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

BACKGROUND: The postoperative varus/valgus stability assessment in stress X-rays has been established as an evaluation index. However, it is performed by the two-dimensional (2D) method rather than the three-dimensional (3D) method. OBJECTIVE: This study aimed to identify the precision and reproducibility of measuring varus/valgus stress X-rays three-dimensionally and to examine varus/valgus stability under anesthesia in imageless robotic assisted total knee arthroplasty (rTKA). METHODS: This prospective study analyzed 52 consecutive rTKAs (five males, 67 ± 5.3 years; 47 females, 74 ± 5.9 years). Postoperative varus/valgus stress X-rays in knee extension under anesthesia at manual maximum stress were three-dimensionally assessed by 2D-3D image matching technique using the 3D bone and component models. Varus/valgus angle between components (VV angle) in no stress, valgus stress, varus stress, medial joint opening (MJO), and lateral joint opening (LJO) were evaluated, clarifying this method's precision and reproducibility and valgus/varus stability. RESULTS: All parameters' precision and reproducibility had <1° mean differences and high intra- and inter-class correlation coefficients. Bland-Altman plots showed no fixed and proportional bias. Non-stress VV angle, valgus VV angle, varus VV angle, MJO, and LJO were 3.6 ± 1.2°, 1.0 ± 1.4°, 7.1 ± 1.9°, 1.5 ± 1.0 mm, and 2.8 ± 2.7 mm, respectively. CONCLUSION: This prospective study demonstrated that (1) the three-dimensional measurement method provided sufficient precision and reproducibility, and (2) the rTKAs could achieve good postoperative varus/valgus stability with a small standard deviation.

DOI： 10.3233/BME-230146

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Autologous platelet-rich plasma (PRP) therapy has been becoming popular for the treatment of musculotendinous injuries among athletes. However, for individual and practical variations, clinical success is hardly predictable. To overcome this difficulty, we have been exploring possible criterion candidates for monitoring its clinical effectiveness. In this study, we focused on sex-based differences in young elite athletes and compared the biochemical compositions of their PRP. Leukocyte-rich PRP (L-PRP) was manually prepared from blood samples collected from male professional soccer players (mPSPs) (n = 25) and female college athletes (fCAs) (n = 36). Platelet-derived growth factor-BB (PDGF-BB), transforming-growth factor-β1 (TGFβ1), platelet factor-4 (PF4), interleukin-1β (IL-1β), and IL-1 receptor antagonist (IL-1RA) were quantified using an enzyme-linked immunosorbent assay. The levels of PDGF-BB, TGFβ1, and PF4 in L-PRP were significantly higher in mPSPs than in fCAs. Conversely, IL-1β and IL-1RA were detected at significantly and slightly higher levels, respectively, in fCAs than in mPSPs. Our findings suggest that, even though L-PRP from fCAs may have lower potential to induce cell growth and differentiation than that of mPSPs, due to the latter's higher capacity to control inflammation, it does not necessarily imply that PRP treatment in fCAs is less effective. Thus, these cytokine levels should be checked before PRP therapy.

DOI： 10.3390/ijms242417487

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

人工膝関節置換術(TKA)を行った末期血友病性関節症膝6名7膝(全例男性、平均年齢44.9歳、平均経過観察期間9.5年)の術後成績として、膝関節可動域、出血、合併症について調査した。可動域の改善度は膝伸展角度20.7°、膝屈曲角度8.6°、range 29.3°と概ね良好に改善していたが、術前可動域の影響が大きく、改善には限界があることが示唆された。平均術中出血量は228.7mLで、手術時間の長い例で多く、手術時にトラネキサム酸を静注した例で少ない傾向を示した。術前Hb値は15.1g/dLと高く、全例術後1週目でHb値が最低値を示したが、2週目には全例回復に転じており、輸血は予防的輸血が1例であった。1例で高度関節内血腫を生じたが、再手術を要する合併症は認めず、凝固因子製剤補充療法下のTKAは比較的安全かつ良好な成績が得られると考えられた。

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Language：Japanese   Publisher：新潟整形外科研究会  

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

PURPOSE: The purpose of this study was to identify factors related to the external rotation of the femur during knee flexion. METHODS: Three-dimensional (3D) digital models of the femur and tibia were reconstructed from computed tomography images of 41 healthy Japanese subjects. Thirteen parameters related to femoral and tibial morphology and alignment of the lower extremities were evaluated, including the inclination angle of the posterior lateral and medial femoral condyles, the ratio of the medial and lateral posterior condyle radii approximated as spheres, the spherical condylar angle, the posterior condylar angle, the medial and lateral posterior tibial slope, the difference of medial and lateral posterior tibial slope, the tibiofemoral rotation angle, the 3D femorotibial angle, the 3D hip-knee-ankle angle, and the passing point of the weight-bearing line (medial-lateral and anterior-posterior). The rotation angle of the femur relative to the tibia during squatting was investigated using a 3D to 2D image matching technique and the relationships with the13 parameters were determined. RESULTS: The femur externally rotated substantially up to 20° of knee flexion (9.2° ± 3.7°) and gently rotated after 20° of knee flexion (12.8° ± 6.2°). The external rotation angle at 20°-120° of knee flexion correlated with the spherical condylar angle, the tibiofemoral rotation angle and the inclination angle of the posterior medial condyles (correlation coefficient; 0.506, 0.364, 0.337, respectively). CONCLUSION: The parameter that was most related to the external rotation of the femur during knee flexion was the spherical condylar angle. LEVEL OF EVIDENCE: IV.

