Language：English   Publisher：JSES Reviews, Reports, and Techniques  

DOI： 10.1016/j.xrrt.2023.12.003

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Language：English   Publisher：JSES International  

Background: The relationship between lower mobility, as measured by the elbow forward translation motion (T-motion) test, a new indicator of shoulder joint complex movement that measures elbow position when both dorsal hands are placed on the iliac crest while in a sitting position, and the parameters calculated by ultrasonography is unknown. The purpose of this study was to investigate the limiting factors of T-motion through motion analysis of the humeral head and rotator cuff muscles using ultrasonography in college baseball players. Methods: Thirteen college baseball players participated in this cross-sectional study. The shortest distance from the posterior edge of the glenoid to the humeral head was measured in the static and T-motion positions, and the difference was calculated as the humeral head translation. The velocity of the infraspinatus was calculated during shoulder internal/external rotation using the particle image velocimetry method. These parameters were compared between the throwing and nonthrowing sides to examine the limiting factors of T-motion. Results: This study indicated moderate-to-good reliability for the parameters calculated by ultrasonography. The mean anterior translation distance was significantly greater on the throwing side than on the nonthrowing side (r = 0.56, P = .015). The mean velocity of infraspinatus during internal rotation was significantly lower on the throwing side than on the nonthrowing side (r = 0.51, P = .028). Conclusion: Increased anterior translation of the humeral head and decreased the velocity of infraspinatus are likely correlated with reduced T-motion mobility in college baseball players. These methods showed potential for physical therapy assessment and intervention to prevent shoulder dysfunction.

DOI： 10.1016/j.jseint.2023.12.012

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Language：English   Publisher：Journal of Wound, Ostomy and Continence Nursing  

PURPOSE: The purpose of this study was to evaluate the benefits of collaborative management between orthopedic surgery and WOC nurses in patients undergoing resection of subcutaneous sarcomas. DESIGN: Retrospective case-control study. SUBJECTS AND SETTING: The sample comprised 25 patients who underwent wide resection for soft tissue sarcoma, followed by 2-stage split-thickness skin grafting. Data collection occurred between January 2015 and April 2021 in a university hospital based in Kagoshima, Japan. For comparison, we categorized these patients into 2 groups: intervention group participants were managed by an orthopedic surgeon and a WOC nurse; nonintervention group members were managed without WOC nurse participation. METHODS: Patient background and treatment-related information was retrospectively collected from medical records and compared between the WOC nurse intervention group and the nonintervention group, including maximum tumor diameter, surgical time, maximum skin defect diameter, length of hospital stay, and time from surgery to complete wound healing. RESULTS: The average length of hospital stay was significantly shorter in the WOC nurse intervention group compared with the nonintervention group (38.3 days, SD = 8.0 vs 47.1 days, SD = 10.2; P =.023). CONCLUSION: Collaborative wound management with a WOC nurse resulted in a shorter hospital length of stay when compared to traditional management with WOC nurse involvement. Based on these findings, we assert that WOC nurses provide an important bridge between postoperative wound management in patients undergoing resection of subcutaneous sarcomas.

DOI： 10.1097/WON.0000000000001060

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PubMed

Language：English   Publisher：Oral Diseases  

Objective: Malignant soft tissue sarcoma (MSTS) is a rare disease, but is seen in patients undergoing orthopedic surgery. Although the association of periodontal disease with various cancers occurring in the oral cavity, gastrointestinal tract, lungs, and prostate, has been reported, the association between periodontal disease and MSTS remains unclear. This study investigated the association between periodontal disease and MSTS in patients undergoing orthopedic surgery. Subjects and Methods: One hundred fifteen patients who underwent orthopedic surgery between 2017 and 2021 were retrospectively enrolled (mean age = 66.8 ± 10.7 years). The patient background was adjusted by the propensity score (PS). Subsequently, the association of periodontal disease with MSTS was analyzed using PS inverse probability of treatment weighting (IPTW). Periodontal status was determined by evaluating the periodontal inflamed surface area, which was calculated by measuring the periodontal probing pocket depth and detecting bleeding on probing. Results: Multivariate logistic regression analysis after adjustment by the PS showed that severe periodontitis was significantly associated with MSTS (odds ratio 2.81, p = 0.04). Furthermore, IPTW showed that severe periodontitis was significantly associated with MSTS (odds ratio 3.21, p = 0.01). Conclusion: The results indicate an association between periodontal inflammation and MSTS.

DOI： 10.1111/odi.14853

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PubMed

Language：English   Publisher：SAGE Open Medicine  

Objectives: Early surgery is recommended for hip fractures in elderly patients. This study was performed to evaluate factors contributing to delayed surgery and associated outcomes in a secondary hospital in Japan with a rehabilitation centre. Methods: We retrospectively reviewed the records of 895 patients aged >50 years [median age, 86 (81–91) years] treated for hip fractures at our institution from 2016 to 2020. We defined surgical delay as surgery performed >48 h after admission. We evaluated several risk factors for surgical delay and associated outcomes: mortality, length of hospital stay and walking status. Results: Binomial logistic regression analysis showed that several factors, including preoperative echocardiographic delay (odds ratio, 9.38; 95% confidence interval, 5.95–15.28), were risk factors for surgical delay. In the multiple regression analyses, surgical delay was a significant risk factor for a longer hospital stay (partial regression coefficient, 6.99; 95% confidence interval, 3.67–10.31). Conclusions: Our findings indicated that preoperative echocardiographic delay was one of the risk factors for surgical delay of hip fractures in elderly patients. Surgical delay was a risk factor for a longer hospital stay, including rehabilitation.

DOI： 10.1177/20503121231222345

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PubMed

Language：Japanese   Publisher：Seminars in Arthroplasty JSES  

Background: Despite the effectiveness of 3-dimensional computed tomography (3D-CT) for identifying bone and joint conditions, there are few clinical data on humeral head enlargement in patients with rotator cuff tears (RCTs), including cuff tear arthropathy (CTA). This study aimed to investigate the factors correlated with humeral head size measured through 3D-CT in patients with RCTs. Methods: This cross-sectional study included 43 preoperative patients who were diagnosed via RCTs. The severity of RCTs was classified into 3 types: small-medium tears, large-massive tears, and CTA. The 3D-radius was calculated from the raw radius data using 3D-CT and adjusted by height as a corrected-radius. The reliability of the 3D-radius measurements was calculated as the intraclass correlation coefficient. Various statistical analyses, including correlation coefficients, group comparisons, and multiple regression analyses, were used to explore factors associated with humeral head size. Results: The interobserver reliability of the 3D-radius was 0.903. The corrected-radius on the affected side exhibited correlations with age (r = 0.598, P < .001) and the acromion-humeral interval (r = −0.609, P < .001). Group comparison between tear sizes, the CTA group had larger corrected-radius than the other groups (P = .001), with no significant difference between the small-medium tear and large-massive tear groups (P = .932). Multiple regression analysis adjusted for covariates revealed that the corrected-radius was correlated with age and the acromion-humeral interval (P < .05, R2 = 0.474). Conclusion: These findings provide valuable clinical insights into the factors associated with humeral head enlargement, particularly in patients with RCTs. The measurement method we used holds promise for informing the selection of artificial head sizes during the preoperative planning of total shoulder arthroplasty.

DOI： 10.1053/j.sart.2024.07.004

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Language：English   Publisher：World Neurosurgery: X  

Objective: Idiopathic normal-pressure hydrocephalus (iNPH) is characterized by symptoms of dementia, urinary incontinence, and gait disturbance; however, gait disturbance tends to persist after shunt surgery. Gait disturbance and urinary dysfunction are also major symptoms of lumbar spinal stenosis (LSS). Currently, the epidemiology of the complications of LSS in iNPH is unclear. Here, we evaluated the coexistence rate of LSS in iNPH cases. Methods: This was a retrospective case–control study. Between 2011 and 2017, 224 patients with a median age of 78 years, including 119 males, were diagnosed with iNPH and underwent lumboperitoneal shunts or ventriculoperitoneal shunts. LSS was diagnosed with magnetic resonance imaging by two spine surgeons. Age, sex, body mass index (BMI), Timed Up and Go (TUG) test, Mini Mental State Examination (MMSE) score, and urinary dysfunction were examined. We compared the changes in these variables in the group of patients with iNPH without LSS versus those with both iNPH and LSS. Results: Seventy-three iNPH patients (32.6%) with LSS had significantly higher age and BMI. The existence of LSS did not alter the postoperative improvement rates of MMSE and urinary dysfunction; however, TUG improvement was significantly impaired in the LSS-positive group. Conclusions: LSS affects improvements in gait disturbance of iNPH patients after shunt operation. Because our results revealed that one-third of iNPH patients were associated with LSS, gait disturbance observed in iNPH patients should be considered a potential complication of LSS.

DOI： 10.1016/j.wnsx.2023.100236

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Language：English   Publisher：Osteoarthritis and Cartilage Open  

Objective: To establish an animal model of modified cuff tear arthropathy (mCTA) in order to better replicate the pathophysiology associated with rotator cuff tear-induced humeral head collapse. Design: mCTA was induced by transection of the rotator cuff, the long head of the biceps brachii (LHB), and superior half of the joint capsule in the right shoulder of 12-week-old rats; the left shoulder underwent sham surgery. The severity of CTA was quantitated using the Murine Shoulder Arthritis Score (MSAS). The trabecular bone of the humeral head and metaphysis was analyzed using bone histomorphometry. The expression of proinflammatory cytokines and catabolic enzymes was evaluated immunohistochemically. Results: In the mCTA model, the MSAS increased starting from 2 weeks after induction, and there was notable subchondral bone collapse with fibrous cells at 4 weeks. The mCTA cartilage exhibited positive staining for TNF-α, IL-1β/6, MMP-3/13, and ADAMTS5. The trabecular bone volume was reduced not only in the subchondral bone but also in the metaphysis of the humeri, and bone resorption was enhanced in these areas. In the collapsed subchondral bone, both bone formation and resorption were increased. The fibrous cells showed expression of TNF-α, IL-6, and MMP-13, along with specific markers of mesenchymal stem cells. Furthermore, the fibrous cells showed osteoblastic characteristics (RUNX2-positive) and expressed RANKL. Conclusions: The LHB and the capsuloligamentous complex are critical stabilizers of the glenohumeral joint, serving to prevent the advancement of CTA following massive rotator cuff tears. Fibrous cells appear to play a role in the humeral head bone resorption.

DOI： 10.1016/j.ocarto.2023.100389

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Language：English   Publisher：Journal of Hospital Infection  

Background: Meticillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen in orthopaedic surgical site infections (SSIs). However, few studies have investigated the transmission process of orthopaedic MRSA SSI. Aim: To investigate the transmission process of orthopaedic MRSA SSI using epidemiological and molecular analyses and to determine a method to prevent MRSA SSI in nosocomial orthopaedic surgery. Methods: Active MRSA surveillance, preoperative decolonization and contact precautions for MRSA-positive cases was performed at our institution. Changes in epidemic strains were evaluated and the possibility of transmission from patients in an orthopaedic ward of a Japanese tertiary-care hospital was assessed by genotyping stored MRSA strains. In addition, data on the prevalence of MRSA SSI, MRSA colonization, and use of an alcohol antiseptic agent (mL/patient-days) during 2005–2022 were retrospectively assessed. Findings: SCCmec type II strain in the SSI group decreased over time, associated with fewer outbreaks. Even during a period of high infection rates, no cases of transmission-induced SSI from nasal MRSA carriers were identified. The infection rate correlated negatively with the use of an alcohol antiseptic agent (r = −0.82; P < 0.0001). Two cases among five nasal carriers developed MRSA SSI caused by strains different from those related to nasal colonization. Conclusion: The infection control measures for transmission from the hospital reservoirs including strict adherence to hand hygiene and decolonization of carriers is likely to be important for the prevention of orthopaedic MRSA SSI. However, the need for contact precautions for decolonized nasal carriers might be low.

DOI： 10.1016/j.jhin.2023.07.011

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PubMed

Language：English   Publisher：JSES International  

Background: Range of motion (ROM) limitations can result in restricted activities of daily living (ADL) due to shoulder dysfunction, suggesting that evaluation of complex shoulder movements is necessary in clinical practice. Here, we present a new physical examination, the elbow forward translation motion (T-motion) test for measuring the position of the elbow when both dorsal hands are placed on the iliac crest in a sitting position and the elbow is moving forward. We examined the relationships between T-motion and shoulder function to identify the significance of this test in clinical practice. Methods: Preoperative patients with rotator cuff tears (RCTs) were eligible for this cross-sectional study. Active ROM and Japanese Orthopaedic Association (JOA) scores were measured as shoulder function. The degree of internal rotation was based on the Constant-Murley Score. We defined a positive T-motion test result as an elbow positioned posterior to the body on the sagittal plane. Group comparisons and logistic regression analyses were conducted to investigate the relationships between the availability of T-motion and shoulder function. Results: Sixty-six patients with RCTs participated in this cross-sectional study. The values of the JOA total score (P < .001), subscale of function and ADL (P < .001), active range of forward flexion (P = .006), abduction (P < .001), and external rotation (P < .001) were lower in the positive group than in the negative group. In addition, a significant correlation was found between the availability of T-motion and internal rotation by the chi-square test (P < .001). Logistic regression analyses showed that internal rotation (odds ratio 2.69; 95% confidence interval 1.47-4.93; P < .01) and external rotation (odds ratio 1.07; 95% confidence interval 1.00-1.14; P = .04) were related to the availability of T-motion after adjustments for covariates, and the cutoff points were 4 points for internal rotation (area under the curve 0.833, sensitivity 53.3%, specificity 86.1%, P < .001) and 35° for external rotation (area under the curve 0.788, sensitivity 60.0%, specificity 88.9%, P < .001). Conclusion: The positive T-motion group exhibited low shoulder function, including a less active ROM and JOA shoulder score. T-motion, which is a quick and simple movement, may be a new indicator for a complex shoulder motion and contribute to evaluating the decreased ADL and limited shoulder motion in patients with RCTs.

DOI： 10.1016/j.jseint.2023.02.019

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PubMed

Language：English   Publisher：Trauma Case Reports  

Background: Acupuncture has become one of the most popular alternative medical treatments in the world. However, if the needle is inserted incorrectly into the body, various adverse events can occur and, in such cases, the needle should be removed. Acupuncture needles are very thin and fragile, making them difficult to detect and to confirm breakage or residual needle fragments during surgery. We report a case of a patient's self-placed acupuncture needle migrating into the cervical spinal canal and its surgical removal. We used cone-beam computed tomography in the hybrid operating room to confirm that the needle was removed in its entirety. Case presentation: A 37-year-old man presented with neck pain and gait disturbance. While he was self-acupuncturing, an acupuncture needle accidentally broke, and the remaining part of the needle penetrated and made contact with the cervical spinal cord. Cervical spine radiographs showed a metallic foreign body between the C1 and C2 spinous processes in the direction of the anterior cervical spine. Computed tomography images revealed that the acupuncture needle was penetrating the spinal canal and was in contact with the cervical cord. The acupuncture needle was removed under general anesthesia. The use of cone-beam computed tomography in the hybrid operating room allowed intraoperative confirmation that there was no breakage during needle removal, and no needle fragments were left behind. His symptoms disappeared without any complications after the operation. Conclusion: To the best of our knowledge, this is the first report of the removal of an acupuncture needle that migrated into the cervical spinal canal using cone-beam computed tomography in a hybrid operating room. Intraoperative cone-beam computed tomography is useful in patients with small, fragile foreign bodies for confirmation of the location of the object and to check for the presence of residual fragments.

DOI： 10.1016/j.tcr.2023.100772

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PubMed

Language：English   Publisher：Scientific Reports  

Liver regeneration is an extraordinarily complex process involving a variety of factors; however, the role of chromatin protein in hepatocyte proliferation is largely unknown. In this study, we investigated the functional role of high-mobility group box 2 (HMGB2), a chromatin protein in liver regeneration using wild-type and HMGB2-knockout (KO) mice. Liver tissues were sampled after 70% partial hepatectomy (PHx), and analyzed by immunohistochemistry, western blotting and flow cytometry using various markers of cell proliferation. In WT mice, hepatocyte proliferation was strongly correlated with the spatiotemporal expression of HMGB2; however, cell proliferation was significantly delayed in hepatocytes of HMGB2-KO mice. Quantitative PCR demonstrated that cyclin D1 and cyclin B1 mRNAs were significantly decreased in HMGB2-KO mice livers. Interestingly, hepatocyte size was significantly larger in HMGB2-KO mice at 36–72 h after PHx, and these results suggest that hepatocyte hypertrophy appeared in parallel with delayed cell proliferation. In vitro experiments demonstrated that cell proliferation was significantly decreased in HMGB2-KO cells. A significant delay in cell proliferation was also found in HMGB2-siRNA transfected cells. In summary, spatiotemporal expression of HMGB2 is important for regulation of hepatocyte proliferation and cell size during liver regeneration.

DOI： 10.1038/s41598-022-16258-4

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PubMed

Language：Japanese   Publisher：Seminars in Arthroplasty JSES  

Background: In shoulder arthroplasty, bone resorption around the stem can lead to stem loosening and makes surgery difficult at the time of revision. Proximal bone resorption after reverse shoulder arthroplasty can cause instability because of a decrease of deltoid wrapping effect. As factors of the stem itself, such as stem coating, shape, length, and use of bone cement, may also affect bone resorption, a single-stem model should be used to compare bone resorptions between different pathologies and surgical procedures. However, to date, a few reports have compared these differences in detail using a single-stem model. Therefore, we investigated the prevalence and location of humeral bone resorption in a single-stem model. Methods: The study included 100 shoulders that underwent anatomical total shoulder arthroplasty (TSA) or humeral head replacement (HHR) with a single uncemented humeral stem from 2008 to 2018. The patients were 31 men and 69 women. The mean age at surgery was 72.9 years (range, 41-86 years). The patients were divided into three groups: especially, 25, 61, and 14 shoulders received TSA for primary osteoarthritis without rotator cuff tears (TSA group), HHR using an anatomical head with rotator cuff repair for cuff tear arthropathy (CTA) (HHR group), and HHR using a CTA head without rotator cuff repair (CTA group), respectively. Patients were monitored for a mean of 56 months (range, 12-98 months). The location of bone resorption was divided into seven zones as follows: zone 1, greater tuberosity; zone 2, lateral diaphysis; zone 3, lateral diaphysis beyond the deltoid tuberosity; zone 4, tip of the stem; zone 5, medial diaphysis beyond the deltoid tuberosity; zone 6, medial diaphysis; and zone 7, calcar region. The degree of bone resorption was classified from grade 0 to 4. Results: Bone resorption of grade 3 or higher was significantly more frequent at the greater tuberosity in the HHR and CTA groups (P <.001 and P <.001, respectively) than that in the TSA group. Grade 4 bone resorption was significantly more frequent in the CTA than that in the TSA and HHR groups in zone 1 (P =.016 and P =.041, respectively). Conclusion: The state of attachment of the rotator cuff to the greater tuberosity might affect bone resorption at the greater tuberosity, such as the greater tuberosity after shoulder arthroplasty. In cases of shoulder arthroplasty for arthropathy with rotator cuff tear, performing rotator cuff repair might prevent bone resorption. Level of evidence: Level IV; Prognosis Study

DOI： 10.1053/j.sart.2021.09.008

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Language：English   Publisher：JBJS Case Connector  

Cases:We present 2 cases (19- and 40-year-old women) of lumbosacral spinal deformity with sacroiliac joint destruction. Reconstruction surgery using a fibular strut autograft was performed in both patients, and spinal reconstruction and fusion were successfully maintained without bone resorption for at least 7 years.Conclusion:This is the first report of reconstructive surgery using a fibular strut bone graft for lumbosacral deformity with destruction of the sacroiliac joint in patients with neurofibromatosis type 1 (NF-1). These findings suggest that reconstruction with a fibular strut autograft is useful for lumbosacral spinal deformity that includes destruction of the sacroiliac joints in NF-1.

DOI： 10.2106/JBJS.CC.21.00653

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PubMed

Language：Japanese   Publisher：World Academy of Sciences Journal  

Abnormal mechanical loading is a main external factor affecting the development of osteoarthritis (OA). Excessive posterior pelvic inclination may decrease the loading area of the acetabulum, increasing mechanical stress to the articular surface and resulting in hip OA. However, exactly how much posterior pelvic inclination produces an excessive load on the articular surface remains unknown. The present study investigated the mechanical stress of 27 hips in 19 women [unilateral (right or left) hip joints of 11 women and bilateral (right and left) hip joints of 8 women were analyzed] with or without acetabular dysplasia by finite element analysis. Patient-specific finite element models were constructed from computed tomography data obtained in the supine position. The posterior pelvic inclination in the models was changed from 0 to 30 degrees in five-degree increments. The association between equivalent stress in the hip joint and the pelvic inclination or acetabular dysplasia was analyzed. The equivalent stress for the femoral head in the original position was 0.97 MPa (0.91-1.01) in normal hip joints and 1.18 MPa (1.00-1.28) in hips with acetabular dysplasia (P=0.023). The equivalent stress significantly increased at >25 degrees of posterior inclination. In normal hips, when the pelvic posterior inclination was increased by 25 and 30 degrees, the equivalent stress was 1.21 (1.11-1.35) and 1.24 (1.20-1.47) MPa, respectively (P=0.029 and 0.010, respectively). The mechanical stress of normal hip joints serially increased as the posterior pelvic inclination increased, reaching a level almost equivalent to that of hip joints with acetabular dysplasia at 25 degrees of posterior inclination. On the whole, the present study demonstrates that posterior pelvic inclination may be a mechanical factor affecting the development of OA in patients without acetabular dysplasia, particularly when the posterior inclination exceeds 25 degrees.

DOI： 10.3892/WASJ.2022.145

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Language：English   Publisher：Histochemistry and Cell Biology  

High-mobility group box 2 (HMGB2) is a chromatin-associated protein that is an important regulator of gene transcription, recombination, and repair processes. The functional importance of HMGB2 has been reported in various organs, including the testis, heart, and cartilage. However, its role in the ovary is largely unknown. In this study, ovary tissues from wild-type (WT) and HMGB2-knock-out (KO) mice were examined by histopathological staining and immunohistochemistry. The ovary size and weight were significantly lower in HMGB2-KO mice than in age-matched WT littermates. Histopathological analysis revealed ovarian atrophy and progressive fibrosis in 10-month-old HMGB2-KO mouse ovaries. Compared to age-matched WT mice, the numbers of oocytes and developing follicles were significantly decreased at 2 months of age and were completely depleted at 10 months of age in HMGB2-KO mice. Immunohistochemistry revealed the expression of HMGB2 in the granulosa cells of developing follicles, oocytes, some corpora lutea, and stromal cells. Importantly, HMGB2-positive cells were co-localized with estrogen receptor beta (ERβ), but not ERα. Estrogen response element-binding activity was demonstrated by southwestern histochemistry, and it was decreased in HMGB2-KO mouse ovaries. Cell proliferation activity was also decreased in HMGB2-KO mouse ovaries in parallel with the decreased folliculogenesis. These results indicated that the depletion of HMGB2 induced ovarian atrophy that was characterized by a decreased ovarian size and weight, progressive fibrosis, as well as decreased oocytes and folliculogenesis. In conclusion, we demonstrated the crucial role of HMGB2 in mouse ovarian folliculogenesis through ERβ expression.

DOI： 10.1007/s00418-022-02074-4

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PubMed

Language：Japanese  

DOI： 10.1177/10225536221119719

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Language：Japanese  

DOI： 10.1177/10225536221103360

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Language：English   Publisher：Biology of Reproduction  

High-mobility group box 2, a chromatin-associated protein that interacts with deoxyribonucleic acid, is implicated in multiple biological processes, including gene transcription, replication, and repair. High-mobility group box 2 is expressed in several tissues, including the testis; however, its functional role is largely unknown. Here, we elucidated the role of high-mobility group box 2 in spermatogenesis. Paraffin-embedded testicular tissues were obtained from 8-week-old and 1-year-old wild-type and knock-out mice. Testis weight and number of seminiferous tubules were decreased, whereas atrophic tubules were increased in high-mobility group box 2-depleted mice. Immunohistochemistry revealed that atrophic tubules contained Sertoli cells, but not germ cells. Moreover, decreased cell proliferation and increased apoptosis were demonstrated in high-mobility group box 2-depleted mouse testis. To elucidate the cause of tubule atrophy, we examined the expression of androgen and estrogen receptors, and the results indicated aberrant expression of androgen receptor and estrogen receptor alpha in Sertoli and Leydig cells. Southwestern histochemistry detected decreased estrogen response element–binding sites in high-mobility group box 2-depleted mouse testis. High-mobility group box 1, which has highly similar structure and function as high-mobility group box 2, was examined by immunohistochemistry and western blotting, which indicated increased expression in testis. These findings indicate a compensatory increase in high-mobility group box 1 expression in high-mobility group box 2 knock-out mouse testis. In summary, depletion of high-mobility group box 2 induced aberrant expression of androgen receptor and estrogen receptor alpha, leading to decreased germ cell proliferation and increased apoptosis which resulted in focal seminiferous tubule atrophy.

DOI： 10.1093/biolre/ioab187

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Language：English   Publisher：Journal of Biological Chemistry  

Ossification of the posterior longitudinal ligament (OPLL) of the spine is a common pathological condition that causes intractable myelopathy and radiculopathy, mainly the result of an endochondral ossification-like process. Our previous genome-wide association study identified six susceptibility loci for OPLL, including the cell division cycle 5-like (CDC5L) gene region. Here, we found CDC5L to be expressed in type II collagen-producing chondrocyte-like fibroblasts in human OPLL specimens, as well as in differentiating ATDC5 chondrocytes. Cdc5l siRNA transfection in murine chondrocytes decreased the expression of the early chondrogenic genes Sox9 and Col2a1, diminished the cartilage matrix production, and enhanced the expression of parathyroid-hormone-related protein (a resting chondrocyte marker). We also showed that Cdc5l shRNA suppressed the growth of cultured murine embryonal metatarsal cartilage rudiments and that Cdc5l knockdown suppressed the growth of ATDC5 cells. Fluorescence-activated cell sorting analysis revealed that the G2/M cell cycle transition was blocked; our data showed that Cdc5l siRNA transfection enhanced expression of Wee1, an inhibitor of the G2/M transition. Cdc5l siRNA also decreased the pre-mRNA splicing efficiency of Sox9 and Col2a1 genes in both ATDC5 cells and primary chondrocytes; conversely, loss of Cdc5l resulted in enhanced splicing of Wee1 pre-mRNA. Finally, an RNA-binding protein immunoprecipitation assay revealed that Cdc5l bound directly to these target gene transcripts. Overall, we conclude that Cdc5l promotes both early chondrogenesis and cartilage growth and may play a role in the etiology of OPLL, at least in part by fine-tuning the pre-mRNA splicing of chondrogenic genes and Wee1, thus initiating the endochondral ossification process.

DOI： 10.1016/j.jbc.2021.100994

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Language：Japanese   Publisher：Scientific Reports  

Most spinal meningiomas arise from the thoracic dura in middle-aged and elderly women. Simpson grade 1 resection is recommended to avoid recurrence. For ventral and ventrolateral tumors, reconstruction after total dural resection is difficult, and spinal fluid leakage is likely. To overcome this concern, Saito et al. developed the technique of resecting the tumor with the inner dural layer, preserving the outer dural layer. Although meningioma rarely recurs, the recurrence period is approximately 8 years postoperatively. No studies have evaluated long-term (> 10-year) outcomes of the Saito method. Here, we report 10 cases of the Saito method with > 10-year follow-up and compare outcomes with those of other standard approaches. Twenty-nine pathology-confirmed meningioma patients underwent surgery in our department, ten with the Saito method. We investigated resection method (dura mater treatment), pathological type, and recurrence and compared pre- and postoperative clinical findings. The median follow-up was 132 months. Recurrence occurred after Simpson grades 3 and 4 resection. Simpson grades 1, 2, and the Saito method resulted in no recurrence. Neurological symptoms improved in all patients at final follow-up. This is the first report of long-term outcomes of the Saito method. The method achieved good neurological improvement with no recurrence in > 10-year follow-up.

