and overall survival. RESULTS: The most frequent primary cancer site was the lung, in 159 patients (37%), followed by the breast in 75 (18%) and the prostate in 46 (11%). Multivariate analyses showed that patients who required ≥5 mg OME/day were approximately twofold more likely to die after a spinal metastases diagnosis than those who required <5 mg OME/day (hazard ratio 2.13; 95% confidence interval 1.69-2.67; p<0.001). The SINS was significantly higher in the opioid requirement group than those in the nonopioid group (p<0.001). CONCLUSIONS: For patients with spinal metastases, opioid requirement was associated with shorter survival, independently of known prognostic factors. The patients were also more likely to have tumor-related spinal instability than those in the nonopioid group.

DOI： 10.22603/ssrr.2021-0169

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Wide resection is the main treatment for sarcomas; however, when they are located near major nerves, their sacrifices might affect limb function. The efficacy of ethanol adjuvant therapy for sarcomas has not been established. In this study, the anti-tumor effect of ethanol, as well as its neurotoxicity, were assessed. In vitro anti-tumor effect of ethanol as evaluated using MTT, wound healing, and invasion assays on a synovial sarcoma cell line (HS-SY-II). In vivo, an assessment was conducted in nude mice (implanted with subcutaneous HS-SY-II) treated with different ethanol concentrations after surgery with a close margin. Sciatic nerve neurotoxicity was assessed with electrophysiological and histological examination. In vitro, ethanol concentrations at 30% and higher showed cytotoxic effects in MTT assay and markedly reduced migration and invasive ability of HS-SY-II. In vivo, both 30% and 99.5% ethanol concentrations, compared to 0% concentration, significantly reduced the local recurrence. However, in the group treated with 99.5% ethanol, nerve conduction tests showed prolonged latency and decreased amplitude, and morphological changes suggestive of nerve degeneration were observed in the sciatic nerve, while the 30% ethanol did not cause neurological damage. In conclusion, 30% is the optimal concentration for ethanol adjuvant therapy after close-margin surgery for sarcoma.

DOI： 10.3390/curroncol30060399

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Early diagnosis of rotator cuff tears is essential for appropriate and timely treatment. Although radiography is the most used technique in clinical practice, it is difficult to accurately rule out rotator cuff tears as an initial imaging diagnostic modality. Deep learning-based artificial intelligence has recently been applied in medicine, especially diagnostic imaging. This study aimed to develop a deep learning algorithm as a screening tool for rotator cuff tears based on radiography. METHODS: We used 2803 shoulder radiographs of the true anteroposterior view to develop the deep learning algorithm. Radiographs were labeled 0 and 1 as intact or low-grade partial-thickness rotator cuff tears and high-grade partial or full-thickness rotator cuff tears, respectively. The diagnosis of rotator cuff tears was determined based on arthroscopic findings. The diagnostic performance of the deep learning algorithm was assessed by calculating the area under the curve (AUC), sensitivity, negative predictive value (NPV), and negative likelihood ratio (LR-) of test datasets with a cutoff value of expected high sensitivity determination based on validation datasets. Furthermore, the diagnostic performance for each rotator cuff tear size was evaluated. RESULTS: The AUC, sensitivity, NPV, and LR- with expected high sensitivity determination were 0.82, 84/92 (91.3%), 102/110 (92.7%), and 0.16, respectively. The sensitivity, NPV, and LR- for full-thickness rotator cuff tears were 69/73 (94.5%), 102/106 (96.2%), and 0.10, respectively, while the diagnostic performance for partial-thickness rotator cuff tears was low at 15/19 (78.9%), NPV of 102/106 (96.2%) and LR- of 0.39. CONCLUSIONS: Our algorithm had a high diagnostic performance for full-thickness rotator cuff tears. The deep learning algorithm based on shoulder radiography helps screen rotator cuff tears by setting an appropriate cutoff value. LEVEL OF EVIDENCE: Level III: Diagnostic Study.

DOI： 10.1016/j.jos.2023.05.004

PubMed

DOI： 10.3390/jcm12103442

PubMed

International / domestic magazine：International journal  

DOI： 10.1016/j.xrrt.2022.11.002

PubMed

高齢のロコモティブシンドローム(LS)患者の検出に用いられる人工知能(AI)ベースの決定システムを開発し、その有用性について検討した。高齢者409名(男性164名、女性245名、平均73.5±5.4歳)を対象に、横断研究を実施して足部スキャン圧システムとして歩行中の足底圧分布を測定し、さらに画像処理システムには畳み込みニューラルネットワーク(CNN)を用いて足底圧をベースにLSの発症可能性を推定した。AIモデルのロジスティック回帰段階では、年齢、性別、身長、体重およびCNNの出力にもとづいて発症予測方程式を作成した。開発コホートの対象者は300名で、このうち104名(34.7%)がLSと診断された。三分割交差検証データセットの平均確度はトレーニングセットが0.71、検証セットが0.68を示しており、CNN出力はLS発症群の方が健常者群より有意に高かった。開発コホートにおける平均AUCは0.84、臨床モデルの平均AUCは0.80であった。足底圧分布をベースとしたAIモデルはLSのスクリーニングに有用なツールであることが示された。

関節リウマチ患者146例(女性82.9%、年齢24～87歳)を対象に、頸部痛がQOLに及ぼす影響と、頸部痛の関連因子について検討した。全例で立位および頸部側面のX線撮像を施行した。頸部痛は質問票と視覚的評価スケールにより評価し、頸部痛による機能障害度はneck disability index(NDI)により測定した。QOLの評価にはEuroQol-5 dimension(EQ-5D)を使用した。頸部痛は81例(55.5%)で認め、平均VASは36.0±20.0mmであった。頸部痛の陽性患者は陰性患者に比べてQOL値が有意に低く、NDIが有意に高かった(いずれもP<0.01)。X線で環軸関節亜脱臼(AAS)は46例(31.5%)で認め、垂直位亜脱臼(VS)は17例(11.6%)であった。多変量解析で年齢(OR 0.958、95%CI 0.924～0.993、P=0.018)、C7矢状垂直軸(OR 1.015、95%CI 1.001～1.029、P=0.036)、上頸部の亜脱臼(AASまたはVS)(OR 2.851、95%CI 1.162～6.993、P=0.022)、椎体終板の侵蝕像(OR 1.434、95%CI 1.021～2.015、P=0.038)が頸部痛の有意な関連因子であった。

頸動脈エコー検査を施行した関節リウマチ(RA)患者と健常者を対象に、頸動脈プラークの新規発生率を比較した。対象は、「RA患者の罹患率と死亡率を下げるためのリスク因子のトータルマネージメント」(TOMORROW研究)に登録されたRA患者208例と、年齢・性別を一致させた健常者205例で、2011年と2017年に頸動脈エコー検査を施行した。試験参加後に53例が脱落し、最終的にRA群175例(女性83.71%、平均58.9±12.7歳)と対照群185例(女性84.32%、平均58.47±12.52歳)を解析した。RA群の疾患活動性のコントロールは比較的に良好で、DAS28-CRPは平均で2.79±1.15、DAS28-CRPが5.1を超える高疾患活動性は僅か7例であった。2011年に頸動脈プラークの有病率はRA群(46.9%)の方が対照群(35.7%)より有意に高かったが、2017年までの6年間で頸動脈プラークの新規発生率に有意な群間差はなかった。多重ロジスティック回帰分析でRAは頸動脈プラークの新規発生のリスク因子でなかった(OR 0.708、95%CI 0.348～1.440)。

症例は54歳女性で、人間ドックにて全身に多発する骨硬化性病変を指摘され、精査目的に当院紹介となった。経過中に腰痛が出現し、MRIで第9胸椎に病的骨折を認めた。血液検査や骨生検では異常所見は認めず、入院後に硬性コルセット装着にて安静加療を行ったが、徐々に骨折部の圧壊の進行を認めたため、第21病日に第7～12胸椎の後方除圧固定術を施行した。術中迅速病理検査では急性骨髄炎の診断であったが、術後の病理組織検査では悪性リンパ腫を否定できず、その後の精査結果よりSAPHO症候群の診断に至った。

症例は51歳女性で、横行結腸のデスモイド腫瘍切除術後半年で右腸腰筋内の複数病変が出現した。デスモイド腫瘍として経過観察したが、2年の経過で腫瘍が増悪し、切開生検を行った。病理診断は腸病変と同様のデスモイド腫瘍であり、VBL+MTX投与を開始したが、徐々に腫瘍の再増大と局所症状の増悪を認め、半年後に2度目の切開生検を行い、デスモイド型線維腫症の転移悪性化と診断した。陽子線治療を行い、腫瘍は軽度縮小するも、3ヵ月後に多発胸膜転移をきたし死亡した。

脊椎転移患者にみられるオピオイド所要量が生存期間に及ぼす影響、オピオイド所要量と腫瘍関連脊椎不安定性との関連について検討した。脊椎転移と診断された428例を対象に診断後1ヵ月におけるオピオイド処方を調査して、経口モルヒネ当量5mg/日以上のオピオイド投与群193例(男性99例、女性94例、平均68.2歳)と5mg/日未満の非オピオイド投与群235例(男性124例、女性111例、平均67.2歳)に分類、脊椎不安定性腫瘍性スコア(SINS)をもとにした脊椎不安定性および全生存期間とオピオイド投与との関連を評価した。腫瘍原発部位は肺癌が159例と最も多く、乳癌が75例、前立腺癌が46例であり、転移部位は胸椎、腰椎、頸椎の順となっていた。全生存期間中央値はオピオイド投与群の方が非オピオイド投与群より有意に短く、多変量解析では死亡リスクはオピオイド投与群が非オピオイド投与群の約2倍に達していた。オピオイド投与群の方がSINSスコアが有意に高く、重度の脊椎不安定性を有することが明らかになった。

症例は13歳男子で、2年前より誘因なく右肩甲部痛が出現し、野球の投球時に右肩甲部痛が強いため当科を受診した。初診時、右肩甲骨の翼状変形を認め、単純X線・3DCT・MRI所見より右肩甲骨の前面から発生した骨軟骨腫と診断し、骨腫瘍摘出術を施行した。病理所見は典型的な骨軟骨腫であり、術後は翼状変形や疼痛の改善が得られ、術後3ヵ月の時点で合併症や再発はみられず、良好に経過している。

はじめに:新鮮OVFのうちMRI予後不良因子(T2強調像で高信号限局型,低信号広範囲型)がないにも関わらず腰痛が遺残した症例について検討した.対象と方法:後ろ向きコホート研究.対象はOVFに対し保存加療を選択し,6ヶ月以上経過観察できた55例(平均年齢75.1歳,女性47例).MRIの予後不良因子を有する症例,馬尾・神経根の圧排を認める症例は除外した.6ヶ月時の腰痛VAS≧40の症例を腰痛遺残群(16例),その他を対照群(39例)に群分けした.評価項目は,初診時のX線動態撮影(座位・仰臥位側面)や全脊柱X線各種パラメーター,腰痛/臀部痛VAS,ODIを用いた.結果:単変量解析にて,初診時の臀部痛VAS(p=0.002),椎体可動角(p=0.047),TK(p=0.046),LL(p=0.031)に有意差があった.以上の有意な項目に年齢,性別,初診時腰痛VASを加えた多変量解析の結果,初診時の臀部痛VASが独立した腰痛遺残の危険因子であった(調整Odds比=1.526,p=0.019).結語:OVF受傷後6ヶ月時の腰痛遺残の危険因子は,初診時の臀部痛であった.(著者抄録)

DOI： 10.1097/BRS.0000000000004595

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The number of elderly patients with cervical trauma is increasing. Such patients are considered to be at high risk for delirium, which is an acute neuropsychological disorder that reduces the patient's capacity to interact with their environment due to impairments in cognition. This study aimed to establish a risk score that predicts delirium in elderly patients with cervical SCI and/or cervical fracture regardless of treatment type. This retrospective cohort study included 1512 patients aged ≥65 years with cervical SCI and/or cervical fracture. The risk factors for delirium according to treatment type (surgical or conservative) were calculated using multivariate logistic regression. A delirium risk score was established as the simple arithmetic sum of points assigned to variables that were significant in the multivariate analyses. Based on the statistical results, the delirium risk score was defined using six factors: old age (≥80 years), hypoalbuminemia, cervical fracture, major organ injury, dependence on pre-injury mobility, and comorbid diabetes. The score's area under the curve for the prediction of delirium was 0.66 (p < 0.001). Although the current scoring system must be validated with an independent dataset, the system remains beneficial because it can be used after screening examinations upon hospitalization and before deciding the treatment strategy.

DOI： 10.3390/jcm12062387

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Perioperative essential amino acid (EAA) supplementation suppresses lower-limb muscle atrophy and promotes functional improvement in the first 4 weeks after total knee arthroplasty (TKA). However, its effect on the recovery of muscle volume and strength in the intermediate term is unclear. The aim of this study was to evaluate the effect of perioperative EAA supplementation on the recovery of lower-limb muscle volume and strength in the 2 years after TKA. METHODS: Sixty patients who underwent unilateral TKA for primary knee osteoarthritis were included in this double-blinded randomized controlled trial. After excluding dropouts, 26 patients assigned to the EAA group (9 g/day) and 26 assigned to the placebo group (powdered lactose, 9 g/day) were available for analysis. Patients received EAA supplementation or a placebo from 1 week prior to surgery to 2 weeks after it. The rectus femoris muscle area was measured using ultrasonography and quadriceps muscle strength was measured isometrically with a handheld dynamometer, preoperatively and periodically up to 2 years postoperatively. Knee pain, knee range of motion, functional mobility, and Knee Society Score 2011 subjective scores were measured at each time point. Perioperative management, except for supplementation, was identical in the 2 groups. RESULTS: Taking the baseline as 100%, the mean values in the EAA and placebo groups were 134% ± 31% and 114% ± 27%, respectively, for the rectus femoris muscle area and 159% ± 54% and 125% ± 40% for the quadriceps muscle strength, respectively, at 2 years after surgery. The differences were significant (p < 0.05). Clinical outcomes were not significantly different between the 2 groups. CONCLUSIONS: Perioperative EAA supplementation contributes to the recovery of rectus femoris muscle volume and quadriceps muscle strength in the 2 years after TKA. The EAA supplementation did not impact clinical outcomes. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.22.00675

PubMed

女児。3歳時に右手関節掌側から手掌部にかけての腫瘤を主訴として紹介来院した。MRIではT1・T2強調画像ともに高輝度の組織内に点在する低輝度部が見られ、手根管部でやや絞扼されたダンベル状腫瘤像(50mm×15mm×11mm)を認め、右正中神経に生じた脂肪線維性過誤腫と考えられた。MRIにて経過観察を行った。その結果、徐々に腫瘤の厚みが減少して扁平化し、7歳現在まで神経症状は出現せずに経過している。引き続き経過観察を行い、手根管症状群に準じた症状を呈するようになれば、手根管開放術を行う方針である。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: In the literature, factors associated with postoperative venous thromboembolisms (VTEs) after anterior cruciate ligament reconstruction (ACLR) are limited. This study aimed to investigate the incidence of venous thromboembolisms (VTEs) after anterior cruciate ligament reconstruction (ACLR) and to identify risk and predictive factors for VTEs. METHODS: This retrospective study included 136 patients who underwent arthroscopic ACLR with mechanical prophylaxis between April 2012 and July 2022. Contrast-enhanced computed tomography (CT) was applied to detect VTEs comprising deep venous thromboses and pulmonary embolisms 7 days after surgery. Data including age, sex, body mass index, concomitant treatments, graft types, smoking status, operative and tourniquet times, postoperative D-dimer levels, and other laboratory test results, were collected for analyses. The incidence of radiographically confirmed VTEs and the associated risk factors, such as age, sex, body mass index, concomitant treatments, graft types, smoking status, operative and tourniquet times, postoperative D-dimer levels, and other laboratory test results, were analyzed. RESULTS: The overall incidence of radiographic VTEs was 11.0% (15 cases) in 136 patients. There was one symptomatic patient who had Homan's sign. Multivariable analysis indicated that postoperative D-dimer level was an independent factor related to a radiographic VTE after ACLR, although there was no association between radiographic VTEs and preoperative status or operation status. The optimal cutoff value for postoperative D-dimer level was 2.8 μg/ml according to the receiver operating characteristic curve analysis, with a sensitivity of 80.0% and specificity of 83.5%. CONCLUSION: The incidence of ACLR-associated radiographical VTEs (deep venous thrombosis and pulmonary embolism) under mechanical prophylaxis was 11.0% in this study. An elevated D-dimer level at 7 days after surgery is an independent predictor of VTE in patients undergoing ACLR. The postoperative D-dimer level is a more reliable marker for identifying VTE in patients who underwent ACLR.

DOI： 10.1186/s12891-023-06212-4

PubMed

DOI： 10.1007/s00586-022-07496-1

PubMed

はじめに:コロナ禍に関連し,電話外来診療を導入した病院は多い.診療システムの継続性や発展性を考慮すると,ニーズの把握と適応症例の明確化が望まれる.本研究の目的は電話診療継続を希望しなかった患者群の特徴を明らかにすることである.対象と方法:電話診療を施行後,主要評価項目として今後の診療希望形態を収集した腰椎変性疾患患者293例を対象とした.質問票を用い,「常に電話診療」「通常の対面診療に電話診療をはさむ」「有事の際に電話診療」「常に対面診療」の4択での回答を依頼した.副次評価項目として患者背景,診療内容,症状の経過を診療記録から収集し,ロジスティック回帰分析を用いて「常に対面診療」を希望した例の特徴を検討した.結果:対面診療希望例は29%であった.他の回答例と比較し70歳代が多く(オッズ比:2.30),電話診療期間の腰痛NRSが高く(1.15),日常生活能力がJ1の例が少ない(0.40)ことがわかった.結語:腰痛の強い例やADLの低い例では,電話診療の継続を希望しない例が多かった.対面で痛みを医師に直接訴えたい例,触診や処置を希望する例が含まれる可能性が考えられる.(著者抄録)

DOI： 10.1007/s00586-022-07495-2

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Ligamentum flavum (LF) hypertrophy is a major cause of lumbar spinal canal stenosis. Although mechanical stress is thought to be a major factor involved in LF hypertrophy, the exact mechanism by which it causes hypertrophy has not yet been fully elucidated. Here, changes in gene expression due to long-term mechanical stress were analyzed using RNA-seq in a rabbit LF hypertrophy model. In combination with previously reported analysis results, periostin was identified as a molecule whose expression fluctuates due to mechanical stress. The expression and function of periostin were further investigated using human LF tissues and primary LF cell cultures. Periostin was abundantly expressed in human hypertrophied LF tissues, and periostin gene expression was significantly correlated with LF thickness. In vitro, mechanical stress increased gene expressions of periostin, transforming growth factor-β1, α-smooth muscle actin, collagen type 1 alpha 1, and interleukin-6 (IL-6) in LF cells. Periostin blockade suppressed the mechanical stress-induced gene expression of IL-6 while periostin treatment increased IL-6 gene expression. Our results suggest that periostin is upregulated by mechanical stress and promotes inflammation by upregulating IL-6 expression, which leads to LF degeneration and hypertrophy. Periostin may be a pivotal molecule for LF hypertrophy and a promising therapeutic target for lumbar spinal stenosis.

DOI： 10.1096/fj.202200917RR

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. METHODS: Between 2009 and 2020, 30 knees of 23 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years in the retrospective nature of the study. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR+AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. RESULTS: Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR+AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. CONCLUSION: Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.

DOI： 10.1186/s12891-022-06100-3

PubMed

骨粗鬆症性椎体骨折または転移性脊椎腫瘍に対しballoon kyphoplasty(BKP)単独、あるいは脊椎固定術併用BKPを施行した67例79椎体(男性26例、女性41例、平均年齢79.5歳)を対象に、周術期の合併症について検討した。その結果、BKP術後にセメント漏出は43例(54.4%)に認められ、うち血管内漏出は7例(8.9%)であった。BKP単独群57例では隣接椎体骨折を10例(17.5%)で生じ、その発生時期は平均24.4日であった。尚、隣接椎体骨折群は非骨折群と比較し、椎体楔状角の矯正角度が大きい傾向を示していた。

症例は44歳女性で、1年半前から二次性歩行障害と膝伸展制限を伴う左膝関節痛を呈しており、関節液吸引といった保存療法を受けるも症状は徐々に悪化していた。思春期より神経性食思不振(AN)をきたし、約10年前に閉経に至り、36歳時にアルコール中毒、37歳時に腎不全、42歳時に高尿酸血症と診断されアロプリノールを処方されていた。受診時の身体所見ではBMI 12.3kg/m2と著明なるい痩を認め、膝関節ROMは20～100°に制限されており、関節周囲に腫脹と圧痛がみられた。単純X線検査で軟部組織による透過性現象と左膝関節腔の狭小化、MRIで多量の関節滲出液、膝蓋上包と膝蓋下脂肪体における腫瘤を認め、臨床検査結果と合わせてANを原因とする痛風性膝関節炎と診断を下し、関節鏡下デブリードマンを施行した。関節鏡所見では大腿顆と滑膜軟骨に粉状の白色沈着物を認め、滑膜切除術と膝蓋上包、膝蓋下脂肪体および中外側溝の結節切除を行った。術後は早期に全荷重負荷とし、疼痛と関節伸展制限は著明に改善が得られた。術後1年、無症状で経過しており、膝関節ROMは0～125°を示し、自立歩行が可能となっている。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: The relationship between spinopelvic mobility and dislocation in total hip arthroplasty (THA) has recently attracted attention. This study aimed to investigate the differences in sacral slope (SS) between two types of upright seated positions and to determine which seated position was appropriate for assessing spinopelvic mobility (change in SS from standing to sitting) before THA. MATERIALS AND METHODS: This prospective cohort study included 75 hips from 75 patients who had undergone primary THA. Each patient underwent preoperative lateral spinopelvic radiography in standing (st) and two seated positions: relaxed (rs) and straight (ss). The change in SS between each position (Δ) was measured. RESULTS: Differences in all spinopelvic sagittal alignment parameters between the two seated positions were statistically significant (p < 0.001). The range, median, and mean values of ΔSSss-rs were -2.0° to 26.5°, 6.8°, and 8.3°, respectively. ΔSSss-rs was significantly correlated with SS, LLA, and PFA in the relaxed seated position (r = -0.52, -0.39, and 0.37; p < 0.001, p < 0.001, and p = 0.001, respectively), but was not correlated to these parameters in the straight seated position. Of the 52 patients with normal spinopelvic mobility in the relaxed seated position (ΔSSst-rs > 10°), 24 (46%) patients were misrepresented as having a stiff spine in the straight seated position (ΔSSst-ss < 10°). CONCLUSION: The change in SS from the straight to the relaxed seated position widely varied in patients before THA. The spinopelvic radiograph in the relaxed seated position is appropriate when evaluating spinopelvic mobility for preoperative planning.

DOI： 10.1051/sicotj/2022051

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: The spread of coronavirus disease 2019 (COVID-19) has caused a great deal of damage to daily medical care. We investigated the impact of the COVID-19 pandemic on bone and soft tissue tumor treatment at our hospital. METHODS: We conducted a retrospective comparative study of two groups of patients at Osaka City University Hospital during the period of increasing COVID-19 infections (February-December 2020, group C) and the same period the previous year (February- December 2019, group NC). Clinical data, including patient's age, gender, type of tumor, neoplasms, number of surgical cases for inpatients and outpatients, operation time, use of implants, length of hospital stay, inpatient hospital costs, number of inpatients receiving anticancer drugs, and postoperative complications in these two groups were retrospectively evaluated. RESULTS: The number of cases of malignant bone and soft tissue tumors that were resected during hospitalization was predominantly higher in group C than in group NC (P = 0.01). There were no significant differences in operation time, use of implants, and postoperative complications between group C and group NC, but there were significant differences in the length of hospital stay and hospital costs (P<0.001). CONCLUSIONS: The COVID-19 pandemic has been recognized throughout the world to have adverse effects in a variety of areas. It had a negative impact on hospital costs and the length of hospital stay in the field of bone and soft tissue tumor treatment.

DOI： 10.1371/journal.pone.0283835

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

OBJECTIVES: Patients with severe coronavirus disease 2019 (COVID-19) who develop pneumonia face the risk of ventilatory muscle disuse in the acute phase, which can result in persistent respiratory impairments in the subacute phase. Although rehabilitation during the acute phase is considered effective, there are limited reports on this topic. Therefore, this study aimed to investigate the effectiveness of acute-phase rehabilitation in patients with severe COVID-19. METHODS: The study included 57 patients (45 men and 12 women; mean age: 63.2±12.1 years) admitted between April and June 2021, all of whom required intubation for respiratory management. Among them, 34 patients underwent acute-phase rehabilitation interventions based on the early goal-directed mobilization protocol. The primary objectives were to assess the occurrence of medical accidents related to acute-phase rehabilitation and evaluate their impact on survival and mobility upon hospital discharge. Statistical techniques and machine learning algorithms were employed for data analysis. RESULTS: Remarkably, no medical accidents occurred during the acute-phase rehabilitation among the patients. Furthermore, our findings indicated that acute-phase rehabilitation did not influence survival outcomes. However, it did have a positive impact on the mobility of patients upon hospital discharge. CONCLUSIONS: Acute-phase rehabilitation can be safely administered to patients with severe COVID-19 by following an early goal-directed mobilization protocol. This approach may also contribute to improved activities of daily living after discharge.

DOI： 10.2490/prm.20230027

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Currently, various minimally invasive surgical techniques are applied for total hip arthroplasty (THA). There are few studies comparing the early postoperative clinical outcomes of minimally invasive THA between anterolateral and posterolateral approaches. In this retrospective study, 62 patients underwent minimally invasive THA via either the anterolateral approach with an intermuscular exposure using the modified Watson-Jones approach (MIS-AL, 34 hips) or mini-incision THA with a posterolateral approach (MIS-PL, 28 hips). We analyzed intraoperative data, postoperative hematological data, postoperative radiographic findings, and the postoperative recovery of muscle strength. The mean surgical time was significantly longer in the MIS-PL than in the MIS-AL group. The mean postoperative serum C-reactive protein level was significantly higher in the MIS-PL group than in the MIS-AL group only on postoperative day 3. There were no significant between-group differences in the postoperative recovery rate of muscle strength during hip abduction. The recovery rate of muscle strength during hip extension was better in the MIS-AL group than in the MIS-PL group only on postoperative day 3. In conclusion, we found no obvious advantage in early postoperative recovery between the MIS-AL and MIS-PL approaches. Therefore, the benefit of rapid postoperative recovery was comparable between the MIS-AL and MIS-PL approaches.

DOI： 10.3390/jcm12010139

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: The pathogenesis of cystic fluid storage in solitary bone cysts remains unclear. We aimed to compare the results of the biochemical analysis of cystic fluid with clinical findings. We identified a significant marker of postoperative recurrence. METHODS: Twenty-seven male and eight female patients were studied; the median age at diagnosis was 11 (5-23) years. The mean follow-up period was 60 months (range: 14-146 months). Clinical information including sex, age, affected site, radiological findings of phase (active or latent), surgical procedure, outcome, and biochemical analysis of serum and cystic fluid was obtained. RESULTS: The 5-year healing rate was 64.0%. Biochemical analysis revealed that total protein and albumin values in the cystic fluid were significantly lower, compared to those in the serum. Levels of bone turnover markers, such as alkaline phosphatase, bone-specific alkaline phosphatase, and tartrate-resistant acid phosphatase 5b were remarkably elevated in the cystic fluid than in the serum. R values were 0.127, 0.076, and 0.095 for alkaline phosphatase, bone-specific alkaline phosphatase, and tartrate-resistant acid phosphatase 5b, respectively. Areas under the receiver operating characteristic curves, calculated to assess the association of alkaline phosphatase, bone-specific alkaline phosphatase, and tartrate-resistant acid phosphatase 5b levels in the cystic fluid with postoperative recurrence, were 0.57, 0.51, and 0.70, respectively. CONCLUSIONS: No clear correlation of bone turnover marker levels between the serum and cystic fluid was observed. The high tartrate-resistant acid phosphatase 5b level in the cystic fluid was associated with postoperative recurrence. The bone resorption caused by osteoclasts is considered to affect postoperative recurrence. LEVEL OF EVIDENCE: Level IV.

DOI： 10.1177/18632521221129368

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Fifteen years have passed since the soft tissue tumor practice guidelines were first published in Japan. Tumor size of ≥ 5 cm and tumor depth were key findings suggestive of malignant soft tissue tumors. We reviewed the referral documents provided by the referring physicians to see if these two findings were reported. The study was conducted from January 2007 to December 2021 and included 142 patients (83 men and 59 women; median age, 64 [6-94] years) with malignant soft tissue tumors. Patient referral documents from physicians were screened for descriptions of the tumor size and depth. The tumor size, depth, and both were described in 51.4%, 36.6%, and 23.2% of the referrals, respectively. Both findings were mentioned in 23.8%, 21.7%, and 25.0% of referrals in 2007-2011, 2012-2016, and 2017-2021, respectively. Of orthopedic surgeons and other physicians, 61.2% and 38.6%, respectively, described the tumor size. Whether the general physicians could follow the soft tissue tumor practice guidelines was difficult to conclude by reviewing patient referral documents. However, orthopedic surgeons seemed to pay more attention to tumor size. Awareness regarding soft tissue tumor practice guidelines should be increased to help diagnose malignant soft tissue tumors early.

DOI： 10.1038/s41598-022-24158-w

PubMed

DOI： 10.1038/s41598-022-23583-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

No reports have previously evaluated the association between surgical technique and the incidence of postoperative spinal epidural hematoma (PSEH) following microendoscopic decompression surgery (MED). This study aimed to evaluate the association between the development of radiographic PSEH (rPSEH) following MED and microendoscopic surgical experience and postoperative clinical outcomes related to the quality of life (QoL). This retrospective cohort study included 3922 patients who had undergone MED performed by a single surgeon. rPSEH was defined as a hematoma that was identified via routine magnetic resonance images performed 3−4 days postoperatively. Patients were divided into rPSEH and control groups to identify the risk factor of rPSEH and assess clinical outcomes. In the multivariate analysis, age (p = 0.002), surgical experience (p = 0.003), surgical time (p = 0.038), multilevel decompression (p < 0.001), and diagnosis (p = 0.004) were identified as independent variables associated with rPSEH. Moreover, in mixed-effect models, the rPSEH group showed less improvement in Oswestry Disability Index (p = 0.014) than the control group. In conclusion, the surgical experience was identified as a risk factor for rPSEH that could lead to poor QoL. The sharing of microendoscopic surgical techniques among surgeons may reduce rPSEH incidence and improve patients’ QoL.