DOI： 10.1186/s40634-023-00686-w

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BACKGROUND: The examination of femoral cortical bone thickness in patients with rheumatoid arthritis (RA) has been notably limited in prior research. We aimed to compare femoral cortical thickness in patients with rheumatoid arthritis (RA) and healthy controls and to investigate the association between femoral cortical thickness and clinical parameters within the RA group. METHODS: Forty-four patients (58 limbs) with RA who underwent total knee arthroplasty were enrolled. Preoperative computed tomography images of the lower limbs were analyzed. The femoral cortex was divided into the proximal, central, and distal diaphysis regions and further into the anterior, posterior, medial, and lateral regions. The divisions were measured using Stradwin® software and standardized by femoral length. Femoral cortical thickness was compared between RA and healthy control (n = 25) groups. Correlation analyses between standardized cortical thickness and disease parameters were performed in the RA group. RESULTS: The RA group had significantly lower standardized femoral cortical thickness at the anterior and medial distal diaphysis than healthy controls. Standardized proximal lateral and central lateral in the RA group were significantly larger than those in the healthy control groups. Standardized femoral cortical thickness was significantly correlated with bone mineral density (BMD) in 11 areas, except the posterior central diaphysis, and with body mass index in 8 areas, except the central posterior, distal lateral, distal anterior, and distal medial diaphysis. CONCLUSIONS: Femoral cortical thinning was noted in patients with RA complicated with destructive knee, particularly at the anterior and medial distal diaphysis. Femoral cortical thickness was significantly correlated with BMD and body mass index (BMI); thus, patients with RA and low BMD and BMI should be cared for to prevent fragility fractures.

DOI： 10.1186/s13018-023-04340-0

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

PURPOSE: The longitudinal changes in alignment and structure, including the joint line and cortical bone thickness (CBT) of the femur and tibia, and knee phenotype in patients with knee osteoarthritis (OA) remain unknown. The aim of this retrospective study was to clarify the longitudinal changes in matched healthy subjects. METHODS: The follow-up Matsudai Knee Osteoarthritis Survey was administered between 23 and 28 years. This study included 285 healthy knees from 235 females with an average age of 53 ± 6 years at baseline. The non-OA individuals, with an average age of 79 ± 4 years, were divided into three groups at baseline according to their follow-up radiographic results [the non-OA (n = 52), early OA (n = 131), and advanced OA groups (n = 102)]. Changes in alignment, joint line, CBT, and knee phenotype were assessed at baseline and at follow-up using standing anteroposterior radiographs. RESULTS: This study showed significant varus changes in the alignment (p < 0.001) and tibial and femoral joint line parameters (p < 0.05) in the OA group. Decreased CBT and increased mediolateral CBT ratios were observed in all groups (p < 0.001). The knee phenotypes in the OA groups were changed to varus angles, especially in the alignment and tibial joint line. CONCLUSIONS: The longitudinal changes of knee phenotypes in alignment and structure (CBT and joint line) from baseline to follow-up were shown in the OA groups. In addition, alignment and tibial structural factors at baseline are useful in predicting the incidence of knee OA in daily practice. LEVELS OF EVIDENCE: III.

DOI： 10.1007/s00167-023-07554-1

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

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Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

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

Platelet-rich plasma (PRP) has been increasingly used in sports medicine owing to its various advantages. The purpose of our project was to standardize the parameters before performing large-scale clinical trials in the near future to precisely evaluate individual PRP quality. To examine the effects of regular exercise on PRP quality, this study focused on young female athletes, who have been relatively less studied. Blood samples were obtained from female college athletes (n = 35) and ordinary healthy adults (n = 30), which were considered as controls, and leukocyte-rich PRP (L-PRP) was prepared manually. Body composition indices were determined using a bathroom weight scale equipped with an impedance meter. Growth factors and cytokines were quantified using ELISA kits. Platelet-derived growth factor-BB (PDGF-BB) and Transforming-growth factors β1 (TGFβ1) levels (per platelet) in L-PRP were significantly lower in female athletes than in controls. In contrast, Interleukin-1β and Interleukin 1 receptor antagonist (IL-1RA) levels (per platelet and L-PRP) in L-PRP were significantly higher in athletes, and this difference was more prominent in IL-1RA. These findings suggest that L-PRP from athletes may facilitate the inflammatory phase of the healing process by regulating the pro-inflammatory and anti-inflammatory balance. These chemical compositions can be adopted as "must-check" parameters to characterize individual PRP preparations prior to clinical trials.

DOI： 10.3390/ijms241713592

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

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Language：Japanese   Publisher：東日本整形災害外科学会  

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

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

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

Platelet polyphosphate (polyP) can be conveniently quantified by exploiting a recent methodological breakthrough using 4',6-diamidino-2-phenylindole (DAPI). However, the preservation of these biological samples has not yet been standardized. In a preliminary study, potential protocols were screened, while accepted protocols were further tested in this study. Pure-platelet-rich plasma (P-PRP) samples and washed platelet suspensions were prepared using blood obtained from non-smoking healthy male donors and were fixed with ThromboFix for 20-24 h at 4 °C. Mass polyP levels were determined using a fluorometer at wavelengths of 425 and 525 nm. Platelet polyP levels were normalized to platelet counts. Statistical analyses were performed using non-parametric tests. Platelet polyP levels significantly decreased by 20% after 7 days in the platelet suspension maintained under fixed conditions at 4 °C (control). In contrast, the platelet polyP levels in both the P-PRP and washed platelet suspensions were maintained without a significant reduction for up to 6 weeks by removing ThromboFix after fixation and subsequent freezing in pure water at -80 °C. Fluorometric polyP quantification often interferes with the low specificity of DAPI binding and the wavelength used. Our validated protocols will enable long-term preservation and high-throughput polyP quantification and can be applied to relatively large cohort studies.