DOI： 10.1038/s41598-021-83712-0

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Language：Japanese   Publisher：Journal of Shoulder and Elbow Surgery  

Background: There are various modifications of the Bankart repair, and postoperative changes to the glenoid morphology after the repair are reported. Among the various procedures performed, a decrease in the lateral glenoid diameter might be related to the surgery that involves removal of the articular cartilage and repair of the labrum–anterior inferior glenohumeral ligament complex on the glenoid surface. This is in contrast to cases without significant bony Bankart lesions that are not on the edge of the glenoid. Thus, this study aimed to compare glenoid rim stress after Bankart repair using 2 methods of finite element analysis: a method of removing the anteroinferior cartilage and repairing the glenohumeral ligament complex on the glenoid and a method of preserving the cartilage and repairing the glenohumeral ligament complex on the glenoid edge. Methods: Five preoperative computed tomography scans of patients with traumatic anterior instability who underwent arthroscopic Bankart repair were used. Two models simulating different surgical procedures were created as follows: in model G, a 5-mm-thick cartilage on the glenoid rim was removed between 2 and 7 o'clock, and the glenohumeral ligament complex was repaired on the medial edge of the glenoid bone where the cartilage was removed. In model E, the cartilage on the glenoid rim was not removed, and the glenohumeral ligament complex was repaired on the glenoid edge. The load stresses on the anteroinferior area of the glenoid after Bankart repair with models G and E were measured using finite element analysis. Results: The stress on the glenoid at 3-4 o'clock was 3.16 MPa in model G and 6.42 MPa in model E (P =.043). The stress at 4-5 o'clock was 1.68 MPa in model G and 4.53 MPa in model E (P =.043). The stress at 5-6 o'clock was 2.26 MPa in model G and 3.93 MPa in model E (P =.043). Conclusion: Significantly lower load stresses were observed at the anteroinferior rim of the glenoid in model G than in model E.

DOI： 10.1016/j.jse.2020.04.023

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PubMed

Language：Japanese   Publisher：Pediatric Infectious Disease Journal  

Bacillus Calmette-Guérin (BCG)-associated osteomyelitis is a rare adverse event following BCG vaccination, and there have been no previous reports of BCG-associated cervical spondylitis. Here, we describe the case of a 3-year-old immunocompetent girl who developed BCG-associated cervical spondylitis and was successfully treated by prompt surgical drainage of the abscess and administration of isoniazid and rifampicin for 9 months without sequelae.

DOI： 10.1097/INF.0000000000002893

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PubMed

Language：English   Publisher：JSES International  

Background: Humeral stem loosening has gained attention as it has been identified as a cause of revision surgery in reverse shoulder arthroplasty (RSA). In RSA, humeral stem revision is very difficult if there is humeral bone loss because of stress shielding. Some studies of humeral bone resorption after anatomic shoulder arthroplasty have been published, but there are few detailed reports of humeral bone resorption after RSA. This study aimed to investigate the prevalence of humeral bone resorption after RSA procedures and to evaluate the risk factors for bone resorption. Methods: This study included 48 shoulders that underwent RSA with an uncemented humeral stem from July 2014 to May 2017 and were followed up for more than 1 year. The prevalence of humeral bone resorption and risk factors were investigated. Logistic, multiple logistic, and multivariate logistic regression analyses were performed to evaluate the data. Results: Grade 0 bone resorption, the most advanced grade, occurred in 8 shoulders (16.7%); grade 1, in 0 (0%); grade 2, in 17 (35.4%); grade 3, in 14 (29.2%); and grade 4, in 9 (18.8%). A high occurrence of bone absorption was observed in zones 1, 2, and 7. Grade 4 bone resorption did not occur in zones 3, 5, and 6. Female sex and an onlay-type stem were significant independent risk factors for grade 4 bone resorption. Conclusions: Bone resorption was frequently observed in the greater tuberosity, lateral diaphysis, and calcar region. Significant risk factors included female sex and an onlay-type stem.

DOI： 10.1016/j.jses.2019.11.007

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PubMed

Language：English   Publisher：Bone Research  

Adult bone structural integrity is maintained by remodeling via the coupling of osteoclastic bone resorption and osteoblastic bone formation. Osteocytes or osteoblasts express receptor activator of nuclear factor κ-B ligand (Rankl) or osteoprotegerin (Opg) to promote or inhibit osteoclastogenesis, respectively. Bone morphogenetic protein (BMP) is a potent bone inducer, but its major role in adult bone is to induce osteocytes to upregulate sclerostin (Sost) and increase the Rankl/Opg expression ratio, resulting in promotion of osteoclastogenesis. However, the precise effect of BMP-target gene(s) in osteoblasts on the Rankl/Opg expression ratio remains unclear. In the present study, we identified atonal homolog 8 (Atoh8), which is directly upregulated by the BMP-Smad1 axis in osteoblasts. In vivo, Atoh8 was detected in osteoblasts but not osteocytes in adult mice. Although global Atoh8-knockout mice showed only a mild phenotype in the neonate skeleton, the bone volume was decreased and osteoclasts were increased in the adult phase. Atoh8-null marrow stroma cells were more potent than wild-type cells in inducing osteoclastogenesis in marrow cells. Atoh8 loss in osteoblasts increased Runx2 expression and the Rankl/Opg expression ratio, while Runx2 knockdown normalized the Rankl/Opg expression ratio. Moreover, Atoh8 formed a protein complex with Runx2 to inhibit Runx2 transcriptional activity and decrease the Rankl/Opg expression ratio. These results suggest that bone remodeling is regulated elaborately by BMP signaling; while BMP primarily promotes bone resorption, it simultaneously induces Atoh8 to inhibit Runx2 and reduce the Rankl/Opg expression ratio in osteoblasts, suppressing osteoclastogenesis and preventing excessive BMP-mediated bone resorption.

DOI： 10.1038/s41413-020-00106-0

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PubMed

Language：English   Publisher：Brain Sciences  

The activation and proliferation of microglia is characteristic of the early stages of brain pathologies. In this study, we aimed to identify a factor that promotes microglial activation and proliferation and examined the in vitro effects on these processes. We cultured microglial cell lines, EOC 2 and SIM-A9, with various growth factors and evaluated cell proliferation, death, and viability. The results showed that only transforming growth factor beta (TGF-β) caused an increase in the in vitro proliferation of both microglial cell lines. It has been reported that colony-stimulating factor 1 promotes the proliferation of microglia, while TGF-β promotes both proliferation and inhibition of cell death of microglia. However, upon comparing the most effective doses of both (assessed from the proliferation assay), we identified no statistically significant difference between the two factors in terms of cell death; thus, both have a proliferative effect on microglial cells. In addition, a TGF-β receptor 1 inhibitor, galunisertib, caused marked inhibition of proliferation in a dose-dependent manner, indicating that inhibition of TGF-β signalling reduces the proliferation of microglia. Therefore, galunisertib may represent a promising therapeutic agent for the treatment of neurodegenerative diseases via inhibition of nerve injury-induced microglial proliferation, which may result in reduced inflammatory and neuropathic and cancer pain.

DOI： 10.3390/brainsci10010020

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PubMed

Language：Japanese   Publisher：Journal of Medical Case Reports  

Background: Avulsion fracture of the medial head of the gastrocnemius muscle is a very rare phenomenon. There are no reports of avulsion fractures associated with multiple ligament injuries before closure of the growth plate. The authors present a case of avulsion fracture of the insertion of the medial head of the gastrocnemius muscle associated with posterior cruciate ligament injury and an avulsion fracture of the medial collateral ligament at the femoral attachment. Case presentation: A 15-year-old Japanese boy was injured by contact with another player while playing soccer. He was immediately admitted to the authors' hospital with knee pain. Radiography and computed tomography revealed an avulsion fracture of the medial collateral ligament at the femoral attachment and an avulsion fracture of the medial head of the gastrocnemius muscle. In examination under anesthesia, the Lachman test was negative and posterior drawer test was positive. Fixation of the avulsion fractures of the medial collateral ligament and medial head of the gastrocnemius was performed 9 days after the injury. After fixation, valgus instability at full extension had disappeared. The knee was immobilized in a brace for 2 weeks postoperatively. One year postoperatively, the posterior drawer test was slightly positive; however, our patient was able to ambulate without pain and returned to sports without feeling instability in his knee. Conclusion: A rare case of avulsion fracture of the gastrocnemius muscle combined with multiple ligament injuries before closure of the growth plate is described. A satisfactory result was obtained by fixation of the avulsed bone fragments of the gastrocnemius muscle and medial collateral ligament. The authors believe that avulsion fracture of the medial head of the gastrocnemius muscle associated with posterior cruciate ligament injury should be repaired.

DOI： 10.1186/s13256-019-2325-z

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PubMed

Language：Japanese   Publisher：Molecular Carcinogenesis  

Undifferentiated pleomorphic sarcoma (UPS) is the second most common soft tissue sarcoma. For patients with unresectable or metastatic disease, chemotherapies are considered, but in many cases they are not curative. There is a need to identify specific molecular dysregulations that can be therapeutic targets. We focused on neurotensin receptor 1 (NTSR1), which belongs to the G-protein-coupled receptor. NTSR1 expression was upregulated in specimens from patients with UPS. Real-time polymerase chain reaction showed that expression of NTSR1 messenger RNA was 5- to 7-fold increased in UPS cells compared with myoblasts. Western blot showed a high expression of NTSR1 protein in UPS cell lines. Knockdown of NTSR1 prevented UPS cell proliferation and invasion. We confirmed that SR48692, an inhibitor of NTSR1, exhibited antitumor activities in UPS cells. The combination index showed that SR48692 and standard chemotherapeutic drugs prevented UPS cell proliferation synergistically. Mouse xenograft models showed that SR48692 inhibited extracellular signal-regulated kinase phosphorylation and enhanced the response to standard chemotherapeutic drugs. Inhibition of NTSR1 improved the effect of standard chemotherapeutic drugs for UPS. SR48692 may be a new drug for targeted UPS therapy.

DOI： 10.1002/mc.23111

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PubMed

Language：Japanese   Publisher：World Neurosurgery  

Background: Several authors have reported the occurrence of extraforaminal L5 nerve root compression between lumbosacral transitional vertebrae (LSTV) and sacral ala, but reports on a lesion caused by an intervertebral osteophyte on the ventral and contralateral side of a unilateral abnormality by LSTV are hardly available. Case Description: A 67-year-old woman presented with pain along the distribution of the L5 nerve root; straight leg raise test, femoral nerve stretch test, and Kemp test were positive on the left. Following plain radiographs, computerized tomography, magnetic resonance imaging, and selective nerve root block, an osteophyte bridging the L5 and S1 vertebral bodies in the ventral side was identified compressing the L5 nerve root. On account of resistance to conservative therapy and the delicate position of the lesion, surgical treatment was performed by an anterior decompression. Subsequently, the patient attained adequate relief from pain and could walk normally. Conclusion: We herein present a very rare case of extraforaminal L5 nerve root compression caused by an intervertebral osteophyte on the ventral and contralateral side of a unilateral abnormality by LSTV, which was managed by anterior decompression.

DOI： 10.1016/j.wneu.2019.04.104

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PubMed

Language：Japanese   Publisher：Oncology Reports  

Tranilast [N-(3′,4′-dimethoxycinnamoyl)-anthranilic acid], initially developed as an antiallergic drug, also exhibits a growth inhibitory effect on various types of cancer. Osteosarcoma is treated mainly with high-dose methotrexate, doxorubicin, cisplatin and ifosfamide; however, 20-30% of patients cannot be cured of metastatic disease. We investigated whether tranilast enhances the anticancer effects of chemotherapeutic drugs and analyzed its mechanism of action in osteosarcomas. Tranilast inhibited proliferation of HOS, 143B, U2OS and MG-63 osteosarcoma cells in a dose-dependent manner, as well as enhancing the effects of cisplatin and doxorubicin. The average combination index at effect levels for tranilast in combination with cisplatin was 0.57 in HOS, 0.4 in 143B, 0.39 in U2OS and 0.51 in MG-63 cells. Tranilast and cisplatin synergistically inhibited the viability of osteosarcoma cells. In flow cytometric analysis, although tranilast alone did not induce significant apoptosis, the combination of tranilast and cisplatin induced early and late apoptotic cell death. Expression of cleaved caspase-3, cleaved poly(ADP-ribose) polymerase and p-H2AX was enhanced by tranilast in combination with cisplatin. Tranilast alone increased expression of p21 and Bim protein in a dose-dependent manner. Cell cycle analysis using flow cytometry demonstrated that the combination of tranilast and cisplatin increased the number of cells in the G2/M phase. Compared with cisplatin alone, the combination increased levels of phospho-cyclin-dependent kinase 1 (Y15). In the 143B xenograft model, tumor growth was significantly inhibited by combined tranilast and cisplatin compared with the controls, whereas cisplatin alone did not significantly inhibit tumor growth. In conclusion, tranilast has a cytostatic effect on osteosarcoma cells and enhances the effect of anticancer drugs, especially cisplatin. Enhanced sensitivity to cisplatin was mediated by increased apoptosis through G2/M arrest. Since tranilast has been clinically approved and has few adverse effects, clinical trials of osteosarcoma chemotherapy in combination with tranilast are expected.

DOI： 10.3892/or.2019.7150

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PubMed

Language：Japanese   Publisher：Oncology Reports  

The treatment of glioblastoma is a critical health issue, owing to its resistance to chemotherapy. The current standard of treatment is surgical resection, followed by adju-vant radiotherapy and temozolomide treatment. Long-term local treatment of glioblastoma is rarely achieved and the majority of the patients undergo relapse. Resistance to temozolomide emerges from numerous signalling pathways that are altered in glioblastoma, including the Hedgehog signalling pathway. Hence, further research is required to identify effective treatment modalities. We investigated the effect of vismodegib, arsenic trioxide and temozolomide on glioblastoma in vitro and in vivo to apply our findings to the clinical setting. WST-1 assay revealed that glioblastoma proliferation was inhibited following treatment with these drugs either in single or in combination; this synergistic effect was confirmed by CalcuSyn software. Western blot analysis revealed an increase in the expression of cleaved caspase-3 and γH2AX. Furthermore, there was marked inhibition and decreased tumour growth in mice that received combination therapy, unlike those that received single agent or vehicle treatment. Our results revealed that the combination of arsenic trioxide/vismodegib and temozolomide may be an attractive therapeutic method for the treatment of glioblastoma.

DOI： 10.3892/or.2019.7100

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PubMed

Language：Japanese   Publisher：Journal of Bone and Mineral Metabolism  

Recently, we reported highly active transforming growth factor (TGF)-β and bone morphogenetic protein (BMP) signaling in human chondrosarcoma samples and concurrent downregulation of paternally expressed gene 10 (PEG10). PEG10 expression was suppressed by TGF-β signaling, and PEG10 interfered with the TGF-β and BMP-SMAD pathways in chondrosarcoma cells. However, the roles of PEG10 in bone tumors, including chondrosarcoma, remain unknown. Here, we report that PEG10 promotes SW1353 chondrosarcoma cell growth by preventing TGF-β1-mediated suppression. In contrast, PEG10 knockdown augments the TGF-β1-induced motility of SW1353 cells. Individually, TGF-β1 and PEG10 siRNA increase AKT phosphorylation, whereas an AKT inhibitor, MK2206, mitigates the effect of PEG10 silencing on cell migration. SW1353 cell invasion was enhanced by BMP-6, which was further increased by PEG10 silencing. The effect of siPEG10 was suppressed by inhibitors of matrix metalloproteinase (MMP). BMP-6 induced expression of MMP-1, -3, and -13, and PEG10 lentivirus or PEG10 siRNA downregulated or further upregulated these MMPs, respectively. PEG10 siRNA increased BMP-6-induced phosphorylation of p38 MAPK and AKT, whereas the p38 inhibitor SB203580 and MK2206 diminished SW1353 cell invasion by PEG10 siRNA. SB203580 and MK2206 impeded the enhancing effect of PEG10 siRNA on the BMP-6-induced expression of MMP-1, -3, and -13. Our findings suggest dual functions for PEG10: accelerating cell growth by suppressing TGF-β signaling and inhibiting cell motility and invasion by interfering with TGF-β and BMP signaling via the AKT and p38 pathways, respectively. Thus, PEG10 might be a molecular target for suppressing the aggressive phenotypes of chondrosarcoma cells.

DOI： 10.1007/s00774-018-0946-8

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PubMed

Language：Japanese   Publisher：Spine  

Study Design.Retrospective case control study.Objective.To investigate whether cervical alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis (DISH).Summary of Background Data.DISH involves a wide range of ligamentous ossifications, which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.Methods.We reviewed five patients with advanced dysphagia due to anterior cervical hyperostosis who underwent resection (S group), and five patients with mild symptoms who were only monitored (NS group). The patients were evaluated using the Eating Assessment Tool-10 (EAT-10) and plain kinetic radiographs of the cervical spine. The O-C2 angle, M-C angle, C2-7 angle, and C2-6a angle were measured in the flexion, neutral, and extension positions. We compared these parameters in the S group versus the NS group, and compared the pre-and postoperative values in the S group.Results.The EAT-10 score indicated a high degree of dysphagia in the S group preoperatively (25 [22-27]) compared with the NS group (1 [1-6]). In the S group, the EAT-10 score significantly decreased postoperatively to 1 (0-1), and improvement of dysphagia was observed. There was a significant difference between the S and NS groups in the ΔC2-7 and ΔC2-6a, and between pre-and postoperative values in the S group. There were no significant changes in O-C2 angle and M-C angle, which are parameters of the superior cervical vertebrae.Conclusion.The present results suggest that the restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.Level of Evidence: 4.

DOI： 10.1097/BRS.0000000000002836

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PubMed

Language：Japanese   Publisher：Molecular Carcinogenesis  

Undifferentiated pleomorphic sarcoma (UPS) is the second most frequent soft tissue sarcoma. Because of its resistance to chemotherapy, UPS patients are treated with surgical resection and complementary radiotherapy. However, since standard chemotherapy has not been established, unresectable or metastatic cases result in a poor prognosis. Therefore, the identification of a more effective therapy for UPS patients is needed. The development and progression of malignant tumors involve epigenetic alterations, and histone deacetylases (HDAC) have become a promising chemotherapeutic target. In this study, we investigated the potential effects and mechanisms of an HDAC inhibitor, LBH589, in UPS cells. We confirmed that LBH589 exhibits potent antitumor activities in four human UPS cell lines (GBS-1, TNMY-1, Nara-F, and Nara-H) and IC50 values ranged from 7 to 13 nM. A mouse xenograft model showed that LBH589 treatment effectively suppressed tumor growth. FACS analysis showed that LBH589 induced apoptosis and G2/M cell cycle arrest. Among apoptosis-related proteins, the expressions of Bcl-2 and Bcl-xL were decreased and the expression of Bak and Bim increased. Among cell cycle-related proteins, reductions of CDK1, p-CDK1, cyclin B1, Aurora A, and Aurora B were observed after LBH589 treatment. RNA microarray identified the FOS-like antigen 1 (FOSL1) gene as a downregulated gene in response to LBH589 in UPS cells. While knockdown of FOSL1 decreased UPS cell proliferation, overexpression induced cell proliferation. Our results show that LBH589 could be a promising chemotherapeutic agent in the treatment of UPS and downregulation of the FOSL1 gene could be the new molecular target of UPS treatment.

DOI： 10.1002/mc.22922

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PubMed

Language：Japanese   Publisher：Journal of Orthopaedic Surgery  

Purpose: The aim of this study was to investigate the histopathological changes in the humeral head in cuff tear arthropathy (CTA) compared with those in glenohumeral osteoarthritis (OA) and humeral neck fracture, which served as non-cuff tear controls. Methods: Twenty-three humeral heads extracted at the time of shoulder prosthesis arthroplasty between June 2014 and July 2015 were evaluated in the present study. The diagnoses included four-part humeral neck fracture (n = 4; average age, 85.0 years), glenohumeral OA (n = 4; average age, 71.0 years), and CTA (n = 15; average age, 73.0 years). The humeral heads were evaluated pathologically by hematoxylin and eosin and Safranin-O staining, and the thickness of the articular cartilage was measured. Results: Fibrillation, thinning, and tearing of the cartilage were observed in the superior area of the humeral heads in CTA and glenohumeral OA. In CTA cases, clusters of chondrocytes in the cartilage were observed. Moreover, the thickness of the cartilage layer in the middle of the humeral head was 1.54 ± 0.07, 0.32 ± 0.46, and 2.19 ± 0.50 mm in humeral neck fracture, glenohumeral OA, and CTA, respectively. The cartilage layer in CTA was thicker than that in glenohumeral OA (CTA vs. OA: p < 0.05). Conclusion: OA changes in the superior area of the humeral heads and thickening of the cartilage layer from the middle to the inferior of the humeral heads were confirmed histopathologically, suggesting that simultaneous mechanical and nutritional factors might be contributing to CTA pathogenesis. The current study provided the better understanding of cartilage damage and thickening in CTA. This will help guide treatment options in the setting of CTA.

DOI： 10.1177/2309499018816428

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PubMed

Language：Japanese   Publisher：Nutrients  

Malignant soft-tissue sarcoma resection is associated with a relatively high incidence of surgical site infection (SSI). The known risk factors for SSI following soft-tissue sarcoma resection include tumor size and location, prolonged surgery, and massive blood loss. The geriatric nutritional risk index (GNRI) was used as a tool to help predict the occurrence of SSI after major surgery. We investigated the utility of the GNRI as a predictor of SSI following soft-tissue sarcoma resection. We retrospectively reviewed 152 patients who underwent surgical resection of soft-tissue sarcoma in our institute, and found that the incidence of SSI was 18.4% (28/152). The SSI and non-SSI groups significantly differed regarding surgical time, diameter of the skin incision, maximum tumor diameter, instrumentation, presence of an open wound, preoperative chemotherapy, preoperative C-reactive protein concentration, and GNRI. Binomial logistic regression analysis showed that the risk factors for SSI following soft-tissue sarcoma surgery were male sex, larger skin incision diameter, larger maximum tumor diameter, presence of an open wound, and lower GNRI. Our findings indicate that malnutrition is a risk factor for SSI after soft-tissue sarcoma resection, and suggest that appropriate assessment and intervention for malnutrition may reduce the incidence of SSI.

DOI： 10.3390/nu10121900

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PubMed

Language：Japanese   Publisher：Molecular Medicine Reports  

Sepsis-associated encephalopathy (SAE) is a systemic inflammatory response syndrome of which the precise associated mechanisms remain unclear. Synoviolin (Syvn1) is an E3 ubiquitin ligase involved in conditions associated with chronic inflammation, including rheumatoid arthritis, obesity, fibrosis and liver cirrhosis. However, the role of Syvn1 in acute inflammation is not clear. The aim of the present study was to investigate the role of Syvn1 in a septic mouse model induced by cecal ligation/perforation (CLP). Metabolome analysis revealed that kynurenine (KYN), a key factor for the development of neuroinflammation, was increased in CLP-induced septic mice. Notably, KYN was not detected in CLP-induced septic Syvn1-deficient mice. KYN is converted to kynurenic acid (KYNA) by kynurenine aminotransferases (KATs), which has a neuroprotective effect. The expression of KAT4 was significantly increased in Syvn1-deficient mice compared to that in wild-type mice. Promoter analysis demonstrated that Syvn1 knockdown induced the KAT4 promoter activity, as assessed by luciferase reporter activity, whereas Syvn1 overexpression repressed this activity in a dose-dependent manner. Furthermore, the KAT4 promoter was significantly activated by the transcriptional factors, NF-E2-related factor 2 and peroxisome proliferator-activated receptor coactivator 1ß, which are targets of Syvn1-induced degradation. In conclusion, the results of the current study demonstrates that the repression of Syvn1 expression induces the conversion of neurotoxic KYN to neuroprotective KYNA in a CLP-induced mouse model of sepsis, and that Syvn1 is a potential novel target for the treatment of SAE.

DOI： 10.3892/mmr.2018.9175

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PubMed

Language：Japanese   Publisher：Scientific Reports  

Although various surgical procedures have been developed for chronic rotator cuff tear repair, the re-tear rate remains high with severe fat infiltration. However, little is known about the molecular regulation of this process. Mesenchymal stem cells (MSCs) in the intra-muscular space are origin of ectopic fat cells in skeletal muscle. We have previously shown that high-mobility group box 2 (HMGB2), which is a nuclear protein commonly associated with mesenchymal differentiation, is involved in the early articular cartilage degeneration. In this study, we addressed the role of HMGB2 in adipogenesis of MSCs and fat infiltration into skeletal muscles. HMGB2 was highly expressed in undifferentiated MSCs and co-localized with platelet-derived growth factor receptor α (PDGFRA) known as an MSC-specific marker, while their expressions were decreased during adipocytic differentiation. Under the deficiency of HMGB2, the expressions of adipogenesis-related molecules were reduced, and adipogenic differentiation is substantially impaired in MSCs. Moreover, HMGB2+ cells were generated in the muscle belly of rat supraspinatus muscles after rotator cuff transection, and some of these cells expressed PDGFRA in intra-muscular spaces. Thus, our findings suggest that the enhance expression of HMGB2 induces the adipogenesis of MSCs and the fat infiltration into skeletal muscles through the cascade of HMGB2-PDGFRA.

DOI： 10.1038/s41598-018-28023-7

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PubMed

Language：Japanese   Publisher：Nutrients  

Predicting outcomes in patients with soft tissue sarcoma (STS) is challenging. To improve these predictions, we retrospectively analyzed common nutritional assessment systems, including Glasgow prognostic score (GPS), Geriatric Nutritional Risk Index (GNRI), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and controlling nutritional (CONUT) score against outcomes in 103 patients with STS, of whom 15 (14.6%) died within 1 year of diagnosis. GPS, GNRI, NLR, PLR, and CONUT scores significantly differed between patients who died within one year and patients who lived longer. Binomial logistic regression analysis showed that male sex, older age at diagnosis, higher GPS, higher stage, and unresectable STS were risk factors for death within a year of diagnosis. Overall survival was evaluated by Cox proportional hazards models, which correlated higher NLR, higher PLR, larger maximum diameter of tumor, higher stage, and unresectable STS with poor prognosis. We next examined prognostic factors in the 93 patients with resectable STS, and found male sex, higher GPS, and higher stage were correlated with poor prognosis in these patients. Our findings suggest that GPS, NLR, and PLR are simple predictors of outcome in patients with STS. Nutritional therapies might improve their GPS and prognosis.

DOI： 10.3390/nu10060765

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PubMed

Language：Japanese   Publisher：Journal of Shoulder and Elbow Surgery  

Background Failure rates after rotator cuff repair remain high in patients with massive tears. Although superior translation of the humeral head has been used to assess the severity of rotator cuff tears, the relevance of anterior migration of the humeral head to clinical outcomes has not been established. The purpose of this study was to investigate the potential role of the T-scale, a measure of the anterolateral translation of the humeral head, as a prognostic factor for rotator cuff repair. Methods One hundred twenty consecutive patients with full-thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale and acromiohumeral interval (AHI) were measured preoperatively on axial computed tomography scans and radiographs, respectively. The correlations of the T-scale and AHI with previously published scores and active forward elevation (FE) were investigated. The outcome of rotator cuff repairs was compared between patients with positive and patients with negative preoperative T-scale values. Results The preoperative T-scale but not AHI correlated significantly with postoperative FE and clinical scores in patients with large to massive tears but not in those with small to medium tears. Postoperative FE and clinical scores were significantly higher in patients with positive T-scale values than in those with negative T-scale values. The relative risk of retear was 2.0 to 7.9 times greater in patients with negative T-scale values. Conclusion Patients with large to massive tears and negative T-scale values had poorer clinical outcomes and higher retear rates. A negative T-scale value represents a useful prognostic factor for considering reverse shoulder arthroplasty in patients at greater risk of retear after rotator cuff repair.

DOI： 10.1016/j.jse.2017.08.026

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PubMed

Language：Japanese   Publisher：Human Cell  

The high-mobility group box (HMGB) family includes four members: HMGB1, 2, 3 and 4. HMGB proteins have two functions. In the nucleus, HMGB proteins bind to DNA in a DNA structure-dependent but nucleotide sequence-independent manner to function in chromatin remodeling. Extracellularly, HMGB proteins function as alarmins, which are endogenous molecules released upon tissue damage to activate the immune system. HMGB1 acts as a late mediator of inflammation and contributes to prolonged and sustained systemic inflammation in subjects with rheumatoid arthritis. By contrast, Hmgb2−/− mice represent a relevant model of aging-related osteoarthritis (OA), which is associated with the suppression of HMGB2 expression in cartilage. Hmgb2 mutant mice not only develop early-onset OA but also exhibit a specific phenotype in the superficial zone (SZ) of articular cartilage. Given the similar expression and activation patterns of HMGB2 and β-catenin in articular cartilage, the loss of these pathways in the SZ of articular cartilage may lead to altered gene expression, cell death and OA-like pathogenesis. Moreover, HMGB2 regulates chondrocyte hypertrophy by mediating Runt-related transcription factor 2 expression and Wnt signaling. Therefore, one possible mechanism explaining the modulation of lymphoid enhancer binding factor 1 (LEF1)-dependent transactivation by HMGB2 is that a differential interaction between HMGB2 and nuclear factors affects the transcription of genes containing LEF1-responsive elements. The multiple functions of HMGB proteins reveal the complex roles of these proteins as innate and endogenous regulators of inflammation in joints and their cooperative roles in cartilage hypertrophy as well as in the maintenance of joint tissue homeostasis.