DOI： 10.3390/jcm11216495

PubMed

化膿性脊椎炎(PVO)の治療後死亡率にび漫性特発性骨増殖症(DISH)が及ぼす影響について検討した。単施設で治療を受けたPVO患者55例(男性30例、女性25例、中央値73歳)を対象に後ろ向きコホート研究を実施し、DISH関連PVO群13例とDISH非関連PVO群42例に分類して死亡率の差を評価した。PVOの罹患部位は頸椎が4例(7%)、胸椎が12例(22%)、腰椎が39例(71%)で、起因菌が33例(60%)から検出され、黄色ブドウ球菌が最も多かった。静注抗生剤の投与期間中央値は6週間、手術を13例(24%)に施行し、経過観察期間中の死亡は18例(33%)となっていた。DISH関連PVO群の死亡率は62%で、88%が入院後1年以内の死亡であり、Kaplan-Meier生存曲線解析では2年死亡率はDISH関連PVO群の方がDISH非関連PVO群より高値を示していた。DISH関連PVO群の方が年齢が有意に高く、入院時のCRPも高値を示しており、敗血症が死因であったのはDISH関連PVO群が8例中6例、DISH非関連PVO群が10例中5例であった。このほか、PVO罹患中心部が椎体であったのはDISH関連PVO群が38%、DISH非関連PVO群が5%と有意差が認められた。DISH関連PVO患者の死亡率は高く、平均余命も短いことが明らかになった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Bone marrow aspirate (BMA) is an excellent source of cells and growth factors and has been used successfully for bone, cartilage, and soft-tissue healing. This study aimed to investigate the histological and biomechanical properties of autogenous tendon graft by injecting BMA and its protective effect against degenerative changes in a rabbit model of meniscal defects. Adult white rabbits were divided into untreated, tendon, and tendon + BMA groups, and meniscal defects were created in the knees. The tendon graft and articular cartilage status were evaluated by macroscopic and histological analysis at 4, 12, and 24 weeks postoperatively among the three groups. The tendon graft in the tendon and tendon + BMA groups were used for biomechanical evaluation at 4, 12, and 24 weeks postoperatively. The meniscal covering ratio in the tendon + BMA group was better than that in the tendon and untreated groups at 12 and 24 weeks postoperatively. The matrix around the central portion of cells in the tendon + BMA group was positively stained by safranin O and toluidine blue staining with metachromasia at 24 weeks. The histological score of the tendon graft in the tendon + BMA group was significantly higher than that in the untreated and tendon groups at 12 and 24 weeks postoperatively. In the tendon + BMA group, cartilage erosion was not shown at 4 weeks, developed slowly, and was better preserved at 12 and 24 weeks compared to the untreated and tendon groups. Histological scores for the articular cartilage were significantly better in the tendon + BMA group at 24 weeks. The compressive stress on the tendon graft in the tendon + BMA group was significantly higher than that in the tendon group at 12 weeks postoperatively. Transplantation of autogenous tendon grafts by injecting BMA improved the histologic score of the regenerated meniscal tissue and was more effective than the tendon and untreated group for preventing cartilage degeneration in a rabbit model of massive meniscal defects.

DOI： 10.3390/ijms232012458

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND AND AIMS: Intraoperative fluorescence angiography with indocyanine green or fluorescein is used in ophthalmology and neurosurgery. However, there are few reports on the use of fluorescence angiography for peripheral neuropathy. This study aimed to assess the validity of fluorescein angiography (FAG) for peripheral nerve entrapment neuropathy. METHODS: We used an established model of chronic nerve compression (CNC) neuropathy in C57BL/6 mice by entrapping their left sciatic nerve with a silastic tube. Mice were assigned to the uninjured group (control), two-week CNC neuropathy group, four-week CNC neuropathy group, or six-week CNC neuropathy group. We then performed FAG to assess neural blood flow and quantified the peak of the luminance at the compression site with luminance analysis software. Following FAG, histological examinations using an anti-fluorescein antibody and Masson's trichrome staining were performed to evaluate the area of fluorescein distribution and epineural fibrosis. RESULTS: The luminance in the CNC neuropathy groups was significantly lower than that in the control group. Histological analysis revealed the fluorescein positive areas in the CNC neuropathy groups were significantly smaller than that in the control group, and the epineural fibrosis areas in the CNC neuropathy groups were significantly larger than that in the control group. CONCLUSION: We observed a significant decline of luminance in the CNC neuropathy groups, and the histological assessment was consistent with this result. FAG was found to be a valid method for assessing CNC neuropathy in mice.

DOI： 10.1080/01616412.2022.2072101

PubMed

鏡視下手根管開放術(ECTR)を施行する際、有鉤骨鉤は手根骨の尺側縁として触知可能なランドマークであるが、有鉤骨鉤には解剖学的破格(低形成)が存在し注意を要する。今回、当科で2016～2020年にECTRを施行した53例56手を対象とし、有鉤骨鉤の低形成を認めた症例の割合と有害事象について調査した。低形成は6手(11%)に認めた。有害事象は、低形成を認めた2手に発生し、内訳は正中神経領域の一過性の痺れ1手、鈍棒挿入時における尺骨神経領域への放散痛1手で、いずれも保存的治療により改善した。このうち放散痛が生じた症例を提示した。

上腕骨近位端骨折続発症に対するリバース型人工肩関節置換術(以下RSA)の短期成績について検討したので報告する.対象は上腕骨近位端骨折続発症に対して,RSAを施行し術後1年以上経過観察可能であった17肩である.評価項目は術後1年時の自動可動域(屈曲,外転,外旋,結帯動作),疼痛,日本整形外科学会肩関節疾患治療成績判定基準(以下JOAスコア)とし,既往手術・RSA術後の大結節の異常の有無と術後成績との関連についても検討した.術後屈曲,外転,JOAスコアは術前後で有意な改善を認めた.また,既往手術なし群はあり群と比較して術後外転可動域が有意に高い値であったが,大結節の異常の有無で術後臨床成績に有意差はなかった.上腕骨近位端骨折続発症に対するRSAは術後成績の改善を認めたが,手術の既往,大結節の治癒が術後成績に影響する可能性があり,初回の治療選択の見極めが重要であり,手術手技の工夫も要すると考えられた.(著者抄録)

RSA施行時にナビゲーションを使用した群15例(N群)と非使用群9例(C群)とで肩甲骨コンポーネントの設置状態を比較し、ナビゲーションの有用性について検討した。術中の肩甲骨コンポーネント目標設置位置は、肩甲骨関節窩前後捻角(GV)と肩甲骨関節窩傾斜角(GI)を0°、下方への張り出し(IO)を3mmとし、目標位置と実際の設置位置とのズレを調べた。結果、GVのズレはN群が3.4±2.3°、C群が7.1±4.3°で、N群のほうが有意に小さかった。GIのズレはN群3.2±1.6°、C群9.9±6.7°で、N群が有意に小さかった。IOのズレはN群1.4±0.9mm、C群2.6±2.6mmで、有意差は認められなかった。手術時間に有意な群間差はなかった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Patient satisfaction is crucial in pay-for-performance initiatives. To achieve further improvement in satisfaction, modifiable factors should be identified according to the surgery type. Using a prospective cohort, we compared the overall treatment satisfaction after microendoscopic lumbar decompression between patients treated postoperatively with a conventional physical therapy (PT) program (control; n = 100) and those treated with a PT program focused on low back pain (LBP) improvement (test; n = 100). Both programs included 40 min outpatient sessions, once per week for 3 months postoperatively. Adequate compliance was achieved in 92 and 84 patients in the control and test cohorts, respectively. There were no significant differences in background factors; however, the patient-reported pain score at 3 months postoperatively was significantly better, and treatment satisfaction was significantly higher in the test than in the control cohort (-0.02 ± 0.02 vs. -0.03 ± 0.03, p = 0.029; 70.2% vs. 55.4%, p = 0.045, respectively). In the multivariate logistic regression analysis, patients treated with the LBP program tended to be more satisfied than those treated with the conventional program, independent of age, sex, and diagnosis (adjusted odds ratio = 2.34, p = 0.012). Postoperative management with the LBP program could reduce pain more effectively and aid spine surgeons in achieving higher overall satisfaction after minimally invasive lumbar decompression, without additional pharmacological therapy.

DOI： 10.3390/jcm11195566

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND:  The treatment of painful neuroma remains challenging. Recently, a nerve-end capping technique using a bioabsorbable nerve conduit was newly introduced to treat amputation neuroma. A collagen-coated polyglycolic acid (PGA) conduit has been commercially available for the reconstruction of peripheral nerve defects, yielding successful clinical outcomes. However, no experimental research has been conducted using this PGA nerve conduit as capping device for treating amputation neuroma. The purpose of this study was to investigate nerve-end capping treatment with the PGA conduit in the rat sciatic nerve amputation model, focusing on histological scar formation and neuroinflammation. METHODS:  Forty-seven rats were divided into two groups: no capping (transected nerve stump without capping; n = 25) and capping (nerve-end capping with collagen-coated PGA nerve conduit; n = 22). Twelve weeks after sciatic neurectomy, neuropathic pain was evaluated using the autotomy score. Stump neuromas were histologically evaluated or perineural scar and neuroinflammation. RESULTS:  While autotomy scores gradually exacerbated in both groups, they were consistently lower in the capping group at 4, 8, and 12 weeks postprocedure. Twelve weeks after surgery, the transected nerve stumps in the no-capping group had formed macroscopic bulbous neuromas strongly adhering to surrounding tissues, whereas they remained wrapped with the PGA nerve conduits loosely adhering to surrounding tissues in the capping group. Histologically, distal axonal fibers were expanded radially and formed neuromas in the no-capping group, while they were terminated within the PGA conduit in the capping group. Perineural scars and neuroinflammation were widely found surrounding the randomly sprouting nerve end in the no-capping group. In capped counterparts, scars and inflammation were limited to closely around the terminated nerve end. CONCLUSION:  Nerve-end capping with a collagen-coated PGA conduit after rat sciatic neurectomy might prevent neuroma formation by suppressing perineural scar formation and neuroinflammation around the nerve stump, potentially relieving neuropathic pain.

DOI： 10.1055/s-0042-1757208

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: This study aimed to compare the amount of extrusion of the discoid lateral meniscus (DLM), which was symptomatic and required surgery, with normal meniscuses and asymptomatic DLMs and examine factors associated with the extrusion of symptomatic DLM. METHODS: Medical records of participants with DLM or normal lateral meniscus (LM) were retrospectively reviewed using magnetic resonance imaging (MRI). DLM cases were divided into symptomatic and asymptomatic groups. The midbody meniscal extrusion was measured using mid-coronal MRI. The association between meniscal extrusion and MRI findings, including the meniscofemoral ligament, meniscotibial ligament (MTL), intrameniscal signal intensity of the peripheral rim, meniscal shift, and skeletal maturity, was evaluated. RESULTS: Eighty-six knees with DLM (63 symptomatic) were included. The control group included 31 patients. The symptomatic group showed significantly greater meniscal extrusion (mean ± standard deviation symptomatic DLM: 1.0 ± 1.1 mm, asymptomatic DLM: 0.1 ± 0.4 mm, and normal LM: 0.3 ± 0.6 mm, P < 0.001) and had a significantly higher incidence of MTL loosening (P = 0.02) and intrameniscal signal (P < 0.001) than the other two groups. In the symptomatic group, multivariable linear regression analysis showed that MTL loosening [β = 1.45, 95% confidence interval (CI) 1.03-1.86, P < 0.001] and intrameniscal signal (β = 0.49, 95% CI 0.09-0.90, P = 0.002) were independent associated factors. CONCLUSIONS: LM extrusion was significantly more common in patients with symptomatic DLM than in those with asymptomatic DLM or a normal LM. MTL loosening and intrameniscal high-signal intensity on MRI were independently associated with meniscal extrusion. These findings help explain the pathogenesis and diagnosis of symptomatic DLM. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-022-07161-6

PubMed

DOI： 10.3390/jcm11175230

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The optimal graft choice between the bone-patellar tendon-bone (BPTB) and the quadriceps tendon remains controversial. Studies evaluating the microscopic anatomy of the quadriceps tendon-patellar bone (QTB) and BPTB grafts for anterior cruciate ligament (ACL) reconstruction are currently lacking. HYPOTHESIS: The relationship between post-ACL reconstruction graft bending angle (GBA) and the angle corresponding to the GBA (cGBA) would indicate that the BPTB can bend more than the QTB at the femoral tunnel aperture. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty paired human cadaveric knees fixed at <10° of knee joint flexion (mean age, 82.5 years) underwent histological sectioning and staining with Masson trichrome and toluidine blue. The femoral ACL insertion, QTB graft, and BPTB graft were microscopically analyzed. The width of the direct insertion, thickness of the uncalcified fibrocartilage and calcified fibrocartilage, ligament attachment angle, and cGBA for each group were measured. Eighteen patients who underwent ACL reconstruction with QTB or BPTB autograft were included for the evaluation of GBA using computed tomography images at 1 week postoperatively. RESULTS: The mean insertion widths of the femoral ACL, QTB, and BPTB were 7.81, 9.07, and 6.54 mm, respectively. The QTB was 16% wider than the ACL, while the BPTB was 16% narrower than the ACL. The mean insertion thicknesses of the femoral ACL, QTB, and BPTB were 0.53, 0.94, and 0.38 mm, respectively. The QTB was 77% thicker than the ACL (P < .001), while the BPTB was 28% thinner than the ACL (P = .017). The mean ligament attachment angles of the femoral ACL, QTB, and BPTB were 20.3°, 30.2°, and 33.3°, respectively, and the QTB and the BPTB were 49% and 64% larger, respectively, than the ACL. The mean cGBAs of the femoral ACL, QTB, and BPTB were 33.9°, 35.1°, and 12.3°, respectively. The BPTB was 64% smaller than the ACL, while there was no significant difference between the QTB and the ACL. The mean GBA was 57.7°. CONCLUSION: The insertion width and thickness were significantly greater and smaller in the QTB and BPTB grafts, respectively, than in the ACL. The relationship between GBA after ACL reconstruction and cGBA in knee extension indicates that at the femoral tunnel aperture, the BPTB can bend more than the QTB. CLINICAL RELEVANCE: QTB graft may allow more anatomic ACL reconstruction to be performed.

DOI： 10.1177/03635465221110895

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Autologous tendon grafts are used for meniscal reconstruction of surgically removed knee joint meniscus. However, as meniscal reconstruction cannot prevent the progression of cartilage degeneration, additional procedures that confer meniscus-like histological properties to the transplanted tendon are required for improved outcomes. HYPOTHESES: Parathyroid hormone (PTH)(1-34) induces cartilage formation in the rat tendon, and transplantation of PTH-treated tendon promotes meniscal regeneration. STUDY DESIGN: Controlled laboratory study. METHODS: Rat Achilles tendon-derived cells were cultured with or without PTH for 28 days and stained with Alcian blue to determine chondrogenic differentiation. After 14 and 28 days of incubation, gene expression was assessed using quantitative real-time polymerase chain reaction. In an in vivo study, rat Achilles tendon was injected with PTH and then transplanted onto a medial meniscal defect. Macroscopic and histological assessments of the regenerated meniscus and of cartilage degeneration in the tibial plateau were performed at 4 and 8 weeks after surgery. RESULTS: In vitro, PTH-treated cells showed better staining with Alcian blue than the control (normal medium) group. PTH1R, Col2a1, Sox9, and RUNX2 were significantly upregulated in PTH-treated cells (P < .05). Macroscopically, the in vivo results revealed more prominent meniscal coverage and lesser progression of articular cartilage degeneration in the PTH group than in the phosphate-buffered saline-injected group. Histologically, toluidine blue staining revealed metachromasia in the PTH-injected tissue at 4 and 8 weeks. The PTH-treated regenerated meniscus showed positive immunostaining for type II collagen in the area exhibiting metachromasia. Moreover, PTH-treated tendon had an enhanced histological score compared with the untreated group at 4 and 8 weeks (P < .05). CONCLUSION: PTH(1-34) induced cartilage formation in the rat tendon. Transplantation of PTH(1-34)-treated Achilles tendon in a rat meniscal defect model induced meniscal regeneration and preserved knee articular cartilage. Macroscopically, PTH groups showed a greater coverage of the regenerated meniscus. Histologically, the regenerated meniscus had higher cartilaginous matrix content in rats transplanted with PTH-treated tendons. PTH(1-34) stimulated tendon-derived cells to promote chondrogenic differentiation. CLINICAL RELEVANCE: Meniscal transplantation using PTH-injected autologous tendon grafts might promote meniscal regeneration and prevent progression of cartilage degeneration by stimulating chondrogenic differentiation of tendon-derived cells.

DOI： 10.1177/03635465221112954

PubMed

DOI： 10.1186/s12877-022-03316-9

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Rotationplasty is a useful option for limb salvage surgery in pediatric patients with malignant bone and soft tissue tumors. However, bone growth after rotationplasty remains poorly characterized. We present a case of a 3-year-old boy with extraskeletal Ewing sarcoma who underwent multidrug chemotherapy (vincristine, doxorubicin, ifosfamide and etoposide), wide resection and functional reconstruction with rotationplasty. No radiotherapy was administered during the treatment course and the patient has been followed up for 16 years after rotationplasty. Leg length at skeletal maturity was predicted using postoperative radiograph measurements of the affected leg at the age of 4 years. Two conventional prediction methods, the multiplier and straight-line graph methods were used for prediction. The predicted leg length was compared with the actual leg length to assess bone growth after rotationplasty. Immediately after surgery, the lengths of the affected lower leg, femur and tibia were 32.5, 15.0 and 17.6 cm, respectively, and the predicted leg length of the affected leg at skeletal maturity using the multiplier and straight-line graph methods was 44.6 and 44.2 cm, respectively. However, the actual length of the affected leg at skeletal maturity was 49.8 cm, and the gap between actual and predicted lengths was more than 5 cm. In conclusion, the affected leg after rotationplasty showed more than expected bone overgrowth compared with the predictions of the conventional methods.

DOI： 10.1093/jjco/hyac133

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: The medial pivot total knee arthroplasty (TKA) has good patients' satisfaction; however, there is likely the restriction of postoperative knee flexion. The 2nd generation medial pivot TKA prosthesis was designed to improve postoperative knee flexion. This study aimed to compare the clinical outcomes and patient satisfaction between the 2nd generation and 1st generation medial pivot TKA prostheses. MATERIALS AND METHODS: We conducted a retrospective study of 472 consecutive TKAs, performed using either the 2nd generation (EVOLUTION™), having smaller posterior femoral condyle and asymmetrical tibial tray, or 1st generation (ADVANCE™) prosthesis. The use of each system was historically determined. Patient age, sex and body mass index were matched between the two groups, with 157 cases ultimately included in each group. Measured clinical outcomes included: knee range of motion, the Knee Society Score, the rate of re-operation, and radiological parameters. Patient satisfaction was evaluated using the 12-item Forgotten Joint Score (FJS-12). RESULTS: The average follow-up period was 5.0 (3.7-6.3) years for the 2nd generation group and 8.7 (6.1-12.8) years for the 1st generation group (p < 0.01). The postoperative knee flexion range was 127° (80°-140°) for the 2nd generation and 118° (90°-135°) for the 1st generation at final follow-up (p < 0.01). On multivariate regression analysis, use of the 2nd generation prosthesis predicted greater postoperative knee flexion. The average FJS-12 score was 64 (0-100) for the 2nd generation and mean 57 (0-100) for the 1st generation (p < 0.01). Other clinical outcomes were similar between the two groups. CONCLUSIONS: Compared to the 1st generation, the 2nd generation medial pivot prosthesis provides greater postoperative knee flexion and patient satisfaction.

DOI： 10.1007/s00402-021-04121-6

PubMed

DOI： 10.1007/s00402-021-04148-9

PubMed

リバース型人工肩関節置換術(RSA)後感染に対して持続的局所抗菌薬灌流(CLAP)を施行した1例を経験したので報告する.症例は87歳女性.6ヵ月前に右肩化膿性関節炎を発症し,鏡視下デブリドマン施行.抗菌薬治療後にRSAを施行した.術後3週で創部に感染兆候出現し,各種検査所見よりRSA術後人工関節周囲感染と診断.洗浄,デブリドマン,インプラント交換及びCLAPを施行.術後1年で感染の再燃なく経過良好である.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: A discoid lateral meniscus (DLM) is associated with increased risk for meniscal tears and progression of knee joint osteoarthritis. Our aim was to differentiate knee joint morphology between patients with and without a DLM, as a function of skeletal maturity, using magnetic (MR) imaging. MATERIALS AND METHODS: This was a retrospective analysis of MR images of the knee for 110 patients, 6-49 years of age. Of these, 62 were in the open physis group (38 with a DLM) and 48 in the closed physis group (23 with a DLM). The following morphological parameters were measured: anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), the lowest point of the lateral femoral condyle (LPLFC), and the posterior lateral condylar angle (PLCA). RESULTS: Regardless of skeletal maturity, a DLM was associated with a greater inclination of the POLTP, lateralization of the LPLFC, and smaller PLCA (p < 0.001 for all compared to that of the control group). In the DLM group, the inclination of the AOLTP and the POLTP were significantly smaller (p < 0.001) and the LPLFC was more lateral (p < 0.001) in the closed physis group than in the open physis group. In the control group, the inclination of the POLTP was larger (p < 0.001) and the PLCA smaller (p = 0.019) in the open than in the closed physis group. CONCLUSIONS: We identified a characteristic knee morphology among patients with a complete DLM using MR imaging, which was observed before physeal closure and persisted after skeletal maturity was attained. We also noted lateralization of the LPLFC in the presence of a DLM, with an increase in lateralization with skeletal maturation. LEVEL OF EVIDENCE: Case-control study, III.

DOI： 10.1007/s00402-022-04538-7

PubMed

DOI： 10.1016/j.ymeth.2020.09.012

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Discoid lateral meniscus (DLM) presents with differing pathoanatomy and may exhibit various types of tears. The treatment strategy is based on the presence and location of instability as a result of deficient capsular attachment. Recently, meniscal stabilization after saucerization has been recommended for DLM to preserve the meniscus shape, prevent extrusion, and mitigate against the progression of osteoarthritis. In addition to stabilization, the resection volume is important to prevent osteoarthritic changes. Although there was no tear and no displacement of the lateral meniscus on magnetic resonance imaging, some DLMs were found to have tears and peripheral instability during arthroscopy. Therefore, the assessment of peripheral instability during surgery is very important to achieve a desirable clinical outcome. This Technical Note describes an arthroscopic technique for anterior peripheral stabilization of the DLM, in which we highlight the surgical procedure for repair of the anterior horn, reassess the instability around the popliteal hiatus after the anterior horn is repaired, and the stabilization of the posterior horn, if necessary.

DOI： 10.1016/j.eats.2022.02.021

PubMed

DOI： 10.1007/s00264-022-05375-4

PubMed

<p>The Shiraniwa Study, a longitudinal observational study, has evaluated the physical symptoms, physical function, and radiological findings in 409 elderly people (aged 65 years or older) living in a suburban area since August 2016.</p><p>Cross-sectional analysis of the study data identified spinal sagittal imbalance, obesity, prevalent vertebral fractures, and anxiety as independent factors associated with low back pain. Interventions against these factors appeared to be effective in preventing low back pain. Longitudinal analysis revealed stage 2 locomotive syndrome (LS) as an independent predictor of deteriorating spinal sagittal imbalance. In addition, elderly in whom the locomotion level improved over time also showed weight loss, which suggests that weight loss may contribute to preventing the progression of spinal imbalance. Weight loss affects two factors associated with low back pain in the elderly (obesity and spinal imbalance) and might therefore be an effective countermeasure against low back pain in this population.</p>

DOI： 10.34371/jspineres.2022-0602

<p>The prevalence of osteoporotic fractures continues to increase due to an aging society. In particular, osteoporotic vertebral fracture (OVF) affects activities of daily living and quality of life in elderly persons. Therefore, early diagnosis and treatment of OVF are important. Magnetic resonance (MR) image is useful in diagnosis, but it is sometimes difficult to diagnose whether fractures are fresh. In this review, we introduce our previous report and summarize previous papers on the diagnosis of OVF and artificial intelligence related to OVF. Our study included 814 patients with fresh OVF. A total of 1,624 slices of T1-weighted MR images were obtained and used for CNN training and validation. Furthermore, two spine surgeons independently evaluated 100 vertebrae, which were randomly extracted from the test data. To evaluate the performance of the CNN, we plotted a receiver operating characteristic (ROC) curve and calculated the area under the curve (AUC). We then compared the sensitivity, specificity, and accuracy of the diagnosis by CNN and that of the two spine surgeons. The AUC was 0.95. The evaluation metrics of the diagnosis (CNN/surgeon 1/surgeon 2) for 100 vertebrae were as follows: sensitivity 0.88 / 0.88 / 1.00; specificity 0.88 / 0.86 / 0.66; and accuracy 0.88 / 0.87 / 0.80. The performance of the CNN was comparable to that of the two spine surgeons in diagnosing fresh OVF on MR images. The performance of some diagnostic support tools using CNN has become comparable to that of specialists in various medical fields. Thus,such tools are expected to contribute to the highly accurate diagnosis of OVF in the near future.</p>

DOI： 10.34371/jspineres.2022-0607

DOI： 10.1016/j.jos.2022.05.012

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The aim of this study was to investigate the influence of systemic chemotherapy on the skeletal growth of young osteosarcoma patients as a treatment-related late adverse effect. We reviewed the height data of 20 osteosarcoma patients (13 males and 7 females) aged ≤18 years. The average (±SD) age at diagnosis was 14.5 (±3.3) years. The average follow-up interval was 89.6 months. After wide resection of the affected bones, reconstruction with tumor prostheses and auto-bone grafting was carried out in 11 and 9 cases, respectively. Pearson’s correlation coefficient was calculated to evaluate the association between actual and predicted (using Paley’s multiplier method) heights. Z-scores were used to compare the initial and final heights with the Japanese national growth curve. Actual and predicted heights were correlated according to Pearson’s correlation coefficient (R = 0.503). Z-analysis showed that statistical significance (p = 0.04) was noted for the height data Z-scores of patients between ≤10 years and >10 years at the final follow-up. Systemic chemotherapy did not reduce skeletal growth in young osteosarcoma patients as a late adverse effect based on two different evaluation methods. However, patients aged ≤10 years at diagnosis may develop a short stature after systemic chemotherapy.

DOI： 10.3390/curroncol29060325

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: A retrospective study. PURPOSE: This study aimed to evaluate the relationship between age and trunk muscle composition and between trunk muscle composition and overall survival in patients with spinal metastasis. OVERVIEW OF LITERATURE: A low skeletal muscle mass is associated with a poor overall survival in patients with cancer. However, no previous studies have evaluated the relative effects of age and disease on muscle mass and muscle quality in patients with advanced cancer. METHODS: This study included 539 patients diagnosed with spinal metastasis from February 2009 to July 2018. The patients were categorized into four groups based on age: <59, 60-69, 70-79, and ≥80 years. Differences in trunk muscle composition among age groups and among groups were classified on the basis of survival (< or >3 months after spinal metastasis diagnosis) were evaluated. RESULTS: In total, 515 patients (273 men, 242 women; mean age, 67.8 years) with complete medical records were included in the analysis. No significant differences were observed in the area of the psoas and paravertebral muscles among age groups in either sex. A significant trend toward a low muscle density with the increase in age was found for both sexes. Patients who survived less than 3 months had significantly smaller trunk muscle area than those who survived for more than 3 months in both sexes. CONCLUSIONS: The results suggest that the reduction in muscle density is associated with advanced age, whereas a decreased muscle area is associated with pathology. Additionally, a small trunk muscle area was associated with a short overall survival. Further studies are needed to elucidate the underlying mechanisms of age- versus cancer-related changes in the muscle area and their influence on overall survival.

DOI： 10.31616/asj.2021.0192

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVES: The purpose of this study was to evaluate the new incidence of carotid plaques in rheumatoid arthritis (RA) patients over a 6-year prospective follow-up and to assess the risk factors. METHODS: This is a 10-year prospective cohort study that included 208 RA patients and 205 age- and gender-matched controls. Ultrasound assessment of the bilateral carotid arteries was performed in 2011 and 2017. RESULTS: There were no differences in the incidence of new carotid atherosclerotic plaques over 6 years between the two groups (35.5% vs. 37.0%, respectively; p = .936). The mean Disease Activity Score 28-C-reactive protein over 6 years in RA patients was 2.73 ± 0.95. Multiple logistic regression analysis showed that RA was not a risk factor for new carotid atherosclerotic plaques (odds ratios, 0.708; 95% confidence interval, 0.348-1.440; p = .340). An average glucocorticoid dose of >1.8 mg/day over 6 years was a risk factor for new carotid atherosclerotic plaques (odds ratios, 8.54; 95% confidence interval, 1.641-44.455; p = .011). CONCLUSIONS: Incidence of new carotid atherosclerotic plaques was similar between well-controlled disease activity RA patients and control subjects. A mean glucocorticoid dose of >1.8 mg/day over 6 years was a risk factor for new carotid atherosclerotic plaques.

DOI： 10.1093/mr/roac051

PubMed

International / domestic magazine：International journal  

Different approaches to fingertip reconstructions are reported for cases in which microsurgical replantation is impossible. This report presents two cases of bipedicled digital artery perforator adiposal flaps for fingertip reconstruction after traumatic amputations. Adiposal flaps, including the radial and ulnar digital artery perforator vessels proximal to the distal interphalangeal joint, were elevated and turned to cover the fingertip defect. After donor-site skin closure, split-thickness skin was grafted onto the fingertip digital artery perforator adiposal flap. The technique is quick and easy to perform under loupe magnification and achieves good results in terms of healing, hand function, appearance, and patient satisfaction.