DOI： 10.3390/mps6040059

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

BACKGROUND: Instability can lead to poor functional results after tricompartmental total knee arthroplasty (TKA). We identified a group of patients who appeared to have anteroposterior (AP) instability in early-range flexion (ie, 20 to 30° range) associated with anterior knee pain and feelings of instability. The purpose of this study was to assess the clinical results in terms of stability and anterior knee pain after revision TKA with a medial-pivot implant and to assess the effect of the implant positioning used in the revision technique. METHODS: There were 45 patients (45 knees) evaluated retrospectively to assess standing lower extremity alignment and functional results by generating a knee stability score after revision TKA with medial pivot implant design. RESULTS: Revision TKA using the medial-pivot TKA lowered the joint line by 3.6 millimeters (mm) (P < .001) and positioned the tibia anteriorly by 3.5 mm (P < .001) on radiographic measurements as compared with results after primary TKA. Moreover, medial pivot revision TKA improved AP stability by a 56-point change in score (P < .001). CONCLUSION: Revision TKA using a medial pivot design improved AP stability and anterior knee pain after failed primary procedures.

DOI： 10.1016/j.arth.2023.03.041

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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

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

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

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

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

Background: Autologous platelet-rich plasma (PRP) therapy is ambiguously thought to be more effective in elite athletes than in sedentary patients, although the possible importance of recipient responsiveness remains poorly understood. To address this issue, along with the well-known PRP quality, in this initial study, we evaluated two candidate biomarkers: body composition indices (BCIs), which reflect systemic physical conditions, and resting platelet ATP levels, which reflect platelet energy expenditure and the mass of energy generation units. Methods: In this cross-sectional cohort study, blood samples were collected from male professional soccer players (PSPs) on a local professional team during the off-season and platelet ATP levels were quantified using an ATP luminescence assay kit. BCIs were measured using the body mass impedance method. Age-matched male sedentary participants were used as the controls. Results: Among the BCIs, the body mass index, basal metabolic rate (BMR), and skeletal muscle weight levels were higher in the PSPs than in the controls. The platelet ATP levels in the PSPs group were significantly lower than those in the control group. The correlation between BMR and platelet ATP levels was moderately negative in the control group, but weakly positive in the PSPs group. Conclusion: Owing to regular physical exercise, PSPs had higher BMR levels and lower platelet ATP levels without a significant mutual correlation compared to sedentary controls. This study did not indicate the influence of these biomarkers on the success of PRP therapy but provided evidence for a better understanding of PRP therapy, particularly for elite athletes.

DOI： 10.3389/fbioe.2023.1255860

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Language：Japanese   Publisher：日本臨床スポーツ医学会  

CiNii Books

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

PURPOSE: The purpose of this study was to analyze the dynamic kinematics of the mobile medial pivot-type total knee arthroplasty (MMPTKA) using the three-dimensional (3D)-to-2D registration technique. METHODS: Cadaveric knees from five humans were used. Computed tomography of the lower limb and preoperative 3D planning for MMPTKA were performed. After performing TKA, passive motion of the knee was observed from a fully extended position to maximum flexion using a flat panel detector. The following parameters were determined: (1) anteroposterior (AP) translations of the medial and lateral most distal points (estimated contact point) of the femoral component, (2) rotational femoral component's X-axis (FCX) angle, and (3) rotational insert angle. Paired t-tests were used to analyze differences in the AP translation between the medial and lateral most distal points of the femoral component as well as differences in the changes in the rotational angle between the FCX and X-axis of the insert on the tibial component's axial plane. RESULTS: The AP translations of the femoral component's medial and lateral most distal points were 8.4 ± 2.5 and 13.6 ± 3.3 mm, respectively (p = 0.001). The rotational angles of the FCX and insert were 10.7° ± 4.9° external rotation and 8.9° ± 4.1° internal rotation, respectively (p = 0.004). CONCLUSIONS: The posterior translation of the lateral side of the femoral component was greater than that of the medial in all cases. Hence, a medial pivot pattern was identified. The femoral component exhibited external rotation throughout knee flexion in all subjects, whereas the mobile insert exhibited internal rotation (opposite pattern relative to the femoral component). This study provides valuable kinematical information of MMPTKA that has not been clear yet.

DOI： 10.1186/s40634-022-00558-9

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

2019年2月～2021年8月の初回片側人工膝関節置換術100膝(男性18膝、女性82膝、平均年齢74.2歳)を対象として診療録から術中出血管理方法を調査し、術中出血量・手術時間、術前から術後4日目のHb・Htの変化量(ΔHb・ΔHt)、術後7日目のCRP、深部静脈血栓症(DVT)の有無を調査した。術中出血管理は止血帯単独55膝(A群)、トラネキサム酸(Txa)単独20膝(B群)、Txa+止血帯追加併用25膝(C群)に分けられ、術中出血量と手術時間はA群が他の2群に比べて有意に少なかった。ΔHb・ΔHtはA群が他の2群に比べて有意に多く、術後7日目のCRPおよびDVT発症率は3群間で有意差を認めなかった。術前の抗凝固薬の服用歴のある血栓性疾患高リスク患者はA群12例(21.8%)、B群2例(10%)、C群12例(48%)でC群がB群に比べ有意に多かった。血栓性疾患の高リスク症例に対する出血管理法としてTxa単独では限界が示唆され、止血帯の使用が考慮されるべきである。

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Language：Japanese   Publisher：新潟整形外科研究会  