DOI： 10.1007/s13577-017-0182-x

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PubMed

Language：Japanese   Publisher：BMC Musculoskeletal Disorders  

Background: Although a loss of rotator cuff integrity leads to the superior migration of the humeral head, the parameters that characterize the anterolateral migration of the humeral head have not been established. The purpose of this study was to investigate the correlation between the translation of the humeral head scale (T-scale) and clinical outcomes of rotator cuff repair, as well as the correlation between the T-scale and radiologic parameters. Methods: One hundred thirty-five consecutive patients with full-Thickness rotator cuff tears underwent primary rotator cuff repair. The T-scale, which indicates the distance from the center of the humeral head to the lateral coracoacromial arch, was measured on axial computed tomography scans, and the acromiohumeral interval (AHI) was measured radiographically. The correlation of the two parameters with the clinical scores of the Japanese Orthopaedic Association and University of California-Los Angeles scores and active forward elevation (FE) were evaluated at the preoperative and postoperative stages, respectively. Results: The postoperative T-scale and AHI correlated well with the postoperative FE and clinical scores in the patients with large-massive tears but not in those patients with small-medium tears and preoperative large-massive tears. A significant correlation was observed between the postoperative T-scale and AHI. The T-scale was subject to cuff repair integrity. Conclusions: We demonstrated that the postoperative T-scale was well correlated with the clinical results and postoperative AHI after rotator cuff repair for large-massive tears, indicating that poor outcomes are associated with combined superior and anterolateral migration of the humeral head following retears.

DOI： 10.1186/s12891-017-1874-9

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PubMed

Language：Japanese   Publisher：BMC Musculoskeletal Disorders  

Background: ADAMTS (a disintegrin and metalloprotease with thrombospondin motifs) proteins play an important pathological role in matrix degeneration. Aggrecan degradation is a significant and critical event in early-stage osteoarthritis. To determine the effect of hemoglobin (Hb) on the ability of synovial tissues to produce ADAMTS family members, we examined the influence of Hb by synovial cells in an in vitro experimental system. Methods: Synovial tissues were obtained from five young patients with meniscal injury under arthroscopic surgery. Primary cultures of human knee synovial cells were treated with different doses of human Hb (0, 25, 50, 100 μg/ml). The culture media were collected 24 h after Hb-treatment. In the time-course studies, cells were treated with and without 100 μg/ml Hb, and culture media were taken at 6, 12, and 24 h. To identify the proteins responsible for aggrecanase activity, Western blot analysis using antibodies against human ADAMTS-5, -8, -9, and -10; enzyme-linked immunosorbent assay (ELISA); and gene expression for ADAMTS-5 and -9 were examined. Statistical comparisons between each group were performed using paired t-tests. Results: Western blot analysis revealed that Hb-treatment resulted in the expression of ADAMTS-5 and -9. Neither control group nor Hb-treated medium showed immunoreactivity against ADAMTS-8 or -10. In a dose-dependency study, the Hb-treated group showed significantly higher levels of ADAMTS-5 and -9 compared with the control (p < 0.05). There was no significant difference between 25, 50, and 100 μg/ml Hb-treated groups. In a time-course study, the ADAMTS-5 and -9 levels in the conditioned medium had significantly increased expression at 6, 12, and 24 h in the Hb-treated group (p < 0.05). Hb evoked significant expression of ADAMTS-9 mRNA at 12 and 24 h (p < 0.05). Conclusions: These findings indicate that Hb induces the expression of ADAMTS-5 and -9 by synovial cells at low doses, even at an acute phase, and suggests a possible role for Hb in cartilage damage after intra-articular hemorrhage. The results also suggest a new potential therapeutic target by inhibiting the activities of ADAMTS-5 and -9 to prevent cartilage damage after intra-articular hemorrhage.

DOI： 10.1186/s12891-017-1815-7

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PubMed

Language：Japanese   Publisher：Journal of Shoulder and Elbow Surgery  

Background Bone resorption around the femoral stem after total hip arthroplasty is a well-known phenomenon. However, only a few studies have evaluated bone resorption after shoulder arthroplasty. This study investigated the prevalence of humeral bone resorption after different shoulder arthroplasty procedures. Methods The study included 147 shoulders that underwent total shoulder arthroplasty (TSA) or humeral head replacement (HHR) with an uncemented humeral stem from November 2008 to May 2015 and were monitored for more than 1 year. The prevalence of humeral bone resorption and risk factors were investigated. Results The most advanced grade of bone resorption, grade 0, occurred in 21 shoulders (14.3%). Grade 1 bone resorption occurred in 10 (6.8%), grade 2 in 28 (19.0%), grade 3 in 61 (41.5%), and grade 4 in 27 (18.4%). High occurrence of bone absorption was observed in zones 1, 2, and 7. Grade 4 bone resorption did not occur in zones 3 and 5. HHR, on-growth type stem coating, and occupation ratio were significant independent risk factors for grade ≥3 bone resorption, whereas female sex and HHR were significant independent risk factors for grade 4. Conclusion Bone resorption was observed in 126 shoulders (85.7%), and full-thickness cortical bone resorption occurred in 27 shoulders (18.4%). Bone resorption was frequently observed at the greater tuberosity, lateral diaphysis, and calcar region (zones 1, 2, and 7). Significant risk factors included female sex, HHR with rotator cuff reconstruction, on-growth type stem coating, and high occupation ratio of the implant.

DOI： 10.1016/j.jse.2017.04.012

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PubMed

Language：Japanese   Publisher：Arthritis and Rheumatology  

Objective: The EFEMP1 gene encoding fibulin 3 is specifically expressed in the superficial zone (SZ) of articular cartilage. The aims of this study were to examine the expression patterns of fibulin 3 in the knee joints during aging and during osteoarthritis (OA) and to determine the role of fibulin 3 in the pathogenesis of OA. Methods: Immunohistochemical analysis was performed on normal and OA knee cartilage samples from humans and mice. Experimental OA was induced in wild-type and fibulin 3−/− mice, and the severity of OA was evaluated by histologic scoring. To examine fibulin 3 function, human chondrocyte monolayer cultures were transfected with small interfering RNA (siRNA), followed by quantitative polymerase chain reaction and Western blot analyses. Human bone marrow–derived mesenchymal stem cells (BM-MSCs) were transduced with an EFEMP1 lentivirus and analyzed for markers of chondrogenesis. Results: Fibulin 3 was specifically expressed in the SZ of normal knee joint cartilage from humans and mice, and the expression levels declined with aging. Both aging-related OA and experimental OA were significantly more severe in fibulin 3−/− mice compared with wild-type mice. Fibulin 3 expression was high in undifferentiated human BM-MSCs and decreased during chondrogenesis. Suppression of fibulin 3 by siRNA significantly increased the expression of SOX9, type II collagen, and aggrecan in human articular chondrocytes, while overexpression of fibulin 3 inhibited chondrogenesis in BM-MSCs. Conclusion: Fibulin 3 is specifically expressed in the SZ of articular cartilage and its expression is reduced in aging and OA. Fibulin 3 regulates differentiation of adult progenitor cells, and its aging-related decline is an early event in the pathogenesis of OA. Preventing aging-associated loss of fibulin 3 or restoring it to normal levels in SZ chondrocytes has the potential to delay or prevent the onset of OA.

DOI： 10.1002/art.39963

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PubMed

Language：Japanese   Publisher：Public Health  

Objectives To clarify the frequency of musculoskeletal problems in public elementary and junior high school children and to determine the advantages and problems of musculoskeletal examinations. Study design School-based cross-sectional study nested in a cohort. Methods We examined 41,376 public elementary and junior high school children (aged 6–15 years) in Miyazaki, Japan, from 2008 to 2014. Participation was voluntary. Participants received an in-school primary musculoskeletal examination (clinical examination with check items and a questionnaire) and a secondary examination at an orthopaedic outpatient clinic as indicated. Estimated prevalence rates for musculoskeletal problems were calculated from the results of both examinations. Results The total estimated prevalence of musculoskeletal problems was 8.6%. Prevalence by school grade ranged from 3.2% to 13.7%. Estimated prevalence rates increased as grade increased and were higher in junior high school students than in elementary school students. The secondary examination identified musculoskeletal problems on the back (65.4%), knee (8.1%), ankle or feet (7.3%) and elbow (5.4%). Of those referred for a secondary examination, 44.4% had not reported musculoskeletal complaints on the initial questionnaire. Overall, 69.8% of problems diagnosed in the secondary examination were previously undiagnosed. Conclusions School-based musculoskeletal examination enables early detection of abnormal growth and disorders of the locomotive organs and is expected to support children's musculoskeletal growth and development. We recommend musculoskeletal examinations as part of school check-ups in Japan. Our findings suggest musculoskeletal examinations should be conducted for students in higher elementary school grades and for all junior high school students. Evaluation should include both direct clinical examination and questionnaires.

DOI： 10.1016/j.puhe.2016.08.010

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Language：Japanese   Publisher：Knee  

Background: To the best of our knowledge, there has been no detailed study on bone-patellar tendon-bone (BTB) grafts for remnant-preserving, selective-bundle anterior cruciate ligament (ACL) augmentation. Therefore, we aimed to develop such a technique using a BTB graft. Method: A total of five patients underwent surgery using the presented procedure. These patients were young, male, and with high body mass index, and hence required very high durability of reconstructed ACL. A femoral bone tunnel was created using the inside-out technique via an accessory far-medial portal, protecting the remnant using a probe, regardless of the presence of an anteromedial (AM) or posterolateral (PL) tunnel. A single tibial tunnel was drilled at the center of the AM or PL attachment and two transverse skin incisions were made in the ipsilateral knee. The central third of the patellar tendon attached to a patellar and tibial bone plug autograft with a width of seven millimeters was harvested by subcutaneous tunneling. The femoral side was fixed using a cortical fixation device for BTB and the tibial bone plug was fixed using an interference screw with the knee at an angle of 20° of flexion by applying maximal manual traction. Results: Bone tunnel enlargement, which was measured by computed digital radiography, was not observed in all cases. A BTB autograft for remnant-preserving, selective-bundle ACL augmentation offers reduced risk of tunnel enlargement. Conclusion: The presented procedure might be considered one of the potentially available options for patients with ACL partial tear who require very high durability of reconstructed ACL. Level of evidence: 5.

DOI： 10.1016/j.knee.2015.11.024

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PubMed

Language：Japanese   Publisher：Journal of Shoulder and Elbow Surgery  

Background: Bone marrow stimulation (BMS) at the footprint of arthroscopic rotator cuff repair has not been fully evaluated according to the preoperative tear size and surgical technique. In this study, we investigated the effect of BMS on cuff repair integrity after an arthroscopic surface-holding (ASH) repair. Materials and methods: A total of 111 patients (mean age, 64.5years) with chronic rotator cuff tears who underwent treatment by the ASH method with BMS by drilling of multiple holes at the footprint (67 shoulders) or without BMS (44 shoulders) were studied, and all patients were observed prospectively. Sugaya's classification was used to evaluate cuff integrity by postoperative magnetic resonance imaging, with types IV and V classified as rotator cuff retears. Results: The mean scores for cuff integrity were 2.2±0.2 and 1.7±0.2 in the non-BMS and BMS groups, respectively. The mean scores were similar between the 2 groups for medium tears; however, scores for large-massive tears were significantly lower in the BMS group. The overall retear rate was 23.9% in the non-BMS group and 9.1% in the BMS group, and the distribution of repair types differed significantly. For large-massive tears, the retear rate was much higher in the non-BMS group (28.6%) than in the BMS group (4.5%), although the rates for medium tears were comparable between the 2 groups. Conclusions: These findings demonstrate that applying BMS to the footprint during ASH repair results in improved cuff repair integrity, particularly in large-massive tears, and suggest the importance of biologic treatment for rotator cuff healing after arthroscopic rotator cuff repair.

DOI： 10.1016/j.jse.2014.09.031

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PubMed

Language：Japanese   Publisher：Knee Surgery, Sports Traumatology, Arthroscopy  

A case of pseudoaneurysm that is a rare complication of shoulder arthroscopy is reported. A 73-year-old man with rotator cuff tear underwent arthroscopic rotator cuff repair. On post-operative day 3, a pulsating mass (diameter 5 mm) was detected near the anterior portal. Then, the mass gradually enlarged, which was diagnosed as pseudoaneurysm. After the consultation with vascular surgeons, the mass was surgically excised following ligation of feeding artery 6 weeks after the arthroscopic surgery. Thus far, no recurrence has been observed.

DOI： 10.1007/s00167-014-2956-y

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PubMed

Language：Japanese   Publisher：Journal of Orthopaedic Science  

Background: Although cadaveric studies have revealed suprascapular notch shape variations, few have investigated the association between suprascapular notch variation and age or gender. The purpose of this study was to investigate suprascapular notch shape variations by use of three-dimensional computed tomography (3DCT) and to determine if there was any association with age or gender.

DOI： 10.1007/s00776-014-0636-x

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PubMed

DOI： 10.4236/ojo.2014.410043

Language：Japanese   Publisher：Journal of Shoulder and Elbow Surgery  

Background: Arthroscopic rotator cuff repair provides satisfactory results; however, there is still a high rate of re-tear. The objective of this study was to present a surface-holding technique that we recently developed for arthroscopic rotator cuff repair in detail and to evaluate the clinical outcome as well as cuff repair integrity with this new method. Materials and methods: A consecutive series of 116 patients with full-thickness rotator cuff tears underwent arthroscopic surface-holding repair and were monitored with the Japanese Orthopaedic Association, Constant-Murley, and University of California-Los Angeles scores to assess the clinical outcome. The mean follow-up period was 17.9months (range, 12-40months). Cuff repair integrity was evaluated by magnetic resonance imaging. Results: All 3 rating systems at the time of final follow-up reflected a significant improvement in functional recovery of the shoulder compared with the preoperative scores. The overall rate of rotator cuff retear was 19.0% (22 of 116 shoulders), and the rates were 13.6% (9 of 66 shoulders) for small and medium-sized tears and 26% (13 of 50 shoulders) for large and massive tears. The rate for large and massive tears was much higher in patients older than 70years (58.3%) compared with those younger than 70years (36.3%), whereas the retear rates were similar in these 2 groups (22.2% and 17.5%, respectively). Conclusions: Arthroscopic surface-holding repair technique with medial suture and transosseous fixation improved rotator cuff healing. This method may be useful both for young patients and for elderly patients, who frequently have chronic large and massive tears, including osteoporotic bones. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.

DOI： 10.1016/j.jse.2014.01.007

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PubMed

Language：Japanese   Publisher：Tissue Engineering - Part A  

Interaction between chondrocytes and the cartilage extracellular matrix (ECM) is essential for maintaining the cartilage's role as a low-friction and load-bearing tissue. In this study, we examined the influence of cartilage zone-specific ECM on human articular chondrocytes (HAC) in two-dimensional and three-dimensional (3D) environments. Two culture systems were used. SYSTEM 1: HAC were cultured on cell-culture plates that had been precoated with the following ECM molecules for 7 days: decorin, biglycan, tenascin C (superficial zone), collagen type II, hyaluronan (HA) (middle and deep zones), and osteopontin (deep zone). Uncoated standard culture plates were used as controls. Expanded cells were examined for phenotypic changes using real-time polymerase chain reaction. In addition, expanded cells were placed into high-density pellet cultures for 14 days. Neocartilage formation was assessed via gene expression and histology evaluations. SYSTEM 2: HAC that were cultured on untreated plates and encapsulated in a 3D alginate scaffold were mixed with one of the zone-specific ECM molecules. Cell viability, gene expression, and histology assessments were conducted on 14-day-old tissues. In HAC monolayer culture, exposure to decorin, HA, and osteopontin increased COL2A1 and aggrecan messenger RNA (mRNA) levels compared with controls. Biglycan up-regulated aggrecan without a significant impact on COL2A1 expression; Tenascin C reduced COL2A1 expression. Neocartilage formed after preculture on tenascin C and collagen type II expressed higher COL2A1 mRNA compared with control pellets. Preculture of HAC on HA decreased both COL2A1 and aggrecan expression levels compared with controls, which was consistent with histology. Reduced proteoglycan 4 (PRG4) mRNA levels were observed in HAC pellets that had been precultured with biglycan and collagen type II. Exposing HAC to HA directly in 3D-alginate culture most effectively induced neocartilage formation, showing increased COL2A1 and aggrecan, and reduced COL1A1 compared with controls. Decorin treatments increased HAC COL2A1 mRNA levels. These data indicate that an appropriate exposure to cartilage-specific ECM proteins could be used to enhance cartilage formation and to even induce the formation of zone-specific phenotypes to improve cartilage regeneration. © Copyright 2014, Mary Ann Liebert, Inc.

DOI： 10.1089/ten.TEA.2012.0618

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PubMed

Language：Japanese   Publisher：Journal of Shoulder and Elbow Surgery  

DOI： 10.1016/j.jse.2012.10.019

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Language：Japanese   Publisher：Arthritis and Rheumatism  

Objective Long bones develop through the strictly regulated process of endochondral ossification within the growth plate, resulting in the replacement of cartilage by bone. Defects in this process can result in skeletal abnormalities and a predisposition to degenerative joint diseases such as osteoarthritis (OA). Studies suggest that activation of the transcription factor peroxisome proliferator-activated receptor γ (PPARγ) is an important therapeutic target in OA. To devise PPARγ-related therapies in OA, it is critical to identify the role of this transcription factor in cartilage biology. Therefore, this study sought to determine the in vivo role of PPARγ in endochondral ossification and cartilage development, using cartilage-specific PPARγ-knockout (KO) mice. Methods Cartilage-specific PPARγ-KO mice were generated using the Cre/loxP system. Histomorphometric and immunohistochemical analyses were performed to assess the patterns of ossification, proliferation, differentiation, and hypertrophy of chondrocytes, skeletal organization, bone density, and calcium deposition in the KO mice. Results PPARγ-KO mice exhibited reductions in body length, body weight, length of the long bones, skeletal growth, cellularity, bone density, calcium deposition, and trabecular bone thickness, abnormal organization of the growth plate, loss of columnar organization, shorter hypertrophic zones, and delayed primary and secondary ossification. Immunohistochemical analyses for Sox9, 5-bromo-2'-deoxyuridine, p57, type X collagen, and platelet endothelial cell adhesion molecule 1 revealed reductions in the differentiation, proliferation, and hypertrophy of chondrocytes and in vascularization of the growth plate in mutant mice. Isolated chondrocytes and cartilage explants from mutant mice showed aberrant expression of Sox9 and extracellular matrix markers, including aggrecan, type II collagen, and matrix metalloproteinase 13. In addition, chondrocytes from mutant mice exhibited enhanced phosphorylation of p38 and decreased expression of Indian hedgehog. Conclusion The presence of PPARγ is required for normal endochondral ossification and cartilage development in vivo. Copyright © 2012 by the American College of Rheumatology.

DOI： 10.1002/art.33490

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Language：Japanese   Publisher：Annals of the Rheumatic Diseases  

Objectives: Osteoarthritis is associated with cell death and extracellular matrix degradation in articular cartilage. Autophagy is an essential cellular homeostasis mechanism that was found to be deficient in ageing and osteoarthritic cartilage. This study determined whether pharmacological inhibition of the mammalian target of rapamycin (mTOR), a key inhibitor of autophagy, has disease-modifying activity in experimental osteoarthritis. Methods: Experimental osteoarthritis was induced by transection of the medial meniscotibial ligament and the medial collateral ligament in 2-month-old C57Bl/6 mice (n=36). Rapamycin (1 mg/kg weight/day) (n=18 mice) or dimethyl sulphoxide vehicle control (n=18 mice) was administered intraperitoneally for 10 weeks. Histopathological changes in articular cartilage and synovium were examined by using semiquantitative scoring systems. Rapamycin effects on mTOR signalling, autophagy, cartilage homeostasis and inflammation were analysed by immunohistochemistry and immunofluorescence staining. Results: Rapamycin affected the mTOR signalling pathway in mouse knee joints as indicated by the inhibition of ribosomal protein S6 phosphorylation, a target of mTOR and activation of LC3, a main marker of autophagy. The severity of cartilage degradation was significantly (p<0.01) reduced in the rapamycin-treated group compared with the control group and this was associated with a significant (p<0.05) decrease in synovitis. Rapamycin treatment also maintained cartilage cellularity and decreased ADAMTS-5 and interleukin-1βexpression in articular cartilage. Conclusions: These results suggest that rapamycin, at least in part by autophagy activation, reduces the severity of experimental osteoarthritis. Pharmacological activation of autophagy may be an effective therapeutic approach for osteoarthritis.

DOI： 10.1136/annrheumdis-2011-200557

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PubMed

Language：Japanese   Publisher：Arthritis and rheumatism  

Mechanical injury induces cell death in cartilage and triggers a remodeling process that ultimately can manifest as osteoarthritis. Autophagy is a process for turnover of intracellular organelles and macromolecules that protects cells during stress responses. This study was undertaken to determine changes in and functions of autophagy following mechanical injury to cartilage. Bovine and human cartilage explants were subjected to mechanical impact (40% strain for 500 msec). Cell viability, sulfated glycosaminoglycan (sGAG) release, and changes in the levels of the autophagy markers ULK1, beclin 1, and microtubule-associated protein 1 light chain 3 (LC3) were evaluated. Cartilage explants were treated with the mammalian target of rapamycin complex 1 (mTORC-1) inhibitor and the autophagy inducer rapamycin and tested for protective effects against mechanical injury. Explants were also treated with the cell death inducers nitric oxide and tumor necrosis factor α (TNFα) plus actinomycin D, and the proinflammatory cytokine interleukin-1α (IL-1α). Mechanical injury induced cell death and loss of sGAG in a time-dependent manner. This was associated with significantly decreased ULK1, beclin 1, and LC3 expression in the cartilage superficial zone (P < 0.05) 48 hours after injury. The levels of LC3-II were increased 24 hours after injury but decreased at 48 and 96 hours. Rapamycin enhanced expression of autophagy regulators and prevented cell death and sGAG loss in mechanically injured explants. Rapamycin also protected against cell death induced by sodium nitroprusside and TNFα plus actinomycin D and prevented sGAG loss induced by IL-1α. Our findings indicate that mechanical injury leads to suppression of autophagy, predominantly in the superficial zone where most of the cell death occurs. Pharmacologic inhibition of mTORC-1, at least in part by enhancement of autophagy, prevents cell and matrix damage, suggesting a novel approach for chondroprotection. Copyright © 2012 by the American College of Rheumatology.

DOI： 10.1002/art.33444

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PubMed

Language：Japanese   Publisher：Journal of Biological Chemistry  

The superficial zone (SZ) of articular cartilage is critical in maintaining tissue function and homeostasis and represents the site of the earliest changes in osteoarthritis (OA). The expression of chromatin protein HMGB2 is restricted to the SZ, which contains cells expressing mesenchymal stem cell (MSC) markers. Age-related loss of HMGB2 and gene deletion are associated with reduced SZ cellularity and early onset OA. This study addressed HMGB2 expression patterns in MSC and its role during differentiation. HMGB2 was detected at higher levels in human MSC as compared with human articular chondrocytes, and its expression declined during chondrogenic differentiation of MSC. Lentiviral HMGB2 transduction of MSC suppressed chondrogenesis as reflected by an inhibition of Col2a1 and Col10a1 expression. Conversely, in bone marrow MSC from Hmgb2 -/- mice, Col10a1 was more strongly expressed than in wild-type MSC. This is consistent with in vivo results from mouse growth plates showing that Hmgb2 is expressed in proliferating and prehypertrophic zones but not in hypertrophic cartilage where Col10a1 is strongly expressed. Osteogenesis was also accelerated in Hmgb2 -/- MSC. The expression of Runx2, which plays a major role in late stage chondrocyte differentiation, was enhanced in Hmgb2 -/- MSC, and HMGB2 negatively regulated the stimulatory effect of Wnt/β-catenin signaling on the Runx2 proximal promoter. These results demonstrate that HMGB2 expression is inversely correlated with the differentiation status of MSC and that HMGB2 suppresses chondrogenic differentiation. The age-related loss of HMGB2 in articular cartilage may represent a mechanism responsible for the decline in adult cartilage stem cell populations. © 2011 by The American Society for Biochemistry and Molecular Biology, Inc.

DOI： 10.1074/jbc.M111.236984

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Language：Japanese   Publisher：Developmental Dynamics  

The chromatin factors Hmgb1 and Hmgb2 have critical roles in cellular processes, including transcription and DNA modification. To identify the function of Hmgb genes in embryonic development, we generated double mutants of Hmgb1;Hmgb2 in mice. While double null embryos arrest at E9.5, Hmgb1-/-; Hmgb2+/- embryos exhibit a loss of digit5, the most posterior digit, in the forelimb. We show that Hmgb1-/-; Hmgb2+/- forelimbs have a reduced level of Shh signaling, as well as a clear downregulation of Wnt and BMP target genes in the posterior region. Moreover, we demonstrate that hmgb1 and hmgb2 in zebrafish embryos enhance Wnt signaling in a variety of tissues, and that double knockdown embryos have reduced Wnt signaling and shh expression in pectoral fin buds. Our data show that Hmgb1 and Hmgb2 function redundantly to enhance Wnt signaling in embryos, and further suggest that integrating Wnt, Shh, and BMP signaling regulates the development of digit5 in forelimbs. © 2011 Wiley-Liss, Inc.

DOI： 10.1002/dvdy.22598

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Language：Japanese   Publisher：Laboratory Investigation  

Granulomatous nephritis can be triggered by diverse factors and results in kidney failure. However, despite accumulating data about granulomatous inflammation, pathogenetic mechanisms in nephritis remain unclear. The DNA-binding highmobility group box-1 protein (HMGB1) initiates and propagates inflammation when released by activated macrophages, and functions as an ‘alarm cytokine’ signaling tissue damage. In this study, we showed elevated HMGB1 expression in renal granulomas in rats with crystal-induced granulomatous nephritis caused by feeding an adenine-rich diet. HMGB1 levels were also raised in urine and serum, as well as in monocyte chemoattractant protein-1 (MCP-1), a mediator of granulomatous inflammation. Injection of HMGB1 worsened renal function and upregulated MCP-1 in rats with crystalinduced granulomatous nephritis. HMGB1 also induced MCP-1 secretion through mitogen-activated protein kinase (MAPK) and phosphoinositide-3-kinase (PI3K) pathways in rat renal tubular epithelial cells in vitro. Hmgb1+/− mice with crystal-induced nephritis displayed reduced MCP-1 expression in the kidneys and in urine and the number of macrophages in the kidneys was significantly decreased. We conclude that HMGB1 is a new mediator involved in crystalinduced nephritis that amplifies granulomatous inflammation in a cycle where MCP-1 attracts activated macrophages, resulting in excessive and sustained HMGB1 release. HMGB1 could be a novel target for inhibiting chronic granulomatous diseases. © 2010 USCAP, Inc. All rights reserved.

DOI： 10.1038/labinvest.2010.64

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PubMed

Language：Japanese   Publisher：Arthritis and Rheumatism  

Objective. Autophagy is a process for turnover of intracellular organelles and molecules that protects cells during stress responses. We undertook this study to evaluate the potential roles of Unc-51-like kinase 1 (ULK1), an inducer of autophagy, Beclin1, a regulator of autophagy, and microtubule-associated protein 1 light chain 3 (LC3), which executes autophagy, in the development of osteoarthritis (OA) and in cartilage cell death. Methods. Expression of ULK1, Beclin1, and LC3 was analyzed in normal and OA human articular cartilage and in knee joints of mice with aging-related and surgically induced OA, using immunohistochemistry and Western blotting. Poly(ADP-ribose) polymerase (PARP) p85 expression was used to determine the correlation between cell death and autophagy. Results. ULK1, Beclin1, and LC3 were constitutively expressed in normal human articular cartilage. ULK1, Beclin1, and LC3 protein expression was reduced in OA chondrocytes and cartilage, but these 3 proteins were strongly expressed in the OA cell clusters. In mouse knee joints, loss of glycosaminoglycans (GAGs) was observed at ages 9 months and 12 months and in the surgical OA model, 8 weeks after knee destabilization. Expression of ULK1, Beclin1, and LC3 decreased together with GAG loss, while PARP p85 expression was increased. Conclusion. Autophagy may be a protective or homeostatic mechanism in normal cartilage. In contrast, human OA and aging-related and surgically induced OA in mice are associated with a reduction and loss of ULK1, Beclin1, and LC3 expression and a related increase in apoptosis. These results suggest that compromised autophagy represents a novel mechanism in the development of OA. © 2010, American College of Rheumatology.