DOI： 10.1016/j.jpra.2022.02.006

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

A number of outcome predictors for carpal tunnel release (CTR) for carpal tunnel syndrome (CTS) have been reported. However, some predictors are controversial, and few studies have referred to the early postoperative outcome prognostic factors after CTR. The aim of this study was to investigate whether pain and numbness at 1 month post-CTR were early postoperative predictors of clinical outcomes 6 months after surgery. Pain and numbness were evaluated using the visual analog scale (VAS) preoperatively and at 1 month post-surgery. Patient-reported outcome measures (PROMs), including the Quick Disabilities of the Arm, Shoulder and Hand (QDASH) measure, the Hand20 questionnaire and the Boston Carpal Tunnel Questionnaire (BCTQ), were recorded for each patient 6 months after surgery. The BCTQ consisted of the Symptom Severity Scale (SSS) and Functional Status Scale (FSS). Multivariable linear regression analysis was performed to investigate the association between the VAS scores and PROMs. We retrospectively identified 93 patients who underwent open carpal tunnel release (OCTR) or endoscopic carpal tunnel release. The mean age of the patients was 67.5 years, and 67 patients (72.0%) were female. Sixty patients were treated by OCTR (65.0%). With multivariable linear regression analysis, we found that pain and numbness, evaluated with VAS 1 month post-surgery had significant correlations with QDASH, Hand20, SSS and FSS 6 months after surgery. In conclusion, pain and numbness 1 month after CTR predict PROMs at 6 months.

DOI： 10.1080/2000656X.2021.1953041

PubMed

DOI： 10.1007/s00586-022-07151-9

PubMed

<p><b>Introduction: </b>The analgesic effect and safety of multimodal cocktail injection after cervical laminoplasty were examined in a prospective randomized controlled trial.</p><p><b>Methods: </b>A total of 50 patients, who underwent cervical laminoplasty, were randomized into two groups. The cocktail group (25 patients) received intraoperative wound infiltration of local anesthetics, epinephrine, prednisolone, and nonsteroidal anti-inflammatory drugs at the end of surgery. The noncocktail group (25 patients) received only intraoperative wound infiltration of levobupivacaine. The outcome measures were amount of postoperative analgesic usage within 24 hours and visual analogue scale (VAS) for pain within 7 days and time to first analgesic demand.</p><p><b>Results: </b>Wound pain VAS was low in the cocktail group at all measurement points 6 hours after surgery, and significantly lower in the cocktail group 1, 3, 5, and 6 days after surgery (p = 0.01, 0.019, 0.024, 0.009). The total amount of postoperative analgesic usage in the first 24 hours was significantly lower in the cocktail group (p = 0.04). No complications, such as postoperative muscle paralysis or wound infection, were observed.</p><p><b>Conclusions: </b>Multimodal cocktail injection significantly reduced VAS for wound pain within 6 days and analgesic usage within 24 hours in postoperative analgesia with no increased side effects after cervical laminoplasty.</p>

DOI： 10.34371/jspineres.2021-0067

DOI： 10.1093/mr/roac049

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Medial-pivot total knee arthroplasty (TKA) is designed with high articular conformity in the medial compartment in order to achieve stability. The subjective outcome of patients has been reported to be good postoperatively; however, the association between the objective and subjective knee stability and the influence of subjective stability on the overall outcomes of TKA remained unknown. Our hypothesis was that postoperative flexion joint-gap imbalance could affect subjective knee instability following TKA in medial-pivot prostheses. The purpose of this study was to analyze the association between the joint gap in flexion and subjective knee instability and between subjective knee instability and outcomes following medial-pivot TKA. METHODS: A total of 769 patients who underwent primary TKA with use of medial-pivot prostheses were enrolled. Clinical outcomes included knee range of motion, Knee Society Score-2011 (KSS-2011), Forgotten Joint Score-12 (FJS-12), patient-reported subjective knee instability, and axial knee radiography to assess flexion joint-gap balance measured at the final follow-up. Clinical outcomes were compared between patients with and without subjective knee instability. Moreover, associated factors were analyzed for postoperative subjective knee instability. RESULTS: Overall, 177 patients (23%) reported experiencing postoperative subjective knee instability. Knee flexion (p = 0.04); KSS-2011 symptom (p<0.001), satisfaction (p<0.001), expectation (p=0.008), and activity (p<0.001) subscales; and FJS-12 (p < 0.001) were significantly worse in patients with subjective knee instability. The KSS-2011 subjective score differences were greater than the minimal clinically important difference. Older age at the time of surgery (odds ratio, 1.04; p = 0.04) and a wider postoperative joint gap in flexion on the medial side (odds ratio, 1.21; p = 0.001) were significant risk factors for subjective knee instability. A gap angle of -2.9° (i.e., medial laxity) was the threshold to predict postoperative knee instability (sensitivity, 0.29; specificity, 0.91). CONCLUSIONS: Postoperative flexion joint-gap laxity on the medial side following medial-pivot TKA affected the patient-reported subjective knee instability scores. Postoperative KSS-2011 subjective scores following medial-pivot TKA were poorer in patients with subjective knee instability. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

DOI： 10.2106/JBJS.21.01034

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Adipose-derived stem cells (ADSCs), due to their regenerative ability, have beneficial effects on bone and cartilage defects. In addition, spheroid formation of ADSCs obtained using three-dimensional (3D) culture accelerates the regenerative ability of ADSCs. The study investigated the regenerative effect of 3D-cultured small size ADSC spheroids without a scaffold in rats with defects in the critical-sized calvarial bone. ADSC-single cells, ADSC-spheroids, or PBS (as control) were implanted in rats, and radiological and histological assessment of bone regeneration was performed. Bone defects were significantly regenerated in the ADSC-spheroid group compared to that in the control group. ADSC-spheroids also showed the most significant bone regeneration in histological assessment. Immunohistochemistry assessment showed that ADSC-spheroids could survive 12 weeks after cell implantation. In vitro, cell apoptosis in ADSC-spheroids was significantly suppressed compared to that in ADSC-single cells. In addition, gene expression related to bone morphogenesis, angiogenesis, and stemness in ADSC-spheroids was elevated. The scaffold-free 3D-cultured small ADSC-spheroids survived in in vitro and in vivo conditions and promoted bone regeneration. Therefore, injectable small size ADSC-spheroids are a novel and less-invasive therapeutic option for treating bone defects.

DOI： 10.1016/j.bbrc.2022.03.027

PubMed

DOI： 10.11359/chubu.2022.467

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Although arthroscopic reshaping surgery for a discoid lateral meniscus (DLM) has good clinical results, it cannot completely prevent degeneration. The degree of DLM extrusion associated with degenerative changes is unclear. PURPOSE/HYPOTHESIS: To measure meniscal extrusion preoperatively and postoperatively in patients who underwent DLM-reshaping surgery and examine factors associated with knee articular cartilage degeneration. It was hypothesized that meniscal extrusion existed preoperatively, progressed postoperatively, and was related to knee joint degeneration. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We retrospectively reviewed the medical records of patients who underwent DLM-reshaping surgery and attended ≥2 years of follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 24 months postoperatively, and residual midbody meniscal extrusion was measured. Cartilage degeneration was detected when the Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the lateral compartment was grade ≥3 at 2 years postoperatively. Factors associated with MRI cartilage degeneration were evaluated. RESULTS: Included in this study were 48 knees in 39 patients; the mean patient age at the time of surgery was 12.0 years. The mean midbody meniscal extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 24 months postoperatively (P < .001). According to the WORMS cartilage score, 16 patients were categorized as having MRI cartilage degeneration. Multivariate logistic analysis showed that an inferior preoperative Lysholm score (odds ratio, 0.89; P = .024) and postoperative extrusion (odds ratio, 6.18; P = .010) significantly increased the risk of cartilage degeneration. The receiver operating characteristic curve showed that a residual meniscal extrusion of 2.0 mm was the cutoff value indicating cartilage degeneration (sensitivity, 87.5%; specificity, 78.1%). CONCLUSION: DLM extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 2 years postoperatively. Postoperative extrusion and a lower preoperative Lysholm score were factors related to MRI cartilage degeneration postoperatively. A postoperative extrusion of 2.0 mm was the cutoff value for MRI cartilage degeneration.

DOI： 10.1177/23259671221091997

PubMed

DOI： 10.1016/j.spinee.2021.11.012

PubMed

82歳女性。前医にてCOVID-19肺炎の入院加療中に炎症所見上昇、発熱が認められ、第12病日に当院へ転院となった。入院時の胸部CTで両肺野に広範な肺炎像がみられ、デキサメサゾンの投与を漸減した。しかし、第15病日には炎症所見が再び上昇し、同時に右膝痛が出現した。胸部X線では肺炎像の増悪はみられず、第19病日に右膝関節穿刺を行ったところ、膝関節偽痛風と診断された。穿刺後は速やかに解熱し、関節痛の改善もみられ、第29病日に自宅退院となった。目下、発症から10ヵ月経過で偽痛風の再発はみられていない。

はじめに:頸椎椎弓形成術における多剤カクテル注射の術後鎮痛効果と安全性の検討を前向き無作為化比較試験で行った.対象と方法:頸椎椎弓形成術を施行した50例を無作為にカクテル群(ロピバカイン18ml,フルルビプロフェン1.25ml,0.1%アドレナリン0.1ml,水溶性プレドニン0.75ml)25例,対照群(レボブピバカイン0.5%20ml投与)25例に分けた.創部痛VAS(帰室時,術後3,6,12時間,術後1,2,3,5,6,7日目),帰室後鎮痛剤を使用するまでの時間,24時間以内の鎮痛剤使用回数を比較した.結果:創部痛VASは術後1,3,5,6日目においてカクテル群が有意に低かった(p=0.01,0.019,0.024,0.009).24時間以内の鎮痛剤使用回数はカクテル群で有意に使用回数が少なかった(p=0.04).術後合併症は認めなかった.結語:多剤カクテル注射はレボブピバカイン単剤の局所浸潤麻酔法と比較し,頸椎椎弓形成術後6日以内の創部痛VAS,24時間以内の鎮痛薬使用量を減少させた.多剤カクテル注射は頸椎椎弓形成術術後疼痛管理の一選択肢になると考える.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

WP9QY (W9) is a receptor activator of nuclear factor-κB ligand (RANKL)-binding peptide that inhibits osteoclastogenesis by blunting the RANKL-RANK interaction, and also increases osteoblastogenesis via RANKL reverse signaling. W9 has dual effects on osteoclasts and osteoblasts; however, it is unknown whether the peptide has an effect on chondrocytes. Here, we report that W9 induces proliferation and differentiation of chondrocytes in vitro and repairs full-thickness articular cartilage defects in vivo. W9 stimulated chondrocyte differentiation in a two-dimensional (2D) culture of human mesenchymal stem cells (hMSCs), and transforming growth factor β3 (TGF-β3) showed synergistic effects with W9 on chondrogenesis. W9 enlarged the size of 3D pellet cultures of hMSCs and produced chondrocyte-specific matrices, especially in combined treatment with TGF-β3. The peptide also stimulated proliferation of hMSCs with induction of expression of chondrogenesis-related genes. Several RANKL inhibitors had no effect on chondrocytic differentiation. RANKL-knockdown experiments showed that W9 did not induce chondrogenesis through RANKL, but did induce osteoblastogenesis through RANKL. Intraarticular injection of W9 resulted in significant repair of full-thickness articular cartilage defects in rabbits. Taken together, these results suggest that W9 ameliorates the articular cartilage defects by increasing the volume of cartilaginous matrices with accompanying induction of proliferation and differentiation of chondrocytes via mechanisms independent of RANKL inhibition and RANKL reverse signaling. Since no pharmaceuticals are clinically available for treatment of cartilage damage such as osteoarthritis, our findings demonstrate the potential of W9 to address the unmet medical needs.

DOI： 10.1016/j.bbrc.2022.03.019

PubMed

DOI： 10.18888/se.0000002114

International / domestic magazine：International journal  

DOI： 10.1038/s41598-022-10386-7

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

CASE: A 43-year-old woman presented with pain, paresthesia, and coldness of the right upper extremity suggestive of the diagnosis of thoracic outlet syndrome. Three-dimensional computed tomography angiography revealed that the right subclavian artery was constricted because it traveled over an abnormal first rib. After anticoagulation and antithrombotic therapy, the patient underwent resection of the abnormal first rib. Postoperative angiography documented improvement over time of the poststenotic dilatation and recanalization of the subclavian artery capable of delivering almost normal distal flow. CONCLUSION: Arterial reconstruction is not always necessary for the treatment of arterial thoracic outlet syndrome associated with poststenotic dilatation of the subclavian artery.

DOI： 10.2106/JBJS.CC.21.00751

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: The characteristic two-dimensional bone morphology in patients with a discoid lateral meniscus (DLM) has been described. However, the associated three-dimensional imaging findings have not been characterized. This study was performed to identify differences in the knee bone morphology between juvenile patients with a DLM and those with a normal meniscus using magnetic resonance (MR) imaging. METHODS: The DLM group comprised 33 consecutive juvenile patients (33 knees) with a complete DLM, and the control group comprised 24 juvenile patients (24 knees) with normal menisci on the basis of MR imaging findings. Each MR image was evaluated to determine the anterior obliquity of the lateral tibial plateau (AOLTP), posterior obliquity of the lateral tibial plateau (POLTP), lowest point of the lateral femoral condyle (LPLFC), posterior lateral condylar angle (PLCA) and posterior medial condylar angle (PMCA). Statistical analyses were performed to determine the differences between the two groups. RESULTS: The POLTP was significantly larger, the LPLFC was significantly more lateral, and the PLCA was significantly smaller in the DLM group than in the control group (p < 0.001, p < 0.001 and p < 0.001 respectively). However, there was no statistically significant difference in the AOLTP or PMCA between the two groups (p = 0.429 and p = 0.148, respectively). CONCLUSIONS: Hypoplasia of the lateral femoral condyle and posterior lateral tibial plateau is recognized in juvenile patients with a complete DLM on coronal and axial MRI images. LEVEL OF EVIDENCE: Diagnostic study, Level III.

DOI： 10.1007/s00402-021-03908-x

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Medial pivot total knee arthroplasty (MP-TKA) is characterized by the ball-in-socket medial tibiofemoral articulation to achieve low wear and to reproduce the medial pivot motion similar to that in the normal knee, and there have been reports of favorable long-term postsurgical outcomes. However, most of these cases concerned varus knees, and the outcomes of MP-TKA in valgus knees are unknown. The objective of this study was to investigate the postoperative outcomes in end-stage valgus knee OA patients who underwent MP-TKA, through comparisons with those who underwent TKA using the same prosthesis for varus deformity. METHODS: This retrospective, single-center, cohort study analyzed 171 knees of 121 patients who were divided into two groups (valgus knee group: 15 knees (13 patients), varus knee group: 156 knees (109 patients)). Primary outcome measures included the knee joint range of motion (evaluated preoperatively and at every year postoperatively). Secondary outcomes included operative time, laboratory data, estimated blood loss, clinical outcome measures and adverse events. RESULTS: There were no significant differences in age, sex and body mass index, as well as in the postoperative primary and secondary outcome measures between the two groups. CONCLUSION: The use of MP-TKA featuring ball-in-socket medial tibiofemoral articulation in patients with valgus knee OA showed equally favorable clinical outcomes more than 2 years after surgery, compared to patients with varus knees who received MP-TKA.

DOI： 10.1007/s00590-021-03007-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Lumbar spinal stenosis (LSS) is a common disease in the elderly, mostly due to degenerative changes in the lumbar spinal complex. Decompression surgery is the standard surgical treatment for LSS. Classically, total laminectomy-which involves resection of the spinous process, entire laminae and medial facet-has been the standard decompression technique; however, it can cause post-surgical instability. To overcome this disadvantage, various minimally invasive techniques that preserve the stabilization structures of the spine have been developed, and surgeons have begun to re-evaluate decompression surgery from the standpoint of reduced invasiveness and cost. More than two decades have passed since the introduction of microendoscopic spine surgery, and studies continue to shed light on its advantages and limitations as new knowledge becomes available. This article is a narrative review of the available literature, along with authors' experience, regarding the indications, surgical techniques, clinical outcomes, and limitations/complications of microendoscopic decompression for LSS.

DOI： 10.3390/medicina58030384

PubMed

DOI： 10.1097/BRS.0000000000004262

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To investigate the ability of serum cartilage oligomeric matrix protein (COMP) to detect early osteoarthritis (OA) (International Cartilage Research Society [ICRS] grade 1 or 2 cartilage lesions) in patients with anterior cruciate ligament (ACL)-deficient patients. METHODS: Patients with an ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum samples for COMP measurement were obtained before surgery. The cartilage surfaces of 6 compartments were classified using the ICRS grading system. The patients were divided into groups with and without early OA according to the cartilage findings and diagnostic criteria for early OA. RESULTS: In total, 98 patients (mean age 23.7 years; range 12 to 49) were included, with 30 patients (30.6%) in the early OA group and 68 (69.4%) in the no early OA group. The 2 groups significantly differed in age, body mass index, preoperative Tegner activity scale, and serum COMP level. The cutoff value of serum COMP for the presence of early OA arthroscopic cartilage lesions was 152.0 ng/mL. Multiple logistic regression analysis revealed age (odds ratio 1.09; 95% confidence interval [CI] 1.02 to 1.16; P = .01) and serum COMP (odds ratio 1.02; 95% CI 1.01 to 1.04; P < .001) to be independent factors for the presence of early OA arthroscopic cartilage findings. CONCLUSIONS: The incidence of early OA arthroscopic cartilage findings was ∼30% in patients with ACL deficiency, and serum COMP levels were significantly higher in the early OA group than in the no early OA group. The optimum cutoff value for serum COMP was 152 ng/mL. Serum COMP can be used to detect early cartilage change in patients with ACL deficiency. LEVEL OF EVIDENCE: Ⅲ, retrospective comparative study.

DOI： 10.1016/j.arthro.2021.06.019

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: We determined the impact of sarcopenia on the treatment outcomes of malignant bone and soft tissue tumors in elderly patients. PATIENTS AND METHODS: We retrospectively reviewed 76 patients (age ≥65 years) who were treated for malignant bone and soft tissue tumors. Sarcopenia was assessed by measuring the cross-sectional area of the psoas muscles at the L3 vertebra from preoperative computed tomography images and categorized using the total psoas area/m 2 (TPA/m 2 ) ≤5.0 cm 2 /m 2 . The patients' clinical data were then evaluated. RESULTS: The operation time, length of hospital stay, and median overall survival were not different between the sarcopenia (n=41) and no-sarcopenia (n=35) groups. The local recurrence rate (p=0.01) and incidence of postoperative complications (p=0.02) significantly differed between both groups. The TPA/m 2  of both groups significantly decreased at the final follow-up. CONCLUSION: Sarcopenia negatively influenced wound healing and local recurrence, and was significantly exacerbated postoperatively in all elderly patients.

DOI： 10.21873/cdp.10094

PubMed

症例は2歳0ヵ月男児で、左第4趾の変形にて近医を受診し、腫瘍や外傷後の変形が疑われた。紹介受診時には左第4趾の遠位が外側に偏位していたが、発赤・発熱・圧痛などはみられず、単純X線では左第4趾の基節骨骨頭の骨性隆起と中節骨の外側への亜脱臼を認めた。MRI T2強調画像にて骨幹端から発生した腫瘍が関節面に及んでいたことから単発性外骨腫を疑い、dysplasia epiphyseal hemimelica(DEH)を否定した上で早期に腫瘍切除術を行った。術中、関節軟骨を被覆していた腫瘍と軟骨帽を可及的に切除し、PIP関節を整復してK-wireで固定した。その結果、術後6ヵ月で腫瘍の再発は認めず、PIP関節のアライメントも良好である。関節面に及んだ外骨腫に対しては、年齢や症状の有無によらず、早期に切除することが望ましいと考えられた。

症例は生後20日の女児で、生下時から両内反足、両上下肢絞扼輪症候群を合併し、特に左下腿に強い絞扼と浮腫を認めた。Ponseti法による両先天性内反足の治療を開始し、右足は順調に経過したが、左足は強いリンパ浮腫のため矯正ギプス治療を継続できなかった。月齢が低く、サイズが小さいため、手術時期について検討しながら装具装着で待機していたが、生後2ヵ月時に急激な循環不全をきたし、左下腿の色調増悪を認めたため、緊急手術として絞扼輪切除術を行った。その後、左側外側接地した状態で安定した歩行を獲得できたため、1歳10ヵ月時に後内側解離術を行い、2歳0ヵ月時点で左足は軽度内反位を認めるもほぼ足底接地可能である。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The cervical ossification of the posterior longitudinal ligament (cOPLL) is sometimes misdiagnosed or overlooked on radiography. Thus, this study aimed to validate the diagnostic yield of our deep learning algorithm which diagnose the presence/absence of cOPLL on cervical radiography and highlighted areas of ossification in positive cases and compare its diagnostic accuracy with that of experienced spine physicians. Firstly, the radiographic data of 486 patients (243 patients with cOPLL and 243 age and sex matched controls) who received cervical radiography and a computer tomography were used to create the deep learning algorithm. The diagnostic accuracy of our algorithm was 0.88 (area under curve, 0.94). Secondly, the numbers of correct diagnoses were compared between the algorithm and consensus of four spine physicians using 50 independent samples. The algorithm had significantly more correct diagnoses than spine physicians (47/50 versus 39/50, respectively; p = 0.041). In conclusion, the accuracy of our deep learning algorithm for cOPLL diagnosis was significantly higher than that of experienced spine physicians. We believe our algorithm, which uses different diagnostic criteria than humans, can significantly improve the diagnostic accuracy of cOPLL when radiography is used.

DOI： 10.1038/s41598-022-06140-8

PubMed

DOI： 10.1016/j.jos.2022.01.010

PubMed

DOI： 10.3171/2021.12.SPINE211151

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Vitamin D has been shown to reduce symptoms in patients with osteoarthritis (OA). In a previous study, local administration of eldecalcitol, an active vitamin D3 analog, reduced degenerative changes in articular cartilage in the early phase of experimental OA. However, the target of vitamin D in OA remains unknown. Here, we investigated the effect of eldecalcitol treatment on chondrocytes, which were divided into superficial zone chondrocytes (SZC), deep zone chondrocytes (DZC), and differentiated chondrocytes. SZC and DZC were cultured in monolayer and 3D pellet cultures treated with eldecalcitol. The gene expressions of articular cartilage and chondrocyte differentiation markers were evaluated. Histological analysis of SZC and DZC 3D pellet cultures was performed. The results showed that the articular cartilage markers ETS-related gene (Erg) and lubricin/proteoglycan 4 (PRG4) were significantly increased in SZC, but not in DZC, in the monolayer culture treated with eldecalcitol. The chondrocyte differentiation markers type X collagen and alkaline phosphatase (ALP) were significantly decreased in the DZC pellet culture treated with eldecalcitol. Immunochemical analysis also showed that Erg and lubricin/PRG4 expressions were elevated in the SZC pellet culture treated with eldecalcitol, while type X collagen and ALP expressions were decreased in the DZC pellet culture treated with eldecalcitol. In conclusion, this study showed that eldecalcitol upregulated articular cartilage markers in SZC and suppressed differentiation markers in DZC. Such regulation of chondrocytes by eldecalcitol could be potentially effective against OA progression.

DOI： 10.1016/j.bbrc.2022.01.119

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Worldwide prevalence of obesity is associated with the increase of lifestyle-related diseases. The accumulation of intermuscular adipose tissue (IMAT) is considered a major problem whereby obesity leads to sarcopenia and metabolic disorders and thus is a promising target for treating these pathological conditions. However, whereas obesity-associated IMAT is suggested to originate from PDGFRα+ mesenchymal progenitors, the processes underlying this adipogenesis remain largely unexplored. Here, we comprehensively investigated intra- and extracellular changes associated with these processes using single-cell RNA sequencing and mass spectrometry. Our single-cell RNA sequencing analysis identified a small PDGFRα+ cell population in obese mice directed strongly toward adipogenesis. Proteomic analysis showed that the appearance of this cell population is accompanied by an increase in galectin-3 in interstitial environments, which was found to activate adipogenic PPARγ signals in PDGFRα+ cells. Moreover, IMAT formation during muscle regeneration was significantly suppressed in galectin-3 knockout mice. Our findings, together with these multi-omics datasets, could unravel microenvironmental networks during muscle regeneration highlighting possible therapeutic targets against IMAT formation in obesity.

DOI： 10.1242/dev.199443

PubMed

DOI： 10.1007/s00167-021-06448-4

PubMed

DOI： 10.1007/s00264-021-05256-2

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

An ulnar cleft hand is a rare congenital deformity presenting with a cleft between the ring and little finger. It may be associated with the absence of a finger. The goals of treatment are cleft closure, increasing the length of the hypoplastic little finger and preservation of function. We report two patients with ulnar cleft hand without missing fingers. Both underwent cleft closure. One was treated by lengthening of the fifth metacarpal with an external fixator, and the other by finger translocation. Both patients achieved a near normal length of the little finger and a reasonable functional and aesthetic outcome. Level of Evidence: Level V (Therapeutic).

DOI： 10.1142/S2424835522720043

PubMed

International / domestic magazine：International journal  

Clear cell chondrosarcoma (CCCS) is a rare, low-grade, malignant chondrogenic bone tumour. This tumour commonly affects the epiphysis of long bones, particularly in the proximal femur. The present study reported on the case of a 58-year-old male with right hip pain of five months duration. Plain radiography, magnetic resonance imaging and computed tomography scan revealed the characteristic appearance of chondroid mineralisation in the right femoral head, suggesting typical CCCS. Although biopsy is the gold standard for definite diagnosis prior to treatment, wide resection with removal of the biopsy tract is thought to negatively affect the surgical margin and postoperative hip function. Therefore, en bloc resection without any biopsy and a hip hemiarthroplasty were performed. The pathological diagnosis was CCCS and an adequate surgical margin was obtained. No local recurrence or distant metastases were detected and postoperative function was excellent at the final follow-up. The femoral head is a typical location of CCCS. Wide resection with adequate margins is the main treatment strategy for CCCS and when radiological features are typical, en bloc resection without a biopsy is an acceptable treatment option to improve patient outcomes.

DOI： 10.3892/mco.2021.2459

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: This study aimed to clarify differences in clinical results, including in patients' joint awareness, between cruciate-substituting (CS) and cruciate-retaining (CR) medial pivot total knee arthroplasty (TKA) over a 10-year follow-up. METHODS: A total of 333 TKAs were included in this study. There were 257 cases of CS and 76 cases of CR TKAs. Knee range of motion, Knee Society Score, and radiological outcomes were assessed. The patients' joint awareness was evaluated using the Forgotten Joint Score-12 at the final follow-up. The survival rate with respect to reoperation or revision was analyzed. RESULTS: The mean follow-up period was 10 ± 1.7 years, and the loss to follow-up was 5.4%. All clinical outcomes improved significantly after surgery in both groups (P < .001). Postoperative knee flexion was 118° ± 13° in the CS group and 116° ± 10° in the CR group (P = .10). The mean Forgotten Joint Score-12 scores were 57 ± 27 points in the CS group and 56 ± 28 points in the CR group (P = .59). Ten years after the operation, the survival rates for reoperation were 96.3% in the CS group and 94.2% in the CR group (P = .61), and those for revision were 98.4% and 98.7% in the CS and CR groups, respectively (P = .87). Other postoperative clinical results did not differ between the 2 groups. CONCLUSION: In this 10-year follow-up study, medial pivot TKA, regardless of polyethylene insert type, showed a high survival rate and good patient awareness of the prosthetic joint.

DOI： 10.1016/j.arth.2021.11.016

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To characterize bone marrow aspirate-derived fibrin clot (BMA clot) and evaluate the clinical result of meniscal repair with a BMA clot for isolated meniscal injury in the avascular zone. METHODS: Blood counts of total leukocytes, platelets, and concentrations of basic fibroblast growth factor (bFGF), transforming growth factor β (TGF-β), and stromal cell-derived factor 1 (SDF-1) were analyzed with BMA, peripheral blood (PB), BMA clot, and PB clot from 5 patients treated for meniscal repair. In addition, a retrospective analysis of 30 patients with isolated avascular meniscal injuries who underwent repair with a BMA clot was performed to assess rate failure. Avascular meniscal injury was identified as horizontal tear, radial tear, and flap tear. Clinical failure was defined as the presence of 1 or more of Barrett's criteria. Anatomic failure was defined as the existence of equivalent signal intensity to intra-articular fluid along the repair area on follow-up magnetic resonance imaging (MRI). Patients' demographic and clinical data were compared between the overall failure group and the success group. RESULTS: The bFGF, TGF-β, and SDF-1 levels of BMA clots were more highly concentrated compared with PB clots. The Lysholm scores and meniscal status evaluated by MRI were significantly improved from preoperatively to postoperatively (both P < .001). The Kellgren-Lawrence grading of knee radiographs did not significantly differ pre- and postoperatively (P = .140). Rates of clinical failure, anatomic failure, and retear were 10%, 6.7%, and 3.3%, respectively. The demographic characteristics and surgical and postoperative status did not significantly differ between the overall failure group and the success group. CONCLUSIONS: BMA clots had increased levels of cytokines compared to PB clots. The retrospective analysis revealed that the rates of clinical failure and anatomic failure after meniscal repair with a BMA clot for isolated avascular meniscal injury were 10% and 6.7%, respectively. LEVEL OF EVIDENCE: Level IV, case series.

DOI： 10.1016/j.arthro.2021.05.026

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To determine the in vivo effectiveness of a single-stage surgical procedure that combines microfracture and an autologous platelet-rich fibrin (PRF) membrane for cartilage repair in a rabbit model. METHODS: Cartilage defects were created in the trochlear groove of the knees of adult white rabbits. Defects were divided into 2 treatment groups: microfracture only (control group) and microfracture covered by a PRF membrane (PRF group). To evaluate the repair cartilage, assessments were performed at 4, 12, and 24 weeks postoperatively using the International Cartilage Repair Society (ICRS) macroscopic scoring system and modified Wakitani histologic grading system. RESULTS: The mean ICRS macroscopic scores in the control and PRF groups were 4.1 and 5.8, respectively, at 4 weeks (P = .0623); 6.3 and 9.8, respectively, at 12 weeks (P = .006); and 6.5 and 10.3, respectively, at 24 weeks (P = .010). The mean modified Wakitani scores in the control and PRF groups were 4.0 and 3.9, respectively, at 4 weeks (P > .999); 5.3 and 10.4, respectively, at 12 weeks (P = .006); and 2.6 and 7.4, respectively, at 24 weeks (P = .012). CONCLUSIONS: The ICRS macroscopic scores and modified Wakitani scores showed that a single-stage surgical procedure combining microfracture and a PRF membrane was more effective than surgery with only microfracture for promoting cartilage repair. CLINICAL RELEVANCE: A single-stage surgical procedure combining microfracture and an autologous PRF membrane is a potentially beneficial treatment method for cartilage defects that does not require using any xenocollagen membrane.