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

PURPOSE: New concept of functional knee phenotypes in Caucasians demonstrated the variability of coronal alignment in knee osteoarthritis (OA), but it remains unclear in Japanese. This study aims to analyze the knee phenotype in advanced varus knee OA for Japanese. In addition, the ethnical difference is discussed. METHODS: This study analyzed 879 knees involving 186 males (74 years) and 693 females (74 years). The knee phenotypes were assessed by the definition in Hirschmann's group. The hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were assessed in CT data according to the coordinate system. The neutral angle was 180° in HKA, 93° in FMA and 87° in TMA. The smaller angle means larger varus angles. RESULTS: The average angle (males, females) of the HKA (170.9 ± 4.3°, 169.4 ± 5.0°), FMA (91.5 ± 2.7°, 90.6 ± 3.0°), and TMA (82.4 ± 3.6°, 82.7 ± 3.7°) demonstrated varus angles with the sex difference (HKA, p < 0.001; FMA, p = 0.001). The phenotypes were 73 types in males and 150 types in females with a mild correlation between the HKA and the FMA or TMA. In 61.3% of males and 52.2% of females, the TMA was greater than the FMA, while the FMA was greater in 16.7% of males and 23.1% of females. CONCLUSION: There were many functional knee phenotypes with sex differences for advanced varus knee OA in Japanese, showing ethnical differences of larger varus angles compared to those for Caucasians in the previous report. LEVEL OF EVIDENCE: IV.

DOI： 10.1007/s00167-022-07248-0

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BACKGROUND: Regenerative therapy using platelet-rich plasma (PRP), a rich source of growth factors, has become popular in orthopedic sports medicine. Elite athletes prefer PRP therapy for their injured muscles and tendons primarily to avoid the possible risks of surgical treatment. However, the clinical effectiveness of PRP therapy in elite athletes compared to that in non-athletes remains unknown. Therefore, to investigate the effectiveness of PRP therapy in professional athletes (pro-athletes), we focused on the quality of PRP preparations and compared the levels of bioactive molecules between pro-athletes and non-athletes. METHODS: PRP was prepared from healthy, non-smoking male professional soccer players (pro-athletes) (n = 22) and non-athletes (VEGF: n = 34, others: n = 38). The levels of TGFβ1, PDGF-BB, VEGF, and PF4 were determined using ELISA kits. Polyphosphate was probed with 4',6-diamidino-2-phenylindole and monitored using a fluorometer. The body composition of the donors was determined using a bathroom weighing scale. RESULTS: The levels of TGFβ1 and VEGF were significantly lower in pro-athletes than in non-athletes, whereas PF4 levels were significantly higher in pro-athletes. No significant difference was found in PDGF-BB levels between these groups. Biomolecule levels were not correlated with polyphosphate levels. CONCLUSION: TGFβ1, VEGF, and PDGF-BB levels in pro-athletes were not higher than those in non-athletes. These findings suggest that growth factor levels in PRP may not be a predominant determinant of the clinical effectiveness of PRP therapy in pro-athletes. Increased PF4 levels in pro-athletes suggest an immunological function of PRP that may positively influence tissue regeneration.

DOI： 10.1186/s13018-022-03362-4

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Language：Japanese   Publisher：(一社)日本臨床バイオメカニクス学会  

我々が開発した変形性膝関節症(膝OA)のX線進行度定量的評価ソフトにて膝OAの進行度予測を行う目的で,その角度評価項目から膝OAと下肢アライメントや骨形態の変化との経年的関連を検討した.1979年から9回実施した大規模集団検診(松代膝検診)で,2007年(調査(1))から2019年(調査(5))の12年間に5回連続受診した170名を対象とし,この間における膝OA病期(Kellgren-Lawrence:KL分類)のgrade変化で不変群と進行群に分け,大腿脛骨角(FTA),大腿骨と脛骨の骨軸傾斜角,大腿骨・脛骨関節面線角(関節裂隙角)を検討した.膝内反に対して,大腿骨骨軸は変化せずに脛骨骨軸が変化していることが示され,脛骨の骨形態や膝関節面接触位置変化が膝OAに影響していることが示唆された.今後,評価項目間や特に裂隙変化等の長さ項目との関連を,性別・年齢別に時間的経過の検討が必要である.(著者抄録)

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Language：Japanese   Publisher：(一社)日本臨床バイオメカニクス学会  

骨幅・皮質骨幅X線測定により骨粗鬆症や荷重負荷状況の解明が可能とされる.我々は疫学調査で立位正面X線画像において脛骨・大腿骨皮質骨幅変化が変形性膝関節症の進行に関連することを報告した.しかし,横断面上の内外側方向の厚さとして測定すべき皮質骨の厚さが,正背面方向の単純X線画像からどの程度定量的に推定,評価可能であるかは明らかではない.本研究では,下肢正面X線像における骨幅及び皮質骨幅測定精度について骨格人体ファントムを対象としてX線およびCT撮影を行い,X線照射角度の変化が皮質骨幅の測定値に与える影響を調べた.その結果,大腿骨において骨幅と内外側における各々の皮質骨幅との比は,X線およびCT撮影ともに照射角度によらずほぼ一定となるが,X線撮影の方がやや厚く評価される傾向を認めた.臨床上のX線撮影では,内外旋20°以内の照射角度であれば皮質骨幅比に及ぼす入射方向の影響は少ないことを示した.(著者抄録)

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

Platelets produce inorganic polyphosphate (polyP) upon activation to stimulate blood coagulation. Some researchers have linked polyP metabolism to ATP production, although the metabolic linkage is yet to be elucidated. We found evidence for this possibility in our previous study on professional athletes (versus non-athletes), and proposed that the regulatory mechanism might be different for these two groups. To explore this aspect further, we investigated the effects of modulated ATP production on polyP levels. Blood samples were obtained from Japanese healthy, non-athletes in the presence of acid-citrate-dextrose. The platelets in the plasma were treated with oligomycin, rotenone, and GlutaMAX to modulate ATP production. PolyP level was quantified fluorometrically and visualized using 4',6-diamidino-2-phenylindole. Correlations between polyP and ATP or NADH were then calculated. Contrary to the hypothesis, inhibitors of ATP production increased polyP levels, whereas amino acid supplementation produced the opposite effect. In general, however, polyP levels were positively correlated with ATP levels and negatively correlated with NADH levels. Since platelets are metabolically active, they exhibit high levels of ATP turnover rate. Therefore, these findings suggest that ATP may be involved in polyP production in the resting platelets of non-athletes.