DOI： 10.1002/art.27305

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PubMed

Language：Japanese   Publisher：Proceedings of the National Academy of Sciences of the United States of America  

The superficial zone (SZ) of articular cartilage is critical in maintaining tissue function and homeostasis and represents the site of the earliest changes in osteoarthritis. Mechanisms that regulate the unique phenotype of SZ chondrocytes and maintain SZ integrity are unknown. We recently demonstrated that expression of the chromatin protein high mobility group box (HMGB) protein 2 is restricted to the SZ in articular cartilage suggesting a transcriptional regulation involving HMGB2 in SZ. Here, we show that an interaction between HMGB2 and the Wnt/β-catenin pathway regulates the maintenance of the SZ.Wefound that the Wnt/β-catenin pathway is active specifically in the SZ in normal mouse knee joints and colocalizes with HMGB2. Both Wnt signaling and HMGB2 expression decrease with aging in mouse joints. Our molecular studies show that HMGB2 enhances the binding of Lef-1 to its target sequence and potentiates transcriptional activation of the Lef-1-β-catenin complex. The HMG domain within HMGB2 is crucial for interaction with Lef-1, suggesting that both HMGB2 and HMGB1 may be involved in this function. Furthermore, conditional deletion of β-catenin in cultured mouse chondrocytes induced apoptosis. These findings define a pathway where protein interactions of HMGB2 and Lef-1 enhance Wnt signaling and promote SZ chondrocyte survival. Loss of the HMGB2-Wnt signaling interaction is a new mechanism in aging-related cartilage pathology.

DOI： 10.1073/pnas.0904414106

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PubMed

Language：Japanese   Publisher：BMC Developmental Biology  

Background. Chondrogenesis and subsequent endochondral ossification are processes tightly regulated by the transcription factor Sox9 (SRY-related high mobility group-Box gene 9), but molecular mechanisms underlying this activity remain unclear. Here we report that coactivator-associated arginine methyltransferase 1 (CARM1) regulates chondrocyte proliferation via arginine methylation of Sox9. Results. CARM1-null mice display delayed endochondral ossification and decreased chondrocyte proliferation. Conversely, cartilage development of CARM1 transgenic mice was accelerated. CARM1 specifically methylates Sox9 at its HMG domain in vivo and in vitro. Arg-methylation of Sox9 by CARM1 disrupts interaction of Sox9 with beta-catenin, regulating Cyclin D1 expression and cell cycle progression of chondrocytes. Conclusion. These results establish a role for CARM1 as an important regulator of chondrocyte proliferation during embryogenesis. © 2009 Ito et al; licensee BioMed Central Ltd.

DOI： 10.1186/1471-213X-9-47

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PubMed

Language：Japanese   Publisher：Proceedings of the National Academy of Sciences of the United States of America  

Osteoarthritis (OA) is the most common joint disease and typically begins with an aging-related disruption of the articular cartilage surface. Mechanisms leading to the aging-related cartilage surface degeneration remain to be determined. Here, we demonstrate that nonhistone chromatin protein high-mobility group box (HMGB) protein 2 is uniquely expressed in the superficial zone (SZ) of human articular cartilage. In human and murine cartilage, there is an aging-related loss of HMGB2 expression, ultimately leading to its complete absence. Mice genetically deficient in HMGB2 (Hmgb2-/-) show earlier onset of and more severe OA. This is associated with a profound reduction in cartilage cellularity attributable to increased cell death. These cellular changes precede glycosaminoglycan depletion and progressive cartilage erosions. Chondrocytes from Hmgb2-/- mice are more susceptible to apoptosis induction in vitro. In conclusion, HMGB2 is a transcriptional regulator specifically expressed in the SZ of human articular cartilage and supports chondrocyte survival. Aging is associated with a loss of HMGB2 expression and reduced cellularity, and this contributes to the development of OA. © 2009 by The National Academy of Sciences of the USA.

DOI： 10.1073/pnas.0806062106

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PubMed

Language：Japanese   Publisher：Cardiovascular Pathology  

Background: C-reactive protein (CRP) is widely used as a sensitive biomarker for inflammation. Increasing evidence suggests that CRP plays a role in inflammation. High-mobility group box-1 (HMGB1), a primarily nuclear protein, is passively released into the extracellular milieu by necrotic or damaged cells and is actively secreted by monocytes/macrophages. Extracellular HMGB1 as a potent inflammatory mediator has stimulated immense curiosity in the field of inflammation research. However, the molecular dialogue implicated between CRP and HMGB1 in delayed inflammatory processes remains to be explored. Methods and results: The levels of HMGB1 in culture supernatants were determined by Western blot analysis and enzyme-linked immunosorbent assay in macrophage RAW264.7 cells. Purified CRP induced the release of HMGB1 in a dose- and time-dependent fashion. Immunofluorescence analysis revealed nuclear translocation of HMGB1 in response to CRP. The binding of CRP to the Fcγ receptor in RAW264.7 cells was confirmed by fluorescence-activated cell sorter analysis. Pretreatment of cells with IgG-Fc fragment, but not IgG-Fab fragment, efficiently blocked this binding. CRP triggered the activation of p38MAPK and ERK1/2, but not Jun N-terminal kinase. Moreover, both p38MAPK inhibitor SB203580 and small interfering RNA significantly suppressed the release of HMGB1, but not the MEK1/2 inhibitor U-0126. Conclusion: We demonstrated for the first time that CRP, a prominent risk marker for inflammation including atherosclerosis, could induce the active release of HMGB1 by RAW264.7 cells through Fcγ receptor/p38MAPK signaling pathways, thus implying that CRP plays a crucial role in the induction, amplification, and prolongation of inflammatory processes, including atherosclerotic lesions. © 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.carpath.2007.08.006

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Language：Japanese   Publisher：Arthritis Research and Therapy  

Introduction: Changes in sulfation of cartilage glycosaminoglycans as mediated by sulfatases can regulate growth factor signaling. The aim of this study was to analyze expression patterns of recently identified extracellular sulfatases Sulf-1 and Sulf-2 in articular cartilage and chondrocytes. Methods: Sulf-1 and Sulf-2 expressions in human articular cartilage from normal donors and patients with osteoarthritis (OA) and in normal and aged mouse joints were analyzed by real-time polymerase chain reaction, immunohistochemistry, and Western blotting. Results: In normal articular cartilage, Sulf-1 and Sulf-2 mRNAs and proteins were expressed predominantly in the superficial zone. OA cartilage showed significantly higher Sulf-1 and Sulf-2 mRNA expression as compared with normal human articular cartilage. Sulf protein expression in OA cartilage was prominent in the cell clusters. Western blotting revealed a profound increase in Sulf protein levels in human OA cartilage. In normal mouse joints, Sulf expression was similar to human cartilage, and with increasing age, there was a marked upregulation of Sulf. Conclusion: The results show low levels of Sulf expression, restricted to the superficial zone in normal articular cartilage. Sulf mRNA and protein levels are increased in aging and OA cartilage. This increased Sulf expression may change the sulfation patterns of heparan sulfate proteoglycans and growth factor activities and thus contribute to abnormal chondrocyte activation and cartilage degradation in OA. © 2008 Otsuki et al.; licensee BioMed Central Ltd.

DOI： 10.1186/ar2432

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Language：Japanese   Publisher：Molecular and Cellular Biology  

High mobility group box 1 protein (HMGB1) is a chromatin protein that has a dual function as a nuclear factor and as an extracellular factor. Extracellular HMGB1 released by damaged cells acts as a chemoattractant, as well as a proinflammatory cytokine, suggesting that HMGB1 is tightly connected to the process of tissue organization. However, the role of HMGB1 in bone and cartilage that undergo remodeling during embryogenesis, tissue repair, and disease is largely unknown. We show here that the stage-specific secretion of HMGB1 in cartilage regulates endochondral ossification. We analyzed the skeletal development of Hmgb1-/- mice during embryogenesis and found that endochondral ossification is significantly impaired due to the delay of cartilage invasion by osteoclasts, osteoblasts, and blood vessels. Immunohistochemical analysis revealed that HMGB1 protein accumulated in the cytosol of hypertrophic chondrocytes at growth plates, and its extracellular release from the chondrocytes was verified by organ culture. Furthermore, we demonstrated that the chondrocyte-secreted HMGB1 functions as a chemoattractant for osteoclasts and osteoblasts, as well as for endothelial cells, further supporting the conclusion that Hmgb1-/- mice are defective in cell invasion. Collectively, these findings suggest that HMGB1 released from differentiating chondrocytes acts, at least in part, as a regulator of endochondral ossification during osteogenesis. Copyright © 2007, American Society for Microbiology. All Rights Reserved.

DOI： 10.1128/MCB.00130-07

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DOI： 10.1016/j.mehy.2006.10.025

PubMed

Language：Japanese   Publisher：Journal of Biological Chemistry  

The growth arrest and DNA damage-inducible 45 β (GADD45β) gene product has been implicated in the stress response, cell cycle arrest, and apoptosis. Here we demonstrated the unexpected expression of GADD45β in the embryonic growth plate and uncovered its novel role as an essential mediator of matrix metalloproteinase-13 (MMP-13) expression during terminal chondrocyte differentiation. We identified GADD45β as a prominent early response gene induced by bone morphogenetic protein-2 (BMP-2) through a Smad1/Runx2-dependent pathway. Because this pathway is involved in skeletal development, we examined mouse embryonic growth plates, and we observed expression of Gadd45β mRNA coincident with Runx2 protein in pre-hypertrophic chondrocytes, whereas GADD45β protein was localized prominently in the nucleus in late stage hypertrophic chondrocytes where Mmp-13 mRNA was expressed. In Gadd45β-/- mouse embryos, defective mineralization and decreased bone growth accompanied deficient Mmp-13 and Col10a1 gene expression in the hypertrophic zone. Transduction of small interfering RNA-GADD45β in epiphyseal chondrocytes in vitro blocked terminal differentiation and the associated expression of Mmp-13 and Col10a1 mRNA in vitro. Finally, GADD45β stimulated MMP-13 promoter activity in chondrocytes through the JNK-mediated phosphorylation of JunD, partnered with Fra2, in synergy with Runx2. These observations indicated that GADD45β plays an essential role during chondrocyte terminal differentiation. © 2005 by The American Society for Biochemistry and Molecular Biology, Inc.

DOI： 10.1074/jbc.M504202200

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PubMed

Language：Japanese   Publisher：Journal of Biological Chemistry  

Chromatin structure is a fundamental component of gene regulation, expression, and cellular differentiation. We have previously reported that the multifunctional coactivator p300 is a member of the Sox9 (Sry-type high mobility group box 9)-related transcriptional apparatus and activates Sox9-dependent transcription during chondrogenesis. However, the mechanism of synergy between Sox9 and p300 in chromatin-mediated transcription has not been elucidated. In the present study we investigated the activity of Sox9 and p300 on chromatinized templates in vitro. Recombinant Sox9 was shown to be associated with several transcriptional cofactors including p300. In vitro transcription assays revealed that p300 potentiated Sox9-dependent transcription on chromatinized DNA and, importantly, was associated with hyperacetylated histones. Consistent with these results, the histone deacetylase inhibitor trichostatin A stimulated the expression of Sox9-regulated cartilage matrix genes and induced histone acetylation around the enhancer region of the collagen α1 (II) gene in chondrocytes. These findings suggest that Sox9 interacts with chromatin and activates transcription via regulation of chromatin modification. © 2005 by The American Society for Biochemistry and Molecular Biology, Inc.

DOI： 10.1074/jbc.M502409200

Scopus

PubMed

Language：Japanese   Publisher：Annals of the Rheumatic Diseases  

Objectives: To define the pathogenesis of pigmented villonodular synovitis (PVNS), by searching for highly expressed genes in primary synovial cells from patients with PVNS. Methods: A combination of subtraction cloning and Southern colony hybridisation was used to detect highly expressed genes in PVNS in comparison with rheumatoid synovial cells. Northern hybridisation was performed to confirm the differential expression of the humanin gene in PVNS. Expression of the humanin peptide was analysed by western blotting and immunohistochemistry. Electron microscopic immunohistochemistry was performed to investigate the distribution of this peptide within the cell. Results: 68 highly expressed genes were identified in PVNS. Humanin genes were strongly expressed in diffuse-type PVNS, but were barely detected in nodular-type PVNS, rheumatoid arthritis, or osteoarthritis. Humanin peptide was identified in synovium from diffuse-type PVNS, and most of the positive cells were distributed in the deep layer of the synovial tissue. Double staining with anti-humanin and anti-heat shock protein 60 showed that humanin was expressed mainly in mitochondria. Electron microscopy disclosed immunolocalisation of this peptide, predominantly around dense iron deposits within the siderosome. Conclusions: Increased expression of the humanin peptide in mitochondria and siderosomes is characteristic of synovial cells from diffuse-type PVNS. Humanin is an anti-apoptotic peptide which is encoded in the mitochondrial genome. Present findings suggest that mitochondrial dysfunction may be the principal factor in pathogenesis of diffuse-type PVNS and that humanin peptide may play a part in the neoplastic process in this form of PVNS.

DOI： 10.1136/ard.2004.025445

Scopus

Language：Japanese   Publisher：Journal of Clinical Investigation  

Thrombomodulin (TM) is an endothelial anticoagulant cofactor that promotes thrombin-mediated formation of activated protein C (APC). We have found that the N-terminal lectin-like domain (D1) of TM has unique antiinflammatory properties. TM, via D1, binds high-mobility group-B1 DNA-binding protein (HMGB1), a factor closely associated with necrotic cell damage following its release from the nucleus, thereby preventing in vitro leukocyte activation, in vivo UV irradiation-induced cutaneous inflammation, and in vivo lipopolysaccharide-induced lethality. Our data also demonstrate antiinflammatory properties of a peptide spanning D1 of TM and suggest its therapeutic potential. These findings highlight a novel mechanism, i.e., sequestration of mediators, through which an endothelial cofactor, TM, suppresses inflammation quite distinctly from its anticoagulant cofactor activity, thereby preventing the interaction of these mediators with cell surface receptors on effector cells in the vasculature.

DOI： 10.1172/JCI22782

Scopus

PubMed

Language：Japanese   Publisher：Journal of Biological Chemistry  

The transcriptional activation by SRY-type high mobility group box 9 (SOX9) and the transforming growth factor β (TGF-β) signals are necessary for chondrogenic differentiation. We have previously shown that CREB-binding protein (CBP/p300) act as an important SOX9 co-activator during chondrogenesis. In the present study, we investigated the relationship between TGF-β-dependent Smad2/3 signaling pathways and the SOX9-CBP/p300 transcriptional complex at the early stage of chondrogenesis. Overexpressed Smad3 strongly induced the primary chondrogenesis of human mesenchymal stem cells. In addition, Smad3 enhanced the transcriptional activity of SOX9 and the expression of α1(II) collagen gene (COL2A1), and small interference RNA against Smad3 (si-Smad3) inhibited them. We observed that Smad2/3 associated with Sox9 in a TGF-β-dependent manner and formed the transcriptional complexes with SOX9 on the enhancer region of COL2A1. Interestingly, the association between Sox9 and CBP/p300 was increased by Smad3 overexpression and was suppressed by si-Smad3. Our findings indicate that Smad3 has a stronger potential to stimulate the SOX9-dependent transcriptional activity by modulating the interaction between SOX9 and CBP/ p300, rather than Smad2. This study suggests that the Smad3 pathway presents a key role for the SOX9-dependent transcriptional activation in primary chondrogenesis. © 2005 by The American Society for Biochemistry and Molecular Biology, Inc.

DOI： 10.1074/jbc.M413913200

Scopus

PubMed

Language：Japanese   Publisher：Proceedings of the National Academy of Sciences of the United States of America  

Chondrogenesis is a multistep pathway in which multipotential mesenchymal stem cells (MSC) differentiate into chondrocytes. The transcription factor Sox9 (SRY-related high mobility group-Box gene 9) regulates chondrocyte differentiation and cartilage-specific expression of genes, such as Col2a1 (collagen type II α1). However, Sox9 expression is detected not only in chondrogenic tissue but also in nonchondrogenic tissues, suggesting the existence of a molecular partner(s) required for Sox9 to control chondrogenesis and chondrogenic gene expression. Here, we report identification of peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) as a coactivator for Sox9 during chondrogenesis. Expression of PGC-1α is induced at chondrogenesis sites during mouse embryonic limb development and during chondrogenesis in human MSC cultures. PGC-1α directly interacts with Sox9 and promotes Sox9-dependent transcriptional activity, suggesting that PGC-1α acts as a transcriptional coactivator for Sox9. Consistent with this finding, PGC-1α disruption in MSC by small interfering RNA inhibits Col2a1 expression during chondrogenesis. Furthermore, overexpression of both PGC-1α and Sox9 induced expression of chondrogenic genes, including Col2a1, followed by chondrogenesis in the MSC and developing chick limb. Together, our results suggest a transcriptional mechanism for chondrogenesis that is coordinated by PGC-1α.

DOI： 10.1073/pnas.0407510102

Scopus

PubMed

Language：Japanese   Publisher：Shock (Augusta, Ga.)  

Acute hypotension, hypoxemia, cardiac arrhythmias, cardiac arrest, (or a combination of these), and sudden death are well-recognized complications of the cemented hip arthroplasty procedure. Collectively, these are known as the bone cement implantation syndrome (BCIS). The endogenous cannabinoids, anandamide (ANA) and 2-arachidonylglycerol (2-AG), are reported to be strong vasodilators and play a role in the hypotension associated with hemorrhagic and septic shock. In the present study, a potential role for the endogenous cannabinoids in influencing hemodynamic variables in BCIS was investigated. Thirty-five patients (35 hips) entered a prospective, randomized clinical trial. The patients were divided into two groups. Group 1 comprised 16 patients who had the component inserted using a conventional cementing technique, whereas group 2 consisted of 19 patients who had the femoral component inserted without cement. Blood samples were taken at six consecutive time points: before anesthesia, after reaming the femur, 2 min after insertion of stems with or without cement into the femur, and 10 min, 20, and 30 min after stem insertion. In group 1 (with cement), the mean levels of ANA and 2-AG significantly increased after stem insertion. In a comparison of each group after stem insertion, mean ANA and 2-AG levels in group 1 also significantly differed from those in group 2. By contrast, in group 2 (without cement) neither ANA nor 2-AG levels exhibited a significant increase or change at any point in time. In conclusion, we have shown for the first time that endogenous cannabinoids are candidates for lipid mediators of BCIS.

DOI： 10.1097/01.SHK.0000094766.36694.49

Scopus

PubMed

Language：Japanese   Publishing type：Doctoral thesis   Publisher：Arthritis and Rheumatism  

Objective. High mobility group box chromosomal protein 1 (HMGB-1), a nuclear DNA binding protein, was recently rediscovered as a new proinflammatory cytokine. The purpose of this study was to demonstrate HMGB-1 expression in vivo and to identify the role of HMGB-1 in the pathogenesis of rheumatoid arthritis (RA). Methods. HMGB-1 concentrations in synovial fluid (SF) and serum from RA and osteoarthritis (OA) patients were measured by immunoblot analysis. The protein's specific receptor, receptor for advanced glycation end products (RAGE), was examined in SF macrophages (SFMs). We measured levels of proinflammatory cytokines released by SFMs treated with HMGB-1 via enzyme-linked immunosorbent assay and used soluble RAGE (sRAGE) to block the release of tumor necrosis factor α (TNFα). Immunohistochemical analysis and immunofluorescence assay were employed to examine localization of HMGB-1 in RA synovium and its translocation in SFMs after TNFα stimulation. Results. HMGB-1 concentrations were significantly higher in SF of RA patients than in that of OA patients. SFMs expressed RAGE and released TNFα, interleukin-1β (IL-1β), and IL-6 upon stimulation with HMGB-1. HMGB-1 was found in CD68-positive cells of RA synovium, and TNFα stimulation translocated HMGB-1 from the nucleus to the cytosol in SFMs. Blockade by sRAGE inhibited the release of TNFα from SFMs. Conclusion. HMGB-1 was more strongly expressed in SF of RA patients than in that of OA patients, inducing the release of proinflammatory cytokines from SFMs. HMGB-1 plays a pivotal role in the pathogenesis of RA and may be an original target of therapy as a novel cytokine.

DOI： 10.1002/art.10859

Scopus

PubMed

Language：Japanese   Publisher：Journal of Rheumatology  

Objective. To detect expression of the secreted frizzled related protein (sFRP) gene in synovial cells from patients with arthritis. Methods. Expression of sFRP-1, 2, 3, 4, and 5 genes was detected in synovial cells from patients with rheumatoid arthritis (RA) and osteoarthritis (OA) by semiquantitative reverse transcription- polymerase chain reaction (RT-PCR) analysis. To identify synovial cell populations expressing sFRP-1, 3, and 4 genes, expression was compared in macrophage-rich populations and fibroblast-like cell-rich populations by RT-PCR. Levels of expression of these genes were also studied in activated peripheral blood mononuclear cells (PBMC) and activated skin fibroblasts. Results. Expression of the sFRP-1, 3, and 4 genes was observed in both RA and OA synovial cells. sFRP-1 and 4 genes were expressed predominantly in fibroblast-like cell-rich populations, and the sFRP-3 gene was expressed predominantly in macrophage-rich populations. Levels of expression of sFRP-3 and 4 genes were elevated in activated PBMC and activated skin fibroblasts. Conclusion. Our findings suggest that sFRP-1, 3, and 4 may play different roles in the pathogenesis of synovitis.

Scopus

Language：Japanese   Publisher：Spine  

STUDY DESIGN: A case report of primary epidural hemangiopericytoma in the lumbar spine and a review of the literature are presented. OBJECTIVE: To present the result of pathologic diagnosis using immunohistochemical staining and the treatment of spinal hemangiopericytoma. SUMMARY OF BACKGROUND DATA: Spinal hemangiopericytoma is a very rare soft tissue tumor with specific pathologic features and a clinical course featuring high rates of recurrence and metastasis. METHODS: A 39-year-old woman reported numbness in both legs. Neither sensory abnormalities nor muscle weakness was present in her lower extremities. Magnetic resonance imaging showed a tumor dorsal to the thecal sac at L1-L2. After L1 and L2 laminectomy, the tumor with its dural base was resected en bloc. RESULTS: The patient's clinical and neurologic symptoms disappeared after surgery. Microscopic examination showed oval- or spindle-shaped cells with slightly acidic cytoplasm and oval nuclei. Silver staining emphasized fibers around tumor cells. The test results for the tumor cells were positive for vimentin staining, but negative for alpha-TM staining using thrombomodulin, a marker for endothelial cells. On the basis of these pathologic findings, the tumor was diagnosed as a hemangiopericytoma, a type of tumor composed of mesenchymal hemangiopericytes. Neither recurrence nor metastasis of the tumor was found during the 2-year follow-up period after surgery. CONCLUSIONS: Soft tissue hemangiopericytoma is a well-recognized entity considered to be an aggressive neoplasm with a high rate of recurrence and a propensity to metastasize. Immunohistochemical investigation was essential for the diagnosis of this tumor. Although hemangiopericytoma very rarely occurs in the spine, surgeons treating patients with this tumor should be aware of its metastatic potential.

Scopus

Language：Japanese   Publisher：Scientific reports  

After surgery for intradural lesions, dural reconstruction is essential for preventing cerebrospinal fluid (CSF) leakage, which can cause serious complications. However, there is currently no established intraoperative procedure. While hydrophobic polyglycolic acid (PGA) sheets and fibrin glue are effective for dural reconstruction, the usefulness of hydrophilic artificial dura mater made of a porous collagen matrix has also been reported. This study aimed to compare the ability of a fibrin-coated porous collagen matrix and a fibrin-coated PGA sheet to prevent CSF leakage during spinal surgery. This study included 319 patients who underwent surgery for intradural lesions requiring dural reconstruction. Patients in the PGA sheet group (group P) and the porous collagen matrix group (group C) were compared. The median age was 60 years. A total of 319 patients were included, with 219 in Group P and 100 in Group C. CSF leakage occurred in 11 patients (5.0%) in Group P and 0 patients in Group C (P < 0.05). This is the first report showing the superiority of a porous collagen matrix sheet over a PGA sheet in preventing CSF leakage during spinal surgery. The porous collagen matrix is hydrophilic and may be more effective against CSF leakage than hydrophobic PGA sheets.

DOI： 10.1038/s41598-024-75085-x

Scopus

Language：Japanese   Publisher：九州・山口スポーツ医・科学研究会  

【はじめに】我々は肘前方突出運動(T-motion)テストを提唱し,腱板断裂患者における有用性について報告した(Uekama et al. JSES int 2023).本テストの可動性低下と超音波で算出されるパラメータとの関係は不明である.本研究の目的は,超音波剪断波エラストグラフィ(SWE)で肩関節後方組織の硬さを測定し,T-motionの制限因子を検討することである.【方法】13名の大学野球選手を対象とし,棘上筋,棘下筋,後方関節包,小円筋のSWE値を測定し,投球側と非投球側で比較した.【結果】SWEにより算出されたパラメータは中等度以上の信頼性を認めた.各腱板・後方関節包でSWE値が投球側において有意に高値を示した.【考察・結論】腱板,関節包などで構成される肩関節後方組織のSWE値の増大は投球側の肩後方タイトネスを示唆し,T-motionの可動性低下の要因となり得る可能性を示した.(著者抄録)

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

はじめに:頸椎後縦靱帯骨化症に対する椎弓形成術において,頸椎伸展位におけるK-lineが術後成績へ与える影響について検討した.対象と方法:術後1年以上観察可能であった62名を対象とした.K-line(-)患者を頸椎伸展位でK-line(+)に変化したE-K-line(+)群,変化しなかったE-K-line(-)群の2群に分け,K-line(+)群を加えた3群間で頸椎レントゲンでの可動域,JOAスコアを比較した.結果:頸椎伸展ROMは3群間で有意差を認め,E-K-line(-)群においてK-line(+)群,E-K-line(+)群と比較して有意に小さかった.JOA改善率は3群間で有意差を認め(K-line(+)群58%,E-K-line(+)群50%,E-K-line(-)群27%,p=0.03),E-K-line(-)群においてK-line(+)群と比較して有意に低かった.結語:E-K-line(+)患者では,椎弓形成術後に良好な成績が期待できる.E-K-lineは頸椎OPLLに対する手術選択の指標として有効である可能性がある.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】頸部神経根症に対しエコー下腕神経叢ブロックを施行してきたのでその治療成績を報告する.【方法】対象はブロック後3ヵ月以上経過した57名(平均年齢58歳,男38名,女19名).罹患神経根を調査し,治療成績は直前,直後,1ヵ月後,3ヵ月後のNRSで評価し,3ヵ月後NRSが3以下良好群,4以上不良群に分けて検討した.【結果】罹患神経根はC5根が5例,C6根が20例,C7根が9例,単一根に同定できない例が23例であった.NRSはブロック前7.1が直後1.8と直後から有意に改善した.3ヵ月後良好群は43例(75%),手術移行例は7例(12%)であった.良好/不良群では直後NRS(1.4/3.1),1ヵ月後NRS(2.2/5.9),年齢(56/64)で有意差を認めた.ヘルニア例の方が頸椎症例よりも有意に良好群が多かった.【考察】エコー下腕神経叢ブロックは神経幹,血管,肋骨が判読でき安全かつ簡便で,早期除痛が期待できる有用な治療法のひとつと考えられた.(著者抄録)

Language：Japanese   Publisher：(一社)日本人工関節学会  

2018年以降の転位型大腿骨頸部骨折に対する人工股関節全置換術(THA)のうち術中透視併用の仰臥位前外側アプローチ(ALSA)によるセメントレスTHA26例(男性7例、女性19例、平均年齢64.2歳:平均BMI22.4:平均経過観察期間23.2ヵ月)の治療成績について後ろ向き検討を行った。その結果、若手医師15名と上級医11名を比較すると、手術時間は若手医師群で有意に長かったが、出血量に有意差は無かった。周術期合併症としてインプラント関連の合併症は無く、術前の歩行能力を維持できた。本法は若手医師も取り込みやすく、安全性と有用性が示唆された。

Language：Japanese   Publisher：(一社)日本人工関節学会  

当院では内側型膝OAに対し、MPP(Medial Parapatellar Approach)、Modified Gap techniqueでPS-TKA(「Vanguard PSRP」[Zimmer-Biomet社製])を行っているが、大腿骨内側後顆骨切り量が増加し、PCO(Posterior Condylar Offset)が減少する症例が少なくなく、全体の3分の1を占めている。今回、PS-TKAにおける大腿骨内側後顆骨切り量の増加(PCOの減少)が術後早期臨床成績に及ぼす影響について、2019年1月から当院で内側型膝OAに対しVanguard PSRPを用いて連続的に施行したTKAで、術後6ヵ月時点での評価が可能であった139膝を対象に検討した。術中に大腿骨内側後顆骨切り量を計測し、Bone Sawの厚みを1mmと考え、インプラント厚9mm±1mm以内であった症例をPCO維持群(75膝)、インプラント厚の1mm以上であった症例をPCO減少群(51膝)とし、両群の臨床成績を比較した。その結果、ROM(伸展制限角・屈曲角度)以外の項目は両群とも術前より有意に改善していたが、FJS(Forgotten Joint Score)、5M-TUG(5M Timed Up and Go Test)改善率においてPCO維持群が有意に成績良好であった。これらの結果から、PS mobile TKA(Vanguard PSRP)において、Posterior Condylar Offset(PCO)の減少は、術後早期臨床成績に悪影響を及ぼすことが示唆された。