DOI： 10.1016/j.arthro.2021.04.055

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Giant cell tumor of soft tissue (GCT-ST), histologically resembling the GCT of the bone, is a rare tumor. The tumor has been categorized to have low malignancy. Few reports of local recurrence or distant metastasis and the use of chemotherapeutic agents for metastatic GCT-ST exist. Herein, we report the efficacy of pazopanib in a 78-year-old Japanese woman with GCT in the intrinsic back musculature with both post-operative local recurrence and lung metastasis. The patient visited the hospital with a three-month history of a palpable mass in the intrinsic back musculature. Following magnetic resonance imaging, the tumor predominantly exhibited slight hyperintensity on T2-weighted images and intense heterogeneous enhancement on contrast-enhanced T1-weighted images. A percutaneous needle biopsy was performed, and the pathological diagnosis was GCT-ST. The patient underwent surgery, and three months later she presented with not only local recurrence but also multiple lung metastases. The patient was immediately treated with pazopanib 400 mg once daily. One month after initiating treatment, a partial response in the pulmonary lesions was observed, and stable disease (SD) effects lasted for 11 months without severe adverse effects. Therefore, pazopanib treatment for metastatic malignant giant cell tumor of soft tissue achieved reasonable success.

DOI： 10.3390/curroncol29020064

PubMed

International / domestic magazine：International journal  

Osteoid osteoma is a benign tumor. Approximately 20% of these tumors are located in the femur. The tumor primarily occurs in children and is treated by surgical excision or radiofrequency ablation. Recently, bone-tumor resection using three-dimensional (3D) intraoperative imaging with an O-arm in combination with a navigation system has been reported to be effective. However, there is a risk of postoperative fracture because of the weakening of the bone after drilling for tumor resection. A 12-year-old Japanese girl presented with an osteoid osteoma in the left femoral shaft, which resulted in a fracture after en bloc resection and artificial bone grafting using a 3D image-guided (O-arm) assisted navigation system. Orthopedic oncologists should be aware of the risk of fracture. Moreover, they should consider the mechanical risk prediction of bone fracture using finite element analysis prior to treatment.

DOI： 10.3390/children9020158

PubMed

DOI： 10.3390/jcm11030602

PubMed

<p><b>Introduction: </b>Osteoporotic vertebral fracture (OVF) is one of the most common fractures among the elderly, and its impact on the cost of care is a concern. Balloon kyphoplasty (BKP) is a widely used treatment for OVF. The purpose of this study is to estimate the cost of conservative treatment and BKP, including the cost of nursing care and the loss of productivity of caregivers, based on previous reports.</p><p><b>Methods: </b>For the distribution of activities of daily living (ADLs) after OVF, we used data from our multicenter prospective study that evaluated BKP and conservative treatment for 6 months in patients aged ≥65 years within 2 months of the onset. Estimates of nursing care costs and informal care costs were estimated mainly based on data published by the Ministry of Health, Labor and Welfare.</p><p><b>Results: </b>To compare nursing care costs, we summed up the distribution of ADLs, the level of nursing care required, and the level of independence in daily living at the end of 6 months of treatment. The per capita nursing care costs by level of nursing care required at the end of 6 months were 39,497 yen/month in the BKP group and 58,298 yen/month in the conservative therapy group with a difference of 18,801 yen/month. The per capita informal care costs by level of care required at the end of 6 months of treatment were 35,722 yen/month in the BKP group and 44,102 yen/month in the conservative therapy group, with a difference of 8,380 yen/month.</p><p><b>Conclusions: </b>For patients with OVF, improvement of ADL via BKP may reduce the cost of care and caregiver productivity loss.</p>

DOI： 10.34371/jspineres.2021-0041

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

CASE: A 20-year-old man with Noonan syndrome had rigid cervical kyphosis caused by cervical myelopathy and thoracic lordosis caused by pulmonary disfunction. Two-staged corrective surgery, which involved initial posterior spinal fusion (PSF) in T2-L2 followed by PSF in C3-T2, had been performed without any complications. The radiographs before surgery and 2 years after surgery showed that cervical lordosis (C2-7) changed form -56° to -29°, and thoracic kyphosis (T5-12) improved from -49° to 10°. CONCLUSION: Initial realignment surgery in the caudal lesion should be better for improving global spinal alignment in patients with rigid spinal deformities at different locations.

DOI： 10.2106/JBJS.CC.21.00559

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Although sarcopenia is associated with poor prognosis for cancer patients, the relationship between muscle quantity and quality, and prognosis of breast cancer patients with bone metastases is unclear. This study aims to evaluate the association of muscle parameters, muscle area and density, and overall survival (OS) from the diagnosis of bone metastases in breast cancer patients with bone metastases. METHODS: This study retrospectively investigated the prognostic value of muscle area and density in 90 women who were diagnosed with breast cancer with bone metastases between September 2005 and June 2018. We measured psoas major muscle and paravertebral muscle area and density on single axial computed tomography images at the L3 level and subgrouped the patients into higher or lower groups for each muscle measurement, using median values as cutoffs. We evaluated associations between OS and muscle parameters, using a Cox proportional hazards model adjusted by age and prognostic score for bone metastases (modified Katagiri score). RESULTS: Median OS among patients with lower psoas major muscle density (25 months) was significantly shorter than in the higher psoas major muscle density group (61 months; hazard ratio: 1.79, 95% confidence interval: 1.01-3.16, P = 0.045). However, muscle area and paravertebral muscle density were not associated with OS in this setting. CONCLUSION: Lower psoas major muscle density was a predictor of poor prognosis in patients with breast cancer metastases to bone. The association between psoas major muscle density and prognosis allows wider research into interventions that can prevent loss of muscle density.

DOI： 10.1093/jjco/hyab166

PubMed

DOI： 10.11359/chubu.2022.79

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DOI： 10.11359/chubu.2022.1

DOI： 10.15106/j_seikei73_28

DOI： 10.11359/chubu.2022.97

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Soft tissue tumors are often accompanied with elevated skin temperature; however, studies concerning the relationship between soft-tissue tumors and skin temperature elevation are scarce. We aimed to evaluate the clinical significance of skin temperature elevation in soft-tissue tumors and identify factors related to skin temperature elevation. PATIENTS AND METHODS: This study comprised 118 patients at our hospital with soft-tissue tumors, excluding lipomatous tumors, whose pathological diagnosis was surgically confirmed between February 2017 and March 2021. Sixty-one and 57 patients had been diagnosed with benign lesions and malignant tumors, respectively (men, 64; women, 54; median age, 61 [range, 20-92] years). The relationship between skin temperature, monitored using a thermography camera, and the presence of soft-tissue malignancy was investigated. We reviewed clinical data to identify factors related to elevated skin temperature. RESULTS: Temperature differences ≥ 0.2 °C compared to the unaffected side were significantly associated with the presence of malignant tumors (p < 0.001). Logistic regression analysis indicated that intertumoral blood supply was associated with elevated skin temperature (OR 3.22, 95% CI 2.03-5.13; p < 0.001). CONCLUSIONS: Elevated skin temperature, influenced by intertumoral blood supply, may be an important adjunct to physical findings when diagnosing malignant soft-tissue tumors. CLINICAL RELEVANCE: Intertumoral blood supply influenced elevated skin temperature in malignant soft-tissue tumors. A skin temperature difference ≥ 0.2 °C compared to the unaffected side can help differentiate between benign and malignant tumors. Skin temperature differences may help in diagnosing malignant soft-tissue tumors.

DOI： 10.1007/s10147-021-02044-1

PubMed

当院の入院前スクリーニング検査でCOVID-19感染症と診断された4例(77歳男性、75歳女性、69歳女性、76歳女性)について検討した。その結果、炎症性疾患であった1例は発熱・高炎症反応を呈していたが、その他の症例はスクリーニング検査時に咳嗽や発熱などの臨床症状を認めず、炎症反応も正常値であった。4例における入院時スクリーニング検査陽性からPCR陰性化までの期間は平均4.25日であった。いずれの症例も特別な治療は行わず、経過観察のみで退院・一般病床への転棟となった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

DOI： 10.1007/s10396-021-01157-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Arthrodesis and prosthetic arthroplasty have been used to treat severe proximal interphalangeal (PIP) joint arthritis. Silicone implant arthroplasty is an established treatment for rheumatoid arthritis (RA) of the fingers. However, few studies have reported the application of silicone implant arthroplasty for the treatment of severe ankylosis of the PIP joint in RA patients. The authors report, for the first time, the case of a 46-year-old woman who presented with severe bony ankylosis of the right fourth and fifth PIP joints at greater than 90° of flexion. Proximal interphalangeal silicone arthroplasty in combination with reconstruction of the extensor mechanism was successfully performed in the affected joints. Four years after surgery, active flexion of the fourth and fifth PIP joints was 55° and 75°, respectively, with an extensor lag of only 5° without pain and joint instability. Proper repair of the extensor mechanism with shortening of the central slips and mobilization of the lateral bands dorsally was most important in maintaining the extended position of the PIP joints. Proximal interphalangeal silicone arthroplasty with intensive reconstruction of the extensor mechanism could become a potential treatment option to maintain joint mobility even in severe ankylosis of the PIP joints in RA patients. [Orthopedics. 2022;45(1):e53-e56.].

DOI： 10.3928/01477447-20211101-02

PubMed

DOI： 10.1007/s00774-021-01261-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Use of a porous tantalum tibial component for total knee arthroplasty (TKA) was reported to have beneficial effects on periprosthetic bone mineral density (BMD). In some cases, hexagonal peg is placed close to or in contact with the tibial cortex, which may result in stress-shielding around the peg. However, no studies have analyzed the relationship between peg position and BMD. The aim of this study was to compare the peg position and BMD around the peg in a porous tantalum tibial component after TKA. METHODS: Twenty-seven patients (27 knees) who underwent primary TKA with a cementless porous tantalum tibial component were investigated. BMD was measured by dual-energy X-ray absorptiometry for 2 years after the operation. The distance between the peg and the tibial cortex (peg distance) was measured on the medial and lateral sides. RESULTS: BMD was decreased in the medial region after the operation (p < 0.01). Relative change in BMD was lower in the medial region than in the central and lateral regions (p < 0.01). Multiple regression analysis showed that medial peg distance was negatively correlated with relative change of BMD in the medial part of the tibia (p = 0.04, R = 0.402). CONCLUSIONS: The medial peg position affected the postoperative relative change of BMD in the medial part of the tibia, but did not affect the longevity of the implant. As the tibial medial peg became closer to the medial tibial cortex, the BMD loss became larger in the medial part of the tibia at 2 years postoperatively.

DOI： 10.1016/j.knee.2021.11.005

PubMed

International / domestic magazine：Domestic journal  

DOI： 10.1007/s10147-021-02055-y

PubMed

サーモグラフィーを用いて、悪性軟部腫瘍における皮膚温上昇の臨床的意義とそれに関連する因子を後方視的に検討した。2017年2月から2021年3月までに手術で病理診断が確定した脂肪腫性腫瘍を除く軟部腫瘍患者118例(年齢20〜92歳)を対象とした。良性病変は61例、悪性腫瘍は57例であった。サーモグラフィーにより患側の腫瘍全体を含む領域と健側の患側と対称的な領域の皮膚温を測定した。良性病変患者の皮膚温差は平均0.03±0.26℃であったが、悪性腫瘍患者の皮膚温差は平均0.35±0.42℃であった。ROC曲線解析の結果、良性病変と悪性腫瘍の皮膚温差のカットオフ値は0.2℃、曲線下面積(AUC)は0.75、オッズ比(OR)は6.71(感度66.7%、特異度77.0%)であった。良性病変では61例中14例、悪性腫瘍では57例中38例で、患側の皮膚温が健側と比較して0.2℃以上高かった。0.2℃以上の皮膚温の差は、悪性腫瘍の存在と有意に関連していた(p<0.001)。さらに、ロジスティック回帰分析により、腫瘍間血液供給は皮膚温上昇と関連していた(OR 3.22、95%CI 2.03〜5.13、p<0.001)。以上より、悪性軟部腫瘍では腫瘍間血液供給が皮膚温上昇に影響を与えることが示された。

症例は77歳女性で、両下肢痛、両下肢しびれ、腰痛を主訴とした。腰部脊椎管狭窄症の診断でL4/L5前側方進入椎体間固定術を施行した。術後3日に低Na血症(129mEq/l)を認め、食塩経口負荷で一旦改善傾向を認めたが、術後12日のリハビリテーション後よりNa 116mEq/lの重篤な低Na血症を認めた。アンジオテンシンII受容体拮抗薬系降圧薬とNSAIDsを定期内服し、初回の腰椎後方除圧術後にも低Na血症で入院加療した既往が判明し、鉱質コルチコイド反応性低Na血症の可能性を考えた。イルベサルタン・アムロジピンベシル酸塩配合、セレコキシブの内服を中止し、1.7%生理食塩水投与を開始した。翌日にNa 124mEq/lまで改善したため1.2%生理食塩水投与に変更し、術後17日より食塩経口負荷を、術後19日よりフルドロコルチゾン酢酸エステル投与を開始した。術後22日にNa 133mEq/lで自宅退院し、退院後4ヵ月でフルドロコルチゾン酢酸エステルを終了した。

はじめに:骨粗鬆症性椎体骨折(OVF)は高齢者の多くが罹患する骨折であり介護費用に与える影響が懸念される.一方でBalloon kyphoplasty(BKP)はOVFに対して広く行われている治療の一つである.本研究目的は過去の報告をもとに介護費用及び介護者の生産性損失を含めた保存治療およびBKPの費用を推計することである.対象と方法:OVF後のADL分布は,新規にOVFを発症した受傷後2ヵ月以内の65歳以上の者を対象としてBKPあるいは保存治療を実施した6ヵ月間の多施設前向き研究のデータを使用した.介護費用の推計やインフォーマルケア費用の推計について,主に厚生労働省が公表しているデータを基に推計した.結果:介護費用は,治療実施6ヵ月後時点のADL分布と要介護度と日常生活自立度の分布を基に算出した.治療実施6ヵ月後時点の要介護度別の1人あたり介護費は,BKP群39,497円/月,保存療法群58,298円/月,差分18,801円/月であった.インフォーマルケア費用の比較として,治療実施6ヵ月後時点の要介護度別の1人あたりインフォーマルケア費用は,BKP群で35,722円/月,保存療法群で44,102円/月,差分は8,380円/月であった.結語:BKPによるADLの改善が,介護費用および介護者の生産性損失を削減する可能性がある.(著者抄録)

3mm以上の側方すべりまたは5°以上の椎間楔状化を伴う腰椎変性疾患110例を対象に、顕微鏡視下片側進入両側除圧術を施行した71例(除圧群:女性29例、男性42例、平均71.4歳)、腰椎後方椎体間固定術を施行した39例(固定群:女性24例、男性15例、平均73.4歳)に分け、臨床成績を比較検討した。その結果、術後2年のJOAスコア改善率は除圧群52.9%、固定群57.4%と、両群間で有意差を認めなかった。VASやSF-36の改善量も両群間で有意差を認めなかった。再手術例は除圧群7例、固定群0例と、除圧群で再手術例が有意に多かった。再手術の原因は、椎間孔部狭窄6例、椎間変性の増悪1例で、再手術例のJOAスコア改善率は平均24%と成績不良であった。

1回以上の電話診療を施行した670例を対象に、患者の満足度に影響した因子について検討した。患者診療満足度の質問票項目に、「とても満足していた」と回答した347例(高満足度群:男性45.2%、平均71.8歳)と、それ以外の回答であった323例(中・低満足度群:男性47.7%、平均70.0歳)の2群に分け、2群間で副次検討項目につき単変量解析を行った。その結果、患者の診療満足度は4段階評価で満点を選択したものが52%であり、とくに70歳代・80歳代で満足度が高い例が多かった。多変量解析では、患者年齢、「訴えの伝達」、「運動指導」が患者満足度に影響する因子であることが明らかとなった。

<p>Introduction: Mental well-being is essential for patient satisfaction. Therefore, a better understanding of the changes in the mental well-being of patients following spinal surgery can be useful to surgeons. We compared the 2-year postoperative change in the mental well-being of patients who underwent cervical and lumbar decompression surgery. Additionally, the predictive factors for improvement in mental well-being associated with both methods were evaluated.</p><p>Methods: The patients who underwent spinal decompression surgery and were followed >2 years postoperatively were enrolled (lumbar cohort: n=111, cervical cohort: n=121). The 36-item Short-Form Health Survey (SF-36) mental component summary (MCS) was set as the mental well-being parameter, and the minimal clinically important difference (MCID) was defined as 4.0. After adjusting the cervical and lumbar cohorts using propensity scores, the improvements in the MCS were compared between the groups using a mixed-effect model. To identify predictors for improvements, the correlation between the MCS changes and preoperative clinical scores was evaluated. Subsequently, multivariate linear regression was applied, which included variables with p<0.10 in the former analysis as explanatory variables, and the change of MCS as the objective variable.</p><p>Results: There were no significant differences in the MCS improvement between the adjusted cervical and lumbar cohorts; 47% and 49%, respectively, had MCS improvement score >MCIDs. However, predictors for the improvement were different between the two cohorts: SF-36 Social functioning in cervical surgery and lower back pain and SF-36 Role physical in lumbar surgery.</p><p>Conclusions: Although there was no significant difference in the improvement in the mental well-being between patients who underwent either cervical or lumbar decompression surgery, less than half of the patients in both groups achieved a meaningful improvement. Preoperative back pain and personal activity were independent predictors in the lumbar cohort, while social functioning was the only predictor in the cervical cohort.</p><p>Level of evidence: III</p>

DOI： 10.22603/ssrr.2021-0060

PubMed

CiNii Article

リバース型人工肩関節置換術（RSA）後感染に対して持続的局所抗菌薬灌流（CLAP）を施行した1例を経験したので報告する．症例は87歳女性．6か月前に右肩化膿性関節炎を発症し，鏡視下デブリドマン施行．抗菌薬治療後にRSAを施行した．術後3週で創部に感染兆候出現し，各種検査所見よりRSA術後人工関節周囲感染と診断．洗浄，デブリドマン，インプラント交換及びCLAPを施行．術後1年で感染の再燃なく経過良好である．

DOI： 10.11296/katakansetsu.46.236

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

INTRODUCTION: A number of imaging technologies have been developed to reduce the risk of pedicle screw (PS) misplacement. For example, preoperative three-dimensional (3D) planning can reportedly enhance implant placement accuracy in some orthopedic surgeries. However, no study has investigated the effect of preoperative 3D planning on PS placement without intraoperative 3D navigation. Thus, in this study, we aim to examine the accuracy of PS placement and identify the risk factors for PS misplacement in thoracolumbar surgeries performed using preoperative 3D planning software with intraoperative fluoroscopic guidance in a retrospective study. METHODS: In total, 25 consecutive patients (197 PSs) underwent thoracic or lumbar spinal fusion surgeries using preoperative 3D planning with intraoperative fluoroscopic guidance. PS misplacement was graded based on the degree of perforation (Grade 0, no perforation; Grade 1, <2 mm; Grade 2, 2-4 mm; Grade 3, >4 mm) observed in postoperative computed tomography (CT). Deviations between planned and actual PSs were evaluated by matching preoperative and postoperative CT volume images for each vertebra. RESULTS: The overall PS misplacement rate was 6.6% (Grade 1: 4.0%, Grade 2: 1.5%, Grade 3: 1.0%). The median linear deviations of PS entry points between planned and actual locations were determined to be 3.3 mm and 3.3 mm for the horizontal and vertical axes, respectively. The median angular deviations of the PS axis were 6.2° and 4.5° for the transverse and sagittal planes, respectively. Multivariate analysis revealed that horizontal deviation of the PS entry point was the sole factor associated with Grade ≥1 PS misplacement (odds ratio=2.47, p<0.001). CONCLUSIONS: Preoperative 3D planning software without intraoperative 3D navigation was able to achieve a relatively low PS misplacement ratio among the reported ratio of conventional techniques without navigation. Surgeons should carefully ensure that the entry point is consistent with preoperative planning, especially in the mediolateral direction to avoid misplacement in this method.

DOI： 10.22603/ssrr.2021-0185

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Superficial soft tissue sarcomas are often left untreated unless they invade the skin and skin ulcers manifest. Progressive sarcomas frequently result in dismal oncological outcomes despite multidisciplinary treatment. This study aimed to identify prognostic factors for superficial soft tissue sarcomas. MATERIALS AND METHODS: This study retrospectively analyzed the clinicopathological data of 82 patients with superficial soft tissue sarcomas treated between August 2003 and December 2020 at our institution. A superficial soft tissue sarcoma was defined if the percentage of the area occupied by the tumor in the assessed region (skin, subcutaneous) was more than 50%. Age, sex, location, tumor size, tumor-skin invasion, tumor grade, and distant metastasis at initial diagnosis were evaluated as potential prognostic factors. Cox proportional hazards regression models were used to identify the prognostic factors. Five-year survival rates were assessed by the Kaplan-Meier method. RESULTS: The mean follow-up time was 60.1 months. The 5-year overall survival, 5-year local recurrence-free survival, and 5-year metastasis survival rates were 76.4%, 60.6%, and 71.0%, respectively. Univariate analysis showed significant relationships between poor prognosis and tumor size ≥5 cm, distant metastasis at initial diagnosis, and tumor-skin invasion. In the multivariate analysis, only the tumor-skin invasion was associated with worse overall survival. CONCLUSIONS: Superficial soft tissue sarcomas have biologically been considered a separate category due to their better prognosis. In this study, the tumor-skin invasion was the only significant factor associated with a poor prognosis. Therefore, all superficial soft tissue sarcomas without tumor-skin invasion should be treated as early as possible.

DOI： 10.1371/journal.pone.0274077

PubMed

DOI： 10.1055/s-0042-1743256

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p><b>Introduction:</b> Pyogenic vertebral osteomyelitis (PVO) is an uncommon but life-threatening infectious disease. Diffuse idiopathic skeletal hyperostosis (DISH) is an age-related disorder and sometimes problematic in terms of spinal instability or high mortality, especially in cases of DISH-related fracture. Meanwhile, no reports have focused on the impact of DISH on the clinical outcomes after treatment for PVO. We hypothesized that PVO occurring at DISH-related segments might contribute to poor clinical results or high mortality rates. The purpose of this study was to investigate the impact of DISH on mortality after treatment for PVO in a retrospective cohort study.</p><p><b>Methods:</b> This study involved patients who were hospitalized and treated for PVO at a single institution. DISH-related PVO was defined as PVO within a segment ossified by DISH or PVO at the neighboring intervertebral level of the segment ossified by DISH. Differences in mortality between patients with DISH-related and non-DISH-related PVO were investigated.</p><p><b>Results:</b> This study included 55 patients. DISH-related PVO was observed in 13 patients. The mortality rate was significantly higher in patients with DISH-related PVO than in those with non-DISH-related PVO (62% and 23%, respectively; p = 0.016). Propensity score-adjusted analysis showed that DISH-related PVO was an independent risk factor for mortality (adjusted hazard ratio, 2.79; p = 0.034). The survival probability was significantly shorter in patients with DISH-related PVO than in those with non-DISH-related PVO (p = 0.006). PVO in which the intravertebral body was the center of involvement was significantly more common in DISH-related PVO than in non-DISH-related PVO (38% and 5%, respectively; p = 0.006).</p><p><b>Conclusions:</b> DISH-related PVO was associated with a higher mortality rate and shorter life expectancy than non-DISH-related PVO. Similar to advanced age, PVO at the segment ossified by DISH should be recognized as a risk factor for mortality when choosing the optimal treatment strategy.</p>

DOI： 10.22603/ssrr.2022-0021

PubMed

DOI： 10.1093/mr/roab106

PubMed

DOI： 10.15106/j_seikei72_1327

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION AND IMPORTANCE: Heterotopic ossification (HO) associated with Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is rare and the treatment strategy is unclear. CASE PRESENTATION: We report the case of a 31-year-old female diagnosed with anti-NMDA receptor encephalitis from Osaka General Medical Center, Osaka, JAPAN that developed heterotopic ossification of the knees during prolonged coma. She was unable to walk because of pain and limited range of motion in both knees. Thirty months after the onset of the coma, surgical excision of the heterotopic bone in both knees was performed. The range of motion of both the knees improved markedly and she had no recurrence of heterotopic ossification on a three-year follow-up. Thus, this case can be used as a guide for surgeons with such patients. CONCLUSIONS: We reported a case of heterotopic bone formation in the periarticular region of both bilateral knees in a patient who suffered a 2-month coma following anti-NMDA receptor encephalitis. Surgical excision of the heterotopic bones significantly improved the passive range of motion in both knees. Three years after the operation, the patient had no complaints about her knees, and there was no recurrence of HO.

DOI： 10.1016/j.ijscr.2021.106643

PubMed

OrthAlign社製HipAlignは、従来のナビゲーションで必要であった大きな装置を必要とせず、単回使用の手のひらサイズのデバイスを用いて、術前計画なしに、手術中に簡便に使用できるポータブルナビゲーションシステムであり、仰臥位THAで用いるHipAlign Supineと側臥位THAで用いるHipAlign New Lateralがある。今回、HipAlign Supineを使用した20関節とHipAlign New Lateralを使用した20関節の短期成績について調査した。評価項目は「カップ設置角度の絶対値誤差」「JOAスコア」「合併症(脱臼・感染)の有無」とした。調査の結果、カップ設置角度の絶対値誤差はHipAlign Supine使用群が外方開角2.7±2.5度、前方開角2.6±2.0度、HipAlign New Lateral使用群が外方開角5.1±3.8度、前方開角3.4±2.4度であった。両群ともJOAスコアは改善し、脱臼・感染例はなかった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Parrot beak tear is a white-white meniscal injury that often occurs in isolated injuries. Partial meniscectomy for parrot beak tears is often recommended, owing to the avascular zone; however, partial meniscectomy, especially with the lateral meniscus, has a high failure rate for return to sports, leading to residual meniscus extrusion and lateral compartment osteoarthritis. Thus, we have developed a repair technique to preserve the parrot beak tear of the avascular zone. This is a modification of the inside-out repair with additional reduction sutures. We recommend this procedure as a technique for repairing avascular parrot beak tears of the lateral meniscus.

DOI： 10.1016/j.eats.2021.08.005

PubMed

2020年11〜12月に大阪府内で行われた大規模アンケート調査から、COVID-19流行以後の生活様式の変化に対して運動指導を希望する整形外科患者の特徴について分析した。その結果、運動指導の希望がある患者は高齢、女性、膝関節疾患や股関節疾患、外出頻度が低下した患者、運動頻度が低下した患者、運動頻度が増加した患者で有意に多かった。また、運動指導の希望がない患者でも運動習慣の低下が約1/3、ADLの増悪が約1割の患者に存在することが明らかになった。

DOI： 10.11477/mf.1408202179

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Background and Objectives: Although percutaneous laser disc decompression (PLDD) is one of the common treatment methods for patients with lumbar disc herniation (LDH), the recurrence of LDH after PLDD is estimated at 4-5%. This study compares the preoperative clinical data and clinical outcomes of patients who underwent primary microendoscopic discectomy (MED) or MED following PLDD. Materials and Methods: We retrospectively analyzed 2678 patients who underwent MED for LDH. The PLDD group included patients with previous PLDD history at the same level of LDH, and a matched control group was created using propensity score matching for age, sex, and body mass index. Preoperative data, preoperative radiographic findings, and surgical data of the groups were compared. To compare postoperative changes in clinical scores between the groups, a mixed-effect model was used. Results: As a result, 42 patients (1.6%) had previously undergone PLDD, and a control group with 42 patients were created. The disc degeneration severity was not significantly different between the groups. However, Modic changes were more frequent in the PLDD group than in the matched control group (p = 0.028). There were no significant differences in dural adhesion rate or surgery-related complications including dural injury, length of stay, and recurrence rate of LDH after surgery. In addition, the improvement of clinical scores did not significantly differ between the two groups (p = 0.112, 0.913, respectively). Conclusions: We concluded that patients with recurrent LDH after PLDD have advanced endplate degeneration, which may reflect endplate injury from a previous PLDD. However, a previous history of PLDD does not have a negative impact on the clinical result of MED.

DOI： 10.3390/medicina57111225

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The acetabular component orientation in total hip arthroplasty is of critical importance to clinical results. Although navigation systems and surgical robots have been introduced, most surgeons still use acetabular component alignment guides. This study aimed to compare the accuracy between modern acetabular component alignment guides for the lateral position and those for the supine position. Thirteen alignment guides for the lateral position and 10 for the supine position were investigated. All the lateral position alignment guides indicated cup alignment in operative definition, and the supine position alignment guides indicated cup alignment in radiographic definition. For lateral position alignment guides, the anteversion actually indicated by the alignment guide itself was smaller than that indicated by the manufacturer by a mean of 6° (maximum, 9°), and the inclination actually indicated by alignment guides themselves was larger than that by the manufacturer (p < 0.01) by a mean of 2° (maximum, 4°). For supine position alignment guides, the inclination and anteversion indicated by the alignment guide itself were identical with those indicated by the manufacturer. The current study showed that the angles actually indicated and those stated by manufacturers were not identical for lateral position alignment guides.