DOI： 10.3390/ijms231911293

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Language：Japanese   Publisher：(一社)日本関節病学会  

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

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

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.14814/phy2.15409

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.14814/phy2.15409

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

BACKGROUND: Closed-wedge high tibial osteotomy (CWHTO) with a fibular osteotomy (FO) causes medial joint space widening in the knee. However, the effect of FO on the joint space width remains unclear. OBJECTIVE: This study aimed to examine the effect of FO on the knee in HTO. METHODS: A compression load test was performed on two amputated human limbs under four conditions: (1) normal (without any osteotomy), (2) open-wedge HTO (OWHTO), (3) OWHTO with FO, and (4) CWHTO. The contact area of the femoral and tibial cartilages and the medial and lateral joint space widths in each condition were evaluated using a motion capture system with computed tomography (CT) and magnetic resonance imaging (MRI) data. RESULTS: The contact area increased on the lateral side after OWHTO, which increased more on the lateral side with a concomitant decrease on the medial side in both subjects when FO was added to OWHTO. An increase in the medial joint space width and a decrease on the lateral side were seen in both OWHTO with FO and CWHTO. CONCLUSIONS: The contact area and joint space widths are affected by the FO, and the effect is more pronounced than the way of HTO (OWHTO or CWHTO).

DOI： 10.3233/BME-221395

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

BACKGROUND: During gait, healthy knee coronal kinematics of each bony axis and lower extremity alignment are important because they could be useful as reference data for several surgeries and provide clarification of the etiology of diseases around the knee in healthy participants; however, it remains unknown. OBJECTIVE: The objective of this study was to clarify the kinematics of lower extremity alignment and the bony axes relative to the ground during gait, focused on the coronal plane, in healthy individuals by applying our unique three-dimensional (3D) motion analysis. METHODS: The study included 21 healthy individuals, including 9 healthy females and 12 healthy males with an average age of 36 ± 17 years. Knee kinematics were calculated in a gait analysis by combining the data from a motion-capture system and a 3D lower-extremity alignment assessment system on biplanar long-leg radiographs by using a 3D-2D registration technique. The main kinematic parameters were the dynamic position change relative to the ground, applying the femoral anatomical axis (FAA), tibial anatomical axis (TAA), and dynamic alignment in the coronal plane during the stance phase of gait. RESULTS: The average changes in FAA, TAA, and dynamic varus alignment were 3.7° ± 1.2°, 3.5° ± 0.8°, and 3.0° ± 1.2°, respectively. The TAA tilted laterally during the loading response and a plateau area appeared afterwards; the FAA gradually inclined laterally until the terminal stance phase, and the dynamic alignment showed varus angular change during the loading response. CONCLUSIONS: The tibia and femur were found to change approximately 2-5° of the position of the bony axes relative to the ground. In terms of clinical relevance, our findings can be used to clarify the etiology of diseases around the knee joint and as reference data for surgeries.

DOI： 10.3233/BME-211383

PubMed

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PURPOSE: This study aims to (1) measure the kinematics of lower extremity alignment and the bony position relative to the ground during walking, focusing on the coronal plane, and (2) determine the correlation between the kinematics and coronal inclination of the medial tibial plateau (coronal inclination) for healthy and varus knee osteoarthritis (OA). METHODS: In this study, 43 women (non-OA, 9 knees; early OA, 13 knees; advanced OA, 21 knees; mean age 58 ± 17 years) were examined. The knee phenotypes in varus knee OA were varied. Three-dimensional (3D) knee kinematics were calculated in gait analysis by combining the motion capture system and the 3D lower extremity alignment assessment system via biplanar long-leg X-rays, applying the 3D-2D registration technique. The main parameters were the kinematics of the bony axes relative to the ground in the coronal plane during the stance phase of the gait. The differences in overall kinematics were assessed using repeated measures ANOVA with Tukey's post hoc test. The association between kinematic parameters and coronal inclination was evaluated by multiple linear regression after univariate analysis. RESULTS: The tibia tilted laterally during the loading response, and a plateau area subsequently appeared until the terminal stance phase, whereas the femur slowly tilted laterally until the terminal stance phase. The dynamic alignment showed a relatively large varus angular change during the loading response in all groups. The trend of motion was similar among all groups (p = n.s.), although to varying degrees. The coronal inclination was the more dominant factor than the Kellgren-Lawrence (K-L) grades (β =  - 0.423, p = 0.005) when the change in dynamic alignment was determined. CONCLUSIONS: The TAA plateau area after the loading response implies that the tibial articular surface may become horizontal. The femur slowly tilted laterally until the terminal stance phase in response to the tibial motion. Consequently, the dynamic alignment showed a varus angular change, in which coronal MCT was more involved than K-L grades.