Language：Japanese   Publisher：(一社)日本肩関節学会  

関節鏡下腱板修復術(以下ARCR)後再断裂例の臨床成績に影響を与える因子を検討した.大・広範囲腱板断裂に対しARCR施行後1年間以上経過観察可能であった108肩中,再断裂を認めた28肩を対象とした(再断裂率25.9%).28肩を再手術に至らなかった24肩(N群)と再手術に至った4肩(R群)の2群に分け比較した.検討項目は,手術時年齢,術前と最終観察時(R群は再手術直前)の自動屈曲角度,日本整形外科学会肩関節疾患治療成績判定基準(JOAスコア),断裂形態,また術前の肩峰骨頭間距離,腱板筋腹の脂肪浸潤とした.臨床所見ではJOAスコア,自動屈曲角度ともにN群がR群に比べ,最終観察時に有意に高値を示した.画像所見ではN群において断裂の前後径が術前よりも有意に縮小しており,またN群はR群に比べ断裂の前後径の縮小量が有意に大きかった.再断裂をきたしても前後径が拡大しない修復が重要である可能性が示唆された.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

2010年から2022年の間に当院を含めた2施設で手術治療を行なった尺側CM関節脱臼骨折13例の治療成績を検討した.手術は全例Kirschner鋼線(以下K鋼線)固定を用い,田崎分類type3,4の3例でheadless screwによる固定を追加した.最終観察時の関節症性変化(以下OA変化),疼痛,関節可動域,握力健側比を調査した.1例で関節面の不整が残った.1例でpower grip時の疼痛が残った.全例で可動域制限はなかった.握力健側比は平均91%だった.低侵襲手術によるCM関節の安定化と有鉤骨遠位関節面の解剖学的整復により,良好な成績を得られたものと考えた.13例の治療成績,特に有鈎骨体部骨折を伴う3例について文献的考察を加え報告する.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】重度四肢外傷は適切な初期対応,速やかな骨軟部組織再建を要する.鹿児島県における重度四肢外傷治療の現状を調査した.【対象と方法】2017年-2021年に,軟部組織再建が可能な3施設で治療した,Gustilo IIIB・IIICの38例を対象とした.検討項目は軟部組織再建手術終了までの日数,術後感染の有無とした.【結果】軟部組織再建まで完遂できた症例は23例,再建に至らず切断となった症例は15例であった.初療から同一施設で治療した症例は16例で,軟部組織再建手術まで平均18.4日,5例に術後感染を生じた.転送症例は7例で,転送までの平均日数は32.1日,軟部組織再建手術まで平均52.7日,3例に術後感染を生じた.【考察】特に転送症例において,軟部組織再建までに長期間を要していた.軟部再建を要するかどうか判断に迷う症例を専門施設に集約することで,より早期に軟部組織再建が可能となり,術後感染率の低下につながることが見込まれる.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】肩関節後方脱臼骨折は肩関節脱臼中0.9%と稀な疾患である.当院にて肩関節後方脱臼骨折に対して観血的整復固定術を施行した3症例の治療成績を報告する.【症例】年齢は52・41・46歳,全例男性であった.受傷機転はバイク事故2例,転落外傷1例と高エネルギー外傷であった.いずれも上腕骨頭関節面前方の陥没骨折を有し,1例は大小結節骨折を含む4part骨折,2例は2part骨折であった.それぞれ,受傷4・5・12日目に手術を行った.全例Deltopectoral approachで進入し,骨頭骨片をjoy stick法にて整復してプレート固定を行った.3例いずれも術後3ヵ月で骨癒合を認め,術後再脱臼は認めなかった.JOA scoreはそれぞれ最終観察時に100,100,97点と良好な結果であった.【結語】肩関節後方脱臼骨折はDeltopectoral approachでの観血的脱臼整復,プレート固定で良好な結果を得ることができる可能性がある.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】広範囲脊椎固定術の術後合併症としてDistal Junctional Failure(DJF)があるが,standardな治療は確立されていない.今回,症候群性側彎症術後においてDJFを来した症例に対し遠位固定端(LIV)を延長せず,前方固定の追加で対処し得た2症例を報告する.【症例】症例1:33歳の男性.神経線維腫症1型による側彎症に対し後方矯正固定術(T9-L3)および頂椎dystrophic change部の支柱骨移植施行.術後3年でL2/3偽関節に対し遠位スクリューの入れ替えと前方固定(椎体間cage併用)を施行.症例2:14歳の女性.Marfan症候群による側彎症に対し後方矯正固定術(T2-L3)施行.術後4年でL2/3偽関節に対し再手術施行.椎体スクリューも併用した.2症例とも再手術後2年で良好な骨癒合が得られている.【結論】本法はLIVを延長することなく対応可能であり,DJF治療の選択肢と考えられる.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

壊血病はビタミンC欠乏により微小血管の損傷,出血をきたす疾患である.今回,大腿骨骨腫瘍を疑われ受診した1例を経験したので報告する.症例:10歳男児.左下肢痛にて前医受診し,MRIで大腿骨に輝度変化を認め,当院小児科紹介受診した.画像より骨腫瘍を疑い組織試験採取を施行したが血腫の診断であった.その後症状遷延したが,歯肉腫脹と出血,併存症として自閉スペクトラム症による著しい偏食があることから壊血病が疑われ,血中ビタミンC濃度の異常低値を確認し診断に至った.ビタミンC補充療法後は疼痛改善し,画像所見も改善を認めた.考察:現代社会では壊血病の発症はほぼ認めないが,近年,発達障害児における偏食やその他の栄養障害に伴う壊血病の報告が散見される.小児壊血病は,骨髄炎,敗血症性関節炎,骨軟部腫瘍,白血病,出血性疾患,リウマチ性疾患などとしばしば誤診されることが報告されている.本症例でも当初は悪性骨腫瘍との鑑別に難渋した.発達歴・既往歴から栄養障害が疑われる場合には鑑別疾患として挙げるべきである.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【背景】肩関節傍関節唇嚢腫は,後上方関節唇近傍の棘窩切痕付近に発生し,肩関節痛や脱力感などの多彩な症状を呈し,肩甲上神経麻痺の原因となる.今回,我々は烏口肩峰靱帯直下の関節窩前上方部に生じた関節唇嚢腫に対して鏡視下手術を施行したテニス選手の1例を経験したので報告する.【症例】32歳男性右利き.テニスのサーブの素振り時に右肩痛出現し,疼痛が持続するため,当院受診.MRIにてSLAP損傷及び肩関節傍関節唇嚢腫を認め,鏡視下関節唇縫合術及び嚢腫切除術を行った.【結語】傍関節唇嚢腫は,関節窩後上方部のSLAP病変に起因し,棘窩切痕付近に発生することが多いが,本症例は,後上方のSLAP病変部と通じる瘻孔を通して,棘上筋と肩甲下筋の間の前上方に存在し,同部の表層にある烏口肩峰靱帯と二次性インピンジメントが生じることで痛みを発症していた.同部での発生は非常に珍しく,鏡視下での切除術により症状は軽減し良好な結果が得られた.(著者抄録)

Language：Japanese   Publisher：(公社)鹿児島県理学療法士協会  

本研究の目的は,リバース型人工肩関節置換術後1年時のADL能力と肩関節可動域の目標値について検討することとした。対象は当院でリバース型人工肩関節置換術を実施し,術前と術後1年時の肩関節機能が計測可能であった15名(77.9±1.1歳)とした。肩関節機能は,屈曲,外転,外旋の自動可動域,内旋(Constantスコアの点数),日本整形外科学会肩関節疾患治療成績判定基準(Japan Orthopaedic Associationスコア:以下,JOAスコア)とした。術後1年時JOAスコアにより経過良好群,経過不良群に分類し,肩関節機能を比較した。群間差を認めた術後1年時の項目は,カットオフ値を算出した。経過不良群において,術後1年時の屈曲,外転,内旋の可動域,JOAスコアのADLと機能の項目が低値を示した(p≦.0014)。経過良好群を予測するカットオフ値は,JOAスコアのADLが8.5点,屈曲が125°,外転が110°,内旋が4点であった。リバース型人工肩関節置換術後の理学療法では,機能向上と並行してADLでの使用を見据えた動作指導などの実施が重要と考えられた。(著者抄録)

Language：Japanese   Publisher：(一社)日本脊椎脊髄病学会  

思春期特発性側彎症Lenke type 1Aでは,L4が右傾斜の1A-Rと左傾斜の1A-Lとに細分化され,1A-Rはdistal adding-on(DA)のリスクが高いとされている.今回Lenke type 1A-RにおけるDAと関連する因子,特に椎体回旋に関して検討した.2009年12月よりLenke type 1A-Rに対し手術を施行した,連続する15例中,画像欠損:1例,drop out:1例を除いた13例(手術時平均年齢:15.3±2.1歳)を対象とした.DAの定義はChoらが報告した(1)Cobb角の5度以上の増加(2)終椎の遠心移動とした.患者背景と術前,初回立位時および術後2年でのX線パラメータ,CTを用いた椎体回旋を術後DAの有無で検討した.術後DAを4/13例(30.7%)に認めた.DAを認めなかったDA-群とDA+群の2群間比較では,DA+群において初回立位時と比べ術後2年時にLIVはLIV+1と間で右回旋が生じていた(p=0.02).DA+群では初回立位時のUIV回旋が左回旋の傾向があり(p=0.07),術後2年でそれらが解消されたことから,DAはLIVを右回旋することでUIV回旋遺残を代償することで生じる可能性があり,Lenke type 1A-Rにおけるdistal adding-onと椎体回旋の関連が示唆された.(著者抄録)

Language：Japanese   Publisher：(一社)日本人工関節学会  

当院で大腿骨頸部骨折に対しAvenir Complete Stemを用いて人工物置換を行った31例(男性9例、女性22例、手術時平均年齢84.3歳)について検討した。その結果、大腿骨髄腔形状はStovepipeが5例、Normalが23例、Champagne-fluteが3例であった。骨質はDorr分類でtypeAが2例、typeBが20例、typeCが9例であった。単純レントゲン正面像では96.8%、側面像では93.5%が中間位に設置されていた。尚、術中骨折は1例(3.2%)に認められ、術中に追加処置を要した。また、術後早期に5mm以上のステム沈下を2例で経験し、1例はカルカーの骨折のため術後2週にセメントステムによる再置換術を要した。

Language：Japanese   Publisher：(一社)日本人工関節学会  

症例1(81歳女性)。左人工膝関節全置換(TKA)術後に左膝窩動脈閉塞を生じ、発症後約5時間で当院へ搬送となった。緊急で外科的血栓除去術と内科的カテーテル治療(ハイブリッド治療)を行った結果、血流の再開ほか、冷感消失を認め、経過は良好であった。症例2(65歳女性)。両側TKA術後に浅大腿動脈中間部の動脈閉塞を発症し、発症後24時間以上を経過して当院へ搬送となった。治療として緊急ハイブリッド治療を行うも、浅大腿動脈中間部より末梢へガイドワイヤーが進まず治療困難で、健側の伏在静脈を用いて浅大腿動脈-後脛骨動脈バイパス術を行った。加えて合併したコンパートメント症候群に対しては減張切開を行った。その結果、術後は下肢冷感は消失したが、麻痺の回復はなく、減張切開部の閉鎖不全やTKA皮切遠位部の黒色壊死、TKA周囲感染が生じ、最終的に悲惨な経過となった。

Language：Japanese   Publisher：(一社)日本人工関節学会  

TKAのKA法に関する先行研究でMacDessiらは、OA発症後もOA発症前のLDFAとMPTAは保たれ、OA発症前のHKA(aHKA)と関節面傾斜(JLO)が推測可能であると報告している。さらに、推測したaHKAとJLOからconstitutional alignmentを9つのTypeに分けたCPAK分類を提唱し、全Typeにおいて、MA法で施行したTKAよりもKA法で施行したTKAのほうが術中軟部組織バランスが良好であったと述べている。TKA術後冠状面アライメント(HKA)と術後臨床成績の関連についての報告には、MA法によるTKAであっても術後に生理的内反位を残存させたほうが術後臨床成績は良好であるとする報告と、差はないとする報告がありcontroversialである。今回、MA法で施行したTKAであっても、術後HKAがaHKAに近似した症例では臨床成績が良いという仮説を立て、aHKAと術後HKAと術後臨床成績の関連について自験例を対象に検討した。その結果、MA法によるTKA施行例においてaHKAと術後HKAと術後短期成績との間に明らかな関連は認められず、仮説は立証されなかった。

Language：Japanese   Publisher：(一社)日本外傷学会  

大腸外科領域で術中の腸管血流評価方法としてIndocyanine green(以下ICG)蛍光法が注目されているが外傷領域で用いられた報告例はまだ少ない.我々は鈍的外傷による外傷性消化管損傷における腸管切除範囲決定に術中ICG蛍光法が有用であった症例を経験した.症例は37歳,男性.約3mの高さから墜落し受傷した.当院病着後の造影CTにて腹腔内出血,腸間膜損傷を認め緊急開腹術を施行した.循環動態が安定していたため,一期的腸管吻合の方針とした.術中ICG蛍光法を用いて腸管血流を評価したうえで結腸切除範囲を決定し,縫合不全のリスクを回避した.術後は合併症なく良好に経過し退院となった.外傷症例においてもその評価方法が有用であることが示唆された.(著者抄録)

Language：Japanese   Publisher：(一社)日本肩関節学会  

関節鏡下腱板修復術後10年以上経過し,直接検診可能であった23肩を対象とした.MRI斜位矢状断像のY viewの位置での棘上筋,棘下筋,肩甲下筋の脂肪浸潤の程度,筋断面積を評価した.症例全体の脂肪浸潤は術後1年時に比し最終観察時に有意に悪化していた.再断裂の有無で2群に分け評価すると,再断裂を認めなかった群では有意な変化を認めなかったが,再断裂群では術後1年時に比し最終観察時に有意に悪化していた.最終観察時の2群間比較では,再断裂群の脂肪浸潤が有意に進行していた.症例全体の筋断面積は術後1年時に比し最終観察時有意な変化を認めなかった.再断裂を認めなかった群では有意な変化を認めなかったが,再断裂群では有意に減少した.最終観察時の2群間比較では,再断裂群の筋断面積が小さい傾向にあったが,有意差を認めなかった.臨床成績と脂肪浸潤および筋萎縮の間に有意な相関を認めなかった.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

上腕骨頭の前外側偏位を定量化したTranslation of the humeral head scale(以下T-scale)の術前値は腱板修復術後の予後因子となることが示唆され,Critical shoulder angle(以下CSA)は腱板断裂の有病率や術後成績との関連が報告されている.今回,T-scaleとCSAとの関連について検討したので報告する.対象は当院で関節鏡下腱板修復術(以下ARCR)を施行した27肩とした.評価項目は術前後のT-scale,JOA score,自動屈曲角度を計測し,CSAとの関連を調べた.結果については,術前のT-scaleは腱板修復術により術後有意に改善し,術前のT-scaleとCSAとの間に有意な正の相関を認めた(相関係数0.50:P<0.001)一方で,CSAと術前後のJOA scoreとの間に有意な相関は認められなかった.これらの所見により,術前T-scaleと腱板断裂の有病率との関連が示唆された一方で,CSAが大きいと腱板修復術後成績が不良となる説を我々の結果は支持しなかった.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】石灰沈着性頸長筋炎の1例を経験したので報告する.【症例】56歳女性.頸部痛を主訴に近医整形外科を受診.保存加療とするも疼痛増強.摂食困難となり近医耳鼻咽喉科を受診した.血液検査にてCRPの著明な上昇と頸部単純CT検査にて第2頸椎前方に石灰化像を認めたため石灰沈着性頸長筋炎が疑われ,当院紹介となった.NSAIDsの内服と頸椎カラー装着により1週間後の再診時には疼痛軽減し,頸椎の可動域制限や炎症徴候も改善した.【考察】石灰沈着性頸長筋炎という稀な1例を経験した.鑑別疾患として化膿性脊椎炎や咽後膿瘍など早期診断・早期治療を要する疾患も含まれており,急性頸部痛を来す疾患の鑑別診断として念頭に置く必要がある.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

足舟状骨疲労骨折に対して保存加療を行った1例と偽関節となり観血的治療を行った2例を経験したので報告する.症例1は20歳男性,バスケットボール選手,左足背部痛出現から2ヵ月後に当院を受診し,足舟状骨疲労骨折の偽関節の診断.症例2は19歳女性,陸上の中距離選手,右足背部痛出現から2年経過してから当院受診し,偽関節の診断.症例3は20歳女性,陸上の長距離選手で,右足背部痛が出現してから3日後に当院受診し足舟状骨疲労骨折の診断に至った.3症例とも最終的に骨癒合しスポーツ復帰を果たしている.スポーツ復帰を早めるためには早期診断が重要で早期復帰を希望するアスリートは骨折型によっては手術を考慮する必要がある.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

当科では軟部肉腫の無計画切除後の症例に対し,追加広範切除術を行っている.今回,粘液線維肉腫に対して行われた無計画切除(UE)後に当科にて追加広範切除を施行した群(UE群)と初回から広範切除を行った群(非UE群)を後方視的に比較解析した.【対象】対象は,2004年9月～2019年9月に当科で手術を行った26例(UE群8例,非UE群18例)である.検討項目は性別,年齢,腫瘍最大径,当院切除後の断端評価,局所再発の有無,遠隔転移の有無とし,二群間比較を行った.【結果】断端陽性はUE 0例(0%),非UE 3例(16.7%),再発はUE 3例(37.5%),非UE 3例(16.7%),転移はUE 3例(37.5%),非UE 2例(11.1%)に認めた.いずれの項目も両群間で有意差は認めなかった.【結論】粘液線維肉腫に対する無計画切除後に可及的早期に追加広範切除を行うことで,再発・転移に関しては初回手術に遜色ない結果を得ることができた.しかし治療転帰に良好に働いているかは定かではなく,今後更なる検討が必要である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】膝関節内の遺残散弾が原因と思われる変形性関節症を経験したので報告する.【症例】77歳男性,1975年に散弾銃暴発による銃創治療の既往がある.2021年4月より左膝関節痛が増強し近医を経て当院紹介受診となった.単純X線でK-L分類grade IVのOA変化と左膝周囲に多数の散弾と覆われる金属球を認め,手術希望があり人工膝関節置換術を施行した.術中所見で軟部組織内に散弾と思われる金属球を認め,関節表面にも複数個の金属球が埋没していた.通常手技で手術施行,骨切り面に複数の金属断面を認め可及的に摘出した.肉眼およびX線透視で膝関節内に遊離散弾が無いことを確認し手術を終了した.術後経過に特に問題なく,術後15日目に自宅退院となった.【考察】受傷当時からこれまでに急性鉛中毒の発生既往は無かったが,術前の血中鉛濃度は25.2ug/dlと正常上限値を僅かに超えており,今後も定期的なfollow upが必要と考えている.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

急性コンパートメント症候群は時間経過に伴い不可逆的変化をもたらすため,迅速な診断,治療を要する.誘引なく発症した前腕急性コンパートメント症候群の一例を経験したので報告する.症例は47歳男性,昼頃から誘因なく左前腕痛を自覚し疼痛増悪したため,夜間救急外来受診となった.左前腕掌側に圧痛および緊満感あり,血流障害,知覚異常,運動麻痺は認めなかった.手指および手関節のpassive stretch pain陽性であった.前腕掌側コンパートメント内圧81mmHgと高値認め,症状出現後11時間30分で筋膜切開を行った.浅指屈筋内に血腫を認め,筋肉内血腫による急性コンパートメント症候群と考えられた.術後は機能障害を残すことなく経過した.非外傷性の急性コンパートメント症候群は比較的まれであり,診断にいたるまでに時間を要することがある.外傷以外にも急性コンパートメント症候群をきたす病態があることを念頭におき,診療にあたることが重要である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

足趾末節骨伸筋腱付着部剥離骨折,所謂"骨性mallet toe"の本邦での症例報告は非常に稀であり,後療法も報告ごとに異なる.今回我々は骨性mallet toeに対して石黒法を用いた内固定により良好な経過を辿った2例を経験したため報告する.63歳女性で正座から立つ際に転倒受傷,左第1趾末節骨骨折.受傷3日で石黒法にて固定.術後5ヵ月時点で歩行安定している.14歳男性,サンダルで走った際に転倒受傷,左第4趾末節骨骨折+PIP脱臼.整復後保存療法も透視下にて不安定性認め受傷16日にて石黒法で固定.術後3ヵ月時点でスポーツ復帰している.2例いずれも過屈曲位で地面に突き受傷していた.本骨折は伸展制限を来す骨折であり,有痛性の胼胝に加えスポーツ障害,高齢者においては易転倒性の原因ともなり得る.同骨折は骨片が小さく腱付着部であることから,石黒法を用いることで良好な骨癒合が得られ,伸展制限なく経過している.(著者抄録)

Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞はじめに　人工股関節全置換術(THA)および人工骨頭置換術(BHA)術後感染(人工股関節周囲感染)は難治化しやすく,重篤な術後合併症の一つである.インプラントを抜去し,抗菌薬含有セメントスペーサー留置(first stage)後,期間を空けて再置換術(second stage)を施行する二期的再置換術は,遅発性,慢性期感染に対する標準的な治療である.当科では以前より治療アルゴリズムを作成し,徐々に改良しながら治療にあたっている(図1).当科における術後成績,感染再燃に関連する因子を検討したので報告する.

Language：Japanese   Publisher：西日本整形・災害外科学会  

活動性の高い患者の転位型大腿骨頸部骨折に対する前方アプローチでの人工股関節全置換術(THA)で,術中後方脱臼傾向の出現を2例経験した.症例は69歳女性と59歳女性,アプローチはそれぞれAntero-Lateral supine approach,Direct anterior approachであった.いずれも大転子での骨性インピンジメントはなかったがトライアル時に後方脱臼傾向あり,ライナートライアルをフード付きに変更して解決した.後方への脱臼にはインピンジメントやcombined anteversionの不良など他の要因も考えうるが,後方支持組織の破綻に着目して文献的考察を含め報告する.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

はじめに:後縦靱帯骨化症(OPLL)の好発年齢は50歳代と報告されているが1),若年発症の因子は未だ不明である.今回,多嚢胞性卵巣症候群(PCOS)を合併した若年発症OPLL症例を報告する.症例:33歳の女性.13歳時にPCOSと診断されている.26歳時に右下肢痛,痺れ認め,他院にて腰椎椎間板ヘルニアの診断で手術施行するも症状持続.さらに増悪傾向となり,当科紹介受診.腰椎OPLLを認め,手術を施行された.考察:前回手術から7年の経過画像を振り返ると,本症例は前回腰椎椎間板ヘルニアと診断された高位における後縦靱帯の著明な骨化伸展を認めており,20歳代でOPLLが既に顕在化していたと考えられる.若年発症OPLLは高度肥満やインスリン異常が関与しているとの報告があり,本症例はPCOSと高インスリン血症を認め,代謝異常がOPLL若年発症に関与している可能性が示唆される1例であった.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

日本MDM社製ASULOCKはlag screwに加えて1本のAnti-Rotation screw(AR screw)と2本のAnti-Rotation pin(AR pin)を追加することで不安定型大腿骨転子部骨折の近位骨片の回旋予防を期待できる.当院で施行した不安定型大腿骨転子部骨折に対するASULOCKの手術成績を評価し,その有用性や問題点について考察した.対象は2019年4月から2020年の12月にCTで不安定型大腿骨転子部骨折と診断し,ASULOCKを用いて骨接合術を施行し,少なくとも術後3ヵ月以上フォローした38症例である.男性8例,女性30例,平均年齢は87.6歳,平均観察期間は34.2週であった.3D-CT分類ではtype I 3 part Bが10例,type I 3 part Cが2例,type I 3 part Dが2例,type I 4 partが24例だった.術後合併症に関しては,AR pinのバックアウトが2例,うち1例はバックアウトしたAR pinのみ除去した.10mm以上のスライディングを認めたのは1例のみで,カットアウトやネイル折損は認めず,後外側骨片を固定可能なASULOCKは不安定型大腿骨転子部骨折に対する有用なインプラントであることが示唆された.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

Pilon骨折は軟部組織障害の合併や固定手技の難しさから治療に難渋することが多い.プレート固定が主流の本骨折に対し髄内釘固定を行った2症例について報告する.1例目は68歳女性,高所より転落し受傷.AO分類43-C1の閉鎖骨折で,主骨折線の関節面からの距離は23mmであった.2例目は76歳女性,バイク事故で受傷.AO分類43-C1の閉鎖骨折,主骨折線-関節面距離は24mmであった.いずれも外側傍膝蓋アプローチ,Stryker社T2 Alpha Tibia Nailing Systemにて内固定を施行.それぞれ術後6週より荷重開始し,皮膚軟部の合併症なく骨癒合が得られた.今回の2症例においては,術前計画で遠位に最低2本のスクリューが挿入可能と判断し髄内釘固定を選択した.さらに遠位スクリューにロッキング機構を有する髄内釘を使用し,関節面骨片固定にCCSを追加することで固定力を強化した.生物学的活性を保てることが骨癒合及び皮膚軟部組織温存に有利に働き,髄内釘は本骨折において有用な固定法であると言える.(著者抄録)

Language：Japanese   Publisher：(一社)日本人工関節学会  

症例は初診時68歳の女性で、変股症に対する左THA目的で当院に紹介された。手術は問題なく終了し、術後早期の経過も特に問題はなかったが、術後1年の定期受診時に左股関節屈曲時の疼痛を訴えた。X線ではインプラントの弛みや骨盤後傾の進行は認めなかったが、CTでカップ突出を認めた。特徴的な症状から腸腰筋インピンジメントを疑い、鎮痛剤内服などの保存治療を開始した。症状はいったん改善傾向にあったが、術後1年6ヵ月から徐々に増悪し、強い痛みのため自動SLR不可能となった。超音波ガイド下の局麻剤注入で症状は一時的に軽快するため腸腰筋インピンジメントと診断し、術後2年2ヵ月時に直視下腸腰筋腱切離術を行い、症状は劇的に改善した。

Language：Japanese   Publisher：西日本整形・災害外科学会  

原発不明癌は癌と肉腫を含む全ての悪性腫瘍の5%以下とまれで,診断が困難であることが多く,治療開始の遅延が大きな問題となる.今回,原発不明がん多発骨転移,後腹膜転移症例において,後腹膜病変より超音波内視鏡下穿刺吸引細胞診(Endoscopic ultrasound guided fine needle aspiration:EUS-FNA)にて比較的迅速に診断を確定し,治療開始できた症例を経験した.症例は70歳男性.体重減少・腰痛を主訴に前医にて全脊椎に多発する骨病変認め,消化器癌骨転移疑いにて胃カメラ・大腸カメラなどの消化器精査行うも診断つかず,当科紹介となった.当院での造影CTにて原発巣を認めず,後腹膜に辺縁不整な腫瘤影を認めた.脊椎病変からの骨生検,もしくは後腹膜病変からの開腹生検を検討していたが,当院消化器内科にて初診より11日目にEUS-FNA施行し,腺癌の診断にて初診から22日で化学療法開始となった.EUS-FNAは低侵襲かつ安全な手技と考えられ,原発不明がん後腹膜転移病変に対して侵襲の少ない診断ツールとして念頭において良いと思われる.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【目的】びまん性特発性骨増殖症(DISH)や強直脊椎炎(AS)のような強直脊椎骨折に大動脈損傷を合併した症例を2例経験したので報告する.【症例】症例は2例(DISH 1例,AS 1例),受傷機転は交通事故と階段からの転落であった.2例とも造影CTを施行され,脊椎骨折と大動脈損傷(仮性動脈瘤1例,大動脈解離1例)の合併を認めた.ステントグラフト内挿術を優先したのちに,脊椎固定術を施行した.【考察】強直脊椎骨折は,診断が遅れる可能性や遅発性神経麻痺のリスクが高く,骨折に伴う様々な合併症が報告されている.大動脈損傷の合併率は1.3%と少ないが,死亡率は60%と非常に高い.転機に多大な影響をもたらすため,強直脊椎骨折では造影CTによる血管評価が必要である.(著者抄録)

Language：Japanese   Publisher：(一社)日本肩関節学会  

関節鏡下腱板修復術後10年以上経過し,最終観察時直接検診可能であった23肩を対象とした.日本整形外科学会肩関節疾患治療成績(JOAスコア),自動屈曲角度とも術後1年時有意に改善し,最終観察時まで維持されていた.再断裂率は43.5%であった.腱板断裂の有無で2群に分け比較すると,2群間で手術時年齢,術後観察期間,修復方法に有意差を認めなかったが,再断裂群が術前の腱板断裂サイズが有意に大きかった.両群ともJOAスコア及び自動屈曲角度は術後1年時有意に改善し,最終観察時まで維持されていた.JOAスコアは術前後とも両群間に有意差を認めなかった.自動屈曲角度は術前,術後1年時には2群間に有意差を認めなかったが,最終観察時のみ有意差を認めた.関節鏡下腱板修復術の臨床成績は術後10年後も維持されており,再断裂の有無で臨床成績に有意差を認めなかった.(著者抄録)