DOI： 10.1038/s41598-021-01420-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The negative impact of cigarette smoking on bone union has been well documented. However, the impact of heated tobacco product (HTP) use on bone fracture-healing remains unclear. The present study investigated the effect of HTPs on preosteoblast viability, osteoblastic differentiation, and fracture-healing and compared the effects with those of conventional combustible cigarettes. METHODS: Cigarette smoke extracts (CSEs) were generated from combustible cigarettes (cCSE) and HTPs (hCSE). CSE concentrations were standardized by assessing optical density. Preosteoblast (MC3T3-E1) cells were incubated with normal medium, cCSE, or hCSE. The cell viability was assessed via MTT assay. After osteoblastic differentiation of CSE-exposed cells, alkaline phosphatase (ALP) activity was assessed. To assess the in vivo effects of CSEs, a femoral midshaft osteotomy was performed in a rat model; thereafter, saline solution, cCSE, or hCSE was injected intraperitoneally, and bone union was assessed on the basis of micro-computed tomography (μCT) and biomechanical analysis 4 weeks later. RESULTS: MC3T3-E1 cell viability was reduced in a time and concentration-dependent manner when treated with either cCSE or hCSE. ALP activity after osteoblastic differentiation of cCSE-treated cells was significantly lower than that of both untreated and hCSE-treated cells (mean and standard deviation, 452.4 ± 48.8 [untreated], 326.2 ± 26.2 [cCSE-treated], and 389.9 ± 26.6 [hCSE-treated] mol/L/min; p = 0.002). Moreover, the levels of osteoblastic differentiation in untreated and hCSE-treated cells differed significantly (p < 0.05). In vivo assessment of the femoral midshaft cortical region revealed that both cCSE and hCSE administration significantly decreased bone mineral content 4 weeks after surgery compared with levels observed in untreated animals (107.0 ± 11.9 [untreated], 94.5 ± 13.0 [cCSE-treated], and 89.0 ± 10.1 mg/cm3 [hCSE-treated]; p = 0.049). Additionally, cCSE and hCSE-exposed femora had significantly lower bone volumes than unexposed femora. Biomechanical analyses showed that both cCSE and hCSE administration significantly decreased femoral maximum load and elastic modulus (p = 0.015 and 0.019). CONCLUSIONS: HTP use impairs cell viability, osteoblastic differentiation, and bone fracture-healing at levels comparable with those associated with combustible cigarette use. CLINICAL RELEVANCE: HTP use negatively affects bone fracture-healing to a degree similar to that of combustible cigarettes. Orthopaedic surgeons should recommend HTP smoking cessation to improve bone union.

DOI： 10.2106/JBJS.20.02227

PubMed

DOI： 10.1016/j.ijfoodmicro.2021.109366

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

ABSTRACT: Preservation of the meniscus has been shown to influence the progression of osteoarthritic changes in the knee. Discoid lateral meniscus (DLM) is classified on the basis of the presence and location of instability resulting from deficient capsular attachments. Recently, meniscal stabilization after saucerization was recommended in cases of DLM to preserve the meniscus shape and avoid the progression of osteoarthritis. However, it is difficult to identify the accurate resection volume and residual meniscal width during surgery, especially when there is an anterocentral shift of the DLM. This Technical Note describes an arthroscopic technique for an anterocentral shift of the DLM in which we highlight the resection point and confirm the methods of retaining an adequate volume of residual meniscus to restore and maintain the shape and function of the meniscus. LEVEL OF EVIDENCE: Level 1, Knee; Level 2, Meniscus.

DOI： 10.1016/j.eats.2021.07.039

PubMed

症例は78歳女性で、T12の骨粗鬆症性椎体骨折に対して椎体切除術が施行され、椎弓根スクリューのゆるみが生じる可能性が考えられたため、セメント注入型椎弓根スクリュー留置術を行うこととした。T10、T11、L1、L2にスクリューを挿入後、T10スクリュー内に骨セメントを注入し、数分後にL2スクリューにもセメント注入を行った。しかし、この時点でL2椎弓根スクリューから静脈への骨セメント漏出が認められ、セメントは徐々に頭側に移動して心臓レベルまで達したため手術を中止した。血圧、心拍数、心電図所見には変化はみられず、セメント周囲の血栓形成予防目的にヘパリンを投与し、肺動脈塞栓術を施行した。経食道心エコー検査では遊走したセメントは右房に流入して心房中隔に達していた。カテーテルを用いたセメント除去を計画し、超音波ガイド下に右大腿静脈を介して下大静脈に16Fシースを進め、回収カテーテルを右房まで到達させた。トリプルループスネアを用いて遊走セメントを捕捉することができ、長さ6.5cmで針状の外観を呈していた。術後の造影CTでは肺塞栓症や心穿孔は認められず、背部痛の改善が得られた。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION/OBJECTIVES: To investigate the association between serum biomarker [cartilage oligomeric matrix protein (COMP) and matrix metalloproteinase-3 (MMP-3)] levels and clinical, magnetic resonance imaging (MRI), and arthroscopic findings in anterior cruciate ligament (ACL)-deficient knees without osteoarthritic changes on radiographs. METHOD: Patients with ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum COMP and MMP-3 levels were measured preoperatively. Correlations of serum biomarker levels with age, body mass index (BMI), duration from time of injury, Tegner activity scale (TAS) score, Lysholm knee score, International Knee Documentation Committee score, KT-1000 arthrometer measurements, whole-organ MRI score (WORMS), MRI T2 relaxation time, and arthroscopic International Cartilage Research Society (ICRS) grade were assessed by calculating Spearman correlation coefficients. Associations between intraoperative findings (cartilage, meniscus) and serum biomarker levels were determined using the Mann-Whitney U test. Multiple regression analysis was performed to investigate the correlations between serum biomarker levels and MRI and arthroscopic findings. RESULTS: Ninety-eight patients with a mean age of 23.7 years were enrolled. Higher serum COMP level was correlated with older age and higher BMI, TAS score, serum MMP-3 level, WORMS, and T2 relaxation times (medial femur, medial tibia). Multivariate analysis showed that the serum COMP level was independently associated with WORMS and ICRS grade. CONCLUSIONS: The serum COMP level was correlated with age, BMI, TAS score, and MMP-3 level in ACL-deficient knees and was independently correlated with WORMS and ICRS grade. Thus, the serum COMP level can help detect cartilage degeneration even in patients without radiographic osteoarthritic changes. Key Points • Serum COMP correlated with WORMS and ICRS grade in ACL deficient knee. • The serum COMP level could help in detecting cartilage degeneration, even in patients with no radiographic osteoarthritic changes.

DOI： 10.1007/s10067-021-05800-w

PubMed

COVID-19パンデミックに伴う外出頻度の減少が脊椎疾患患者に及ぼす影響を検討した。脊椎クリニックを受診する脊椎疾患患者855例を対象に多施設共同横断質問紙調査研究を実施した。外出頻度減少群160例と非減少群695例に分類し、運動習慣、ロコモティブシンドローム(LS)の有病率および健康関連QOL(HRQOL)をパンデミックの前後に評価した。その結果、HRQOLに関してEQ-5D-5Lスコアは外出減少群の方が非減少群より有意に低下していた。多変量ロジスティック回帰分析では、COVID-19パンデミック後に外出頻度が減少した患者においてパンデミック前と比較して、運動習慣の減少、LSの発症率増加、HRQOLの悪化が認められた。また、外出頻度の減少がみられた160例を軽度減少群116例と高度減少群44例に分けてサブ解析を実施したところ、脊椎疾患の重症度、運動習慣、LSの有病率およびHRQOLに関して有意な群間差はなかった。COVID-19パンデミックに伴う外出制限によって、脊椎疾患患者において運動習慣の有意な減少、LSの発症率増加、HRQOLの悪化が生じていた。

びまん性特発性骨増殖症(DISH)患者の腰椎狭窄症(LSS)に対する除圧術後の再手術の長期リスク因子を検討した。LSSに対して除圧術が施行された1150例のうち、術前の画像で腰椎への進展が認められた57例(男性48例、女性9例、平均69.5±6.4歳)を対象にサーベイ研究を実施し、初回手術と同レベルでの再手術に関わるリスク因子を評価した。その結果、初回手術と同レベルの再手術が施行されたのは10例(17.5%)であり、再手術までの期間は平均24.4±21.3ヵ月であった。再手術施行群と非施行群との比較では、DISHによる骨化セグメント数、腰痛骨化スコアに有意差は認められず、多変量解析でも有意なリスク因子は抽出されなかった。一方、減圧レベルでの差をみると、矢状回転角10°以上を示すのは再手術施行群の方が非施行群より有意に多く、CT上の椎間関節開大も再手術施行群に多く検出された。除圧レベル〜DISH下端部の距離と再手術との間に有意な関連はなく、Cox比例ハザード回帰分析では再手術の独立リスク因子として矢状回転角10°以上と椎間関節開大の2つが示された。

DOI： 10.3390/jcm10215001

PubMed

DOI： 10.15106/j_besei80_45

DOI： 10.15106/j_besei80_130

DOI： 10.15106/j_besei80_63

DOI： 10.3171/2021.6.SPINE21721

PubMed

<p><b>Introduction: </b>In spinal fusion surgery, deviation of the pedicle screw (PS) causes complications such as nerve and vascular injury and pedicle fracture. In this study, we investigated the accuracy of PS placement in thoracolumbar fusion using 3D preoperative planning software.</p><p><b>Methods: </b>Thirty-three patients (263 screws) who underwent a thoracolumbar fusion with PS from April 2019 to March 2020 were included in the study. The accuracy of PS insertion was evaluated by postoperative CT. The difference in the deviation rate according to the implantation method (percutaneous or open) and the surgeon (A; more than 10 years of experience in spine surgery, B; less than 5 years of experience in spine surgery, C; general orthopedic surgeon) was also examined.</p><p><b>Results: </b>A total of 12 PS deviations (4.6%) were observed, and no nerve or vascular injuries were observed. There was no significant difference in the deviation rate between percutaneous and open techniques when grade 1 or higher was defined as the deviation group (percutaneous 5.0% (6/119), open 4.2% (6/144). p=0.73). There was also no difference between surgeons (A 4.5% (7/157), B 4.3% (3/69), C 5.4% (2/37), p=0.96).</p><p><b>Conclusions: </b>Preoperative planning with 3D software can help to reduce the deviation rate in PS insertion.</p>

DOI： 10.34371/jspineres.2021-1005

CiNii Article

<p><b>Introduction: </b>Surgical treatment of thoracolumbar vertebral fractures with diffuse idiopathic skeletal hyperostosis (DISH) needs longer fixation than fractures without DISH, because the segments without ossification by DISH are exposed to higher mechanical stress due to a longer lever arm in the spinal column. Recently, the usefulness of penetrating endplate screw (PES) for patients with DISH have been reported in several reports. We have performed 3 cases using the PES technique for thoracolumbar vertebral fracture with DISH. The purpose of this report was to report the result of the surgery and discuss the indication of the PES technique.</p><p><b>Case report: </b>One case was fracture with acute phase and two cases were fractures with sub-acute phase. PES technique was used at the ossified segment by DISH and conventional pedicle screw technique was used non-ossified segment. Balloon kyphoplasty was used for fractures with sub-acute phase. The two cases showed good outcomes both in the clinical and radiological assessment. However, one case (T12 vertebral fracture with T8-12 DISH) showed screw loosening at the most caudal screw 1week after the surgery. Screw loosening was getting worse, and revision surgery of implant removal was performed 6 months after the index surgery.</p><p><b>Conclusions: </b>Screws with the PES technique have reportedly 1.4-fold pull-out strength compared with conventional pedicle screws. The poor outcome case in this study was set screws with PES technique in cranial 2 vertebrae and conventional pedicle screw in caudal two vertebrae, therefore, the reason of poor outcomes might arise from the difference of the screw fixation strength between cranial and caudal. PES technique is useful for fixation to the DISH segment. However, additional maneuver considering fixation strength of screws with the PES technique is necessary for fixation at non-ossified vertebra in case of the end fracture of ossification by DISH.</p>

DOI： 10.34371/jspineres.2021-1007

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: This study evaluated the regenerated cartilage after opening-wedge high tibial osteotomy (OWHTO) with concomitant microfracture by second-look arthroscopy, Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and magnetic resonance imaging (MRI) T2 mapping. It was hypothesised that cartilage regeneration can be achieved by HTO, but the quality of regenerated cartilage is not normal cartilage. METHODS: OWHTO was performed in eight knees of seven patients (mean age, 57.6 ± 5.2 years). Microfracture for the cartilage defect was performed followed by OWHTO, and second-look arthroscopy was performed at the time of plate removal (14.1 ± 4.5 months after OWHTO). MRI was assessed at three months and one year after surgery. The status of articular cartilage regeneration was assessed by the ICRS grade, MOCART score and T2 value. RESULTS: The number of subjects in ICRS grade 1/2/3/4 changed significantly from 0/0/4/4 preoperatively to 0/2/6/0 postoperatively in the medial femoral condyle (MFC) (P < 0.05) and 0/0/0/8 preoperatively to 0/0/7/1 postoperatively in the medial tibial plateau (MTP) (P < 0.05). Mean MOCART scores for MFC and MTP at one year after surgery exhibited significant increases compared with the results at three months after surgery. Mean T2 values for MFC and MTP did not differ at three months and one year after surgery. CONCLUSION: The appearance and morphological evaluation by ICRS grade and MOCART score of regenerated cartilage were improved after OWHTO with concomitant microfracture. However, there were no significant qualitative differences in T2 values. This suggests that the regenerated cartilage tissue was likely to be insufficient cartilage. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

DOI： 10.1186/s40634-021-00413-3

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Solitary bone cysts in the calcaneus (calcaneal bone cysts) are often asymptomatic. Pathological fractures are rare, and few reports are available concerning its risk assessment. Therefore, the indication for operative interventions remains debatable, and further discussion on the treatment of symptomatic cysts and pathological fractures in calcaneal bone cysts is necessary. MATERIALS AND METHODS: Clinical data of 21 patients with calcaneal bone cysts (16 men and five women) was retrospectively reviewed. The average age was 13.3 (range, 7-23) years. Clinical data, such as concerning symptoms, radiological findings, pathological findings and outcomes, were investigated, and the pathogenesis of symptomatic cysts was studied. RESULTS: Thirteen cysts were symptomatic, and eight were incidentally discovered. Computed tomography revealed no fracture in 12 cases, microfracture in eight and complete fracture in one. The areas under the curves of the receiver operating characteristic curves calculated to establish an association between cyst size and symptoms and cyst size and pathological fractures (microfracture and complete fracture) were 0.78 and 0.71, respectively. Symptomatic cysts and pathological fractures were associated with the cyst ratio (cyst size/calcaneus ≥ 0.20). On magnetic resonance imaging (MRI), fluid levels were observed in 11 of 21 (52%) patients. At the time of surgery, blood from the haemorrhage was aspirated from 15 of 21 (71%) cysts. CONCLUSIONS: Orthopaedic surgeons should be aware that the cyst ratio is associated with clinical symptoms and pathological fractures. MRI and gross findings revealed haemorrhage in the cystic fluid. In calcaneal bone cysts, repeated microfractures and spontaneous healing might occur.

DOI： 10.1007/s00402-021-04202-6

PubMed

DOI： 10.1007/s00586-021-07014-9

PubMed

はじめに:脊椎固定術において椎弓根スクリュー(PS)の逸脱は神経・血管損傷,椎弓根の骨折などの合併症を引き起こす.今回,3次元術前計画ソフトウェアを用いた胸腰椎の固定術におけるPSの刺入精度を調査したので報告する.対象と方法:対象は2019年4月から2020年3月までにPSによる胸腰椎の固定術を行った33例(263本)である.3次元ソフトウェア(ZedSpine,LEXI,Tokyo,Japan)を用いて全例に対しスクリュー径・長さ・刺入経路を術前に計画した.PSの刺入精度を術後CTで評価した.刺入方法(経皮的手技,open手技),術者(A;脊椎手術経験10年以上,B;脊椎手術経験5年未満,C;脊椎非専門整形外科医)による逸脱率の違いに関しても検討を行った.結果:PSの逸脱は合計12本(4.6%)あり,Grade 1が8例,Grade 2が3例,Grade 3が1例であった.PS逸脱例による神経,血管損傷は認めなかった.またGrade 1以上を逸脱群とした時,経皮的手技とopen手技とでは逸脱率に有意な差を認めなかった(経皮的手技5.0%(6/119),open 4.2%(6/144).p=0.73).術者間による差も認めなかった(A 4.5%(7/157),B 4.3%(3/69),C 5.4%(2/37),p=0.96).結論:3次元ソフトウェアによる術前計画はPS刺入において逸脱率を低下させる一助になる.(著者抄録)

術中CTナビゲーション支援下に骨・軟部腫瘍手術を行った37例40手術を対象に、治療成績を後方視的に調査した。組織型は良性21例、悪性骨腫瘍5例、悪性軟部腫瘍骨浸潤11例であった。その結果、術後経過観察期間は平均37.0ヵ月であった。腫瘍最大径は平均40.1mmで、皮膚切開は平均8.1cmであった。手術時間は平均166分で、出血量は平均103mlであった。全例でナビゲーションの使用目的を達成できた。悪性腫瘍の広範切除はclear marginであった。経過観察期間内に良性の動脈瘤様骨嚢腫1例と骨内ガングリオン1例が再発したが、再手術を行った症例はなかった。悪性末梢神経鞘腫瘍の他院切除後再発の症例において再発を認め、再切除を行った。最終観察時に癌の転移を含めた悪性腫瘍の予後はCDF 9例、NED 4例、AWD 2例、DOD 1例であった。

はじめに:DISHを伴う胸腰椎椎体骨折は骨性架橋の存在により骨折部に力学的ストレスがかかりやすく,長範囲に固定するなど工夫が必要である.近年,椎体終板を貫くPenetrating Endplate Screw(PES)法が考案され,良好な固定力や成績が報告されてきた.本症例報告の目的は当院でPES法を用いた3例の手術成績を報告するとともにPES法の適応について考察することである.症例:スクリューはDISH架橋椎体にはPES法で,非DISH架橋椎体には従来のpedicle screw(PS)軌道で設置した.2例は経過良好であったが,1例は術後1週で固定最尾側L2のスクリューの引き抜きが生じ,次第にゆるみが大きくなりL2根症状を呈し経過不良であった.経過不良であった1例はDISH架橋椎体最尾側の骨折であり,PES法を2aboveに従来のPSを2belowに設置していた.結語:経過不良の1例は脊椎アンカーの固定力に頭尾側で差があった事が原因と推察された.DISH架橋椎体内の骨折にはPES法は有用であるが,DISH非架橋椎体にも固定を行う必要のある症例に対しては,非架橋椎体の固定法の工夫が必要である.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND AND AIMS: Nerve capping treatment using bioabsorbable nerve conduits has recently been introduced for painful amputation neuroma. However, no clinical or experimental data are available for comparing nerve conduits with open distal ends and closed distal ends. Here, we investigated the nerve conduit with open or closed distal ends as the superior capping device, using a commercially available polyglycolic acid (PGA) nerve conduit in a rat sciatic nerve amputation model. METHODS: Ninety-one rats were assigned to three groups: no-capping (n = 30), capping the resected nerve stump with open ends (n = 31), and closed-end nerve conduits (n = 30). Twelve weeks after sciatic neurectomy, with or without capping, the evaluation of neuropathic pain using the autotomy score was performed. Stump neuromas with perineural scars and neuroinflammation were evaluated histologically. RESULTS: The mean autotomy scores in the closed-end nerve conduit group were significantly lower than those in the no-capping group. However, the difference between the open-end nerve conduit and the closed-end nerve conduit groups was insignificant. Histologically, distal axonal fibers expanded radially and formed neuromas in the no-capping group while they were terminated within the PGA conduit in both capping groups. In particular, the closed-end version of the PGA nerve conduit blocked scarring from intruding through the open end and protected the nerve stump with less neuroinflammation. Nerve capping with the closed-end version of the PGA nerve conduit most effectively suppressed perineural neuroinflammation and scar formation around the resected nerve stump. INTERPRETATION: Nerve capping with the PGA nerve conduit, particularly those with closed ends, after rat sciatic neurectomy prevented amputation neuroma and relieved neuropathic pain.

DOI： 10.1016/j.clineuro.2021.106920

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Arthroscopic reshaping surgery is the first treatment option for a symptomatic discoid lateral meniscus (DLM) to preserve the peripheral rim. However, the degree of postoperative morphological change in the residual meniscus is unclear. PURPOSE/HYPOTHESIS: The purpose of this study was to measure the meniscus after reshaping surgery for a DLM, to verify when the morphological change occurred, and to examine the related risk factors. The hypothesis was that the residual meniscal width would decrease throughout the postoperative course. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We retrospectively reviewed the medical records of patients who underwent reshaping surgery for a symptomatic DLM and had undergone follow-up for ≥2 years. Magnetic resonance imaging (MRI) was routinely performed preoperatively and at 3, 6, 12, and 24 months postoperatively, and the width, height, and extrusion of the residual meniscus were measured. According to the width of the midbody on final MRI scans, we compared the preoperative and postoperative data for the preserved group (≥5 mm) and decreased group (<5 mm). The associated risk factors for a decreased meniscal width (<5 mm) of the midbody were analyzed on final MRI scans. RESULTS: We included 61 knees of 54 patients in this study. The mean age at the time of surgery was 11.7 years. The intraobserver and interobserver reliabilities of the midbody width were 0.937 and 0.921, respectively. The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery (from 9.1 to 8.6 mm [P < .001], from 7.5 to 6.1 mm [P < .001], and from 9.5 to 8.9 mm [P = .001], respectively). Meniscal extrusion of the midbody did not change significantly (from 1.2 to 1.5 mm; P = .062). Overall, 46 knees (n = 20/32 in the preserved group and n = 26/29 in the decreased group) had longitudinal tears that required meniscal repair. Clinical outcomes did not differ significantly between the 2 groups. Multivariate logistic analysis showed that intrameniscal degeneration (odds ratio, 4.36; P = .023) significantly increased the risk of a decreased meniscal width. CONCLUSION: The width of the anterior horn, midbody, and posterior horn decreased significantly from 3 to 24 months after surgery. In particular, the average decrease rate of the midbody was 19%. No clinical difference was seen in patients with a decreased width and height or with peripheral extrusion. Increased intrameniscal signals on preoperative MRI scans were associated with an increased risk of a decreased meniscal width. Surgeons should consider this result to determine the amount of resection.

DOI： 10.1177/03635465211033586

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The treatment strategy for osteochondritis dissecans (OCD) with discoid lateral meniscus (DLM) in adults remains unclear. CASE PRESENTATION: A 22-year-old man presented with left knee pain after spraining his knee. Physical examination revealed lateral joint line tenderness and a positive McMurray test. Radiographic imaging showed OCD of the lateral femoral condyle classified as stage 3 on Brückl's classification. Magnetic resonance imaging showed complete DLM with anterocentral shift based on Ahn's classification and an OCD of 11 mm × 8 mm, grade 2 based on Nelson's classification. On computed tomography (CT), a demarcated fragment was observed in the lesion. Based on these findings, saucerization with meniscal repair was performed for unstable DLM. The OCD lesion presented with softening without any fissure and was diagnosed as grade 1. No surgical procedure was added. One year after surgery, the union of the fragment was confirmed on radiograph and CT. At the final follow-up five years after surgery, the Lysholm score had improved from 58 to 100 points. CONCLUSIONS: We experienced an adult case of stable OCD with concurrent DLM that achieved spontaneous healing after undergoing reshaping surgery for DLM, mimicking normal meniscal morphology, without additional treatment for the stable OCD lesion.

DOI： 10.1016/j.ijscr.2021.106427

PubMed

DOI： 10.1186/s13023-021-02031-9

PubMed

DOI： 10.1097/BRS.0000000000003997

PubMed

DOI： 10.3390/jcm10174012

PubMed

DOI： 10.1177/23094990211060967

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The combined anteversion theory to prevent impingement in total hip arthroplasty (THA) has been proposed. However, because stem-anteversion is influenced by the native femoral anteversion and the stem flexion/extension angle, it is often difficult to adjust stem anteversion during surgery. Therefore, the stem-first (combined anteversion) technique may be useful to adjust and achieve appropriate cup anteversion during surgery with respect to the implanted stem anteversion angle. However, the technique may adversely affect cup or stem angle accuracy and result in intra-operative bleeding, post-operative adverse events, and prolonged operative time. It is inconclusive whether either the stem-first or cup-first technique is safe or accurate. Therefore, this study assessed the accuracy and safety of stem-first THA compared to those of cup-first THA. MATERIALS AND METHODS: This prospective randomised controlled trial analysed 114 patients who were randomly divided into 2 groups (stem-first group: n = 57, cup-first group (control group): n = 57). Primary outcomes included cup and stem angle, the discrepancies from the targeted angle and combined anteversion (evaluated via CT at 3 months postoperatively). Secondary outcomes included intraoperative blood loss, operative time, WOMAC, and adverse events. RESULTS: There were no significant differences in age, gender, BMI or in the primary and secondary outcomes between the 2 groups. CONCLUSIONS: Performing stem-first in THA did not adversely affect cup and stem angle accuracy, or result in intraoperative bleeding, prolongation of operative time, or postoperative adverse events. Thus, performing stem-first may be advantageous for achieving combined anteversion theory. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN) registration number UMIN000025189.

DOI： 10.1177/11207000211039767

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

CASE: A 32-year-old man with Ehlers-Danlos syndrome (EDS) fell while snowboarding and injured his right elbow. Radiography revealed a posterior dislocation of the elbow and a proximal radioulnar joint dislocation. A diagnosis of transverse divergent dislocation of the elbow was established. Open reduction and repair of the annular ligament, anterior oblique ligament, and capsule was performed with good clinical results. CONCLUSION: This is the first report of divergent dislocation of the elbow in an adult with EDS. Dislocation occurred without a fracture that required open reduction and internal fixation. The presence of soft-tissue fragility, hyperextension, and joint laxity peculiar to EDS are likely contributing factors to this phenomenon.

DOI： 10.2106/JBJS.CC.21.00159

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: The authors aimed to determine the efficacy of open-door laminoplasty with stand-alone autologous bone spacer for preserving enlarged lamina in patients with cervical myelopathy. METHODS: Patients who underwent open-door laminoplasty for cervical myelopathy with stand-alone autologous bone spacer and underwent CT 1 week and 1 year after surgery were included in this study. There were 20 men and 13 women, with an average (range) age of 65.0 (37-86) years. Seventeen patients were younger than 70 years, and 16 patients were older than 70 years. Autogenous bone spacers made from spinous processes were used in all patients. Slits were made on both sides of the spacers. The lamina was raised with a curette, and a spacer was inserted without any sutures. Before surgery and 1 week and 1 year after surgery, the anteroposterior diameter (APD) of the spinal canal was measured using midsagittal-plane CT-multiplanar reconstruction. The bone union rate of the hinge side and autogenous bone spacer of each lamina was determined using CT images obtained 1 year after surgery. Results 1 year after surgery were evaluated using Japanese Orthopaedic Association (JOA) score. RESULTS: The mean ± SD APD increase rate was 56.3% ± 21.3% 1 week after surgery and 51.7% ± 20.6% 1 year later. The average APD decrease rate was 2.9% ± 3.8%. The bone union rate on the hinge side was 100%, and that of autologous bone spacer was 93.8% 1 year after surgery. The mean APD decrease rate was 3.3% in patients younger than 70 years and 2.3% in those older than 70 years. There was no significant difference between the two groups (p > 0.05, nonpaired t-test). The JOA score averaged 10.1 before surgery and 13.3 a year after surgery (total score 17). The average improvement rate was 46.3% ± 26.4%. CONCLUSIONS: The authors devised and implemented a technique for inserting an autologous bone spacer between the opened lamina and lateral mass without sutures. The enlarged spinal canal was maintained 1 year after surgery. This simple method does not require any instrumentation or additional cost to stabilize the opened lamina.

DOI： 10.3171/2021.1.SPINE201633

PubMed

HipAlign New Supineを用いて側臥位で人工股関節全置換術(THA)を行った20関節(A群)と、その20関節に性別、年齢、病名をマッチさせたHipAlign Supineを用いて仰臥位THAを行った20関節(B群)を対象とした。術後1週にZed Hipを用いて三次元的に計測したカップ設置角(外方開角、前方開角)と術中に示した各ナビゲーションの表示角度との絶対値誤差を群間比較した。また、臨床成績としてJOA score、合併症(脱臼・感染)を群間比較した。その結果、JOA scoreは両群間で有意差がなく、全例に合併症を認めなかった。カップ設置角度の絶対値誤差が外方開角・前方開角ともに5°以内の差であった症例はA群65%、B群85%で、両群とも全ての症例で外方開角・前方開角とも10°以内の差で設置できていた。ポータブルナビゲーションのHipAlign SupineとHipAlign New Supineは、THAにおける正確なカップ設置と早期合併症予防に有用と考えられた。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To compare the occurrence of bone tunnel laceration, the short-term clinical results, and cuff repair integrity of transosseous arthroscopic rotator cuff repair (ARCR) using a tunneling device, with and without lateral cortical augmentation. METHODS: A retrospective review of patients who underwent transosseous ARCR from May 2012 to December 2017 was conducted. The inclusion criterion was repairable medium- to massive-sized full-thickness rotator cuff tear. This study included 2 consecutive series of patients undergoing transosseous ARCR with and without lateral cortical augmentation, called the ITO method and AT method, respectively. The incidence of bone tunnel laceration was evaluated intraoperatively. Patients were assessed through a range of motion and Constant scores preoperatively and at final follow-up. Further, magnetic resonance imaging was performed at 24 months postoperatively to examine the repaired rotator cuff integrity. RESULTS: A total of 121 subjects were included: 33 in the AT group and 88 in the ITO group. The intraoperative bone tunnel laceration occurrence rate was 67% and 4% for the AT and ITO methods, respectively; the difference was significant (P = .001). Anatomic failure rate (Sugaya Ⅲ, Ⅳ, and Ⅴ) rate for medium- to large-sized tears was significantly lower for the ITO than for the AT method (29% vs 65%, P = .004), but not for massive tears (61% vs 69%, P = .515). The mean forward elevation, abduction, external rotation, internal rotation, and Constant score were significantly improved at final follow-up from preoperative values. There were no significant differences between the 2 methods. CONCLUSIONS: Transosseous ARCR using a tunneling device with and without lateral cortical augmentation is a reliable method of improving clinical results at a minimum follow-up of 2 years. The intraoperative occurrence rate of bone tunnel laceration occurrence rate and the anatomic failure rate of medium- to large-sized cuff tear were lower with lateral cortical augmentation than without it. LEVEL OF EVIDENCE: Level Ⅳ, therapeutic cases series.