DOI： 10.1007/s00167-022-07019-x

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

症例1は12歳男児で、走り高跳びの踏切の際に受傷し、単純X線、単純CT画像より左脛骨粗面剥離骨折、Watson-Jones分類1型と診断した。受傷後2日目に手術を施行し、中空海綿骨スクリューとフラットワッシャーを用いて骨接合術を施行した。術後3週の非荷重期間を設け、術後3ヵ月で体育参加を許可し、術後6ヵ月で骨癒合したため8ヵ月で抜釘を施行した。症例2は14歳男児で、症例1と同様に受傷し、右脛骨粗面剥離骨折、Watson-Jones分類1型と診断した。さらにMRIで内側膝蓋支帯の損傷が疑われ、受傷後4日目の手術前の膝関節鏡検査でも同様の所見であった。脛骨粗面骨片は中空海綿骨スクリュー2本とフラットワッシャーで接合し、さらにSUTUREFIX Ultraで膝蓋靱帯を補強し、内側膝蓋脛骨靱帯断裂は前方関節包ごと縫合して修復した。術後は2週間の非荷重とし、術後3ヵ月で陸上競技に復帰し、術後8ヵ月で癒合を確認したため術後1年で抜釘を施行した。

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Purpose: This study aimed to examine the in vitro elution profiles of echinocandins, micafungin and caspofungin, obtained from antibiotic-loaded bone cement (ALBC) comprising apatite (BIOPEX-R Excellent [BP-EX ®], HOYA Corporation, Tokyo, Japan) or polymethylmethacrylate (PMMA). Methods: ALBC containing micafungin or caspofungin in BP-EX® or PMMA were submerged in 10 mL/g of sterile phosphate buffer solution (PBS) and placed in an incubator shaker at 37 °C for 7 days. At predetermined time intervals (1, 2, 3, 6, and 7 days), all PBS was removed and replaced with fresh PBS. High-performance liquid chromatography was used to determine the amounts of antifungal compounds present in the collected PBS. The surface structures of ALBC comprising BP-EX ® and PMMA were observed using scanning electron microscopy (SEM). Results: The amount of micafungin released from BP-EX® was significantly higher than that from PMMA (p = 0.007). Significantly less amounts of caspofungin than those of micafungin were released (p < 0.001) from BP-EX®. The release of micafungin and caspofungin from BP-EX® and PMMA completed in days. Conclusion: ALBC containing micafungin and caspofungin in BP-EX® or PMMA demonstrated characteristic elution profiles in vitro. These results are probably associated with the number of pore channels among crystals of apatite in BP-EX®, allowing the release of antibiotics as observed by SEM. Level of Evidence: Level of IV.

DOI： 10.1007/s40846-021-00672-6

Scopus

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BACKGROUND: After total knee arthroplasty (TKA), the femur tends to be located posteriorly under weight-bearing (WB) conditions, and a paradoxical femoral anterior motion occurs, leading to joint instability. OBJECTIVE: We aimed to clarify factors which affect the postoperative femoral anteroposterior position relative to the tibia under WB conditions (A-P position) in medial pivot (MP) TKA. METHODS: Among 126 knees (81 women) with primary TKA using MP prosthesis for varus osteoarthritic knees, 70 knees had cruciate-retaining inserts (CR) with the reduced conformity and 56 knees had cruciate-substituting inserts (CS) with the full conformity. Using the three-dimensional (3D) assessment system, the associations between the A-P position and the factors including pre- and postoperative lower extremity alignment, component positions, and posterior femoral condylar offset (PCO), were assessed regarding the type of inserts. RESULTS: Significant correlations were seen between the A-P position and posterior tibial slope (PTS), medial PCO, and lateral PCO. Regarding the difference between the two inserts, the PTS, medial PCO, and lateral PCO significantly correlated with the A-P position in the CR, but only the PTS correlated in the CS. CONCLUSIONS: The increased PTS and decreased PCO were the dominant factors for the A-P position in MP TKA.

DOI： 10.3233/BME-211299

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BACKGROUND: The quadriceps femoris may be a reliable reference to proper alignment in total knee arthroplasty (TKA). We previously showed the quadriceps vector (QV) to be the most parallel to the spherical axis (SA-center hip to center medial condyle) for healthy knees. The purpose of this study was to determine whether the QV is the most parallel to the SA in knees with varus osteoarthritis (OA). METHODS: CT imaging for 35 varus OA and 40 healthy Japanese knees was used to construct 3D models of the femur, patella and each quadriceps component for each subject. The QV was calculated using principal component analysis for direction and was compared with the relationship of the QV to the measurement axes of the lower extremity, including the anatomical, mechanical and spherical axes. RESULTS: The direction of the QV for the OA knee group was different from that for the healthy knee group in 3D space (medio-lateral direction: women, p = 0.532, men, p = 0.540; antero-posterior direction: women, p = 0.141, men, p < 0.001). However, the angle of the QV in relation to measurement axes in the coronal plane was closest to the SA in both groups (around 1°), with no difference between the groups (women, p = 0.382, men, p = 0.943). CONCLUSION: In the coronal plane, the SA most closely approximates the QV for both healthy and OA knees. The more posterior QV position in the 3D space may affect the patellofemoral joint.