Language：Japanese   Publisher：日本股関節学会  

75歳以上のstovepipe形状(canal flare index 3未満)の転位型大腿骨頸部骨折に対し、taper wedge stemを用いて人工骨頭挿入術を行った36例を対象に、術後X線経過と周術期合併症を調査した。その結果、男性2例、女性34例で、平均年齢は87.8(75〜98)歳であった。ステムアライメントは、X線の正面像で3°以上の内反・外反挿入はなく、側面像で3°以上の屈曲挿入を5例に認めた。6ヵ月以上経過観察できた24例に進行性の沈下を認めず、全例がbone ingrowth fixationであった。周術期合併症として、ワイアリングを必要とする術中骨折を4例(2例はラスピング時、2例は整復操作時)、下肢静脈フィルター設置を必要とした下肢静脈血栓症を1例、追加手術を必要とした術後骨折・脱臼を1例に認めた。高齢の転位型大腿骨頸部骨折のstovepipe症例では、taper wedge stemを用いた人工骨頭挿入術が有用と考えられた。

Language：Japanese   Publisher：(株)南江堂  

膝前十字靱帯(ACL)断裂受傷時のMRIにおける外側半月板後節の後方逸脱に着目し、外側半月板後節の後方逸脱と外側半月板断裂との関係を調査した。対象は、ACL断裂に対して鏡視下ACL再建術を施行した患者のなかで、受傷時のMRIにおいて、脛骨外顆の前方変位が5mm以上存在し、ACL再建時に外側半月板の評価を行った24例(男性16名、女性8名)とした。外側半月板断裂は、なし群12例、あり群12例であった。BMIは、なし群が平均23.7(20.7〜36.4)、あり群が平均25.9(21.2〜32.0)であり、2群間に有意差があった。また、脛骨外顆前方変位量は、なし群が平均7.53(5.3〜10.1)mm、あり群が平均8.78(5.4〜14.4)mmと有意差はなかったが、外側半月板後方逸脱量は、なし群で平均1.60(1.0〜2.6)mmに対して、あり群で平均3.23(2.0〜4.9)mmとなり、あり群で有意な増加を認めた。外側半月板後方逸脱率も、なし群で平均16.68(9.10〜27.47)%に対して、あり群で平均32.30(19.13〜43.36)%となり、こちらもあり群で有意な増加を認める結果となった。また、外側半月板後方逸脱量および後方逸脱率のカットオフ値を算出するためのROC曲線を用いた解析では、後方逸脱量のカットオフ値が2.0mm(感度1.00、特異度0.75)、後方逸脱率のカットオフ値が19.6%(感度0.91、特異度0.83)であった。

Language：Japanese   Publisher：(一社)日本手外科学会  

手に発生する軟部腫瘍はそのほとんどが良性であるが,ごく稀に悪性も存在する.今回,手に発生した腫瘤の症例69例を後ろ向きに解析しそれぞれの腫瘍の特徴を検討した.これまでの報告と同様,そのほとんどが良性軟部腫瘍であり悪性はまれであった.腱鞘巨細胞腫やTinel signのある神経鞘腫,脂肪腫,血管腫,線維腫,グロムス腫瘍などは特徴的な臨床所見やMRI所見にて術前診断は比較的容易であったが,手掌発生の腫瘤,特に神経鞘腫(Tinel signを呈さないもの)や血管平滑筋腫悪性などの実質性腫瘍では悪性軟部腫瘍との鑑別が困難である症例も含まれた.悪性軟部腫瘍を疑わせる所見として,手掌発生であること,腫瘍径が比較的大きいこと,MRIでのT2強調像で高信号を呈する実質性病変で,ガドリニウム(Gd)にて造影効果のある腫瘤であることが挙げられた.これらの条件を満たすものは正確な診断確定のため生検を考慮してもよいと考えられた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【背景】頸椎前縦靱帯骨化はびまん性脊椎骨増殖症の頸椎病変として知られているが本症によって気道狭窄を生じた報告は稀である.【症例】64歳の男性.当院受診1年前より嚥下障害を自覚.3週前より特に誘因なく喘鳴,呼吸困難認め,増悪したため,当院救急部受診となる.同日気管内挿管施行後,上気道狭窄の診断にて気管切開施行.当初上咽頭腫瘍疑われ,耳鼻咽喉科にて精査するも,喉咽頭領域の腫瘍性病変やクループ等の病変は認めなかった.CTで頸椎前縦靱帯骨化による気道狭窄,嚥下造影にて著明な気管内への造影剤流入認めたため,頸椎前方アプローチによる骨化巣切除施行.手術4日後に気管カニューレ抜去,経口摂取可能となり,その後も呼吸苦,嚥下困難も消失し,自宅退院可能となった.【まとめ】有症状の本疾患に対し,手術療法は有用な治療である.本疾患は稀な病態であるが,上気道狭窄を来した疾患においての鑑別疾患の1つとすべきである.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

種子島は鹿児島県本土の南方に位置する人口およそ3万人の離島である.65歳以上の高齢者の人口はおよそ1万人程度であり転倒による大腿骨頸部骨折,椎体骨折の患者も多く救急搬送される.椎体骨折の治療は一般的にコルセットによる外固定が基本であるが,種子島のような離島においては義肢装具士が週に1回しか来島せず,また台風や天候不良の影響で船や飛行機が欠航となり装具採型が出来ない,また装具が予定通りに届かないといった事例も発生するために離床やリハビリ開始が遅れてしまうことも珍しくはなかった.そこで当院では2018年6月よりカバー付きキャスティングシステム(商品名:フィットキュア・スパイン アルケア株式会社)という外固定装具を採用し院内に常備する体制を整えた.本装具の導入により椎体骨折患者の早期離床,早期退院が可能となった.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

上位胸椎癒合椎を起点とした胸腰椎側彎症の成人進行例の1例を報告する.症例は61歳の女性.40歳代時に右肋骨隆起,右肩高位を自覚.53歳時に腰痛認め,前医受診.50歳後半より立位保持時の腰痛を自覚し症状増悪するため,前医受診し,当科紹介となる.T3-4に前後一致の癒合椎,胸椎主カーブ:40度,L3/4に椎間のwedgingを呈し,8年の経過で脊柱変形の進行と腰痛の進行認め,手術を施行した.癒合椎下の8年前の主カーブは軽度であったが,60歳前で40度台まで進行している.癒合椎部を主とした変形進行ではなく,また,いわゆるde novo側彎としては非典型的なカーブであり,経過画像からはT3-4の癒合椎以下の側彎が進行し構築され,腰椎代償が破綻したと考えられる.比較的進行が緩徐な上位胸椎癒合椎であっても,加齢変性が加わり代償性カーブの構築化,破綻する症例はあるため,経過フォローが必要である.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

我々はより正確な人工関節の設置を目指し,ナビゲーションを導入している.本研究の目的はReverse Shoulder Arthroplasty(以下RSA)におけるスクリュー固定に対するナビゲーションの効果を検討することである.対象はRSA施行後CT撮影が可能であった13例13肩とした.ナビゲーションの使用の有無で2群に分け(使用群8肩,非使用群5肩),使用したスクリュー長及びスクリュー先端から骨皮質までの距離を測定した.スクリューは上方,前下方,後下方,下方の4ヶ所で使用していたが,ナビゲーションの使用の有無で有意差を認めたのは上方スクリューのみであった.(使用群平均29.3mm,非使用群平均21.2mm)スクリュー先端から骨皮質までの距離では有意差を認めなかった.ナビゲーション使用群で上方スクリューのみであったが有意に長いスクリューを安全に挿入できていたと考えた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

症例は76歳男性,10年前に左母趾を捻挫後,母趾の内反変形が進行し,疼痛も徐々に増悪したため当科受診となった.疼痛が強く,通常の靴も履けない状態であった.左母趾MTP関節は内反方向に異常可動性を認め,容易に徒手整復可能であった.単純X線像では重度の内反変形を認めた.この症例に対して,Fiber Tape(Arthrex社)とTenodesis screw(Arthrex社)を用いて変形を矯正した.術後,疼痛は改善し,可動域制限を特に認めず,矯正位は保持されていた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

2010年から2019年までに当院で舟状骨偽関節に対して手術治療を行った13例(全例男性)について治療成績を検討した.手術時年齢は18〜70(平均36)歳,骨折部位は体部11例,近位2例,Filan-Herbert分類はD1 1例,D2 10例,D3 2例,受傷から手術までの期間は受傷時期不明の2例を除き,2ヵ月〜2年8ヵ月(平均8.3ヵ月)であった.全例で遊離自家骨移植(腸骨11例,橈骨遠位1例,肘頭1例)を行い,headless compression screwで固定した.1例で骨癒合が得られず再度遊離骨移植術を行い,最終的に全例で骨癒合が得られた.今回の症例は殆どが体部骨折でD1,D2症例であったが,これらにおいては遊離自家骨移植にて諸家の報告する血管柄付き骨移植術の成績とも差のない成績が得られており,症例を吟味すれば遊離自家骨移植は今後も有力な選択肢となるものと考えた.一方骨癒合が得られにくいとされるD3,D4症例では,血管柄付骨移植術を考慮する必要があると思われた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

高年者の腰椎X-pにおいて腰椎椎間板内に生じるガス像は比較的よくみられる所見ではあるが,通常は臨床症状と無関係であることが多い.今回我々は右L3の神経根症状を呈し,その責任高位の椎間板および隣接する脊柱管内に巨大なガス像を認める症例を経験した.症例は82歳,女性.特に誘因無く右大腿部の疼痛,しびれを自覚するようになり当科受診.腰椎MRIにてL2/3右側に巨大なヘルニアを疑う所見を認めた.ミエロCTを施行したところヘルニアと評価していた病変は脊柱管内を占拠する巨大なガスであることが判明した.椎弓形成術を施行し同部位の硬膜は一部陥凹しており強い圧迫が存在していたことが示唆された.術後経過良好で下肢痛は消失した.本症例の病態としては椎間板内にvacuum phenomenonが形成され,その気体が後方へ移動した繊維輪とともに後縦靱帯を突き破りガス像として脊柱管を占拠したものと考えられた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

超高齢化社会を迎え化膿性脊椎炎の患者数は増加している.我々は腰椎化膿性脊椎炎に対してPEDにて掻把後PPSを用いて2期的に後方固定術を施行している.その手術をH27年以降施行した症例62症例(男性39例,女性23例)を対象とし,手術時間・術中出血量・術前合併症・PPS術後CRP陰性化までの期間・前方固定術追加の有無から化膿性脊椎炎に対するその治療の有効性を検討した.平均手術時年齢は73.1歳(表1),平均手術時間はPEDで68.8分,PPSで110.1分,平均術中出血量はPEDで10g,PPSで71.6gであったPPS術後CRPが1mg/dl未満となるまで平均17.5日,0.4mg/dl未満となるまで平均25日であった.後方固定術後に前方固定術が追加された症例は0例であった.PEDは敗血症の症例でも局所麻酔で施行可能であり,PDと比較して硬膜外膿瘍が除去可能である.PED施行後PPSを用いた後方固定術を行うことで腰椎前方再建術を回避できると考えた.(著者抄録)

Publisher：(株)南江堂  

女子バスケットボール選手62名124足(平均年齢14.0歳)を対象に、慢性足関節不安定症(CAI)と動的姿勢制御の関連についてSEBTを用いて検討した。その結果、CAI(+)群はCAI(-)群と比較し、有意にSEBT-ANTの低下、足関節背屈可動域の低下が認められた。今回の検討では足関節可動域改善や体幹、股関節、膝関節周囲の筋力増強、バランストレーニングが足関節捻挫の初回受傷の予防だけでなく、再発予防にも有効である可能性が示唆された。

Publisher：(一社)日本人工関節学会  

過去3年間に当院で加療したVancouver分類Type B大腿骨ステム周囲骨折15例(男性1例、女性14例、受傷時年齢84.2歳)の治療成績について検討した。治療法は車椅子レベルであった2例には保存的治療が選択され、他の13例は手術治療が行われた。平均観察期間13.7ヵ月の結果、術後感染を合併した1例を除き、14例が平均4.2ヵ月で骨癒合が得られていた。合併症は深部感染が2例、術後骨折と脱臼が各1例に認められた。うち深部感染の1例で二期的再置換術が行われ、術後骨折例でORIFの追加が行われた。

Publisher：(一社)日本肩関節学会  

化膿性肩関節炎に対する鏡視下洗浄デブリドマン後の開放性ドレナージは術後早期からリハビリを行える利点から機能予後も良好であることが報告されており,当院でも同方法を採用している.今回,腱板断裂を基礎に持つ化膿性肩関節炎5症例の治療成績を検討したので報告する.2015年以降に治療した5例(平均年齢72.4歳)を対象とした.起因菌にMRSAなどの薬剤耐性菌はなかった.全例で感染鎮静化が得られ,再燃は無かった.ドレン留置期間は平均14日,鎮静化までの期間は25日であった.最終観察時ROMは屈曲平均83度であった.腱板断裂を合併する化膿性肩関節炎では機能低下が感染によりさらに進行し,保存加療だけでは不十分と思われる症例が存在した.いかに周術期感染を回避して機能獲得のための追加手術を行うかという治療戦略を確立する必要があると思われた.(著者抄録)

Publisher：(一社)日本肩関節学会  

本研究の目的は腱板断裂患者の可動域に影響を与える因子を検討することである.当院で鏡視下腱板修復術を施行した22肩を対象とし,術前90°以上自動屈曲可能な群をP群,不可能な群をI群,健側を対照C群とした.表面マーカーを貼付し,三次元動作解析装置で肩関節運動時の胸郭の屈曲伸展角度・回旋角度・側方傾斜角度,肩甲骨の上下方回旋角度,上腕骨内外旋角度を計測した.同時に僧帽筋,棘下筋,三角筋,大胸筋,前鋸筋の筋活動も計測した.前方および肩甲骨面挙上においてI群はC群に比し有意に上腕骨外旋角度が小さかった.側方挙上時の胸郭回旋においてP群とC群の間に有意な差を認めた.筋電図では前方挙上においてP群に比し,I群で有意に僧帽筋・前鋸筋で活動が高かった.P群の胸郭回旋とI群の筋活動は代償動作と考えられた.腱板断裂患者において挙上が可能か否かに上腕骨外旋角度が影響している可能性が示唆された.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

【はじめに】ビスフォスフォネート製剤(以下,BP製剤)の長期服用患者が増加するのに伴い,非定型大腿骨骨折(以下,AFF)の報告が散見され,両側例も10〜15%と稀ではない.今回我々は,AFF両側受傷の6例を経験したので報告する.【対象及び方法】2016年1月〜2018年12月までに大腿骨骨折に対して当院で加療を行った症例を後ろ向きに調査し,両側AFFと診断し,術後12ヵ月以上経過した6例12肢.全例女性(平均年齢83歳).初回骨折発生時の診断率,骨折型(完全or不全),骨折の発症時期,BP製剤服用歴,治療方法,最終観察時までの骨癒合の有無について検討を行った.【結果】診断率は33%,完全骨折が58.3%,両側同時発生は33%,BP製剤の服用例は83.3%に認めた.治療は1例を除く全例で手術療法が選択され,9肢で骨癒合を認めた.【考察】特徴的なレントゲン所見を認める時は本骨折を念頭に入れ,対側も含めた骨折の検索が重要であると考えられた.(著者抄録)

Language：Japanese   Publisher：西日本整形・災害外科学会  

当院では重度手根管症候群に対し,環指浅指屈筋腱を用い,Guyon管をプーリーとして一期的に母指対立再建術を行っている.今回,その治療成績について報告する.2011年5月〜2019年3月に手術を行い術後6ヵ月以上経過観察可能であった18例22手,手術時年齢70〜88歳(平均80歳)を対象とした.術前後の電気生理学的所見,Hand20,SWT,握力,Pulp pinchについて比較検討した.電気生理学的検査においてPadua分類extremeでは半数以上が術後もextremeであったが,Hand20は全例で改善を認め平均57.9点の改善を認めた.母指対立障害を主訴とする重度手根管症候群に対し一期的母指対立再建術と早期運動療法を併用し良好な成績が得られた.(著者抄録)

Publisher：西日本整形・災害外科学会  

膝蓋腱断裂は比較的稀な損傷である.今回我々は交通外傷に伴い脛骨近位部開放骨折を合併した外傷性膝蓋腱断裂の1例を経験したので報告する.【症例】24歳男性.軽トラック走行中に対向車と正面衝突し当院救急搬送.搬送時,右膝関節自動伸展不能.膝関節前方部に5cmの開放創を認め,Gastilo-Anderson分類type 2の開放骨折及び膝蓋腱断裂と診断し,同日洗浄と膝蓋腱の可及的縫合術を行った.受傷後7日で感染がないことを確認後,関節内骨折観血的手術と靱帯修復を行った.術後は3週間Knee brace固定し,歩行は許可,術後4週目より他動可動域訓練,術後6週より自動可動域訓練を行った.【結果】術後14ヵ月で感染や可動域制限は認めていない.【考察】今回は,ブレーキを強く踏もうとした介達外力に加え,ダッシュボート損傷による直達外力によりと受傷した推察された.開放骨折を合併しており早期手術を行うことができず術後後療法は遅れたが,結果は良好であった.(著者抄録)

Publisher：西日本整形・災害外科学会  

変形性膝関節症患者に施行された膝関節MRIの解析を行いBML(bone marrow lsion)について検討を行った.対象は当科で膝関節MRIを施行した286症例,288膝関節.これらに対しX-p上のK-L分類,BMLの有無,BMLスコアリング等について解析を行った.また当科でTKAを施行した32症例,33膝関節についても同様の検討を行った.288膝関節のうちBMLを有したのは49.3%であった.K-L分類別ではK-L1で11.9%,K-L2で50%,K-L3で74%,K-L4で97.9%であった.Boston-Leeds Osteo-arthritis Knee Scoreを用いたスコアリングではそれぞれ平均値でK-L1 4.5点,K-L2 5.5点,K-L3 8.1点,K-L4 11.3点であった.またTKAを施行した33膝関節のうち96.9%にBMLを認めスコアリングでは平均12.7点であった.膝OA患者に手術加療を検討するにあたりBMLの状態を評価することは手術適応の新たな指標になりえる.(著者抄録)

Publisher：(一社)日本骨折治療学会  

骨粗鬆症治療に対するビスフォスフォネート製剤の長期服用患者の増加に伴い,大腿骨を中心に非定型骨折の発生が問題となっているが,尺骨骨幹部に関しては比較的稀である.今回尺骨骨幹部非定型骨折の2例を経験したので報告する.両症例ともに10年以上のビスフォスフォネート製剤投与歴のある80歳代の女性で,4肢中2肢は手術療法,1肢は保存療法,1肢は無症候性であり経過観察とした.初診時に診断されなかった2肢は骨癒合不全を起こしており,1肢は偽関節手術,1肢はLIPUSによる治療を追加した.最終観察時は全例骨癒合を認めているが,非定型骨折は骨癒合しにくい傾向にあり,ビスフォスフォネート製剤の長期服用例の軽微な外傷後の尺骨骨幹部骨折には同疾患を念頭に置く必要がある.また,治療に関しては手術時の固定方法や補助療法も含めた骨癒合促進の工夫が必要である.(著者抄録)

Publisher：九州・山口スポーツ医・科学研究会  

前十字靱帯(以下ACL)脛骨付着部裂離骨折は小中学生に多く,幼児での発症は稀であり,軟骨部分での裂離骨折であるCartilaginous tibial eminence fracture(以下CTEF)のタイプになることがある.今回,4歳女児に発症したCTEFの症例を経験したので報告する.受傷はサッカーでの軽微な外傷で,複数の病院を受診するも診断がつかず,受傷後約4週で前医でのCTEFの診断にて当科紹介受診となった.鏡視下で母床を新鮮化し,エンドボタンを用いてpull out fixationを施行した.術後1年での再鏡視でも骨癒合良好であり,安定性も良好であった.CTEFは稀な外傷であるが,通常のACL脛骨付着部裂離骨折と比べて軽微な外傷で発症すると言われており,この疾患の存在を認識し,早期診断,早期治療が必要であると考える.(著者抄録)

Publisher：(一社)日本臨床整形外科学会  

緒言:特徴的なmagnetic resonance imaging(以下MRI)像を呈した外側円板状半月板の辺縁断裂の2例を報告する。症例:症例1は9歳女児。MRIで外側半月板が後内方にシフトし、円板状半月板の前節部断裂と診断した。前節から中節の辺縁断裂で、形成切除後、辺縁部を縫合した。症例2は16歳男性。右膝脱臼感で紹介となった。MRIにて外側半月板後節と関節包の間隙が広く、popliteomeniscal fascicle(以下PMF)が描出されておらず、complete discoidで後節の不安定性があると考えた。後方不安定性を認め、形成切除後に後節を縫合した。考察:外側半月板を温存することは非常に重要であり、断裂形態を把握するための特徴的なMRI像を知っておく必要がある。結語:今回、辺縁部不安定性のある外側円板状半月板に対して、形成切除術に辺縁縫合術を加え、良好な成績を得た。術前のMRIでの特徴的な画像を見逃さないことが重要である。(著者抄録)

Publisher：(株)南江堂  

当科で前十字靱帯(ACL)損傷に対し靱帯再建術を行った46例(男性30例、女性16例、平均年齢26歳)を対象に、ACL損傷に伴う膝内側コンパートメントの骨挫傷と内側半月板損傷との関連性について検討した。その結果、骨挫傷は44例(95.7%)に認められ、うち外側コンパートメントのみに骨挫傷が存在する症例は20例(43.5%)であった。内側コンパートメントのみの骨挫傷の症例はなく、両方に存在する症例が24例(52.2%)であった。今回の検討では脛骨内顆後方だけでなく、大腿骨内顆にも骨挫傷が存在する症例は内側半月板損傷の発症頻度が高い傾向を示していた。

Publisher：西日本整形・災害外科学会  

関節鏡下腱板修復術(ARCR)において腱板のリリースを必要とした症例の臨床成績及び再断裂率を検討した.ARCRを施行した68肩を対象とし,腱板周囲のリリースを行った群(R群)41肩,行わなかった群(N群)27肩の2群に分け検討した.日本整形外科学会肩関節疾患治療成績判定基準,自動可動域ともに術後有意に改善し,両者とも術前後とも2群間に有意差は認めなかった.再断裂率はR群23.3%,N群27.3%で2群間に有意差を認めなかった.またsingle-row法で修復された腱板の再断裂率はN群60%,R群42.9%であった.R群ではリリース無しでは一次修復不能な腱板がリリースによって一次修復可能となり,臨床成績,再断裂ともにリリースを要しなかった群と有意差を認めず,腱板周囲のリリースは効果的であると考えた.一方リリースを併用しないsingle-row法による修復は検討の余地があると考えた.(著者抄録)

Publisher：西日本整形・災害外科学会  

従来肩峰骨頭間距離(AHI)は腱板断裂の有無の指標とされてきたが,手術により腱板修復がなされても術後AHIが狭小化する症例を経験することがある.本研究の目的は関節鏡視下腱板修復術(ARCR)後のAHIの変化に影響する因子を検討することである.ARCRを施行した15例15肩を対象とした.手術時平均年齢65.7歳,全例関節鏡視下にdual-row法で腱板を修復した.検討項目はX線上のAHIとMRI上の腱板断裂の大きさ,肩甲骨の形態,腱板の修復状態,腱板機能とした.AHIは肩関節正面像で術後3ヵ月から術後1年までの間の変化量を調査した.MRI上の肩甲骨の形態評価には斜位矢状断を用い肩峰の前下縁と烏口突起上縁の距離を計測した.また烏口突起基部,肩甲棘基部,肩甲骨体部がなす角を計測した.烏口突起基部と肩甲棘基部がなす角が大きくなるに従い術後3ヵ月から術後1年の間にAHIが有意に減少していた.(著者抄録)

Publisher：西日本整形・災害外科学会  

筋上皮腫は,唾液腺由来の腫瘍であり整形外科で治療することは稀である.今回,胸壁に発生した悪性筋上皮腫の治療を経験したので報告する.症例:64歳女性,約10年前から左側背部の腫瘤を自覚していた.最近の1,2年間で急速に増大傾向にあったため,近医にて肉腫が疑われ当科紹介となった.MRIで皮下から広背筋下にかけて約80mm大の軟部腫瘍を認めた.深部は肋間から胸腔側に突出しており,肋間筋・壁側胸膜への浸潤が疑われた.針生検にて,円形細胞主体,免疫染色で上皮系マーカーが陽性で,肉腫の可能性が示唆されたが確定診断には至らなかった.MIB-1 indexが部分的に20%あり,画像上も浸潤傾向が疑われ,臨床的に軟部肉腫と考え広範切除を施行した.切除後の病理結果は悪性筋上皮腫であった.考察:筋上皮腫は全唾液腺腫瘍の1.5%程度であり,ほとんどが唾液腺原発である.渉猟した範囲では軟部組織原発は122例,胸壁発生は3例とさらに稀であった.(著者抄録)

Publisher：西日本整形・災害外科学会  

投球障害肩の一因として肩甲上腕関節が過度の水平伸展位をとることで発生するインターナルインピンジメントが報告されている.今回我々は肩関節外転角度と肩甲上腕関節水平伸展角度の関係を調査し,肩甲上腕関節水平伸展角度に影響を与える因子を検討した.対象は肩関節に愁訴の無い男性10名20肩とし,方法は肩関節30°内旋,中間位,90°外旋位の状態で,肩関節を120°,90°,60°,30°外転させ,それぞれの肢位で肩甲上腕関節水平伸展角度を計測した.肩甲棘と上腕のなす角度を肩甲上腕水平伸展角度とした.外転角度が減少するにつれ肩甲上腕関節水平伸展角度が増加する傾向にあり,外転120°と60°での肩甲上腕関節水平伸展角度には有意差を認めた.肩関節水平伸展角度と自動屈曲角度及び肩甲骨上方回旋角度に正の相関を認めた.いわゆる「肘下がり」がインターナルインピンジメントを増長させる可能性が示唆された.(著者抄録)

Publisher：九州リウマチ学会  

生物学的製剤使用中の関節リウマチ患者153例(男性26例、女性127例)を対象に、骨量減少リスク因子について検討した。その結果、骨塩量減少のリスク因子は罹病期間が短いこと、BMIが低いこと、プレドニゾロンの使用量が多いことであることが示唆された。

Publisher：西日本整形・災害外科学会  

近年,関節鏡下腱板修復術(ARCR)において肩甲下筋(SSC)修復を必要とする際,上腕二頭筋長頭腱(LHB)を切腱もしくは腱固定をする報告が多い.我々はこのような場合でも可及的にLHB温存している.本研究の目的はLHBを温存したSSC修復を含んだARCRの手術成績を報告することである.SSC修復を含むARCRを施行し,術後1年以上経過観察可能であった59例59肩を対象とした.これらをLHBの処理の有無で2群に分け評価した.LHBの処理は術中所見で決定し,結節間溝からの脱臼を整復できない例,通常の1/3以下に菲薄化した例もしくはhourglass test陽性例に対し腱固定術を行った.日本整形外科学会肩関節疾患治療成績判定基準,自動屈曲角度は2群とも術後有意に改善し,術前後とも2群間に有意差を認めなかった.SSC修復を含むARCRにおいてLHBの処理は必ずしも必要ではないことが示唆された.(著者抄録)

Publisher：西日本整形・災害外科学会  

ハムストリングでのACL再建術でも,稀に術後の膝蓋骨高の低下を来たすことがある.今回,術後の膝蓋下脂肪体の線維化の程度と膝蓋骨高の経時的変化を調査した.症例はハムストリングでACL再建術を行った26例.術前,術後3ヵ月,1年でMRI撮影し,膝蓋下脂肪体の線維化はincomplete,complete,diffuseの3つに分類し,膝蓋骨高はInsall-Salvati ratio(以下ISR)を計測した.膝蓋下脂肪体の線維化は,incomplete 17例,complete 7例,diffuse 2例であった.Completeでは3ヵ月で軽度ISRは低下し,1年でほぼ術前の状態に回復した.Diffuseの2例は3ヵ月,1年と徐々にISRは低下し,回復は示さなかった.ハムストリングでのACL再建術でも線維化の程度により膝蓋骨高は経時的に変化し,術後の広範囲な膝蓋下脂肪体の線維化では膝蓋骨低位が起こる可能性がある.(著者抄録)