DOI： 10.1016/j.asmr.2021.02.004

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Since the advent of induced pluripotent stem cells (iPSCs), clinical trials using iPSC-based cell transplantation therapy have been performed in various fields of regenerative medicine. We previously demonstrated that the transplantation of mouse iPSC-derived neurospheres containing neural stem/progenitor cells with bioabsorbable nerve conduits promoted nerve regeneration in the long term in murine sciatic nerve defect models. However, it remains unclear how long the grafted iPSC-derived neurospheres survived and worked after implantation. In this study, the long-term survival of the transplanted mouse iPSC-derived neurospheres with nerve conduits was evaluated in high-immunosuppressed or non-immunosuppressed mice using in vivo imaging for the development of iPSC-based cell therapy for peripheral nerve injury. Complete 5-mm long defects were created in the sciatic nerves of immunosuppressed and non-immunosuppressed mice and reconstructed using nerve conduits coated with iPSC-derived neurospheres labeled with ffLuc. The survival of mouse iPSC-derived neurospheres on nerve conduits was monitored using in vivo imaging. The transplanted iPSC-derived neurospheres with nerve conduits survived for 365 days after transplantation in the immunosuppressed allograft models, but only survived for at least 14 days in non-immunosuppressed allograft models. This is the first study to find the longest survival rate of stem cells with nerve conduits transplanted into the peripheral nerve defects using in vivo imaging and demonstrates the differences in graft survival rate between the immunosuppressed allograft model and immune responsive allograft model. In the future, if iPSC-derived neurospheres are successfully transplanted into peripheral nerve defects with nerve conduits using iPSC stock cells without eliciting an immune response, axonal regeneration will be induced due to the longstanding supportive effect of grafted cells on direct remyelination and/or secretion of trophic factors.

DOI： 10.1016/j.bbrep.2021.100979

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: To evaluate prevalence and prognosis of postoperative coronal imbalance (CIB) and factors related to its onset and spontaneous improvement in patients with Lenke 5C adolescent idiopathic scoliosis who underwent selective thoracolumbar-lumbar fusion. METHODS: We measured radiographic parameters and evaluated clinical outcomes using the Scoliosis Research Society-22 questionnaire in patients with Lenke 5C adolescent idiopathic scoliosis and a minimum 2-year follow-up. CIB was defined as >2 cm distance between C7 plumb line and central sacral vertical line. We compared parameters between patients with CIB (CIB group) and without CIB (coronal balanced group). RESULTS: Inclusion criteria were met by 29 patients (mean age at surgery:17.0 years; average follow-up period: 45.6 months). CIB was found in 10 patients 1 week after surgery (34.5%); this decreased to 6.9% at final follow-up. Comparative analysis indicated significant values as follows: age at surgery (17.5 years vs. 14.7 years, P = 0.005), lumbosacral curve (5.9° vs. 11.2°, P = 0.02), and L5 tilt (-3.6° vs. -8.1°, P = 0.02) in bending film. Greater changes of lowest instrumented vertebra disc angle, which means scoliotic angles between LIV and LIV+1, were significantly associated with spontaneous improvement of CIB (P = 0.04). Clinical outcomes were comparable between the coronal balanced and CIB groups. CONCLUSIONS: Although CIB was frequently detected in the early postoperative period after selective thoracolumbar-lumbar fusion, it mostly corrected spontaneously. Relatively younger age at surgery and less flexible lumbosacral curve may be related to postoperative CIB, and greater changes of LIV disc angle may be associated with spontaneous improvement of CIB.

DOI： 10.1016/j.wneu.2021.04.024

PubMed

International / domestic magazine：Domestic journal  

DOI： 10.1016/j.jos.2021.05.008

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

This study investigated whether mixing low viscosity alginic acid with calcium phosphate cement (CPC) causes interconnected porosity in the CPC and enhances bone replacement by improving the biological interactions. Furthermore, we hypothesized that low viscosity alginic acid would shorten the setting time of CPC and improve its strength. CPC samples were prepared with 0, 5, 10, and 20% low viscosity alginic acid. After immersion in acetate buffer, possible porosification in CPC was monitored in vitro using scanning electron microscopy (SEM), and the setting times and compressive strengths were measured. In vivo study was conducted by placing CPC in a hole created on the femur of New Zealand white rabbit. Microcomputed tomography and histological examination were performed 6 weeks after implantation. SEM images confirmed that alginic acid enhanced the porosity of CPC compared to the control, and the setting time and compressive strength also improved. When incorporating a maximum amount of alginic acid, the new bone mass was significantly higher than the control group (P = 0.0153). These biological responses are promising for the translation of these biomaterials and their commercialization for clinic applications.

DOI： 10.1007/s10856-021-06555-1

PubMed

DOI： 10.11392/jsao.50.89

CiNii Article

DOI： 10.3171/2020.11.SPINE201552

PubMed

DOI： 10.1016/j.xnsj.2021.100071

PubMed

神経痛性筋萎縮症(neuralgic amyotrophy;NA)による右短母指外転筋の遺残麻痺・母指対立障害に対して、腱移行手術を施行した症例(63歳、男性)について報告する。発症後1年で局所麻酔によるwide awake surgeryを行い、環指の浅指屈筋を長母指伸筋と短母指外転筋に腱移行した。術後2年において右母指対立は可能で、母指の使いやすさも改善していた。NAで最終的に麻痺筋が残存した場合は腱移行術による機能再建が適応となるが、NAの筋力回復は多様で個々の症例によって異なるため、術中に手指の自動運動を確認できるwide awake surgeryによる腱移行術が有用であった。(著者抄録)

手根管症候群に対する客観的な感覚評価における重症度と、患者立脚型質問表に反映される重症度との間の関連は明確ではない。本検討では、CTS患者の手指感覚障害をSemmes-Weinstein monofilament test・静的2点識別覚にて評価し、CTSI-JSSH質問表の各質問との関連を検討した。疾患特異性の高いCTSI-JSSH質問表の感覚に関する質問項目であっても、SWとs2PDとの間に相関関係はほとんどみられなかった。(著者抄録)

DOI： 10.15106/j_seikei72_642

<p><b>Introduction: </b>Spinal sagittal imbalance is reported to be associated with a decline in patients' quality of life; however, the cause of its progression has not been investigated. The purpose of this study was to clarify the characteristics of elderly patients with deteriorating spinal sagittal imbalance over a 2-year period.</p><p><b>Methods: </b>A total of 321 participants (133 males and 188 females; mean age 72.9±4.9 years) from the Shiraniwa study were included in this analysis. Based on the SVA measured from whole spine radiographs, we classified the participants into the following three groups: SVA≤40 mm, 40 mm<SVA≤95 mm, and SVA>95 mm. Participants who showed disease progression from the first year to the third year were defined as the deteriorating spinal sagittal imbalance (DSI) group.</p><p>We compared the following items between DSI and non-DSI groups: the incidence of prevalent vertebral fractures, disc degeneration, and back muscle strength; locomotive syndrome (LS) stage 2; and sarcopenia. Using multiple logistic regression analysis, we investigated the predictors for DSI. Moreover, body composition measured using a bio-impedance analysis machine (BIA) was compared between the two groups.</p><p><b>Results: </b>Overall, 45 (14.0%) participants were classified into the DSI group. The prevalence of LS stage 2 was significantly higher in the DSI group than in the non-DSI group (55.6% vs. 28.0%; p<0.01). LS stage 2 was an independent predictor of DSI with an adjusted odds ratio of 2.35 (95% CI: 1.08-5.12). Regarding the body composition measured by BIA, the ratio of trunk muscle to trunk weight percentage was significantly lower in the DSI group (male: 74.1%/78.2%, p=0.02; women: 63.7%/70.9%, p<0.01).</p><p><b>Conclusions: </b>LS stage 2 was an independent predictor of deteriorating spinal sagittal imbalance over a 2-year period. Elderly patients with deteriorating spinal sagittal imbalance showed a significantly lower ratio of trunk muscle to trunk weight percentage.</p>

DOI： 10.34371/jspineres.2021-0014

CiNii Article

DOI： 10.15106/j_seikei72_667

DOI： 10.18885/jjs.0000000631

DOI： 10.18885/jjs.0000000637

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: Experimental animal study. OBJECTIVE: The aim of this study was to clarify chronological effects of mechanical stress on ligamentum flavum (LF) using a long-term fusion rabbit model. SUMMARY OF BACKGROUND DATA: LF hypertrophy is a major pathology of lumbar spinal stenosis (LSS), but its mechanism remains unclear. We previously demonstrated mechanical-stress-induced LF hypertrophy with a rabbit model. However, we only investigated LFs at a single time point in the short-term; the effects of long-term mechanical stress have not been elucidated. METHODS: Eighteen-week-old male New Zealand White rabbits were randomly divided into two groups: the mechanical stress group underwent L2-3 and L4-5 posterolateral fusion and resection of the L3-4 supraspinal muscle, whereas the control group underwent only surgical exposure. Rabbits were sacrificed 16 and 52 weeks after the procedure. Axial specimens of LFs at L3-4 were evaluated histologically. Immunohistochemistry for alpha-smooth muscle actin (α-SMA) was performed to assess the numbers of vessels and myofibroblasts. RESULTS: In the mechanical stress group, LFs at the L3-4 level exhibited hypertrophy with elastic fiber disruption and cartilage matrix production at 16 and 52 weeks. A trend test indicated that mechanical stress induced LF hypertrophy, elastic fiber disruption, and cartilage matrix production in a time-dependent manner, with the lowest levels before treatment and the highest at 52 weeks. Immunostaining for α-SMA showed similar numbers of vessels in both groups, whereas the percentage of myofibroblasts was significantly larger at 16 and 52 weeks in the mechanical stress group than in the control group. CONCLUSION: We demonstrated that long-term mechanical stress caused LF hypertrophy with progressive elastic fiber disruption and cartilage matrix production accompanied by enhanced myofibroblasts. In addition, the reported rabbit model could be extended to elucidate the mechanism of LF hypertrophy and to develop new therapeutic strategies for LSS by preventing LF hypertrophy.Level of Evidence: SSSSS.

DOI： 10.1097/BRS.0000000000003832

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Triggering due to de Quervain's disease is exceedingly rare. This is the first successfully diagnosed case of the snapping phenomenon of the extensor pollicis brevis (EPB) tendon in de Quervain's disease evaluated with preoperative dynamic ultrasonography, clearly demonstrated in an intraoperative video, and treated with decompression of EPB subcompartment only under a wide-awake surgery. Dynamic ultrasonographic images identified snapping caused by unsmooth excursion of an enlarged EPB tendon in a separate subcompartment. In snapping de Quervain's disease, ultrasonographic evaluations and wide-awake surgery are essential to exactly diagnose and successfully treat the snapping condition of the EPB and/or APL tendons.

DOI： 10.1002/jcu.22934

PubMed

International / domestic magazine：International journal  

DOI： 10.1016/j.spinee.2021.01.013

PubMed

はじめに:本研究の目的は脊柱インバランスが進行する高齢者の特徴を示すことである.対象と方法:Shiraniwa Study初年度,3年次のいずれにも参加した321名(男性133名,女性188名,平均72.9±4.9歳)を対象とした.全脊柱X線写真より計測したC7SVAより,≦40mm,40mm〜95mm,>95mmの3段階に分け,2年の経過で1段階以上増悪したものを進行群とし,その特徴を評価した.結果:14.0%(45名)が進行群に該当した.ロコモ度2該当者は進行群で有意に多く(55.6%/28.0%,p<0.01),調整オッズ比2.35(95%信頼区間:1.08〜5.12)と脊柱インバランス進行の独立した予測因子であった一方で,既存椎体骨折,椎間板変性,背筋力,サルコペニア有病率に有意差は認めなかった.また,体幹部重量に占める筋量が進行群で有意に低かった(男:74.1%/78.2%,p=0.02,女:63.7%/70.9%,p<0.01).結語:ロコモ度2は脊柱インバランス進行の予測因子であり,進行群で体幹部重量に占める筋量が有意に低かった.(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-021-87334-4

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00586-021-06754-y

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BSD.0000000000001170

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: We previously demonstrated that a bioabsorbable nerve conduit coated with mouse induced pluripotent stem cell (iPSC)-derived neurospheres accelerated peripheral nerve regeneration in mice. OBJECTIVE: We examined the fate and utility of iPSC-derived neurospheres transplanted with nerve conduits for the treatment of sciatic nerve gaps in mice. METHODS: Complete 5-mm defects were created in sciatic nerves and reconstructed using nerve conduits that were either uncoated or coated with mouse iPSC-derived neurospheres. The survival of the neurospheres on the nerve conduits was tracked using an in vivo imaging. The localization of the transplanted cells and regenerating axons was examined histologically. The gene expression levels in the nerve conduits were evaluated. RESULTS: The neurospheres survived for at least 14 days, peaking at 4--7 days after implantation. The grafted neurospheres remained as Schwann-like cells within the nerve conduits and migrated into the regenerated axons. The expression levels of ATF3, BDNF, and GDNF in the nerve conduit coated with neurospheres were upregulated. CONCLUSIONS: Mouse iPSC-derived neurospheres transplanted with nerve conduits for the treatment of sciatic nerve defects in mice migrated into regenerating axons, survived as Schwann-like cells, and promoted axonal growth with an elevation in the expression of nerve regeneration-associated trophic factors.

DOI： 10.3233/BME-201182

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2021.03.006

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.3390/jcm10061187

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00256-021-03753-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Hypertrophy of the ligamentum flavum (LF) is a major cause of lumbar spinal stenosis (LSS), and the pathology involves disruption of elastic fibers, fibrosis with increased cellularity and collagens, and/or calcification. Previous studies have implicated the increased expression of the proteoglycan family in hypertrophied LF. Furthermore, the gene expression profile in a rabbit experimental model of LF hypertrophy revealed that biglycan (BGN) is upregulated in hypertrophied LF by mechanical stress. However, the expression and function of BGN in human LF has not been well elucidated. To investigate the involvement of BGN in the pathomechanism of human ligamentum hypertrophy, first we confirmed increased expression of BGN by immunohistochemistry in the extracellular matrix of hypertrophied LF of LSS patients compared to LF without hypertrophy. Experiments using primary cell cultures revealed that BGN promoted cell proliferation. Furthermore, BGN induces changes in cell morphology and promotes myofibroblastic differentiation and cell migration. These effects are observed for both cells from hypertrophied and non-hypertrophied LF. The present study revealed hyper-expression of BGN in hypertrophied LF and function of increased proteoglycan in LF cells. BGN may play a crucial role in the pathophysiology of LF hypertrophy through cell proliferation, myofibroblastic differentiation, and cell migration.

DOI： 10.1038/s41598-021-84363-x

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BRS.0000000000003787

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Additional bone resection in the distal femur is performed to increase the extension joint gap in total knee arthroplasty (TKA). The present study aimed to analyze the relationship between the amount of additional bone resection in the distal femur and the increase in the extension joint gap in TKA. METHODS: Fifty knees undergoing TKA for varus osteoarthritis were evaluated. Two femoral trial component models were prepared: (1) a normal model with 9-mm-thick distal and posterior femoral components and (2) an additional bone resection model with a 5-mm-thick distal femoral component (9 mm to 4 mm) and a 9-mm-thick posterior femoral component, which simulated an additional bone cut in the distal femur of 4 mm. The femoral trial component models were set before implantation, and the extension joint gap was measured using a tensor device that had a shape identical to that of the fixed-bearing tibial insert. RESULTS: The additional bone resection model had a larger joint gap than the normal model (P < .01). The mean extension gap increase in the additional bone resection model was 2 (standard deviation 1) mm, which was less than the thickness of the additional bone resection (4 mm) (P < .01). CONCLUSION: The amount of additional bone resection in the distal femur was not equal to the increase in the extension joint gap. Additional bone resection of 4 mm in the distal femur only increased the extension joint gap by a mean of 2 mm.

DOI： 10.1016/j.arth.2020.09.002

PubMed

半月板縫合後の治癒評価において、単純MRIでは損傷時の高輝度変化が術後長期間残存するため正確な評価は困難とされている。近年、軟骨や半月板の質的MRIが開発され、単純MRIでは特定できない異常を捉えることが可能になってきた。著者等は、質的MRIの一つであるT2マッピングを用いて半月板縫合後の治癒評価を行い、単純MRIに比べて有意に正確に評価できたことを以前報告した。今回、本法を用いて半月板縫合後治癒時期の検討を行った。対象はACL再建術施行時に半月板縫合を行った14例とした。検討方法は、術前のT2マッピングで損傷部位に認めたcolored meniscal tear line(CMTL)が、術後3・6・12ヵ月のうちどの時点で消失したか調べた。結果、術後3ヵ月で消失したものが4例、6ヵ月が5例、12ヵ月が5例であり、平均消失時期は術後7.3ヵ月であった。

当院で2018〜2019年に骨付き大腿四頭筋腱を用いてACL再建術を行い術後12ヵ月以上観察しえた13例を対象とし、術後6ヵ月・12ヵ月時の「腱採取部痛」「大腿四頭筋力」「ハムストリング筋力」、術後12ヵ月時の「膝関節前方安定性」「腱採取部ドプラー信号強度」等について調査した。ドプラー信号強度は、grade 0(信号なし)、grade 1(spot状の信号)、grade 2(腱の厚みの半分以下の信号)、grade 3(腱の厚みの半分以上の信号)に分類し、grade別で「腱採取部痛」「筋力」を比較した。術後12ヵ月時の臨床成績は「関節安定性」「腱採取部痛」「筋力」とも良好であった。ドプラー信号強度は、grade 0または1が11例(85%)、grade 2が2例(15%)で、grade 3はなかった。grade 0・1群はgrade 2群に比べて「腱採取部痛」「筋力」の数値が良好であった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Fibrosis is one of the main pathologies caused by hypertrophy of the ligamentum flavum (LF), which leads to lumbar spinal stenosis (LSS). The fibroblast growth factor (FGF) family is a key mediator of fibrosis. However, acidic fibroblast growth factor (FGF-1) expression and function are not well understood in LF. This study sought to evaluate FGF-1 expression in the hypertrophied and non-hypertrophied human LF, and to investigate its function using primary human LF cell cultures. METHODS: We obtained hypertrophied lumbar LF from LSS patients and non-hypertrophied lumbar LF from control patients during surgery. Immunohistochemistry and qPCR were performed to evaluate FGF-1 expression in LF tissue. The function of FGF-1 and transforming growth factor beta 1 (TGF-β1) was also investigated using primary LF cell culture. The effects on cell morphology and cell proliferation were examined using a crystal violet staining assay and MTT assay, respectively. Immunocytochemistry, western blotting, and qPCR were performed to evaluate the effect of FGF-1 on TGF-β1-induced myofibroblast differentiation and fibrosis. RESULTS: Immunohistochemistry and qPCR showed higher FGF-1 expression in hypertrophied LF compared to control LF. Crystal violet staining and MTT assay revealed that FGF-1 decreases LF cell size and inhibits their proliferation in a dose-dependent manner, whereas TGF-β1 increases cell size and promotes proliferation. Immunocytochemistry and western blotting further demonstrated that TGF-β1 increases, while FGF-1 decreases, α-SMA expression in LF cells. Moreover, FGF-1 also caused downregulation of collagen type 1 and type 3 expression in LF cells. CONCLUSION: FGF-1 is highly upregulated in the LF of LSS patients. Meanwhile, in vitro, FGF-1 exhibits antagonistic effects to TGF-β1 by inhibiting cell proliferation and decreasing LF cell size as well as the expression of fibrosis markers. These results suggest that FGF-1 has an anti-fibrotic role in the pathophysiology of LF hypertrophy.

DOI： 10.1016/j.jos.2021.01.004

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Peripheral nerve regeneration using nerve conduits has been less effective than autogenous nerve grafts. To overcome this hurdle, we developed a tissue-engineered nerve conduit coated with mouse induced pluripotent stem cell (iPSC)-derived neurospheres, for the first time, which accelerated nerve regeneration in mice. We previously demonstrated the long-term efficacy and safety outcomes of this hybrid nerve conduit for mouse peripheral nerve regeneration. In this study, we investigated the therapeutic potential of nerve conduits coated with human iPSC (hiPSC)-derived neurospheres in rat sciatic nerve defects, as a translational preclinical study. The hiPSC-derived quaternary neurospheres containing neural stem/progenitor cells were three-dimensionally cultured within the nerve conduit (poly L-lactide and polycaprolactone copolymer) for 14 days. Complete 5-mm defects were created as a small size peripheral nerve defect in sciatic nerves of athymic nude rats and reconstructed with nerve conduit alone (control group), nerve conduits coated with hiPSC-derived neurospheres (iPS group), and autogenous nerve grafts (autograft group) (n = 8 per group). The survival of the iPSC-derived neurospheres was continuously tracked using in vivo imaging. At 12 weeks postoperatively, motor and sensory function and histological nerve regeneration were evaluated. Before implantation, the hiPSC-derived quaternary neurospheres that three-dimensional coated the nerve conduit were differentiated into Schwann-like cells. The transplanted hiPSC-derived neurospheres survived for at least 56 days after implantation. The iPS group showed non-significance higher sensory regeneration than the autograft group. Although there was no actual motor functional nerve regeneration in the three groups: control, iPS, and autograft groups, the motor function in the iPS group recovered significantly better than that in the control group, but it did not recover to the same level as that in the autograft group. Histologically, the iPS group demonstrated significantly higher axon numbers and areas, and lower G-ratio values than the control group, whereas the autograft group demonstrated the highest axon numbers and areas and the lowest G-ratio values. Nerve conduit three-dimensionally coated with hiPSC-derived neurospheres promoted axonal regeneration and functional recovery in repairing rat sciatic nerve small size defects. Transplantation of hiPSC-derived neurospheres with nerve conduits is a promising clinical iPSC-based cell therapy for the treatment of peripheral nerve defects.

DOI： 10.1038/s41598-021-83385-9

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Understanding the natural history of the spinopelvic alignment in adolescent idiopathic scoliosis (AIS) is important in developing surgical strategies for patients with adult idiopathic lumbar scoliosis (AdLS). Because it is challenging to follow individuals without any treatments, we sought to estimate its natural history by comparing radiographic characteristics of patients with AIS and AdLS. METHODS: We included patients with Lenke 5 AIS and patients with AdLS who were diagnosed with Lenke 5 AIS in adolescence. The Cobb angle of the curve and spinopelvic parameters were measured by whole spine radiographs. The AdLS patients were divided into 2 groups according to age <50 years (AdLS<50) or ≥50 years (AdLS≥50). Radiographic parameters were compared among the AIS, AdLS<50, and AdLS≥50 groups. The relationship between age and each parameter was analyzed using nonlinear regression analysis. RESULTS: We analyzed 40 patients with AIS (all female, mean age 16.8 ± 3.2 years) and 35 patients with AdLS (34 female and 1 male, mean age 55.4 ± 12.1 years). Thoracolumbar/lumbar curve and thoracolumbar kyphosis was significantly greater in the AdLS<50 group compared with the AIS group, without progression after age 50 years. Lumbar lordosis and pelvic tilt deteriorated linearly with age. AIS and AdLS<50 patients maintained sagittal balance, which deteriorated in AdLS≥50 patients. CONCLUSIONS: Our results may predict the following natural course of Lenke 5 AIS: (1) progression of scoliotic deformity of thoracolumbar/lumbar curve with increased thoracolumbar kyphosis; (2) subsequent lumbar hypolordosis followed by pelvic retroversion; and (3) sagittal imbalance after failure of compensation.

DOI： 10.1016/j.wneu.2021.02.031

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND CONTEXT: Ligamentum flavum (LF) hypertrophy plays a dominant role in lumbar spinal stenosis (LSS). A previous study found that fibroblast growth factor 9 (FGF9) was upregulated with mechanical stress in rabbit LF. However, the expression and function of FGF9 are not well understood in human LF. PURPOSE: To evaluate FGF9 expression and function in human LF with and without hypertrophy. STUDY DESIGN: This study employed a basic research study design utilizing human LF tissue for histological analyses. PATIENT SAMPLES: Hypertrophied LF tissue sample from patients with LSS, and nonhypertrophied (control) LFs from patients with lumbar disc herniation or other diseases were obtained during surgery. METHODS: LF specimens were histologically analyzed for FGF9 and vascular endothelial growth factor A (VEGF-A) by immunohistochemistry. The number of total and FGF9 immuno-positive cells and blood vessels were counted and compared between LF with and without hypertrophy. For functional analysis, the effect of FGF9 on cell proliferation and migration was examined using a primary cell culture of human LF. RESULTS: Histological studies revealed that the total cell number was significantly higher in the LF of patients with LSS than in the LF of control patients. Immunohistochemistry showed that the percentage of FGF9-positive cells was significantly higher in the LF of patients with LSS than in the controls, and it positively correlated with patients' age, regardless of disease. Double immune-positive cells for FGF9 and VEGF-A were often observed in vascular endothelial cells and fibroblasts in the fibrotic area of hypertrophied LF, and the number of double positive vessels was significantly higher in LF of LSS patients than in the LF of controls. Primary cell culture of human LF revealed that FGF9 promoted the proliferation and migration of LF cells. CONCLUSION: The present study demonstrated that FGF9 expression is highly upregulated in hypertrophied human LF. FGF9 potentially plays a pivotal role in the process of hypertrophy of LF, which is associated with mechanical stress, through cell proliferation and migration. CLINICAL SIGNIFICANCE: The results from this study partially reveal the molecular mechanisms of LF hypertrophy and suggest that FGF9 may be involved in the process of LF degeneration in elderly patients.

DOI： 10.1016/j.spinee.2021.02.004

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1016/j.bjps.2021.01.011

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11657-021-00884-y

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To quantitatively evaluate degeneration of articular cartilage using magnetic resonance imaging (MRI) T2 mapping before and after arthroscopic surgery for discoid lateral meniscus (DLM). METHODS: We retrospectively reviewed the medical records of patients who underwent arthroscopic reshaping surgery for symptomatic DLM from September 2013 to October 2017 and who had undergone follow-up for ≥2 years. MRI T2 relaxation examinations had been performed preoperatively and at 3, 6, 12, and 24 months postoperatively. The T2 relaxation times of the whole lateral femoral condyle and the tibial plateau were assessed. In addition, the lateral femoral condyle was divided into 3 subcompartmental areas: anterior, middle, and posterior. RESULTS: In total, 30 knees of 27 patients were included in this study. The patients' mean age at operation was 13.3 years (range 6-23 years), and the mean follow-up period was 31.6 months. Saucerization alone was performed in 3 knees and saucerization with repair in 27 knees. The T2 relaxation time of the whole lateral femoral condyle was significantly increased at 3 and 6 months postoperatively and significantly decreased at 12 and 24 months. The T2 relaxation time of the whole lateral tibial plateau was significantly increased at 3 months postoperatively and significantly decreased at 24 months. The T2 relaxation time of the posterior subcompartment of the lateral femoral condyle was significantly increased at 3 months and significantly decreased at 12 and 24 months. CONCLUSIONS: The T2 relaxation time of the lateral femorotibial joint cartilage increased at 3 and 6 months postoperatively and then had decreased at 12 and 24 months. Quantitative MRI allowed us to monitor the substantial changes in the cartilage during the early postoperative period and the recovery at the distant time point after reshaping surgery for DLM. LEVEL OF EVIDENCE: Level IV, case series.

DOI： 10.1016/j.arthro.2020.09.036

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: Although minimally invasive endoscopic surgery techniques are established standard treatment choices for various degenerative conditions of the lumbar spine, the surgical indications of such techniques for specific cases, such as segments with ossification of the ligamentum flavum (OLF) or calcification of the ligamentum flavum (CLF), remain under investigation. Therefore, the authors aimed to demonstrate the short-term outcomes of minimally invasive endoscopic surgery in patients with degenerative lumbar disease with CLF or OLF. METHODS: This is a retrospective cohort study including consecutive patients who underwent microendoscopic posterior decompression at the authors' institution, where the presence of OLF and CLF did not influence the surgical indication. Fifty-nine patients with OLF and 39 patients with CLF on preoperative CT were identified from the database. Subsequently, two matched control groups (one each matched to the OLF and CLF groups) were created using propensity scores to adjust for age, sex, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index, and diagnosis. The background, surgical outcomes, and changes in clinical scores were compared between the matched groups. If there was a significant difference in the improvement of clinical scores, a multivariate linear regression model was applied. RESULTS: On performing univariate analysis, patients with OLF were found to have a higher body mass index (Mann-Whitney U-test, p = 0.001), higher incidence of preoperative motor weakness (chi-square test, p = 0.019), longer operative time (Mann-Whitney U-test, p < 0.001), and lower improvement in the JOA score (mixed-effects model, p = 0.023) than the matched controls. On performing multivariate analysis, the presence of OLF was identified as an independent variable associated with a poor recovery rate based on the JOA score (multivariate linear regression, p < 0.001). In contrast, there were no significant differences between patients with CLF and their matched controls in terms of preoperative and surgical data and postoperative improvements in clinical scores. CONCLUSIONS: Although the perioperative surgical outcomes, including the surgical complications, and the in-hospital period did not significantly differ, the short-term improvement in the JOA score was significantly lower in patients with degenerative lumbar disease accompanied by OLF than in the patients from the matched control group. In contrast, there were no significant differences in the short-term improvement in clinical scores and perioperative outcomes between patients with CLF and their matched control group. Thus, the surgical indications of minimally invasive posterior decompression for patients with CLF can be the same as those for patients without CLF; however, the indications for patients with OLF should be further investigated in future studies, including the other surgical methods.

DOI： 10.3171/2020.6.SPINE20946

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIM: This study aimed to identify the risk of pathological fractures after bone tumour biopsy. MATERIALS AND METHODS: Fifty rabbit femurs were divided into groups according to defect size: Control (no defect), type 1 (10% width), type 2 (20% width), type 3 (30% width), and type 4 (40% width). Another 20 were also divided into control, type A (27% length), type B (40% length), and type C (53% length) groups. Performing femoral head compression testing allowed each parameter (maximum load, displacement, elastic modulus, and fracture energy) to be calculated individually. RESULTS: Compressive maximum load was significantly higher for type 1 than for the other types when testing rectangular defects of different widths, while there were no significant differences between the three types when testing by defect length. CONCLUSION: It may be useful for orthopaedic oncologists to make a rectangular biopsy hole with a width measuring less than 10% of the circumference and to enlarge the hole longitudinally to avoid pathological fracture.