DOI： 10.1016/j.knee.2021.09.002

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

大規模集団検診(松代膝検診)で確認した変形性膝関節症(膝OA)進行に伴う膝前後単純X線画像上の下腿骨位置や形状の定量的評価で膝OA進行度判定が可能と考え、半自動評価システムを開発した。松代膝検診第5回(2007年)から12年間の5回をすべて受診した対象のうち、任意で抽出した男女各10名の単純X線画像を対象に測定の信頼性を評価および従来の手動デジタイズ法との測定精度と測定時間を比較検討した。測定の信頼性として検者内では級内相関係数:ICC=0.98、検者間ではICC=0.96、従来法との比較でもICC=0.96と高い信頼性を示した。また、評価指標で、脛骨関節面傾斜、関節裂隙幅比の減少、脛骨内側皮質骨幅比の増加、FTAの増加など過去に報告した膝OA進行に伴う変化が算出された。特に、骨の参照軸の自動抽出により測定値の安定とこれによる測定時間が約1/3に短縮した。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症(膝OA)の自然経過と危険因子を把握するために疫学調査が重要であり、我々は長期縦断集団膝検診を行ってきた。そのX線定量評価から進行予測をするため、基盤となる疫学要因について12年間3年間隔5回の連続受診者170名を対象に検討した。膝外側角及び疫学要因である体格指数、股関節内旋可動域、膝伸展筋力、膝屈曲拘縮について、項目ごとに膝OA病期(Kellgren-Lawrence:K-L分類)のgrade別に比較をした。また、12年間のgrade変化を基準に非進行群と進行群に分け、群別経時的変化の比較を行った。全ての項目において男女ともgradeとの関連を認めた。今後膝OA進行予測には、年齢及び進行した時間的経過等を含めた項目間の関連や、個別疫学要因についても関節裂隙等のX線定量評価に対する総合的検討が必要と考える。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症(膝OA)の異常運動lateral thrust(LT)はOA進行要因として主に歩行解析や筋力との関連で検討される。3次元アライメント評価を行った非OAと進行期OA女性各15例に対し、非荷重位(臥位:CT撮像位)と荷重位(立位:2方向X線画像と骨3DCTモデルのマッチング)間における大腿骨・脛骨間の相対位置変化を冠状面方向で評価した。非OA、OAの両例において非荷重位と立位荷重位を比較すると、荷重により脛骨内側関節面が大腿骨関節面に接近した位置にあり、脛骨は大腿骨に対して外側に位置していた。また、側方への移動量は非OAに比してOAが大きいことを確認した。膝OAのLTは脛骨近位内側関節面への偏荷重を荷重面水平化の方向に位置修正を行い、その際大腿骨内側関節接触点を中心とした脛骨の相対位置移動としての評価が可能なことを示唆した。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

健常者の大腿骨皮質骨幅は性差や加齢の影響で異なる。皮質骨幅は加齢の影響で経時的に変化すると想定されるが、有限要素解析を用いた研究は多くない。本研究では形状最適化手法を用いて経年変化を再現した解析を行った。健常の男性3名(29.7±0.5歳)、女性3名(34.3±3.4歳)のCT画像から有限要素モデルを構築し、形状最適化手法を用いて経年変化を再現した。近位、中央、遠位の各断面を内側、外側、前方、後方の4つに分けて各領域の平均皮質骨幅を算出し、解析前後で比較した。全体として各部位の皮質骨幅は減少傾向を示した。一方で、女性においては近位内側と中央内側で皮質骨幅が増加する結果となり、一部の部位では男女で経年変化における皮質骨幅変化に異なる傾向がみられた。本研究では、骨粗鬆症による影響を考慮していないため、形態と荷重線の関係によって、経年変化による皮質骨幅変化が引き起こされる可能性が示唆された。(著者抄録)

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

PURPOSE: The purpose of this study was to evaluate the post-operative three-dimensional (3D) femoral and tibial component positions in total knee arthroplasty (TKA) by the same co-ordinates' system as for pre-operative planning and to compare it with a two-dimensional (2D) evaluation. MATERIALS AND METHODS: Sixty-five primary TKAs due to osteoarthritis were included. A computed tomography (CT) scan of the femur and tibia was obtained and pre-operative 3D planning was performed. Then, 3D and 2D post-operative evaluations of the component positions were performed. KneeCAS (LEXI, Inc., Tokyo, Japan), a lower-extremity alignment assessment system, was used for the 3D post-operative evaluation. Standard short-knee radiographs were used for the 2D post-operative evaluation. Differences between the pre-operative planning and post-operative coronal and sagittal alignment of components were investigated and compared with the results of the 3D and 2D evaluations. RESULTS: According to the 3D evaluation, the difference between the pre-operative planning and actual post-operative sagittal alignment of the femoral component and the coronal and sagittal alignments of the tibial component were 2.6° ± 1.8°, 2.2° ± 1.8° and 3.2° ± 2.4°, respectively. Using the 2D evaluation, they were 1.9° ± 1.5°, 1.3° ± 1.2° and 1.8° ± 1.4°, making the difference in 3D evaluation significantly higher (p = 0.013, = 0.003 and < 0.001). For the sagittal alignment of the femoral component and the coronal and sagittal alignment of the tibial component, the outlier (> ± 3°) ratio for the 3D evaluation was also significantly higher than that of the 2D evaluation (p < 0.001, = 0.009 and < 0.001). CONCLUSIONS: The difference between the pre-operative planning and post-operative component alignment in the 3D evaluation is significantly higher than that of the 2D, even if the same cases have been evaluated. Two-dimensional evaluation may mask or underestimate the post-operative implant malposition. Three-dimensional evaluation using the same co-ordinates' system as for pre-operative planning is necessary to accurately evaluate the post-operative component position.