Publisher：西日本整形・災害外科学会  

近年critical shoulder angle(以下CSA)と腱板断裂及び修復後腱板再断裂に関する報告が散見される.今回当院で行った関節鏡下腱板修復術(以下ARCR)患者におけるCSAと臨床成績,再断裂及びimpingement徴候の関連を検討したので報告する.対象は当院でARCRを施行し,1年以上経過観察可能であった76肩とした.CSAが35度未満の群(以下under群)と35度以上の群(以下over群)に分けて,術前後のJOA score,修復腱板の再断裂率,impingement徴候の陽性率を評価したがいずれも2群間に有意差を認めなかった.Impingement徴候陽性率はunder群では術後有意に改善し,over群では改善傾向にあるものの統計学的有意差を認めなかった.以上の結果より術後のimpingement徴候の有無にCSAが関与する可能性が示唆された.(著者抄録)

Publisher：(株)南江堂  

症例1(18歳男性)。サッカーの試合中に右大腿前面を強打して近医を受診、安静指示であったが、疼痛の改善なく、翌日に当科へ受診となった。症例2(17歳男性)。サッカー中に左大腿前面を蹴られ受傷し、近医にて筋挫傷の診断でクーリングを受けたが、受傷後4日で歩行不能となり、当科へ受診となった。両症例ともMRIで中間広筋内血腫と診断され、入院後にクーリング、包帯による圧迫、下肢挙上を開始した。症例1は受傷後3週でも著明なROM制限を認め、血腫が広範囲であったため、エコーを併用した関節鏡視下血腫除去術が行なわれた。一方、症例2は受傷後2週でROMの改善はなく、ウロキナーゼによる血腫溶解吸引療法が行なわれた。いずれの症例も経過良好で、受傷後3ヵ月経過でROM制限なくサッカーに復帰できている。

Publisher：西日本整形・災害外科学会  

<p>従来肩峰骨頭間距離（AHI）は腱板断裂の有無の指標とされてきたが，手術により腱板修復がなされても術後AHIが狭小化する症例を経験することがある．本研究の目的は関節鏡視下腱板修復術（ARCR）後のAHIの変化に影響する因子を検討することである．ARCRを施行した15例15肩を対象とした．手術時平均年齢65.7歳，全例関節鏡視下にdual-row法で腱板を修復した．検討項目はX線上のAHIとMRI上の腱板断裂の大きさ，肩甲骨の形態，腱板の修復状態，腱板機能とした．AHIは肩関節正面像で術後3か月から術後1年までの間の変化量を調査した．MRI上の肩甲骨の形態評価には斜位矢状断を用い肩峰の前下縁と烏口突起上縁の距離を計測した．また烏口突起基部，肩甲棘基部，肩甲骨体部がなす角を計測した．烏口突起基部と肩甲棘基部がなす角が大きくなるに従い術後3か月から術後1年の間にAHIが有意に減少していた．</p>

DOI： 10.5035/nishiseisai.69.405

Publisher：(一社)日本脊椎脊髄病学会  

症例は52歳女性。腰痛、左大腿部前面から外側にかけての疼痛、両大腿の筋力低下を主訴に近医を受診し、MRIにてT12/L1に硬膜内髄外腫瘍を認めた。腫瘍はT1、T2強調像で共に等信号、Gd造影にて均一に造影された。腫瘍切除術を施行し、術後病理組織検査の結果、明細胞髄膜腫の確定診断が得られた。脊髄明細胞髄膜腫は硬膜と付着しないまれな腫瘍で、WHO grade 2に分類される。切除後に術前症状は消失し、術後1年時点で再発はみられない。(著者抄録)

Language：Japanese   Publisher：(一社)日本人工関節学会  

PS-TKAにおいて大腿骨後顆骨切り量の増加(Posterior condylar offsetの減少)が術後可動域と早期臨床成績に及ぼす影響について検討した。対象と方法は、当院で2015〜2017年に内側型膝OAに対しVanguard RPでTKAを施行し術後1年以上観察できた症例のうち、大腿骨内側後顆骨切り量がインプラント厚の0〜2mm未満であった34膝を"Posterior condylar offset(PCO)維持群"とし、インプラント厚の3mm以上であった30膝を"PCO減少群"として、最終観察時の「膝伸展角度」「膝屈曲角度」「WOMAC」「FJS」「KSS」を群間比較した。結果、いずれの比較項目にも有意な群間差は認められず、Modified gap techniqueで行うPS-TKAにおいて大腿骨内側後顆骨切り量の増加は術後可動域と早期臨床成績に悪影響を及ぼさないことが示唆された。

Publisher：(一社)日本肩関節学会  

関節鏡下腱板修復(ARCR)において関節鏡下肩峰下除圧術(ASD)は一般的に行われている手技である.しかし烏口肩峰靱帯は烏口肩峰アーチの一部をなし,骨頭の前上方への変位を抑制しており,ARCRにおいて腱板再断裂を完全には予防できない以上,烏口肩峰靱帯はARCR後の重要な組織と考え,我々は基本的にASDを行っていない.本研究の目的はASDを併用しないARCRの臨床成績を評価することである.ARCRを行い一次修復可能であった53肩を対象とした.術前の肩関節3DCTを使用した骨棘の有無,骨棘の形態の評価及び日本整形外科学会治療判定基準を用いた臨床成績の評価を行った.ASDの有無では臨床成績に有意差を認めず,これは骨棘のある症例に限っても同様であった.また骨棘形態による臨床成績の有意差も認めなかった.ARCRにおいてASDは必ずしも全例に必要な処置ではないことが示唆された.(著者抄録)

Publisher：(一社)日本肩関節学会  

近年,鏡視下腱板修復術において上腕二頭筋長頭腱切腱術や腱固定術が行われる機会が増加している.いずれの術式も肩関節における上腕二頭筋機能には影響しないとの報告が見受けられるが,上腕二頭筋が主動力筋である前腕回外筋力を評価した報告は少ない.また前腕回外筋力評価には大型の測定機器が必要で日常診療では非現実的である.今回一般的に使用できる徒手筋力計を用いた前腕回外筋力測定装置を考案し,その信頼性を評価した.肩・肘関節に愁訴の無い15肩に対し,大型の多用途筋機能評価運動装置BIODEXと我々が考案した装置での計測値を比較した.我々の装置は徒手筋力計であるmobieと計測用のハンドルを板に固定し,これらを金属プレートで連結したものである.二つの測定値の相関係数は0.89,級内相関係数は0.79でその信頼性は十分であった.前腕回外筋力は利き手側が非利き手側より有意に大きく,その比は平均1.1であった.(著者抄録)

Publisher：(一社)日本手外科学会  

2010年から2018年の間に当院で手術治療を行った尺側CM関節脱臼骨折11例の治療成績を検討した.手術は全例Kirschner鋼線(以下K鋼線)固定を行い,田崎分類type 3 with 4th carpometacarpal fracture-dislocationの1例のみheadless screwによる固定を追加した.最終観察時の骨癒合,関節症性変化(以下OA変化),疼痛,関節可動域,握力健側比を調査した.結果は全例で骨癒合が得られ,1例のみ関節面の不整を認めた.疼痛は1例のみpower gripの際に疼痛が残存した.全例で可動域制限はみられなかった.握力健側比は平均94.2%であった.最近では創外固定やプレートによる手術例も報告されているが,最も簡便である鋼線固定においてもCM関節の安定化と有鉤骨遠位関節面の解剖学的整復により,比較的良好な成績が得られた.(著者抄録)

Publisher：西日本整形・災害外科学会  

【はじめに】褐色脂肪腫は褐色脂肪組織に由来するまれな軟部腫瘍であり,悪性軟部腫瘍,とくに脂肪肉腫との鑑別が問題となる.褐色脂肪腫はFDG-PETで高度集積を来すことが報告されており,脂肪肉腫との鑑別としてFDG-PETが有用であるとされる.【症例】40歳女性,4ヵ月前より背部の腫瘤を自覚.MRI上,僧帽筋下に脂肪成分を含み造影効果を有する80mm大の腫瘤を認めた.FDG-PETにてSUV59.5→70.5と非常に強いFDGの集積を認めたため開放生検を施行し,褐色細胞腫と診断されたため辺縁切除術を施行した.術後2年の現在,再発もなく術後経過良好である.【考察】褐色脂肪腫は一般的にFDGの高度集積を来すことが報告されているが,なかにはFDGの集積が低い症例も報告されている.褐色脂肪に対するFDGの集積は外気温や薬剤による影響を受けやすく,注意が必要と考えられた.(著者抄録)

Publisher：西日本整形・災害外科学会  

【目的】遠位橈尺関節症(DRUJ-OA)による伸筋腱皮下断裂は関節リウマチ(RA)によるものと比べると頻度は低いが時に遭遇する疾患である.当院での3例の手術経験を報告する.【症例】症例1 81歳女性.1ヵ月前に環小指伸展不能となる.2腱断裂(小指総指伸筋腱(EDC4,5))を認め,隣接腱(EDC3)への端側縫合とSauve-Kapandji法(SK法)による関節形成術を行った.症例2 86歳女性.1ヵ月前に環小指伸展不能となる.2腱断裂(EDC4,5)認め,隣接腱(EDC3)への端側縫合とSK法を行った.症例3 77歳女性.1ヵ月前に小指伸展不能となる.1腱断裂(EDC5)を認め,隣接腱(EDC4)への端側縫合とSK法を行った.【考察】DRUJ-OAではRAと異なり,橈骨尺側切痕の変形や尺骨頭の背側転位などの骨形態が腱断裂に関与すると考えられる.臨床成績は他の報告と同様良好であった.(著者抄録)

Publisher：西日本整形・災害外科学会  

スポーツ障害の1つである疲労骨折は繰り返し加わる小さな力によって起こるため,早期診断に苦慮する事もある.特に荷重のかかる下肢の疲労骨折は,復帰時期も含めて治療に難渋する事が多い.今回,我々は比較的稀な足関節内果疲労骨折の3例を経験し,その後の経過について検討を行ったので報告する.【症例1】20歳男性,大学陸上部のやり投げ選手.本人が手術を希望せず保存的加療.経過良好にて競技復帰【症例2】14歳男性,剣道部.手術加療も再骨折し,再手術施行し競技復帰【症例3】14歳女性,テニスクラブに所属.手術加療後競技復帰.本骨折は保存的加療を行っても良好な経過がみられるが,遷延治癒や再骨折もあり早期スポーツ復帰を希望する場合は手術を考慮するべきである.手術加療を行っても偽関節の形成や,抜釘後に再骨折を来す場合があり,抜釘時期も含めて注意深く経過を観察していく必要がある.(著者抄録)

Publisher：日本股関節学会  

39歳男。右股関節の激痛で目覚め、歩行困難となり前医受診した。38℃台の発熱を認め、鑑別疾患として化膿性股関節炎も念頭に抗菌剤投与を開始された。発症後3日目に当科へ紹介され入院となった。臨床症状や関節液の性状から化膿性股関節炎を強く疑い、細菌培養は陰性であったが、前医での抗菌剤投与による偽陰性の可能性も考慮して直ちに外科治療的介入を行い、良好な結果が得られた。

Language：Japanese   Publisher：(株)三輪書店  

2012〜2015年に標記疾患に対し手術を施行した4例(S群)と経過観察した5例(NS群)の計9例(平均年齢66.4歳)を対象に、Eating Assessment Tool-10(EAT-10)と頸椎パラメータを後方視的に検討した。S群術後経過観察期間は平均21ヵ月であった。EAT-10はS群術前27.3点、NS群3.0点とS群で嚥下障害は高度であったが、術後は0.8点と有意に低下した。S群の手術前後、S群とNS群との頸椎パラメータ比較では、ともにC2-7角とC2-6a角において有意差を認め、S群術前で頸椎屈曲制限を認めた。

Publisher：(株)南江堂  

66歳女。上背部腫瘤を主訴とした。腫瘤は4cm大の弾性硬・無痛性で、MRIでは左頸板状筋、最長筋内に42×33×41mm大、T2強調像で筋組織よりもやや高輝度、辺縁不明瞭な軟部腫瘍を認めた。針生検で悪性所見は認めず経過観察としたが、6ヵ月後のCTで腫瘍径が50×45×110mmへ増大を認めたため切開生検を行った。病理所見よりデスモイド型線維腫の診断を得て、トラニラストとセレコキシブ内服を開始した。投与開始1年で腫瘍の縮小傾向を認め、3年経過時に縮小率71%で部分寛解にいたった。投与開始から3年4ヵ月でも腫瘍の再発・増大は認めていない。

Publisher：西日本整形・災害外科学会  

本邦で施行されるTKAの約3%が再置換術である。2大要因は人工関節周囲感染(以下PJI)とaseptic looseningである。今回我々は両者の鑑別に難渋した症例を経験したので報告する。症例は78歳女性、右変形性膝関節症に対し近医にてTKA施行され術直後は経過良好であったが、術後3年で右膝痛と腫脹が出現、保存的に経過観察とされていたが徐々に増悪、術後7年でPJI疑いで紹介受診となった。採血データでCRP陽性・ESR亢進、CT・MRIにて膝蓋上嚢にリング状エンハンス、シンチグラムでの集積亢進を認めたが、関節液所見は細菌培養陰性、好中球数90/ul、分画11%、α-defensin陰性であった。関節液所見を重視するMSIS(Musculoskeletal Infection Society)のPJI診断基準5)に準じPJIを否定し再置換術を施行した。PJIの診断には関節液所見が重要である。(著者抄録)

Publisher：西日本整形・災害外科学会  

【はじめに】アダマンチノーマは良く知られた悪性骨腫瘍であるが、発生は非常に稀であり診断の遅れが報告されている。【症例】43歳男性、建築業。4年前から右下腿を数回打撲、3年前に近医を受診し右脛骨前面骨皮質の不整と硬化像を指摘されたが経過観察となる。1ヵ月前に再度打撲、前医を受診。MRIにて右脛骨近位部に腫瘍像を指摘され当科紹介受診された。単純X線にて脛骨近位骨幹部前面骨皮質に透亮像、その遠位と近位に骨硬化像を認めた。MRIにて骨透亮像部に骨外に進展する腫瘍を認め、生検にてアダマンチノーマの診断を得た。遠隔転移は認めず、腫瘍広範切除術を施行した。腫瘍辺縁から1cmマージンで切除後、同側腓骨を有茎血管柄付き移植し再建した。術後8ヵ月、骨癒合を認める一方再発転位は認められず、職場復帰している。【考察】職業柄、繰り返す打撲を契機に受診していたことも診断の遅れにつながった症例と考えられた。広範切除後の再建方法として有茎血管柄付き腓骨移植は簡便で有用な方法であることが示された。(著者抄録)

Publisher：西日本整形・災害外科学会  

近年整形外科領域においてアクネ菌が人体に様々な影響を及ぼしていることが指摘されている。今回アクネ菌による化膿性股関節炎の症例を経験したため報告をする。【症例】大理石病を有する66歳女性。約20年前に左股関節インプラント手術後にMRSA感染を発症した既往があった。左股関節痛を主訴に当院を外来受診。MRIにて左股関節周囲に巨大膿瘍を疑う所見を認めた。またCRP 31.1mg/dlと高値であったため排膿、洗浄処置を施行した。既往からMRSAによる感染が考えられたためバンコマイシン入りセメントビーズを局所に充填する処置を行った。しかしその後の培養結果ではアクネ菌のみが検出された。当初はcontaminationを疑うもMRSAは全く検出されなかったためアクネ菌による化膿性股関節炎の診断でセメントビーズの除去、抗生剤を変更して投与したところ感染は鎮静化するに至った。(著者抄録)

Publisher：西日本整形・災害外科学会  

早期発症側弯症に対する成長温存手術は、growth spurt前の脊柱変形に対する手術として、近年選択されている。今回低身長を合併した先天性前側弯症に対し、Shilla法に準じた成長温存手術を行った症例を報告する。10歳女児。117cm(-3SD)24kg(-2SD)初潮未。低身長に対し、成長ホルモン投与中。9歳時の学校検診で脊柱変形を指摘され当科受診。初診時に分節異常による脊柱変形(Cobb角:49度)による先天性前側弯と診断。Growing rodでは前弯のコントロールが困難と考えられ、当初Final fusionを検討したが、低身長もあるため、Shilla法に準じた成長温存手術を選択した。Shilla法に準じた成長温存手術はgrowing rodに比べ、多数回手術が回避できる利点に加え、頂椎カーブを扱うため、矢状面バランスも獲得しやすい利点もある。長期成績やメタローシスなどの問題点もあるが、成長温存手術を検討する際の選択肢となり得る。(著者抄録)

Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

関節鏡手術時に採取したヒト膝関節滑膜細胞を培養し、ヒトヘモグロビン(Hb)を25、50、100μg/mlの各濃度で添加し、24時間後の培養液を採取して濃度依存性の影響を検討した。また、Hb濃度を100μg/mlに統一したものを添加後6、12、24時間で培養液を採取し、時間依存性の影響を検討した。ADAMTSファミリーの中でマトリックス分解に影響を及ぼしているとされるADAMTS-5、8、9、10について、Western blotting法、ELISA法、realtime PCR法で評価した。その結果、25μg/mlの低濃度のHb添加でもコントロール群に比べ有意にADAMTS-5、9の活性が亢進した。また、添加後6時間経過の時点でも優位に活性亢進した。低濃度・短時間でもHbは滑膜からのADAMTS-5、9の活性・発現を亢進させると考えられた。スポーツ外傷等の単回の関節内出血において受傷後早期に軟骨破壊が惹起する可能性が示唆され、早期の血腫除去や洗浄が必要と考えられた。

Publisher：西日本整形・災害外科学会  

<p>早期発症側弯症に対する成長温存手術は，growth spurt前の脊柱変形に対する手術として，近年選択されている．今回低身長を合併した先天性前側弯症に対し，Shilla法に準じた成長温存手術を行った症例を報告する．10歳　女児　117 cm（－3 SD）24 kg（－2 SD）初潮未．低身長に対し，成長ホルモン投与中．9歳時の学校検診で脊柱変形を指摘され当科受診．初診時に分節異常による脊柱変形（Cobb角：49度）による先天性前側弯と診断．Growing rodでは前弯のコントロールが困難と考えられ，当初Final fusionを検討したが，低身長もあるため，Shilla法に準じた成長温存手術を選択した．Shilla法に準じた成長温存手術はgrowing rodに比べ，多数回手術が回避できる利点に加え，頂椎カーブを扱うため，矢状面バランスも獲得しやすい利点もある．長期成績やメタローシスなどの問題点もあるが，成長温存手術を検討する際の選択肢となり得る．</p>

DOI： 10.5035/nishiseisai.68.251

Publisher：(一社)日本肩関節学会  

高齢者の腱板断裂に伴う偽性麻痺肩に対して、RSAを推奨する報告がある。今回70歳以上、自動挙上90度未満の腱板断裂例に対する鏡視下手術の成績を調査した。術後12ヵ月以上観察できた32肩を対象とした。年齢は平均73.9歳、観察期間は平均25.1ヵ月であった。手術法は一次修復術27肩、部分修復術3肩、パッチ法2肩であった。一次修復例の腱板修復状態を術後1年時MRIで調査し、菅谷分類別の術前後のJOAスコア、自動挙上角度(aAE)を調査した。部分修復術、パッチ法のJOAスコア、aAEも調査した。腱板修復状態はtype 1、15肩、type 3、1肩、type 4、4肩、type 5、7肩であった。JOAスコア、aAEは概ね改善していたがtype 5とパッチ法が他より劣っていた。部分修復術は良好であった。RSAは最終手術である認識が必要である。低侵襲な鏡視下手術は有効で、今後さらに見直されるべきものと考える。(著者抄録)

Publisher：(一社)日本肩関節学会  

近年、小頭離断性骨軟骨炎(以下OCD)の早期発見を目的とした野球検診が全国的に広がっている。我々も平成22年度より宮崎県少年野球検診を行っている。7年間で合計3051名が検診を受診し、OCDと診断されたのは84名(2.8%)であった。我々はOCDは投球機会の多い投手・捕手をしている体格のいいチームの中心選手に多い印象をもっている。それを検討するために体格(身長・体重)とポジション(投手・捕手をしているか)、加えて投球時痛・小頭部圧痛・肘関節可動域制限の有無に関し、OCD群とコントロール群の2群間で検討したので報告する。結果は身長・体重に関しては有意差はなかった。投手・捕手の割合、投球時痛・小頭部圧痛・可動域制限がある割合はすべてOCD群で有意に高かった。OCDは投手捕手をしている選手に多く発生していた。ポジションや投球数を考慮した予防活動が必要である。(著者抄録)

Publisher：西日本整形・災害外科学会  

症例は39歳、女性、ミニバレー中に右橈尺骨骨幹部骨折、上腕骨内側上顆裂離骨折を受傷し、前医で保存的に加療を受けた。骨癒合後に可動域訓練を開始したが、尺骨神経領域の痺れが出現し、当科を紹介受診した。可動域制限は軽度であったが、肘部管症候群の所見を呈していた。単純X線では、上腕骨内側上顆裂離骨折および橈尺骨の変形癒合を認めた。肘部管および骨折部周囲での尺骨神経の絞扼を疑い、尺骨神経皮下前方移行術と骨折部周囲の尺骨神経の剥離を行った。肘部管および橈尺骨骨幹部において尺骨神経の絞扼を呈していた。術後経過は良好であった。症状が出現した際には早期の神経剥離術が必要であり、外傷部位が複数に及ぶ場合は、各々の部位での神経の確認が必要と考えられた。(著者抄録)

Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

2013年7月〜2015年6月に標記の術式を施行した8例8膝(全例男性、平均年齢25.4歳)の経験を報告した。全例複合靱帯損傷例であり、自家半腱様筋腱を用いて膝窩腓骨靱帯および外側側副靱帯を再建し、Larson法を改良して大腿骨側は移植腱の遊離端をそれぞれpull-out法で解剖学的付着部に固定した。観察期間は平均22.4ヵ月であり、Lysholmスコア、JOAスコアは術前と比較して有意に改善した。等速性膝伸展・屈曲筋力の平均はそれぞれ健側比80%以上、前方もしくは後方脛骨移動距離の健側差は2mm未満であり、徒手検査で内反不安定性、回旋不安定性は認めなかった。2例に5°以下の伸展制限を認めた。

Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

平成25〜28年度宮崎県少年野球検診を受診した小学生延べ2041名の健診結果と可動域測定の結果との関連について検討した。検診結果が異常なしの「異常なし群」1749名、二次検診で肘に何らかの異常を認めた「異常あり群」292名、そのうち小頭離断性骨軟骨炎(OCD)を認めた「OCD群」57名に群別して可動域測定の結果を比較した。その結果、異常あり群では異常なし群と比較して下肢柔軟性が有意に低下しており、指床間距離(FFD)と両側の下肢伸展挙上に有意差を認めた。OCD群では可動域・柔軟性に統一した結果が出なかったが、異常なし群と比較してFFDが有意に低下していた。また、肩関節可動域に有意な群間差はなかったが、各群とも投球側の内旋角度が減少し、外旋角度は増大していた。

Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

膝内側側副靱帯(MCL)3度損傷に対し、脛骨付着部を温存した自家半腱様筋腱グラフトを用いた再建術を施行し、その術後成績について検討した。当科において上記術式を施行した10例中、術後1年以上経過観察し得た6例(全例男性、平均28.3歳)を対象とした。スポーツによる受傷が4例で転落外傷が2例であった。スポーツによるものは全例KD-1であり、転落によるものはすべてKD-3であった。術後の平均膝伸展筋力(患健側比)は-4.35%、屈曲筋力は-0.05%であった。術後の可動域はおおむね良好であったが、KD-3の2症例において5°以下の膝伸展制限を認めた。Lysholm scoreは術前平均34.5点が術後平均87.8点へ改善した。術後のMCL不安定性は認めなかった。脛骨付着部を温存した自家半腱様筋グラフトによるMCL再建術は良好な術後短期成績を呈した。

Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

外側広範型上腕骨小頭離断性骨軟骨炎(OCD)の手術成績を評価し、その成績を左右する因子について検討した。2007年1月〜2014年12月に当科で外側広範型OCDに対し手術を行い、術後1年以上経過観察可能であった23例23肘を対象とした。A群をICRS OCD IIに骨軟骨片固定術を行った4肘、B群をICRS OCD IIIに骨軟骨柱移植術を行った9肘、C群をICRS OCD IVに鏡視下郭清術を行った4肘、D群をICRS OCD IVに骨軟骨柱移植術を行った6肘とした。検討の結果、外側広範型OCD IIIの手術成績は良好であったが、外側広範型OCD IVの手術成績は不安定であった。C群の不良例は術前、骨端線が残存し可動域制限が著明な例であり、良好例は骨端線が閉鎖し、可動域制限が軽度の例であった。手術成績を左右する因子は術前の可動域であると考えられ、術前の可動域制限が重度となる前に手術が必要と思われた。

Publisher：(一社)日本肩関節学会  

2002年から2014年迄の間に、一次修復不能な後上方腱板広範囲断裂に対し広背筋・大円筋移行術を行い2年以上経過観察可能であった25例25肩の術後成績を検討した。関節症変化がなく、骨頭を温存し移行術を行ったのは12例12肩(RCT群)、関節症をともなうcuff tear arthropathyで小径骨頭を用いた人工骨頭置換術と移行術を行ったのは13例13肩(CTA群)であった。RCT群は平均年齢65.0歳、男性11例、女性1例、平均経過観察時間は38.3ヵ月であった。CTA群は平均年齢68.6歳、男性4例、女性9例、平均経過観察時間は52.9ヵ月であった。両群の術前と最終観察時のJOAスコアと肩関節可動域、外旋ラグサインの変化、合併症、さらにRCT群では術前と最終観察時のX線所見、術後のMRIによる再断裂の有無を調査した。JOAスコアはRCT群39.9点から77.7点、CTA群は40.6点から78.0点へ、屈曲はRCT群は49.6°から141.3°、CTA群は56.5°から136.9°へ、外旋はRCT群は15.4°から33.3°、CTA群は16.2°から29.2°へ有意に改善した。外旋ラグサインは術後全例で消失していた。合併症は認めなかった。RCT群で4肩(33.3%)に術後の肩甲上腕関節症の進行を認め、4肩(33.3%)に骨頭上方化の進行を認めた。再断裂は認めなかった。両群でJOAスコア、外旋ラグサインを含め可動域の改善を認めており、広背筋・大円筋移行術は一次修復不能な後上方腱板断裂に対する有用な手技であると考えられた。(著者抄録)

Publisher：(一社)日本肩関節学会  

アテトーゼ型脳性麻痺の32歳女性で単回の右肩亜脱臼後に肩痛が持続した.運動療法で改善しなかったため,鏡視下デブリードマンを行った.術後4ヵ月で右肩痛が再発した.不随意運動のため,肩関節不安定性が運動療法で制御できないものと考え,鏡視下バンカート修復術を行った.術後右肩痛は改善した.不随意運動を伴う肩痛は,微小な肩関節不安定性が原因である可能性があることを念頭に置く必要がある.(著者抄録)

Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

28歳男性。山腹で作業中に耕運機に左下肢を巻き込まれて受傷、ドクターカー、ドウターヘリを経て搬送された。初診時、開放性左膝関節完全脱臼に脛腓骨骨折を合併しており、初期治療として洗浄、脱臼整復、創外固定、およびMCLの1次修復を行い、受傷後1週で脛骨骨幹部のプレート固定を施行した。受傷後3週で膝関節の創外固定を抜去して硬性装具に変更し、受傷後3ヵ月で関節鏡視下に前十字・後十字・内側側副靱帯および後外側支持機能を同時再建した。術後3年の時点でLysholm scoreは87点で、可動域は0〜135°で正座不可であるが、サポーターを着用しランニングが可能で現場作業にも復帰している。

Language：Japanese   Publisher：(一社)日本肩関節学会  

過去10年間の外傷性肩関節前方不安定症に対する鏡視下バンカート修復術(ABR)症例74肩(男性58肩、女性16肩、平均年齢27.6±11.5歳)を対象に、術後成績について検討した。対象は経過観察期間12〜85ヵ月であった。その結果、JSS-SISscore、Rowe scoreは術後有意な改善を認め、患側ER1、ER2、ADDは健側に比して有意な低下が認められた。日常生活に支障をきたす可動域制限はなく、追加手術の有無で術後可動域制限に有意差は認められなかった。再脱臼は4肩で、腱板疎部縫縮術追加を行った15〜16歳のラグビー選手で、ラグビー復帰後に再受傷した。再脱臼率はコリジョンアスリートの19%であり、コリジョンアスリートに対するABRでは強固な補強術が必要であると考えられた。

Publisher：九州・山口スポーツ医・科学研究会  

弾発膝の原因の一つである膝関節滑膜ヒダ障害は内側例が多く,外側例は比較的稀である.今回,外側滑膜ヒダ障害と思われる1例を経験し,鏡視下切除により良好な成績を得たので報告する.両膝関節外側部痛,膝関節屈曲伸展に伴う弾発を主訴とした15歳女性で,小学生より硬式野球を継続していた.単純X線では異常所見なく,MRIでは一部,外側支帯の肥厚が疑われた.身体所見より両側外側滑膜ヒダ障害を疑い,関節鏡視下切除術を施行した.鏡視では外側上嚢隔壁から外側支帯に肥厚した索状物を認め,索状物及び外側支帯の一部を切離した.術後は両膝関節屈曲伸展の弾発は消失し,術後4ヵ月後も再発は認めていない.早期切除を行った事により早期スポーツ復帰が可能であったことから,早期の鏡視下切除も選択肢の一つと考えられる.(著者抄録)

Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

当科で再建術を施行し術後1年以上観察しえた19例の成績を調査し、対照群(ハムストリング腱単独で2重束ACL再建術を施行した群)と比較検討した。調査項目は「Lysholm score」「脛骨前方移動量」「膝伸展・屈曲筋力の患健比」「大腿骨孔拡大」とした。「大腿骨孔拡大」の計測方法は、術直後と術後1年時にデジタルX線正面像・側面像から計測し、術後1年時の値が術直後の値より10%以上増加しているものを"骨孔拡大あり"とした。検討の結果、対照群に比べて「脛骨前方移動量」「大腿骨孔拡大あり例の割合」が有意に低値であった。

Language：Japanese   Publisher：日本肘関節学会  

野球選手の上腕骨小頭離断性骨軟骨炎(小頭OCD)の手術成績を検討することを目的とした。対象は31例31肘であり、年齢は11～16歳(平均13.9歳)であった。手術法は鏡視下廓清術:15肘、骨軟骨片固定術:5肘、および骨軟骨柱移植術:11肘であった。病型とICRS OCD分類別の成績を術前、術後1年時JOA-JES score、自動屈曲、伸展角度、競技復帰状況で評価した。各手術とも外側広範型OCD IV以外は術後概ね良好に回復していた。外側広範型OCD IVの鏡視下廓清術、骨軟骨柱移植術の成績は不安定であった。外側広範型OCD IVの3肘以外は完全復帰していた。外側広範型OCD IVを生じさせないために早期発見、早期治療、保存療法の徹底、手術手技の習熟、新たな手術手技の検討が必要である。(著者抄録)

Language：Japanese   Publisher：(一社)日本肩関節学会  

Terrible triad of shoulder(以下TTS)は腱板断裂と神経損傷を伴った肩関節前方脱臼であり、腋窩神経麻痺を伴うことが多い。今回、手術を行わなかった自験例5肩の経過をretrospectiveに調査し、腱板断裂に対する治療方針ついて考察した。調査項目は「受傷前の自動挙上角度に回復したか否か」「麻痺回復徴候がみられはじめた時期」「初診時と最終観察時のJOAスコア」とした。調査の結果、全例が受傷前の自動挙上角度に回復しており、回復した時期は受傷後5〜12ヵ月(平均7.8ヵ月)であった。麻痺回復徴候がみられはじめた時期は受傷後2〜6ヵ月(平均3.4ヵ月)であった。JOAスコアは初診時32.5±11.9点が最終観察時60.6±3.6点に改善していた。これらの結果から、TTSの腱板断裂は手術の絶対適応ではなく、症例個々の断裂状態に応じて検討すべきと考えられた。

Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

ARCR後のアンカー孔拡大は糸のワイパー現象が原因で,アイレットが露出したアンカーではアイレットが骨表面から露出することがある.そのためフルスレッドアンカーを用いてきた.そのsuture bridge法後のアンカー孔の状態を検討した.54肩(男性34肩,女性20肩)を対象とした.年齢は33.75歳.平均62.1歳.内側に4種類のフルスレッドアンカーを使用し,外側に3種類のbridge用アンカーを使用した.大結節での内側アンカー突出の有無,外側アンカー突出の有無,糸状侵食の有無を術後1年時CTで評価した.アンカー孔の状態と臨床成績の関係を術後1年時JOA score,腱板修復状態との関係を術後1年時MRIで調査した.内側アンカーでは5肩に5本の突出を認め,49肩に認めなかった.外側アンカーは4肩に4本の突出を認め,50肩に認めなかった.糸状侵食を47肩に認め,7肩に認めなかった.アンカー突出,糸状侵食の有無で術後JOA scoreに有意差はなかった.再断裂を12肩に認めた.アンカー突出の有無と再断裂の有無に有意差はなかった.糸状侵食の有無と再断裂の有無に有意差を認めた.フルスレッドアンカーではアンカーが露出する危険性がないと予想しそれを使用したが,少数例でアンカーの突出を認めた.アンカー孔近位部が拡大しアンカーが突出していたことから,windscreen-wiper motionに加え,アンカーの引き抜き,micro-motionの関与が推測された.54肩中47肩に糸状侵食を認め,それがない例に再断裂が多かった.腱板付着部の骨侵食像は腱板治癒に有意に働いている可能性があると思われた.(著者抄録)

Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

自家ハムストリング腱を用いたbi-socket法によるPCL再建術の術後短期成績について報告した。自家ハムストリング腱を用いてPCL再建術を施行した17例を対象とし、PCL単独損傷は8例、膝複合靱帯損傷は9例であった。術後Lysholm scoreは平均85.5点と良好であった。術後膝屈曲角度は平均132.7°で、屈曲制限症例が多くみられた。膝伸展および屈曲筋力はいずれも健側比80%以上を呈し、良好な結果であった。脛骨後方移動量は術前平均12.2mmから術後平均2.9mmと著明に改善した。

Publisher：(一社)日本肩関節学会  

49歳男。バイクで走行中に転倒し、右肩甲骨体部骨折を受傷した。近医で保存的に加療され骨癒合したが、右肩痛の改善なく、受傷8ヵ月後に当科受診した。保存的加療を行ったが疼痛は改善せず、肩関節内のひっかかり感を認めたため、受傷13ヵ月後に検査的意味もこめて鏡視下手術を行った。術中所見として腱板関節面断裂と後方関節唇損傷を認め、デブリドマンを施行した。術後にひっかかり感は消失したが、術後4ヵ月時に術前とは異なる症状の右肩痛が出現した。具体的には、特定の肢位で出現する疼痛と、左肩外側への放散痛を認めた。CT検査で肩甲骨体部からquadrilateral spaceに伸びる骨棘を認め、理学所見と合わせて骨棘による腋窩神経障害と診断した。骨棘切除術を行い、疼痛は消失した。

Publisher：(一社)日本肩関節学会  

自施設で2002年以降に肩関節リウマチに対して人工関節置換術を行い術後1年以上経過している18例を対象とし、患者立脚肩関節評価法Shoulder36(Sh36)によるADLの調査と、自動可動域(屈曲・下垂位外旋)の調査を行い、相互の関連について検討した。結果、Sh36の全36項目中12項目が自動可動域と有意な相関を示した。この12項目の各ADL動作に必要な最低限の可動域について検討したので併せて報告した。

Language：Japanese   Publisher：(一社)日本肩関節学会  

当科の鏡視下腱板修復術(ARCR)は、腱板の断裂形態に応じた整復を意識したsuture bridge法を施行している。具体的には、delaminationのある症例に対しては、腱板付着部内側に挿入したアンカーに深層を結節縫合し、その内側の深層・浅層に通した糸でsuture bridgeする"double layer suture bridge法"(DLSB法)を行い、delaminationのない症例に対しては、suture bridge後に内側の糸をmattressで抑え込む"single layer suture法"(SLSB法)を行っている。今回、2010年10月〜2012年3月にARCRを施行した49肩を対象とし、縫合法別に、滑液包側に結び目(knot)が出る方法(SLSB法に側側縫合を追加した方法)を行った群20肩(以下A群)と、knotが出ない方法(DLSB法)を行った群29肩(B群)に分け、術前後のJOAスコアと術後1年時の腱板修復状態を群間比較した。結果、JOAスコアはA群で術前平均63.1点から術後1年時94.4点に改善し、B群で術前平均60.1点から術後1年時92.9点に改善していた。腱板修復状態は、再断裂例の割合がA群25%、B群21%であった。術後の肩峰下骨形態を術後1年時CTで評価し、一部が侵食している"impingement type"、腱板の形に適合している"congruity type"、変化がない"normal type"の3型に分類したところ、A群ではimpingement typeが10肩(50%)、congruity typeが9肩(45%)、normal typeが1肩(5%)、B群ではそれぞれ4肩(14%)、22肩(76%)、3肩(10%)であった。

Language：Japanese   Publisher：(一社)日本関節鏡・膝・スポーツ整形外科学会  

肩峰骨化核の先天的癒合不全であるOs acromialeの発生頻度は2〜8%といわれる.また,癒合していないOs acromialeはsubacrominal impingementを生じ,腱板断裂に関連があるといわれる.Os acrominaleを伴った腱板断裂に対し鏡視下に腱板修復,Os acrominale切除術を行い機能障害なく改善した2肩を経験したので報告する.症例は67歳,女性で両側例であった.誘因なく両肩痛,挙上困難が出現した.身体所見,画像診断で両側にOs acromialeを伴った腱板断裂を認めた.術前JOA scoreは右40点,左49点であった.右側から手術を行い,その半年後に左側の手術を行った.手術は関節鏡視下に腱板を修復し,Os acromialeは肩峰下滑液包鏡視で周囲から剥離して摘出した.術後1年時JOA scoreは右87点,左90点で,術後1年時MRIでの腱板修復状態は両側とも完全修復されていた.Os acromialeに対する手術方法は骨片摘出術,肩峰形成術,観血的整復固定術がある.骨片摘出術は肩峰の短縮から三角筋筋力低下,肩峰形成術は骨片が残存することから術後再発,観血的整復固定術は内固定材による合併症がそれぞれ危惧される.関節鏡視下に骨片摘出を行う本法は低侵襲で,三角筋に対する影響も少なく,合併症の原因となる内固定材を使用しない.本法はOs acromialeを伴う腱板断裂例に対し,選択肢となり得る方法と考える.(著者抄録)

Publisher：(一社)日本肩関節学会  

70歳未満の修復不能な広範囲腱板断裂症例18肩(男9肩、女9肩、平均年齢63.9歳)に対し、小径の上腕骨頭を用いた人工骨頭置換術と腱板再建術を施行し、一年以上経過観察した。併用術式は広背筋移行術8肩、大胸筋移行術1肩、広背筋移行術と大胸筋移行術の両方を併用1肩、上腕二頭筋長頭腱をパッチとして使用した1肩であった。日本整形外科学会肩関節疾患治療成績判定基準は術前41.1点から82.6点に改善し、自動屈曲可動域は術前72.5°から145.6°、自動外旋可動域は術前17.5°から37.8°へ良好な改善を認め、脱臼・感染・骨折・神経損傷などの合併症は認めなかった。本術式は、比較的若年者に対し関節窩のbone stockを残す意味でも非常に有用な方法であると考えられた。

Publisher：(一社)日本肩関節学会  

鏡視下Surface-holding法を行い、術後1年以降に直接検診およびMRI検査を行った腱板断裂103肩を対象として、本法の臨床成績と術後cuff integrityを調査した。腱板断裂サイズは中断裂以下61肩、大断裂以上42肩であり、最終観察時の日整会肩関節疾患治療成績判定基準(JOAスコア)と術後MRIにおける菅谷分類にて評価した。その結果、全体の術後平均JOAスコアは92.5点で、JOAスコアの評価ではGood以上が94%であり、cuff integrityの評価における再断裂は12肩(11.6%)であったが、大・広範囲断裂の再断裂率は16.7%であった。また、再断裂の有無と臨床成績との関係においては再断裂群で臨床成績が劣る症例が多かった。

Language：Japanese   Publisher：(一社)日本肩関節学会  

術前屈曲角度が60°以下の関節症を伴う広範囲腱板断裂に対し、最小径骨頭を用いた人工骨頭置換術と腱板再建術を施行した22例23肩(男5肩・女18肩・平均73歳)の成績を報告した。経過観察期間12〜72ヵ月で、100°以上に挙上可能となったのは19肩で、屈曲は術前平均41.7°から123.7°、外旋は17.2°から30.4°に改善した。日整会肩関節疾患治療成績判定基準では36.5点から75.2点と有意に改善した。可動域改善因子として腱板における脂肪変性の程度をMRI画像で検討したところ、術後100°以上の挙上可能19例と不能4例において棘上、棘下、肩甲下筋、小円筋で有意差はなく、性別、年齢、広背筋或いは大胸筋移行例についても有意差はなかった。ただし挙上可能群のうち外旋改善9例と非改善10例の比較では、後者で有意に脂肪変性所見を棘上筋、棘下筋に認め、これらの脂肪変性の程度は偽性麻痺において術後外旋改善の予測因子となる可能性が示唆された。

Publisher：九州リウマチ学会  

41歳男.左鎖骨及び胸鎖関節部腫脹・疼痛を主訴とした.血液学的検査にて炎症反応の亢進が認められ,抗核抗体は陰性であった.画像所見も併せ急性骨髄炎と診断し,直ちに非ステロイド性抗炎症薬と抗生剤を投与したが症状は不変であり,3日後に手掌・足底部に発疹を認め,掌蹠膿疱症が疑われた.診断確定後,抗アレルギー剤が投与開始され,発症後12日目には皮疹の消失に加え鎖骨病変の症状軽減,炎症反応の沈静化も認められた.血液学的にもCRP,ESRの著減が確認された.本症例では抗アレルギー剤の抗ヒスタミン効果の他にIL-8抑制,sICAM-1発現抑制,GM-CSF抑制,好酸球遊走抑制作用が作用した可能性があり,鎖骨及び胸鎖関節病変は掌蹠膿疱症に伴う全身疾患の一病変であることが示唆された

Publisher：九州リウマチ学会  

高度の機能障害があり著しい拘縮による可動域制限を有するために人工関節置換術に至った若年性関節リウマチ(JRA)の2症例を報告した.症例1は23歳女で14歳時に発症,症例2は19歳女で5歳時に発症していた.術後の移動動作において,両症例とも車椅子レベルから自力歩行レベル迄の改善は得られた.症例1は4年間車椅子の状態から就労可能となった.症例2は術後獲得した可動域の再悪化があり,さらに対側の骨破壊の進行が出現している.人工関節置換術を選択する際には,十分なインフォームドコンセントを得ることが重要であり,術後の理学療法にも十分注意を払いながら加療していく必要があると思われた

Language：Japanese   Publisher：西日本整形・災害外科学会  

L1椎体上縁とL5椎体下縁のCobb角を腰椎前彎角とし,前方開角が0度を超えるものを腰椎前彎(A群),0度を超えないものを後彎(B群)として検討した.対象は70〜103歳の男女40例とした.股関節可動域はA群で軽度の屈曲制限を認めたが,B群は正常に近い可動域を示した.両群ともに膝関節には屈曲制限と軽度伸展制限があり,骨粗鬆症性変化及び骨粗鬆症変形椎体数にも2群間に有意差はなかった.杖・歩行器を含め自力独歩可能はA群に多かった.B群では股関節の屈曲により体幹のバランスを代償していたが,歩行能力を完全には代償できず,歩行能力の低下を示していた.高齢者ではADLの上から腰椎前彎の維持が重要であった

Publisher：西日本整形・災害外科学会  

屍体標本12体の環軸椎部を一塊として摘出し,環軸関節螺子貫通部の肉眼解剖所見と3DCTによる再構築画像との比較を行った.死体標本での実測値とCT再構築像の測定値は,左右差はあるものの最狭部幅,許容刺入角度,最短及び最長螺子長のいずれにおいても極めて良く相関し,3DCTでの計測が信頼できることが証明された.1検体には一側に横突孔の破格による螺子逸脱があったが,このような刺入困難な例も,術前3DCTによるシミュレーションにより安全な術式の選択ができることが明らかとなった

Language：Japanese   Publisher：(一社)日本小児整形外科学会  

小児期の大腿骨頭すべり症の10例13股関節に対する経皮的鋼線固定による治療成績について検討を行った.手術時の平均年齢は11歳(9〜14歳)で平均経過観察期間は30ヵ月であった.全例に良好な治療成績が得られ,X線上では全例が骨頭は良好な再構築により球形となっていた.関節可動域も良好で,臨床的に問題となるような下肢短縮はなかった.Kirschner鋼線による経皮的固定術は,中等症迄の大腿骨頭すべり症の治療法として簡便かつ有用な治療法である

Publisher：西日本整形・災害外科学会  

軽症な骨形成不全症で,長期間放置された大腿骨偽関節の2例の観血的治療経験について報告した.軽症例で骨折の危険性が少なく,偽関節部の異常可動性は軽度で,骨変形があったが長期間無痛であり,歩行が可能であった為手術に消極的で放置された.偽関節部に疼痛が生じた時点で手術を施行した.高度の角状変形がある大腿骨偽関節例で良好な変形の矯正を得る為には,軟部組織と骨切除を十分に行う必要があった.固定方法として髄内釘,plate,創外固定器による固定を用いたが,Ender釘固定による髄内固定が骨癒合には有用であった

Language：Japanese   Publisher：(株)アークメディア  

腰椎椎間板ヘルニアに対し経皮的椎間板切除術(PD)を施行し,術後10年以上経過した33例の治療成績を検討した.Macnabの評価法によりgood以上の手術有効群の占める割合は,術直後82%,術後5年時76%,最終調査時73%であった.椎間板造影所見にて椎間板変性度が高度なものほど,手術成績が劣る傾向が認められた.8例に再手術が行われ,PDから再手術までの期間は1年〜5年5ヵ月であった.Love変法による治療成績を比較したところ,PDは術後10年以上経過しても約75%の症例でLove変法と同等の治療成績が維持されていた

Publisher：西日本脊椎研究会  

手術年齢が70歳以上の後頭頸椎手術を受けた慢性関節リウマチ(RA)症例を対象とし,術後成績の検討を行った.術後3例が死亡したが手術が誘因の死亡ではなかった.手術成績は疼痛の改善を見るものが多かったが,重症例では神経学的改善が得られていなかった.ADL機能評価では術前車椅子の3例中1例のみが独歩可へと改善したのみであった.QOL生活自立度は穿孔性腹膜炎の1例を除き,術後6ヵ月時のレベルが維持されていた.心筋梗塞で亡くなった症例も死亡の直前まで自立しており,高齢者においても獲得されたQOLは維持されることが判明した.重症例における脊髄麻痺の改善は悲観的であり早期の手術が望まれた

Publisher：九州リウマチ学会  

破壊性椎間板病変を伴う強直性脊椎炎の2例を経験した.症例1は60歳男.Th12,L1椎弓切除及び可及的整復位でのLuque Rodを併用した後方固定術を施行した.術後麻痺の軽減は得られなかったが,脊椎痛はほぼ消失した.症例2は41歳男.Pedicle Screwを併用し後方固定術を行った.後方移植骨の骨癒合と椎体間の骨形成を確認し,前方の骨癒合も得られた.術後背部痛も消失し後彎も軽度改善を認め,立体保持が得られ,患者の満足が得られた.2症例とも外科的治療を施行し,術後良好な骨癒合とADLを獲得できた

Publisher：西日本整形・災害外科学会  

高齢者の立位全脊柱Sagittal Spinal AlignmentをX線学的に検討した.高齢者の特徴として,腰椎前彎角の減少,重心線の前方偏移,骨盤後傾の傾向が認められた.腰椎前彎群と腰椎後彎群を比較すると,後彎群では胸椎後彎の消失,重心線の前方偏移が認められた

Publisher：西日本脊椎研究会  

72歳女.第2頸椎歯突起から第7頸椎に及ぶ連続型OPLLに環軸椎脱臼を合併した症例に対し手術を行った.C1 laminectomy,C2-C6迄のlaminoplasty,rectangular rodによる後頭骨-頸椎固定を行った.術後2ヵ月のレントゲン写真では脊椎アライメントには術前と変化ない.JOA score術前7.5点から術後9.5点に改善し,本人の満足度も高い

Language：Japanese

Ossification of the posterior longitudinal ligament (OPLL) occurs mainly through endochondral ossification. Although researchers have been attempting to elucidate the pathogenesis of OPLL for many years, it remains unclear which cell types in the ligament have chondrogenic capacity. Furthermore, the contribution of direct bone formation without chondrogenesis remains elusive. To characterize the osteochondrogenic potential of the cells around the ossification area of OPLL, we immunohistochemically evaluated a series of proteins specific to endochondral ossification. We found SOX9/type II collagen-positive chondrocytes in the fibrocartilage area, hypertrophic chondrocytes with type X collagen expression, and osteoblastic cells expressing RUNX2, osterix, and bone sialoprotein in the stromal fibrous area (SFA) between the ossified areas, thereby confirming the concept of an endochondral ossification-like process. In addition, the osteoblastic cells and blood vessel cells in the degenerated ligament, as well as the cells in the SFA outside of the ossified area, expressed both osteoblastic markers and SOX9, suggesting that these cells were bipotential osteochondral progenitor cells. Additionally, we revealed that the blood vessel cells and stromal fibrous cells exhibited bipotential osteochondrogenic features. Our observation suggests that any or all of these osteochondral mesenchymal cells may be initiators of OPLL.

DOI： 10.1007/978-981-15-3855-1_6

Scopus

Language：Japanese

Tendon transfer is one of the useful procedures in patients with massive rotator cuff tears with or without arthritis of shoulder joint. When the case with tearing of two tendons of the rotator cuff has hypertrophied teres minor and subscapularis muscles without arthritis of the shoulder joint, partial subscapularis transfer, as reported by Cofield, would be a useful technique. If a case having tearing of three tendons of the rotator cuff has only hypertrophied teres minor muscle without arthritis of the shoulder joint, pectoralis major transfer underneath the conjoined tendon could obtain a good outcome. Cases with tears of three tendons of the rotator cuff having only hypertrophied subscapularis muscle, the so-called posterosuperior tear of the rotator cuff, without arthritis of the shoulder joint, need latissimus dorsi and teres major transfer. Furthermore, it is necessary to replace the humeral head by shoulder arthroplasty with using a smaller size of humeral head prosthesis in patients with shoulder arthropathy because of the reduced size of the original humeral head. In this chapter, Dr. Oizumi describes the so-called Cofield procedure, such as a partial subscapularis transfer, Dr. Yamaguchi explains the technique of pectoralis major muscle transfer, and Dr. Matsuhashi introduces the so-called Paavoleinen technique and the latissimus dorsi and teres major transfer from anterior approach. Finally, Dr. Taniguchi described the concept and technique of a smaller humeral head replacement with cuff reconstruction using muscle transfer in patients with cuff tear arthropathy.

DOI： 10.1007/978-4-431-55988-7_12

Scopus

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞はじめに　令和2年度と3年度の日本整形外科学会専門医試験は,新型コロナウイルス感染拡大に伴い,各都道府県に設けられた会場でcomputer based testing(CBT)方式で行われた.筆答試験120問に引き続き行われていたビデオ問題と症例問題による口頭試験がなくなり,筆答試験100問のみと簡略化されたのが主な変更点である.令和3年度の専門医試験委員会委員長を務めた経験より,CBT方式に移行した整形外科専門医試験に関する最近の動向について解説したい.

Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞リバース型人工肩関節置換術(reverse shoulder arthroplasty;RSA)は2014年にわが国に導入されたが,2020年度の日本人工関節学会レジストリーにおいては3,237件の登録がみられ,急速に普及が進んでいる。腱板がなくとも自動挙上を可能とする利点がある一方で,外旋機能の再獲得は困難とされる。筆者らは,残存腱板を用いた可及的な腱板修復術を加えることにより,さらなる機能回復を目指している。本稿では,当教室で行っている術式について,合併症予防の工夫も含めて概説する。

Language：Japanese   Publisher：岐阜人工関節フォーラム事務局  

Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞日本でもダイバーシティや男女共同参画,女性活躍の議論が高まっている。本当の意味でのダイバーシティを推進するためには,女性だけでなく女性を支える男性に対しても多様な意見や働き方を認め,お互い補いつつ共にキャリアアップが目指せるようなシステムが理想である。社会は変わりつつあるものの未だ道半ばであり,特に医療界では医師の過剰な仕事量や長時間労働の問題が解決しない限りはまだまだ現実的ではない。現在の若い世代の医師という職業や人生におけるプライオリティ,家事や子育てに対する意識は確実に変化している。若手を指導するわれわれ40代以降がこれらの変化を受け入れることがダイバーシティの第一歩であると考えている。

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)先端医学社  

＜ポイント＞・腱板断裂の多くは保存治療で無症候化し機能回復が得られるが、十分な通院加療の継続が困難な場合は、自宅での自主訓練を推奨している。・「肩甲胸郭関節を含めた肩関節可動域の拡大」、「肩甲骨の安定性と運動性の改善」、「残存腱板機能の改善とその維持」、「胸郭・骨盤・股関節機能の改善」がおもな目的となる。・機能低下している部位を改善することで肩関節周囲の痛みや筋力がどの程度改善するかを評価し、その限界を患者と共有しながら目標を設定する。(著者抄録)

Publisher：(株)南江堂  

＜文献概要＞はじめに　腱板断裂は,代表的な肩関節変性疾患である.本邦で約1,900万人に存在するといわれ,40歳代以下では5.1%であるが,70歳代で45.8%,80歳代で50%と,加齢依存性の発生がみられる.画像上腱板断裂がみられても,無症候性の断裂がその65.4%を占める事実は,断裂イコール治療の対象ではないことを示している.また,症候性の断裂においても,まずは理学療法の徹底を指示すべき症例がある一方で,いたずらに時間を浪費せずに即手術決定としたほうがよい症例もある.この辺のさじ加減が腱板断裂の診断と治療のむずかしさであるが,少なくとも手術適応,術式は単にMRIでみられる断裂の大きさで決まるわけではない.腱板断裂の治療方針について筆者の考えを述べてみたい.

Publisher：(一社)日本脊椎脊髄病学会  

脆弱性骨折による骨盤輪骨折(以下FFPs)が人口高齢化に伴い増加しつつある.われわれはFFPsに対して後方approachでPPS(percutaneous pedicle screw)を使用し経皮的に固定する,M-plate(仙骨後面の浅い症例には使えない)をmodifiedした方法を考案した.経皮的にiliac screw,IS screwを挿入し,それぞれ左右をrodで固定した.screw headがflexibleにてrodの設置位置を自由に変更可能であった.IS screwにconnecterを介して左右をrodで締結した.さらにrod間をcross link 2個で締結した.PPSを用いたこの経皮的後方固定術を4症例経験した.平均手術時は77.6歳で,平均手術時間2時間42分,術中平均出血量は375gであった.術後成績は良好であった.この手術方法はFFPsに対して有用な手術方法である.(著者抄録)

Publisher：大道学館出版部  

Publisher：(公社)日本整形外科学会  

Publisher：(株)メディカルプレス  

1.肩関節周囲の慢性疼痛は、過去の全国調査において腰、頸とともに上位3位を占めるほど頻度が高い。2.中年以降に発症しやすい肩関節の代表的な加齢依存性変性疾患として、肩関節周囲炎と腱板断裂が挙げられる。3.日常診療でよく遭遇するこれらの疾患について共通して言えるのは、画像評価で即手術適応になることは少なく、まずは保存療法が基本であるという点である。4.確実な保存療法を行うには、各変性疾患の病態と特徴をしっかり理解した上で理学療法を行うことが望まれる。(著者抄録)

Publisher：(株)メジカルビュー社  

単純性骨嚢腫(SBC)は,小児で偶発的にみつかることが多い骨病変である。病態はいまだ不明であるが,骨内に限局する液体の貯留がみられ,病変の増大とともに病的骨折のリスクが高まる。本稿では単純性骨嚢腫の診断と治療に必要な基本的な知識と,単純性骨嚢腫と鑑別すべき代表的な骨腫瘍について述べる。(著者抄録)

Publisher：(株)メジカルビュー社  

Language：Japanese   Publisher：(株)メジカルビュー社  

Language：Japanese   Publisher：(株)南江堂  

Language：Japanese   Publisher：(株)全日本病院出版会  

肩腱板修復術は、McLaughlin法に代表されるtransosseous法が主流であったが、鏡視下手術の普及に伴い、鏡視下で縫合可能なスーチャーアンカーを用いた種々の術式が開発されてきた。現在、鏡視下一次修復で一般的に使用されるsingle/dual row法、suture bridge法は様々な利点がある一方で、それぞれ短所も持ち合わせている。特に高齢者においては、骨の脆弱化によるアンカー逸脱、元々の腱板変性による術後再断裂などが高率で報告されており、それらを克服する強固な縫合法の開発が望まれる。このような問題点を克服するために開発されたsurface holding法は、特に高齢者の腱板断裂における術後成績に関しては、再断裂が極めて少なく、成績も良好であった。筆者らは烏口肩峰アーチにおけるインピンジメントが腱板断裂の一次的な原因と考えるため、同部位の除圧も追加している。長期予後の経過観察は必要であるものの、surface holding法は高齢者以外の症例に対しても幅広く適用があると考えられた。(著者抄録)

Language：Japanese   Publisher：(株)メジカルビュー社  

Language：Japanese   Publisher：Medical Hypotheses  

DOI： 10.1016/j.mehy.2006.10.025

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