DOI： 10.21873/anticanres.14819

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To investigate the incidence and characteristics of subsequent vertebral fracture after osteoporotic vertebral fractures (OVFs) and identify risk factors for subsequent vertebral fractures. METHODS: This post-hoc analysis from a prospective randomized multicenter trial included 225 patients with a 48-week follow-up period. Differences between the subsequent and non-subsequent fracture groups were analyzed. RESULTS: Of the 225 patients, 15 (6.7%) had a subsequent fracture during the 48-week follow-up. The annual incidence of subsequent vertebral fracture after fresh OVFs in women aged 65-85 years was 68.8 per 1000 person-years. Most patients (73.3%) experienced subsequent vertebral fractures within 6 months. At 48 weeks, European Quality of Life-5 Dimensions, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire pain-related disorder, walking ability, social life function, and lumbar function scores were significantly lower, while the visual analog scale (VAS) for low back pain was higher in patients with subsequent fracture. Cox proportional hazards analysis showed that a VAS score ≥ 70 at 0 weeks was an independent predictor of subsequent vertebral fracture. After adjustment for history of previous fracture, there was a ~ 67% reduction in the risk of subsequent vertebral fracture at the rigid-brace treatment. CONCLUSION: Women with a fresh OVF were at higher risk for subsequent vertebral fracture within the next year. Severe low back pain and use of soft braces were associated with higher risk of subsequent vertebral fractures. Therefore, when treating patients after OVFs with these risk factors, more attention may be needed for the occurrence of subsequent vertebral fractures. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00586-021-06741-3

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

We present a case of a postoperative cartilage defect in a patient with polydactyly who was treated with a costal osteochondral graft. Excision of the radial digit and ligamentous periosteal flap with longitudinal osteotomy were performed when the patient was 1 year old. The alignment of the interphalangeal joint was straight after surgery, but the deviation gradually developed. A revision surgery using a costal osteochondral graft was performed when the patient was 3 years old. A satisfactory outcome was obtained at the 3-year follow-up. The authors suggest that a costal osteochondral graft may be a reasonable option for revision surgery for a postoperative cartilage defect.

DOI： 10.1136/bcr-2020-237823

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Leg length discrepancy (LLD) after total hip arthroplasty (THA) prevents functional recovery and reduces patient satisfaction. We investigated impact of changes in patient-perceived LLD on patient satisfaction and walking ability. METHODS: one hundred and forty-nine patients with unilateral hip osteoarthritis undergoing THA from 2014 to 2017, (125 women, 24 men; average age, 68.5 years) with an objective LLD < 1 cm were included. Outcome measures included the patient-perceived LLD, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, 10-m walking speed, and affected leg loading rate, assessed preoperatively and at 3 weeks, 3 months, and 1 year postoperatively. RESULTS: The absolute patient-perceived LLD (mean ± SD) (the number of patients with perceived LLD > 5 mm) were 6.4 ± 9.6 mm [88 patients (59%)] preoperatively; and 2.2 ± 4.0 mm [48 (32%); p < 0.001], 0.7 ± 2.3 mm [17 (11%); p < 0.001], and 0.4 ± 1.6 mm [10 (7%); p = 0.095] at 3 weeks, 3 months, and 1 year postoperatively, respectively. All outcome measures improved over time. One year postoperatively, a weak positive correlation between the patient-perceived LLD and WOMAC or 10-m walking speed (r = 0.24, 0.23, respectively) was found. The risk of patient-perceived LLD persisting > 1 year postoperatively was 5.5-fold higher in patients who exhibited it at 3 months and those with a WOMAC score > 10 at 3 months postoperatively, using multivariate logistic regression. CONCLUSION: Achieving a post-THA objective LLD < 1 cm significantly reduced the patient-perceived LLD up to 3 months postoperatively. The residual patient-perceived LLD at 1 year postoperatively was predicted from the WOMAC score or the presence of patient-perceived LLD at 3 months after THA. LEVEL OF EVIDENCE: Therapeutic level IV.

DOI： 10.1007/s00590-021-02879-4

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-021-82015-8

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00167-021-06448-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Bone morphogenetic proteins (BMPs) induce osteogenesis in various environments. However, when BMPs are used alone in the bone marrow environment, the maintenance of new bone formation is difficult owing to vigorous bone resorption. This is because BMPs stimulate the differentiation of not only osteoblast precursor cells but also osteoclast precursor cells. The present study aimed to induce and maintain new bone formation using the topical co-administration of recombinant human BMP-2 (rh-BMP-2) and zoledronate (ZOL) on beta-tricalcium phosphate (β-TCP) composite. METHODS: β-TCP columns were impregnated with both rh-BMP-2 (30 µg) and ZOL (5 µg), rh-BMP-2 alone, or ZOL alone, and implanted into the left femur canal of New Zealand white rabbits (n = 56). The implanted β-TCP columns were harvested and evaluated at 3 and 6 weeks after implantation. These harvested β-TCP columns were evaluated radiologically using plane radiograph, and histologically using haematoxylin/eosin (H&E) and Masson's trichrome (MT) staining. In addition, micro-computed tomography (CT) was performed for qualitative analysis of bone formation in each group (n = 7). RESULTS: Tissue sections stained with H&E and MT dyes revealed that new bone formation inside the β-TCP composite was significantly greater in those impregnated with both rh-BMP-2 and ZOL than in those from the other experimental groups at 3 and 6 weeks after implantations (p < 0.05). Micro-CT data also demonstrated that the bone volume and the bone mineral density inside the β-TCP columns were significantly greater in those impregnated with both rh-BMP-2 and ZOL than in those from the other experimental groups at 3 and 6 weeks after implantations (p < 0.05). CONCLUSIONS: The topical co-administration of both rh-BMP-2 and ZOL on β-TCP composite promoted and maintained newly formed bone structure in the bone marrow environment.

DOI： 10.1186/s12891-021-03971-w

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-020-80129-z

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s11657-020-00866-6

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVE: The object of this study was to analyze the prevalence of postoperative coronal imbalance (CIB) and related factors in patients with adult lumbar scoliosis. METHODS: This was a retrospective single-center study of data from patients with adult spinal deformity (ASD) who had undergone corrective surgery performed by a single surgeon between 2009 and 2017. The inclusion criteria were as follows: 1) age at surgery > 40 years, 2) Cobb angles of the thoracolumbar/lumbar (TL/L) curve > 40°, 3) upper instrumented vertebra of T9 or T10, 4) lowest instrumented vertebra of L5 or the pelvis, and 5) minimum 2-year follow-up period. Radiographic parameters were measured before surgery, 2 weeks after surgery, and at the latest follow-up. Curve flexibility was also assessed using side bending radiographs. Clinical outcomes were evaluated using the 22-Item Scoliosis Research Society Outcomes Questionnaire (SRS-22) and the SF-36. CIB was considered to have occurred if the C7 plumbline was more than 2.5 cm lateral to the central sacral vertical line (i.e., coronal vertical axis [CVA] > 2.5 cm) at the final follow-up. Parameters between the patients with (CIB group) and without (coronal balance [CB] group) CIB were compared, and factors related to CIB were evaluated. RESULTS: From among 66 consecutively treated ASD patients, a total of 37 patients (mean age at surgery 66.3 years, average follow-up 63 months) met the study inclusion criteria. CIB was found in 6 patients at the final follow-up (16.2%), and the CVA of all patients in the CIB group shifted to the convex side of the TL/L curve. A comparative analysis between the CB and CIB groups, respectively, at the final follow-up indicated the following factors were related to CIB: lumbosacral (LS) curve, 11.0°/16.5° (p = 0.02); LS correction rate (CR), 61%/47% (p = 0.02); and CR ratio (LS vs TL/L), 0.93/0.67 (p = 0.0002). Regarding clinical outcomes, the satisfaction domain of the SRS-22 (CB 4.4 vs CIB 3.5) showed a significant difference between the CIB and CB groups (p = 0.02), and patients in the CB group tended to score better on the pain domain (CB 4.3 vs CIB 3.7), but the difference was not significant (p = 0.06). CONCLUSIONS: Postoperative CIB negatively impacted patients' HRQOL. An imbalanced correction ratio between the TL/L and LS curves may cause postoperative CIB. Therefore, adequate correction of the LS curve may prevent postoperative CIB.

DOI： 10.3171/2020.6.SPINE20670

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

OBJECTIVES: Enthesitis is a major musculoskeletal manifestation of psoriatic arthritis (PsA). It is conventionally assessed clinically, by the presence of tenderness, despite its low reliability. However, ultrasound (US) provides a sensitive and feasible method for evaluating enthesitis. We investigated enthesitis as assessed clinically and by US in patients with PsA. METHODS: Forty-seven patients with PsA underwent US examination of the bilateral humeral medial epicondyles and insertions of the triceps, distal quadriceps, proximal/distal patellae, Achilles tendons, and plantar fascia. These 14 entheses were also clinically evaluated by tenderness. The correspondence between US and clinical enthesitis was evaluated, as well as their associations with inflammatory markers (C-reactive protein [CRP], matrix metalloproteinase-3 [MMP-3]), disease activity indices (Disease Activity in Psoriatic Arthritis [DAPSA], Disease Activity Score 28 joints [DAS28-CRP], Psoriatic Arthritis Screening and Evaluation [PASE], Psoriasis Area Severity Index [PASI]), radiographic damage (modified Total Sharp Score [mTSS]), and functional status (health assessment questionnaire [HAQ]), and axial involvement. RESULTS: Among 47 patients with PsA, 37 and 23 had US and clinical enthesitis, respectively. US and clinical enthesitis had very low concordance (kappa coefficient 0.04), with no correlation between enthesitis counts (r=0.15, p=0.30). The US enthesitis count correlated only with the MMP-3 level (r=0.41, p=0.007), whereas the clinical enthesitis count correlated with the DAPSA, DAS28-CRP, HAQ, and PASE (r=0.50, p<0.001; r=0.44, p=0.002; r=0.41, p=0.008; r=0.54, p<0.001, respectively). CONCLUSIONS: US and clinical enthesitis are completely different entities. US enthesitis, but not clinical enthesitis, reflects inflammatory conditions.

DOI： 10.55563/clinexprheumatol/u8qc6c

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1177/2309499021994969

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.knee.2020.12.009

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2020.02.006

PubMed

高齢者コホート研究(白庭研究)に登録された被験者におけるサルコペニア、ロコモティブシンドローム(LS)およびフレイルの有病率について検討し、このような健康悪化状態がコホート研究からの脱落に及ぼす影響を評価した。2016年の第1回サーベイに参加した65歳以上の409名(男性164名、女性245名、平均73.5歳)を対象にサルコペニアなどの有病率を調査し、2017年の第2回サーベイに参加できなかった者を脱落者と判定、研究からの脱落に関わる予測因子を評価した。第1回サーベイの409名中、サルコペニアの有病率は4.4%、LSステージ2の有病率は40.1%、フレイルの有病率は14.2%であった。また、サルコペニア群のうち77.8%にLSステージ2、フレイル群のうち89.7%にLSステージ2の罹患が認められた。第2回サーベイに参加できなかったのは71名で、最終的にこのうち46名を脱落者と判定した。コホート研究からの脱落率はサルコペニア、LSステージ2およびフレイルの三つがいずれもみられなかった者が4.5%、LSステージ2を有する者が12.3%、フレイルを有する者が33.3%、サルコペニア、LSステージ2、フレイルの三つをすべて有する者が37.5%となっていた。多変量ロジスティック回帰分析では、脱落の独立予測因子としてLSステージ2とフレイルが抽出された。

DOI： 10.4103/jcvjs.JCVJS_182_20

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.22603/ssrr.2021-0011

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p>Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) extended to the lumbar segments (L-DISH) reportedly has adverse effects on the surgical outcomes of lumbar spinal stenosis (LSS). However, the risk factors in patients with L-DISH have not been clarified. The purpose of this study was to investigate the long-term risk factors for reoperation at the same level after decompression surgery alone for LSS in patients with L-DISH in a retrospective cohort study.</p><p>Methods: A postoperative postal survey was sent to 1,150 consecutive patients who underwent decompression surgery alone for LSS from 2002 to 2010. Among all respondents, patients who exhibited L-DISH by preoperative total spine X-ray were included in this study. We investigated risk factors for reoperation at the same level as the initial surgery among various demographic and radiological parameters, including the lumbar ossification condition and computed tomography (CT) or magnetic resonance imaging findings.</p><p>Results: A total of 57 patients were analyzed. Reoperations at the same level as that of the index surgery were performed in 10 patients (17.5%) and at 11 levels within a mean of 9.2 years. Cox proportional hazard regression analysis indicated that the independent risk factors for reoperation were a sagittal rotation angle ≥10° (adjusted hazard ratio: 5.17) and facet opening on CT (adjusted hazard ratio: 4.82). Neither sagittal translation nor the ossification condition in the lumbar segments affected reoperations.</p><p>Conclusions: A sagittal rotation angle ≥10° and facet opening on preoperative CT were risk factors for reoperation at the same level as that of the index surgery in patients with L-DISH. The surgical strategy should be carefully considered in those patients.</p>

DOI： 10.22603/ssrr.2020-0227

PubMed

CiNii Article

DOI： 10.11296/katakansetsu.45.435

CiNii Article

当院通院中の乾癬患者94例(女性34例36%、年齢58.4±14.7歳)を対象に、関節症状の合併と皮膚病変の重症度およびBMIの関連について検討した。その結果、乾癬患者のうち関節症状を合併したPsA群は48例、合併なしのPsO群は46例であった。2群間でBMIに有意差はみられなかった。また、PsA群においてBMI、皮膚病変の重症度、関節症状の重症度は、いずれも有意な関連を認めなかった。

DOI： 10.11296/katakansetsu.45.436

CiNii Article

DOI： 10.11296/katakansetsu.45.462

CiNii Article

DOI： 10.11296/katakansetsu.45.444

CiNii Article

DOI： 10.11296/katakansetsu.45.437

CiNii Article

DOI： 10.34473/jossm.41.3_160

CiNii Article

<p>Introduction: The coronavirus disease 2019 (COVID-19) pandemic has greatly changed the lifestyles of individuals due to the need to prevent disease spread. Globally, governments have enforced various policies, including travel bans, quarantine, home confinement, and lockdowns, as safety measures. Consequently, the frequency of individuals going out has decreased. This survey aimed to assess how decreasing the frequency of going out due to the COVID-19 pandemic impacts patients with spinal disorders.</p><p>Methods: This multicenter cross-sectional questionnaire survey included patients who visited four private spine clinics for any symptoms. Participants completed questionnaires pre- and post-pandemic that assessed the following topics: frequency of leaving home, exercise habits, locomotive syndrome, and health-related quality of life (HRQOL). Patients were divided into decreased and non-decreased frequency of going out groups, according to observed changes in their frequencies of leaving home. Both groups were statistically compared using univariate and multivariate logistic regression analyses to identify factors associated with the frequency of going out.</p><p>Results: Among 855 patients, 160 (18.7%; the decreased group) reported that they went out less frequently, and 695 (81.3%; the non-decreased group) reported that they left home equally frequently post- versus pre-pandemic. Multivariate analyses showed that exercise habits significantly decreased (adjusted odds ratio (aOR) = 2.67, p = 0.004), the incidence of locomotive syndrome significantly increased (aOR = 2.86, p = 0.012), and HRQOL significantly deteriorated (aOR = 4.14, p < 0.001) in the decreased group compared to the non-decreased group.</p><p>Conclusions: Restrictions regarding leaving home due to the COVID-19 pandemic significantly decreased exercise frequency, increased the occurrence of locomotive syndrome, and were associated with deterioration of HRQOL in patients with spine disorders. It may be beneficial for spine surgeons to encourage patients with spinal disorders to leave home at a frequency similar to what they did pre-pandemic while avoiding crowded areas, despite the presence of the COVID-19 pandemic.</p>

DOI： 10.22603/ssrr.2021-0088

PubMed

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: We aimed to determine if finite element analysis (FEA) provides useful thresholds for bone biopsy practice patterns. METHODS: The femoral head compression test was performed on rabbit femurs, using FEA to identify the part of the bone that preferentially fractures (n=15/group). Four types of rectangular biopsy holes were made using finite element (FE) models. These models were divided into control (no defect), defect 1 (10% width), defect 2 (20% width), defect 3 (30% width), and defect 4 (40% width) groups (n=15 each). Three types of rectangular biopsy holes (defect A, 27% length; defect B, 40% length; defect C, 53% length) were also made using FE models (n=15 each). The load to failure was then predicted using FEA. RESULTS: Almost all femurs with no defect were fractured at the femoral shaft in both the femoral head compression test and FEA. The experimental load to failure in intact femurs was predicted well by the FE models (R2=0.74, p<0.001). There was also a strong linear correlation of stiffness between compression test in femurs with no defect and the FEA (R2=0.68, p<0.001). Therefore, the femoral shaft was targeted for FEA. The median predicted loads by FEA were significantly higher for defect 1 than for the other types when testing the widths of the rectangular defects, but there were no significant differences among the three types when testing for defect length. CONCLUSION: The FEA results correlated well with those of the femoral head compression test. A width <10% of the circumference length in bone biopsy holes helps minimize bone strength reduction using FEA. It may be useful for orthopedic doctors to perform FEA to avoid pathological fractures after bone tumor biopsy.

DOI： 10.2147/CMAR.S307586

PubMed

DOI： 10.11296/katakansetsu.45.448

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Medical treatment using non-thermal atmospheric pressure plasma (NTAPP) is rapidly gaining recognition. NTAPP is thought to be a new therapeutic method because it could generate highly reactive species in an ambient atmosphere which could be exposed to biological targets (e.g., cells and tissues). If plasma-generated reactive species could stimulate bone regeneration, NTAPP can provide a new treatment opportunity in regenerative medicine. Here, we investigated the impact of NTAPP on bone regeneration using a large bone defect in New Zealand White rabbits and a simple atmospheric pressure plasma (helium microplasma jet). We observed the recovery progress of the large bone defects by X-ray imaging over eight weeks after surgery. The X-ray results showed a clear difference in the occupancy of the new bone of the large bone defect among groups with different plasma treatment times, whereas the new bone occupancy was not substantial in the untreated control group. According to the results of micro-computed tomography analysis at eight weeks, the most successful bone regeneration was achieved using a plasma treatment time of 10 min, wherein the new bone volume was 1.51 times larger than that in the plasma untreated control group. Using H&E and Masson trichrome stains, nucleated cells were uniformly observed, and no inclusion was confirmed, respectively, in the groups of plasma treatment. We concluded the critical large bone defect were filled with new bone. Overall, these results suggest that NTAPP is promising for fracture treatment.

DOI： 10.1371/journal.pone.0255861

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Romosozumab is a humanized, anti-sclerostin monoclonal antibody used to treat osteoporosis, which increases bone formation and decreases bone resorption. It enhances fracture healing and systemic romosozumab administration may have therapeutic potentials for accelerating bone healing of even nonunion. Herein, a 61-year-old heavy smoker male with distal radius nonunion who achieved successful bone union by combination therapy of romosozumab and spanning distraction plate fixation with bone graft substitutes was presented. Through the dorsal approach, atrophic comminuted nonunion of the distal radius was sufficiently debrided. Reduction of the distal radius was performed using indirect ligamentotaxis, and a 14-hole locking plate was fixed from the third metacarpal to the radial shaft. A beta (β) tricalcium phosphate block was mainly packed into the substantial metaphyseal bone defect with additional bone graft from the resected ulnar head. Postoperatively, systemic administration of monthly romosozumab was continued for six months. Complete bone union was achieved 20 weeks postoperatively and the plate was, then, removed. Wrist extension and flexion improved to 75o and 55o, respectively, without pain, and grip strength increased 52 weeks postoperatively from 5.5 kg to 22.4 kg. During romosozumab treatment, bone formation marker levels increased rapidly and finally returned to baseline, and bone resorption marker levels remained low. In conclusion, combination of systemic romosozumab administration and grafting β-tricalcium phosphate with bridge plating provides an effective treatment option for difficult cases of comminuted distal radius nonunion with risk factors such as smoking, diabetes, and fragility.

DOI： 10.52312/jdrs.2021.82661

PubMed

DOI： 10.11296/katakansetsu.45.449

CiNii Article

DOI： 10.11477/mf.5002201543

Publishing type：Research paper (scientific journal)  

DOI： 10.1038/s41598-020-77345-y

PubMed

DOI： 10.1038/s41598-020-61748-y

Publishing type：Research paper (scientific journal)  

ウェアラブル加速度計(以下、加速度計)を用いて、脳卒中片麻痺患者の歩行中の頸部/腰部動揺と歩行能力との関連を評価した。さらに、当該患者の歩行能力を予測する客観的評価ツールとして加速度計を利用可能か評価した。足に関節障害のない脳卒中片麻痺患者(患者群)36名(男性29名、女性7名、平均69.9±9.1歳)と健常者(対照群)40名(男性26名、女性14名、平均27.7±7.7歳)を対象に、第7頸椎(C7)と第3腰椎(L3)に加速度計を装着した。歩行時の加速度は、3軸方向(内側、垂直、前後)で測定した。二乗平均平方根を算出し、頸部/腰部動揺の指標とした。これらの値とFunctional Ambulation Classification(FAC)スコアで測定した歩行自立度との関連を評価した。その結果、患者群では歩行自立度の低下に伴って頸部・腰部動揺が3軸方向とも有意に増加した。患者群では、歩行自立度が低いほど頸部動揺が大きくなったが、FAC3群では頸部動揺が腰部動揺より大きく、逆の現象が見られた。

Publishing type：Research paper (scientific journal)  

手根管症候群と診断し手術を施行した症例に対し,術前に知覚障害を定量的に評価し,環指正中線を境界とする知覚障害,いわゆるring finger splittingの陽性率と,電気生理学的重症度の違いによる陽性率の差について検討した.ring finger splittingは手根管症候群のおおよそ6-7割で陽性となり,その陽性率は電気学的重症度によらず不変であった.診断の際にはring finger splittingの陽性率を念頭におき診断を進めることが肝要である.(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.3171/2020.4.SPINE191566

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Achieving an adequate level of patient's satisfaction with results is one of the goals of adult spinal deformity (ASD) surgery. However, it is unclear whether the same factors affect satisfaction in all patient populations. Patients' age influences the postoperative course and prevalence of complications after ASD surgery. The purpose of this study was to determine the factors predicting satisfaction 2 years after ASD surgery in younger and older patients. METHODS: A total of 119 patients under 40 years old, 155 patients 40 to 65 years old, and 148 patients over 65 years old at surgery who were followed for a minimum of 2 years after surgery were included. Multivariate analysis was used to determine independent related factors with maximum AUC for satisfaction 2 years after surgery in each group. A propensity-matched cohort under equivalent demographic and clinical characteristics was used to confirm the results. RESULTS: Logistic regression analyses revealed satisfaction among the under-40 group corresponded to prior spine surgery, complications, and self-image. That among the 40-to-65 group corresponded to neurologic complication, revision surgery, pain, and sagittal vertical axis restoration. Among the over-65 group satisfaction correlated with revision surgery, standing ability, and lumbar lordosis index restoration. Propensity score matching confirmed that sagittal alignment correction led to substantial satisfaction. CONCLUSIONS: In younger patients, avoiding complications and improving patients' self-image were essential for substantial satisfaction levels. In older patients, revision, standing ability, as well as sagittal spinopelvic alignment restoration, were the key factors. Surgeons should consider the differences in goals of each patient.

DOI： 10.1007/s00586-020-06611-4

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Many Asian populations have a unique floor-based lifestyle that might cause mechanical stress of the knees. It is important to clarify the longevity of a medial pivot total knee arthroplasty, as its prosthetic design could cause mechanical stress onto the insert. The purpose of this study was to clarify the clinical results of medial pivot total knee arthroplasty for Asian patients in a 10-year follow-up study. METHODS: Consecutive, primary total knee arthroplasties (n = 257) were analyzed in the study using the medial pivot knee system. The clinical outcomes were assessed preoperatively and at the final follow-up. The patient-reported Forgotten Joint Score-12 and radiological outcomes were measured at the final follow-up. The survival rate was assessed with reoperation or revision as the end-point. RESULTS: The mean follow-up period was 10.1 ± 1.7 years. The lost to follow-up was 4.5%. All clinical outcomes improved significantly after surgery (p < 0.001). The mean postoperative knee flexion was 118° ± 11° and the mean Forgotten Joint Score-12 was 59.7 ± 27 points. The radiolucent line was observed in 29 patients (11.3%), however there was no aseptic loosening noted. The survival rates with reoperation or revision were 96.3% or 98.4% at 10 years after the operation. CONCLUSIONS: Medial pivot total knee arthroplasty used for Asian patients showed good longevity and patient-reported outcome measurement in a mean 10-year follow-up study. Medial pivot total knee arthroplasty has long-term stability among patients who have a floor-based lifestyle. LEVEL OF EVIDENCE: III.

DOI： 10.1016/j.knee.2020.09.009

PubMed

Publishing type：Research paper (scientific journal)  

肘関節分散脱臼は腕尺関節,腕橈関節,近位橈尺関節の全てが脱臼する稀な疾患で,大半が小児例である.成人例の報告は本邦で4例,海外で7例と極めて珍しく,全例で観血的整復固定を要する骨折を合併していた.今回,極めて稀なEhlers-Danlos症候群の成人に発症した肘関節分散脱臼を経験したため報告する.症例は32歳,男性で,スノーボード中に後方へ転倒し,右肘関節伸展,前腕回外位で手をつき受傷した.近医で右肘関節分散脱臼と診断されたが,整復位保持が困難で当院紹介受診となり,受傷2週間後に手術を施行した.輪状靱帯と内側側副靱帯が断裂しており,同部位を縫合した.また脱臼に伴う関節包の著明な弛緩を認めたため,縫縮したところ,易脱臼性は改善された.術後3年の最終調査時において,肘関節の回内制限は残存しているが易脱臼性はなく,動揺性も認めていない.観血的整復固定を要する骨折を伴わない肘関節分散脱臼は成人例では極めて稀であり,本症例はEhlers-Danlos症候群に起因する軟部組織の脆弱性や過伸展性,関節の弛緩性を有していたことが原因ではないかと考えられた.(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.spinee.2020.06.020

PubMed

日本小児整形外科学会および日本小児股関節研究会の取り組みにより、乳児股関節検診の推奨項目が作成され、全国的に実施している地域が増えてきている。ただし、都市部では、新生児数が多いことに伴う、二次検診施設の確保の憂いもあり、まだあまり導入が進んでいない。そこで、大阪府において推奨項目が導入できるかどうか評価するため、二つのアンケート調査を施行した。若手整形外科医師へのアンケート調査からは、一般整形外科医における乳児股関節二次検診はおおむね可能と考えられる結果であり、また、医療機関へのアンケート調査からは、多くの施設から受け入れ可との回答が得られた。より良い検診体制の構築に向けて、大阪府における乳児股関節検診推奨項目の導入は可能であると考える。一次健診医である小児科医および二次検診医となる整形外科医が勤務する施設と、緊密な連携体制を構築し、医療体制の充実を図る必要がある。(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Our previous study showed that the decrease in relative change of bone mineral density (BMD) in the lateral part of the tibia was significantly less in the group treated with the cementless porous tantalum component than in the group treated with the cemented cobalt-chromium tibial component up to 5 years after the operation. However, the long-term benefits of porous tantalum tibial component on BMD have not been proven. The aim of this study was to update a matched cohort study at a minimum of 6 years' follow-up period. METHODS: Twenty patients with a porous tantalum tibial component and 18 patients with a cemented cobalt-chromium-alloy tibial component were investigated for more than 6 years in the present study. The mean follow-up period was 11.4 years. Dual X-ray absorptiometry was used to measure the BMD. RESULTS: The decrease in relative change of BMD in the lateral aspect of the tibia was significantly less with the porous tantalum tibial component than that with the cemented cobalt-chromium tibial component up to 5 years. However, at the final follow-up period, no significant difference was observed in the relative change of BMD between the 2 groups. No prosthetic migration or periprosthetic fracture was detected in either group. CONCLUSION: The present study is one of the studies with the longest follow-up period on BMD after total knee arthroplasty. Porous tantalum tibial component did not have a favorable effect on the BMD of the proximal tibia after total knee arthroplasty for long term.

DOI： 10.1016/j.arth.2020.06.014

PubMed

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

Publishing type：Research paper (scientific journal)  

リバース型人工肩関節置換術(以下,RSA)術後1年の臨床成績及び周術期合併症発生率を年代別に比較した.対象はRSAを施行した122肩である.術前,術後1年に肩関節自動可動域,Constant score,VASを評価した.手術時年齢を80歳未満群(以下,U群)85肩,80歳以上群(以下,O群)37肩の2群に分けて比較検討した.両群ともに術前と比較して術後1年で,屈曲,外転,Constant score,VASの有意な改善がみられた.術前から術後1年での臨床成績の改善値は,屈曲,外転,下垂位外旋,Constant score,VASでは両群に有意差を認めなかったが,結帯に関してはU群が有意に低下していた.周術期合併症発生率はU群で16.5%,O群で8.1%であった.術後1年の臨床成績の改善値は,結帯を除いて両群に有意差はなく,周術期合併症発生率も両群に有意差を認めなかった.(著者抄録)

Publishing type：Research paper (scientific journal)  

リバース型人工肩関節置換術の術後CT画像を使用し,2次元(以下,2D)評価と3次元(以下,3D)評価を行い,検者間及び検者内信頼性を検証した.対象は12例.2D評価として,SYNAPSE VINCENTを用いて計測した.3D評価として,Zed Shoulderを用いた.肩甲骨関節窩傾斜角(以下,GI),肩甲骨関節窩前後捻角(以下,GV),ステム後捻角(以下,SR),上腕骨オフセット(以下,HO)を計測した.2名の整形外科医で,1ヵ月以上の間隔を空けて2回計測した.2D計測と3D計測の検者間及び検者内信頼性を級内相関係数(ICC)にて算出した.検者間信頼性において2D計測のGI,SRと3D計測のHOが低く,検者内信頼性において2D計測のGV,HOと3D計測のSR,HOが低かった.今後,3D評価のさらなる再現性と正確性の確立のため,3Dで各種パラメータを自動表示するために必要な肩甲骨及び上腕骨上の特徴的な点をとる方法を検討する必要がある.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIMS: Vitamin E-infused highly cross-linked polyethylene (E1) has recently been introduced in total knee arthroplasty (TKA). An in vitro wear simulator study showed that E1 reduced polyethylene wear. However there is no published information regarding in vivo wear. Previous reports suggest that newly introduced materials which reduce in vitro polyethylene wear do not necessarily reduce in vivo polyethylene wear. To assist in the evaluation of the newly introduced material before widespread use, we established an in vivo polyethylene wear particle analysis for TKA. The aim of this study was to compare in vivo polyethylene wear particle generation between E1 and conventional polyethylene (ArCom) in TKA. METHODS: A total of 34 knees undergoing TKA (17 each with ArCom or E1) were investigated. Except for the polyethylene insert material, the prostheses used for both groups were identical. Synovial fluid was obtained at a mean of 3.4 years (SD 1.3) postoperatively. The in vivo polyethylene wear particles were isolated from the synovial fluid using a previously validated method and examined by scanning electron microscopy. RESULTS: The total number of polyethylene wear particles obtained from the knees with E1 (mean 6.9, SD 4.0 × 107 counts/knee) was greater than that obtained from those with ArCom (mean 2.2, SD 2.6 × 107 counts/knee) (p = 0.001). The particle size (equivalent circle of diameter) from the knees with E1 was smaller (mean 0.5 μm, SD 0.1) than that of knees with ArCom (mean 1.5, SD 0.3 μm) (p = 0.001). The aspect ratio of particles from the knees with E1 (mean 1.3, SD 0.1) was smaller than that with ArCom (mean 1.4, SD 0.1) (p < 0.001 ). CONCLUSION: This is the first report of in vivo wear particle analysis of E1. E1 polyethylene did not reduce the number of in vivo polyethylene wear particles compared with ArCom in early clinical stage. Further careful follow-up of newly introduced E1 for TKA should be carried out. Cite this article: Bone Joint J 2020;102-B(11):1527-1534.

DOI： 10.1302/0301-620X.102B11.BJJ-2020-0413.R1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Although carpal tunnel syndrome (CTS) is exceedingly rare in children, its prevalence in those with Hunter syndrome, mucopolysaccharidosis type II, is high. With the advent of hematopoietic stem cell transplantation and enzyme replacement therapy, the survival of patients with Hunter syndrome has dramatically improved. With improved longevity in these patients, CTS continues to progress with age. However, most patients with Hunter syndrome with CTS have generally been treated with an open carpal tunnel release (OCTR) only, without considering the severity. Here, we present a mid-term follow-up of a 16-year-old patient with Hunter syndrome associated with severe bilateral CTS successfully treated by the simultaneous opposition tendon transfer with an OCTR to improve the thumb function. Intraoperatively, the median nerve was constricted and flattened with congestion by the transverse carpal ligament. External and internal neurolysis of the scarred median nerve were performed and found epineural fibrosis and tethered epineurium. An intraneural lipoma of the left median nerve was especially resected with epineurotomy. During neurolysis and tendon transfer, the soft tissue was very viscous, a characteristic of mucopolysaccharidoses. Transferring the tension of the palmaris longus tendon to the abductor pollicis brevis for the thumb palmar abduction should be stronger than routine adult patients because the soft tissue such as the tendon excursion is stickier and more contracted in patients with Hunter syndrome. Postoperatively, a thumb spica splint was applied for 3 weeks, and then active motion exercises were cautiously started to prevent joint contracture. Early recognition and surgical intervention for CTS are essential in patients with Hunter syndrome.

DOI： 10.1097/GOX.0000000000003251

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The purpose of this study was to assess the surgical outcomes of posterior vertebral column resection (PVCR) with short-segment fusion for pediatric patients with congenital kyphoscoliosis (CKS). The medical records of 12 consecutive pediatric patients with CKS due to hemivertebrae located in thoracolumbar and lumbar area that had undergone PVCR and presented for follow-up at a minimum of 2 years were retrospectively reviewed. The mean follow-up period was 56.2 months, and the mean age at the surgery was 9.2 years. We evaluated radiographic parameters using plain radiographs, and evaluated segmental correction using computed tomography imaging. The mean values of the preoperative Cobb angle (cranial curve, main curve, and caudal curve) were 16.0°, 41.3°, and 25.0°, respectively. The main curve was reduced 5.4° after surgery and was maintained at 6.3° at the time of the most recent follow-up. The overall correction rate of main curve was 86.6%. Spontaneous correction rate in the cranial curve and caudal curve were calculated as 55.9 and 80.8%, respectively. The mean segmental scoliosis in the osteotomized segments and fused segments at preoperative/postoperative/final follow-up (FFU) were 40.8°/7.8°/9.2° and 34.3°/3.9°/5.1°, respectively. The mean segmental kyphosis in the osteotomized segments and fused segments at the preoperative/postoperative/FFU were 36.0°/3.8°/4.0° and 27.5°/-1.3°/0.7°, respectively. Our data indicate that PVCR with short-segment fusion for CKS can provide good correction in the main curve and spontaneous correction in the compensatory curves after a minimum 2-year follow-up. Further investigation over the long term is mandatory for pediatric patients.

DOI： 10.1097/BPB.0000000000000729

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.31616/asj.2020.0133

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon. CASE PRESENTATION: A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well. CONCLUSIONS: Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

DOI： 10.1186/s12891-020-03692-6

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BPO.0000000000001636

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.ymeth.2020.09.012

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1097/BRS.0000000000003528

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To assess the length and thickness of the quadriceps tendon (QT) and anterior cruciate ligament (ACL) to predict the required QT length for individual ACL reconstruction. METHODS: Thirty patients (9 females, 21 males; mean age 24.5 years; mean height 169.3 cm) who underwent ACL reconstruction using the QT with a bone plug autograft were enrolled. The length and thickness of the QT on preoperative magnetic resonance imaging (MRI) were compared with those measured under direct visualization. The ACL length was measured on preoperative MRI and three-dimensional computed tomography after ACL reconstruction. The QT length on MRI was compared with the required graft length, and the factors related to an adequate QT length were assessed. RESULTS: The mean QT length on MRI was 60.8 ± 1.3 mm and was significantly positively correlated with the QT length under direct visualization (P < 0.01). On MRI, the mean ACL length was 30.8 ± 1.2 mm and the mean QT thickness was 6.3 ± 0.2 mm. Although the mean QT was 0.1 mm longer than the mean required graft length, the QT on MRI was shorter than the required graft length in 37% of patients (11/30). Adequate QT length was related to a QT length of more than 60 mm, but not to age, sex, height, or ACL length. CONCLUSION: Although preoperative MRI predicted the required QT length for ACL reconstruction, 37% of patients lacked an adequate QT length, and a QT shorter than 60 mm required the addition of patellar bone. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-020-06261-5

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. METHODS: Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. RESULTS: Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. CONCLUSIONS: Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.

DOI： 10.1007/s00586-020-06513-5

PubMed

Publishing type：Research paper (scientific journal)  

陳旧性肩関節前方脱臼に対して様々な治療法が報告されている.本研究の目的は陳旧性肩関節前方脱臼に対するリバース型人工肩関節置換術(以下RSA)の短期臨床成績を評価することである.対照は10例10肩,女性9肩,男性1肩で,手術時平均年齢は78.4歳であった.臨床成績は術前,術後1年時に評価し,肩関節自動可動域(屈曲,外転,下垂位外旋,内旋),日本整形外科学会肩関節疾患治療成績判定基準(以下JOAスコア),Constantスコアを測定した.肩関節自動可動域は屈曲が術前平均46.5度から術後1年で平均104度に,外転が術前平均46.5度から術後1年で平均92度に,下垂位外旋が術前平均-6.5度から術後1年で平均11.5度に,結帯スコアは術前平均1.6点が術後1年で平均4点に,JOAスコアは術前平均32.6点が術後1年で平均67.4点に,Constantスコアは術前平均23.3点が術後1年で平均50.3点に有意に改善みられた(全てp<0.05).陳旧性肩関節前方脱臼に対するRSAの術後1年での臨床成績は良好であった.(著者抄録)

Publishing type：Research paper (scientific journal)  

46歳女。右環指・小指の変形を主訴に紹介受診した。右小指は約5年前、環指は約3年前に、それぞれPIP関節炎に伴う屈曲変形が出現し、その後関節強直に至っていた。患者はPIP関節屈曲変形の矯正だけでなく手指屈曲が可能な可動性のあるPIP関節を希望したため、環指・小指の人工PIP関節(シリコンインプラント)置換術を施行した。後療法ではPIP関節を伸展位に保持できるよう、PIP関節を伸展位で長めに外固定することにより良好な術後可動域が得られた。

Publishing type：Research paper (scientific journal)  

人工肩関節全置換術(以下,TSA)術後の反復性肩関節後方脱臼に対して,リバース型人工肩関節置換術(以下,RSA)を施行した1例を経験したので報告する.症例は86歳女性で,肩関節単純X線でTSA後の上腕骨頭の上方化,CTでグレノイドコンポーネントの後捻と上腕骨頭の後方亜脱臼を認めた.ステムとグレノイドコンポーネントを抜去し,Norris法による腸骨移植を併用し,RSAを施行した.術後1年で再脱臼を認めることなく経過良好である.(著者抄録)

Publishing type：Research paper (scientific journal)  

リバース型人工肩関節置換術の術前CT画像を使用し,2次元(以下,2D)評価と3次元(以下,3D)評価を行い,検者間及び検者内信頼性を検証した.対象は12例.3D評価として,術前に1mmスライスで撮像したCTのaxial像のDICOMデータをLEXI社Zed Shoulderに読み込み関節窩傾斜角(以下,GI),関節窩前後捻角(以下,GV),上腕骨後捻角(以下HR),関節窩最大高(以下,GH),関節窩最大幅(以下,GW)を計測した.一方,2D評価として単純CTを用い計測した.2名の整形外科医で,1ヵ月以上の間隔にて2回計測した.2D計測と3D計測の検者間及び検者内信頼性を級内相関係数(ICC)にて算出した.検者間信頼性において2D計測のGI,GVと3D計測のGI,GV,HRが低く,検者内信頼性において2D計測のGI,GVと3D計測のGIが低かった.今後,3D評価のさらなる再現性と正確性の確立のため,参照点デジタイズの方法の改良および座標系の再構築を行う必要性がある.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

In the aging society in Japan, the occurrence of multiple primary cancers has recently increased due to an increase in life expectancy and increased development in cancer diagnostic technology and improvement in treatment outcomes. However, few reports have focused on multiple primary cancers in patients with bone and soft tissue tumors. The present study aimed to analyze the clinical characteristics of patients with multiple malignancies of the bone and soft tissue. Between April 2008 and April 2017, among 973 patients treated at the Department of Orthopedic Surgery, Osaka City University Hospital, those with multiple primary cancers involving bone and soft tissue were identified. The number of cases with multiple cancers in the present study was 30/973 (3.08%), including 21 males and 9 females. The median age at diagnosis of patients with bone and soft tissue sarcoma was 73.5 years (range, 7-83 years). There were 22 patients with double cancers, and 5, 2 and 1 patients with triple, quadruple and quintuple cancers, respectively. Colorectal cancer was the most common primary cancer (n=9). In total, 28.6% of patients had simultaneous cancer, while 71.4% of patients had heterochronous cancer. The overall 5-year survival for all patients was 75.6%. The prognosis of patients with double cancer of bone and soft tissue sarcoma was not necessarily poor. However, it is necessary to pay attention to the possibility of secondary malignancy. Therefore, it is essential to be careful and well organized when selecting treatment modalities and to adopt a logistical approach for the care of patients with ongoing multiple malignancies.

DOI： 10.3892/mco.2020.2088

PubMed

DOI： 10.31616/asj.2020.0357

Publishing type：Research paper (scientific journal)  

当科でPOLARSTEMを使用した23例25関節を対象とし、術後1週間以内のX線像をもとに「ステムアライメント」「ステムの挿入深度」「Cancellous bedの有無」について調査した。また、術前X線でテンプレートした予想のステムサイズと実際に使用したステムサイズの違いについて調査した。ステムアライメントは、術中に内外反・屈曲伸展とも0°の挿入を目標とし、術後のX線計測では全例が内外反・屈曲伸展とも2°以内に設置されていた。ステムの挿入深度については、ラスプ深度と本物のステムの挿入深度の違いについて評価し、手術時の印象としてラスプ深度より本物のステムが浮いた症例はなかった。X線正面像でCancellous bedが確認できたのは16関節(64%)であった。術前X線でテンプレートしたステムサイズと実際のステムサイズの違いについては、実際のステムが1サイズ大きくなったものが1関節(4%)、1サイズ小さくなったものが3関節(12%)、違いはなく一致したものが21関節(84%)であった。

Publishing type：Research paper (scientific journal)  

第4腰椎椎体骨折後遅発性麻痺に対して,X-coreを用いて後方棘突起列を温存した1 above 1 belowのShort fusionを3症例に行った.術後臨床成績は良好であり,術後局所前彎角や椎体間高は矯正され最終観察時まで維持できており,全例で骨癒合を認めた.骨粗鬆症性第4腰椎椎体骨折後遅発性麻痺に対して,本術式は選択肢の一つとなり得ると考えられた.(著者抄録)

Publishing type：Research paper (scientific journal)  

骨粗鬆症性椎体骨折に対するBalloon kyphoplasty(BKP)後、再手術になる症例について、術前の画像学的特徴を調査した。対象は、BKP後の再手術14例とBKP単独105例とした。再手術14例中10例は、後方固定の追加を行い、セメントを抜去せず、instrumentationと骨移植を行った。4例は前方後方同時固定術を行い、前方からの椎体亜全摘、セメント除去および骨移植を実施した。骨折形態についてはAO分類を用いた。脆弱性骨折については、椎体楔状角や動態撮影での椎体可動性、CTでの後壁損傷、椎弓根骨折、棘突起骨折、diffuse idiopathic skeletal hyperostosis(DISH)の存在、終板の欠損、Split typeなどの評価を行った。その結果、再手術群とBKP単独群において、術前の椎体可動性は、再手術群で有意に大きかった。術前椎体楔状角は、有意差がなかった。術直後の楔状角は、再手術群で有意に小さかった。DISHおよび、棘突起骨折や椎弓根骨折、後壁損傷は有意差がなかった。Split typeおよび終板欠損は、再手術で有意に頻度が高かった。ROC curveでは、再手術に関連する術前の椎体可動角のカットオフ値は14°であった。Split type、14°以上の椎体可動性、終板欠損が再手術の危険因子であった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

STUDY DESIGN: A retrospective case control study. PURPOSE: The purpose of this study was to compare the surgical outcomes of multilevel lateral lumbar interbody fusion (LIF) and multilevel posterior lumbar interbody fusion (PLIF) in the surgical treatment of adult spinal deformity (ASD) and to evaluate the sagittal plane correction by combining LIF with posterior-column osteotomy (PCO). OVERVIEW OF LITERATURE: The surgical outcomes between multilevel LIF and multilevel PLIF in ASD patients remain unclear. METHODS: We retrospectively reviewed 31 ASD patients who underwent multilevel LIF combined with PCO (LIF group, n=14) or multilevel PLIF (PLIF group, n=17) and with a minimum 2-year follow-up. In the comparison between LIF and PLIF groups, their mean age at surgery was 69.4 vs. 61.8 years while the mean follow-up period was 29.2 vs. 59.3 months. We evaluated the transition of pelvic incidence-lumbar lordosis (PI-LL) and disc angle (DA) in the LIF group, in fulcrum backward bending (FBB), after LIF and after posterior spinal fusion (PSF) with PCO. The spinopelvic radiographic parameters were compared between LIF and PLIF groups. RESULTS: Compared with the PLIF group, the LIF group had less blood loss and comparable surgical outcomes with respect to radiographic data, health-related quality of life scores and surgical time. In the LIF group, the mean DA and PI-LL were unchanged after LIF (DA, 5.8°; PI-LL, 15°) compared with the values using FBB (DA, 4.3°; PI-LL, 15°) and improved significantly after PSF with PCO (DA, 8.1°; PI-LL, 0°). CONCLUSIONS: In the surgical treatment of ASD, multilevel LIF is less invasive than multilevel PLIF and combination of LIF and PCO would be necessary for optimal sagittal correction in patients with rigid deformity.

DOI： 10.31616/asj.2019.0357

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The stromal-cell-derived factor-1α (SDF-1) is well-known for playing important roles in the regeneration of tissue by enhancing cell migration. However, the effect of SDF-1 in meniscal healing remains unknown. The purpose of this study is to investigate the effects of intra-articular injection of SDF-1 on meniscus healing in a rat meniscal defect model. The intra-articular SDF-1 injection was performed at meniscectomy and one week later. Macroscopic and histological assessments of the reparative meniscus were conducted at one, two and six weeks after meniscectomy in rats. In the macroscopic evaluation, the SDF-1 group showed an increase in the size of the reparative meniscus at six weeks after meniscectomy compared to the phosphate-buffered saline (PBS) injection (no-treatment) group. Histological findings showed that intra-articular injection of SDF-1 enhanced the migration of macrophages to the site of the regenerative meniscus at one and two weeks after meniscectomy. CD68- and CD163-positive cells in the SDF-1 group at one week after meniscectomy were significantly higher than in the no-treatment group. CD163-positive cells in the SDF-1 group at two weeks were significantly higher than in the no-treatment group. At one week after meniscectomy, there were cells expressing mesenchymal-stem-cell-related markers in the SDF-1 group. These results indicate the potential of regenerative healing of the meniscus by SDF-1 injection via macrophage and mesenchymal stem cell accumulation. In the present study, intra-articular administration of SDF-1 contributed to meniscal healing via macrophage, CD90-positive cell and CD105-positive cell accumulation in a rat meniscal defect model. The SDF-1-CXCR4 pathway plays an important role in the meniscal healing process. For potential clinical translation, SDF-1 injection therapy seems to be a promising approach for the biological augmentation in meniscal injury areas to enhance healing capacity.

DOI： 10.3390/ijms21155454

PubMed

Publishing type：Research paper (scientific journal)  

HipAlign New Lateral(本製品)を用いて行った側臥位人工股関節全置換術(THA)でのカップ設置角度の精度を検証した。本製品を用いてTHAを行った14例14関節(男性2例、女性12例、平均62.8歳)を対象とした。全例側臥位で手術を行い、アプローチの内訳は、anterolateralアプローチが8例、direct lateralアプローチが2例、OCMアプローチが4例であった。手術中に本製品を用いてカップ設置を行い、設置後に本製品が表示した角度を記録した。カップ設置角度の誤差は絶対値で外方開角5.1±3.4°、前方開角1.3±1.3°であった。カップ設置での的中率で考えると、外方開角・前方開角ともに5°以内の誤差で設置できた症例は57%、10°以内の誤差で設置できた症例は92%であった。本製品はTHAにおけるカップ設置に有用と結論づけることが可能と思われた。

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2020.04.016

PubMed

DOI： 10.1016/j.jos.2020.04.016

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

We evaluated the abnormal displacement of a complete discoid lateral meniscus in two patients with symptoms of a large popping sound during knee flexion and extension, so-called "snapping", and no displacement of the discoid meniscus on routine Magnetic Resonance Imaging (MRI) analysis. MRI images indicated an anterocentral shift of the lateral discoid meniscus on knee deep flexion in one case and a posterocentral shift of the meniscus on knee full extension in the other case. Abnormal meniscal instability was confirmed under arthroscopy in both knees. After arthroscopic partial meniscectomy, one case of posterior horn instability was treated with an inside-out arthroscopic technique, whereas the other case of anterior horn instability was treated with an all-inside repair technique. We conclude that the symptom of a large popping sound during knee motion may indicate abnormal displacement of a complete discoid lateral meniscus and that further MRI analyses on knee full extension and deep flexion may reveal discernible meniscal displacement.

DOI： 10.1016/j.asmart.2020.03.004

PubMed

Publishing type：Research paper (scientific journal)  

77歳男。1週間前より誘因なく出現した腰背部痛、左優位の両下肢筋力低下、臍部以下のしびれにて受診した。血液検査ではCRP上昇を認めたが、腫瘍、自己免疫疾患、血管炎マーカーは陰性であり、髄液検査では単核球優位の細胞数と総蛋白の上昇を呈した。画像検査ではMRIガドリニウム造影でTh9-L2の多椎間に連続し、硬膜を全周性に取り囲む占拠性病変を認めたことから肥厚性硬膜炎が疑われ、ステロイド治療が有効であったが、診断確定の目的で背側肥厚硬膜切除生検を行い、肥厚性硬膜炎と診断された。術後再発は認めず、術後1年経過時点で筋力は改善し、屋内伝い歩きが可能となった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Postoperative limitations in the range of motion (ROM) after TKA may occur occasionally and restrict a patient's ADL. Although ROM exercise is a means of increasing the ROM after TKA, the optimal time of initiating ROM exercise is still unclear. The purpose of this study is to examine different initiation timings of postoperative ROM exercises after TKA and to compare the results in terms of postoperative pain, swelling, and ROM improvement to determine the optimal time of initiating ROM exercises following TKA. METHODS: This was a prospective, single-center, single-blinded randomized controlled trial involving 109 patients scheduled for unilateral TKA. All patients underwent the physiotherapist assisted passive and active same rehabilitation program that only differed in the starting time of ROM exercise on postoperative day 1 or day 7. Postoperative assessment was performed with all attending personnel blinded to group assignment. Visual analog scale (VAS) of pain, ROM, thigh swelling, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and adverse outcomes were compared between groups on postoperative days within 2 years after surgery. RESULTS: VAS scores during the postoperative period from 18 to 72 h were significantly lower in the group with starting time of ROM exercise on postoperative day 1. The ROM, laboratory data, thigh girth, WOMAC and the incidence of complications did not differ between the two groups at any postoperative time-point. CONCLUSIONS: The results of this study suggested that ROM exercises beginning in the early postoperative stage are advantageous in reducing the postoperative pain after TKA.

DOI： 10.1016/j.asmart.2020.03.003

PubMed

Publishing type：Research paper (scientific journal)  

軟部組織腫瘍患者100例を対象とし、整形外科腫瘍医により、触診で認められる異常熱感部位の温度を測定し、皮膚温と悪性腫瘍との関連を調査した。なお、患側部と健側部の実測値の測定には非接触型赤外線温度計と赤外線サーモグラフィーカメラで計測した。その結果、整形外科腫瘍医の半数以上から、患側部と健側部間では0.2℃以上の温度差が検出され、軟部組織腫瘍患者100例中92例に対し、触診所見の一致が認められた。また、異常な温度分布に関しても、悪性腫瘍の有無との有意な関連性が示され、0.2℃以上の温度差は、悪性腫瘍と有意に関連することが明らかにされた。本検討により、整形外科腫瘍医による異常な温度分布の検出は、軟部組織病変で悪性腫瘍を示唆する、臨床的に重要な所見と判断された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Soft-tissue tumors are often accompanied by abnormal temperature distribution detected during palpation. However, the assessment of temperature distribution is subjective, limiting its wide use in cancer screening. The aim of this study was to evaluate the clinical significance of the thermal detection of soft-tissue tumors. METHODS: This study involved 100 soft-tissue tumor patients, the pathological diagnosis of which was confirmed by surgery from February 2017 to March 2019 in our hospital. Sixty patients were diagnosed with benign lesions, while 40 patients had malignant tumors. The cohort consisted of 52 males and 48 females, with a median age of 62 (range 22-84). Temperature difference detection by orthopedic oncologists, as well as the consistency and accuracy of temperature distribution detection by orthopedic oncologists, were investigated. The relationship between abnormal temperature distribution and the presence of malignancy in soft tissue was also explored. RESULTS: We found that more than half of the orthopedic oncologists could detect a temperature difference of 0.2 °C or higher. All three surgeons reported consistent temperature distribution findings after palpation in 92 out of 100 soft-tumor patients. The presence of abnormal temperature distribution was significantly associated with the presence of malignancy (P < 0.0017). Temperature differences of 0.2 °C or higher were significantly associated with the presence of malignant tumors (P < 0.001). CONCLUSIONS: Diagnosis of abnormal temperature distribution by orthopedic oncologists could suggest the presence of malignancy in patients with soft-tissue lesions.

DOI： 10.1007/s10147-020-01658-1

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jos.2020.04.015

PubMed

<p><b>Purpose: </b>There is no consensus of regarding the indication of surgical treatment of the less invasive decompression procedure for lumbar spinal stenosis (LSS). Although facet joint opening (FO) on preoperative computed tomography (CT) images has been reported as a parameter indicating segmental instability, there is no report on how FO affects on postoperative outcomes. The purpose of this study was to investigate risk factors for revision surgery after less invasive decompression surgery for LSS including FO by a minimum-5-year postoperative survey.</p><p><b>Materials and Methods: </b>A total of 244 patients who underwent microscopic or microendoscopic decompression surgery for LSS and followed for ≥5 years were included in this study. We investigated revision lumbar surgeries at the same levels or other lumbar levels based on medical records. Revision surgeries due to postoperative hematoma or infection were excluded. FO was defined as a ≥2 mm opening on preoperative axial CT images at each lumbar intervertebral level. We evaluated the FO at index decompression levels and sum of FO-positive levels from L1-2 to L5-S. Risk factors for further surgeries were investigated among demographics, preoperative symptoms, and radiological parameters other than FO using univariate and cox proportional hazard regression analysis.</p><p><b>Results: </b>There was 26 reoperations (10.7%) at a mean of 3.9 years after primary surgeries. FO at index decompression levels was significantly more frequent in patients with than without revision surgeries (69 and 39%, respectively, p=0.003). The sum of FO-positive levels among lumbar segments was significantly higher in patients with than without revision surgeries (2.0 and 1.2 levels, respectively, p=0.001). The cox proportional hazard regression analysis indicated that the sum of FO-positive levels among lumbar segments was one of the risk factors for revision surgery (p=0.003, adjusted hazard ratio: 1.47).</p><p><b>Conclusions: </b>The FO of index decompression levels and sum of FO were associated with the need for further lumbar surgeries after less invasive surgery. FO might indicate not only segmental instability but also predictive parameter for progression of degenerative change.</p>

DOI： 10.34371/jspineres.2020-0512

CiNii Article

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Treatment options for metastatic osteosarcoma are limited. The present study aimed to evaluate whether radiofrequency ablation (RFA) combined with intratumoural OK-432 injection induces systemic anti-tumour immunity in rat osteosarcoma model. Eighty of 145 rats were assigned to four groups to evaluate overall survival and tumour size: control (no treatment), RFA-only, OK-432, and RFA-OK-432. The remaining 65 were assigned for histological examination. Maximum diameters of tibial and lung tumours were determined. Tumour samples were histologically examined using haematoxylin-eosin and immunohistochemical staining. Overall survival was significantly prolonged in the RFA-OK-432 group compared to the RFA-only and OK-432 groups. Only rats in the RFA-OK-432 group exhibited significant decreases in maximum tumour diameter after treatment. Ki-67-positive tumour cells in the RFA-OK-432 group were significantly stained negative on immunohistochemical analysis as opposed to those in the RFA-only and OK-432 groups. The number of CD11c+, OX-62+, CD4+, and CD8 + cells significantly increased in the RFA-OK-432 group compared to the RFA-only group. RFA with intratumoural OK-432 injection resulted in distant tumour suppression, prolonged survival, and increased dendritic cells, cytotoxic T cells, IFN-γ, and TNF-α, whereas RFA or OK-432 alone did not produce this effect. This combination may induce an abscopal effect in human osteosarcoma.

DOI： 10.1038/s41598-020-66934-6

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1302/0301-620X.102B6.BJJ-2019-1370.R1

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1136/annrheumdis-2020-eular.2413

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Peri-prosthetic bone mineral density (BMD) decreases after total knee arthroplasty (TKA). We aimed to specifically compare peri-prosthetic BMD changes between mobile- and fixed-bearing prostheses in patients undergoing oral bisphosphonate therapy, hypothesizing that mobile-bearing components would have a favorable effect on postoperative peri-prosthetic BMD. METHODS: This prospective cohort study investigated 30 patients who underwent simultaneous bilateral TKA for primary knee osteoarthritis between December 2007 and September 2012. All patients underwent mobile-bearing TKA in one knee and fixed-bearing TKA in the other and received oral alendronate therapy at a dosage of 35 mg/week. Peri-prosthetic and lumbar spine BMDs were measured using dual X-ray absorptiometry scans, with peri-prosthetic BMD changes being compared between the two prostheses in each patient at six months and one, two, three, and five years post-operation. RESULTS: Clinical results did not significantly differ between two prostheses. Relative change of lumbar spine BMD was significantly greater at five years post-operation than at one year post-operation (p = 0.01), and was significantly correlated at five years post-operation with peri-prosthetic BMD in the central femur (r = 0.39, p = 0.002), posterior femur (r = 0.39, p = 0.002), and medial tibia (r = 0.42, p = 0.007). CONCLUSIONS: There was no difference in peri-prosthetic BMD changes between two prostheses in patients undergoing oral bisphosphonate therapy. Our results suggest that the influence of oral bisphosphonate therapy might offset the influence of prosthetic design. Thus, oral bisphosphonate therapy may be more effective than prosthetic design selection in preventing post-TKA peri-prosthetic BMD loss. LEVEL OF EVIDENCE: II.

DOI： 10.1016/j.knee.2020.04.011

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1136/annrheumdis-2020-eular.1617

Publishing type：Research paper (scientific journal)  

DOI： 10.1136/annrheumdis-2020-eular.2794

Publishing type：Research paper (scientific journal)  

DOI： 10.1136/annrheumdis-2020-eular.2538

Publishing type：Research paper (scientific journal)  

CTにおけるfacet joint opening(FO)は不安定性の指標になるとの報告がある一方で,腰椎変性疾患に対して低侵襲除圧術の限界について一定した見解がない.本研究は低侵襲除圧術で手術加療を行い最低5年の経過観察をしえた244例の再手術についてFOを含めて危険因子解析を行った.その結果,除圧椎間のFOのみならず,腰椎全体でFOをきたす椎間が多いことも再手術の危険因子であることが示された.(著者抄録)

Publishing type：Research paper (scientific journal)  

DOI： 10.1136/annrheumdis-2020-eular.2775