DOI： 10.1186/s43019-021-00106-2

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BACKGROUND: The association between the toe angle and bony rotational factors is critical to explain issues related to the onset and progression of knee osteoarthritis (OA). OBJECTIVE: The study aimed to clarify the association between the toe angle and each of the femoral and tibial transvers direction relative to gait direction, rotational knee alignment, and bony torsional deformity for the subjects with knee OA. METHODS: This study evaluated 58 knees in 24 healthy elderly (72 ± 5 years) and 34 varus knee OA (72 ± 6 years). A three-dimensional (3D) assessment system was used on 3D models and biplanar long-leg radiographs with the toe angle reflecting gait direction, applying a 3D-to-2D image registration technique. The main parameters on the transverse plane were: (1) toe angle, (2) transverse direction of the femur and tibia relative to the gait direction, (3) femoral neck anteversion, (4) condylar twist angle, (5) tibial torsion, and (6) rotational knee alignment. RESULTS: The alignment parameters, except for the tibial transverse direction, were different between healthy and osteoarthritic knees. In knee OA, the femoral neck anteversion - femoral transverse direction (p = 0.001), femoral transverse direction - tibial transverse direction (p < 0.001), and tibial transverse direction - toe angle (p < 0.001) were associated. CONCLUSIONS: The osteoarthritic knees showed that the femoral neck anteversion was associated with the femoral transverse direction, which determined the tibial transverse direction by adjusting the rotational knee alignment, leading to the toe angle.

DOI： 10.3233/BME-211245

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BACKGROUND: Assessment of three-dimensional (3D) femorotibial alignment is essential for successful knee osteoarthritis treatment in the elderly. The complex morphology of the posterior tibial slope (PTS) might have an influence on sagittal and rotational alignment and the positional relationship between the femur and tibia in the anterior-posterior (AP) direction under weight-bearing conditions. OBJECTIVE: This study aimed to clarify the association between the PTS and 3D femorotibial alignment under weight-bearing conditions in healthy Japanese elderly individuals. METHODS: We investigated the 3D femorotibial alignment of 110 lower extremities of 55 healthy individuals (26 women, 29 men, mean age: 70 ± 6 years). Using our previously reported 3D-to-2D image registration technique, we evaluated the 3D hip-knee-ankle angle (3DHKA) in the sagittal plane, rotational alignment, and the distance between the femoral and tibial origins in the AP direction (tibial AP position) as femorotibial alignment parameters under weight-bearing conditions. We assessed the medial and lateral PTS and their angular difference (PTS difference) as PTS parameters. Stepwise multiple linear regression analysis was performed using PTS parameters and other possible confounders (age, sex, height, and weight) as the independent variables and femorotibial alignment parameters as the dependent variable. RESULTS: Weight (𝛽 = 0.393, p < 0.001) and lateral PTS (𝛽 = 0.298, p < 0.001) were the predictors associated with 3DHKA in the sagittal plane. Lateral PTS (𝛽 = 0.304, p = 0.001) was the only predictor associated with the tibial AP position. Sex (𝛽 = -0.282, p = 0.002) and PTS difference (𝛽 = -0.231, p = 0.012) were associated with rotational alignment. CONCLUSIONS: We found that a steeper lateral PTS resulted in a more flexed knee and anterior tibia. The PTS difference was positively correlated with tibial external rotation. Our data could be used as the standard reference for realignment surgery to ensure PTS is appropriately maintained.

DOI： 10.3233/BME-201209

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BACKGROUND: We aimed to analyze the surface morphology of the distal femur in three dimensions for the healthy elderly, based on the concept that the surgical epicondylar axis (SEA) is a better surrogate for the flexion-extension axis of the knee joint. METHODS: We studied 77 healthy elderly volunteers (40 males and 37 females; age, 68 ± 6 years). The medial and lateral contact lines were calculated three-dimensionally, using the highest points of the medial and lateral condyles in 201 cross-sectional planes around the SEA (every 1°, -60° (hyperextension) to 140° (flexion)). A piecewise fitting function consisting of two linear segments was applied to detect the inflection point of the constant radii in the sagittal plane. The main assessment parameters were knee flexion angle at the inflection point of the radius (inflection angle), mean radius from 0° to the inflection angle (constant radius), and coronal tilt angle of the contact line. RESULTS: The inflection angles, constant radii, and coronal tilt angles were 78.2 ± 8.6°, 26.1 ± 2.3 mm, and -0.6 ± 3.2° and 65.6 ± 9.2°, 23.9 ± 2.2 mm, and 6.2 ± 3.2° in the medial and lateral condyles, respectively (all, P < 0.001). The coronal alignment was 88.7 ± 2.2°. CONCLUSIONS: The medial and lateral femoral condyles showed asymmetrical morphologies with the almost 'constant' radius of sagittal curvature from 0° to around 80° and 65° of knee flexion, respectively.

DOI： 10.1016/j.knee.2021.03.022

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

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

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Language：English   Publisher：SPRINGER HEIDELBERG  

DOI： 10.1007/s40846-021-00604-4

Web of Science

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PURPOSE: This study aimed to identify the predictive factors for postoperative osteochondritis dissecans (OCD) in juvenile and adolescent knees with discoid lateral meniscus (DLM). METHODS: In total, 242 patients with symptomatic DLM who underwent surgery were identified. Inclusion criteria were set as follows: (1) age ≤ 17 years with an open growth plate, (2) follow-up magnetic resonance imaging, and (3) absence of preoperative OCD. Consequently, 52 patients were retrospectively investigated. Average age during surgery, body mass index (BMI), and follow-up duration were 12 years [95% confidence interval (CI) 11-13], 19.2 kg/m2 (95% CI 18.4-20.1), and 27.3 months (95% CI 20.9-33.7), respectively. Age, sex, sports activities, BMI, symptomatic OCD in other joints, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures (saucerization alone or with stabilization, and subtotal meniscectomy), and postoperative meniscal width were analyzed as possible predictive factors. RESULTS: Postoperatively, 42 patients without OCD and 10 with OCD were observed. In univariate analysis, younger age [odds ratio (OR) 1.5; p = 0.003], subtotal meniscectomy (OR 6.3; p = 0.027), and shorter meniscal width (OR 2.7; p = 0.005) were predictive factors for postoperative OCD. Multivariate analysis demonstrated that younger age (OR 1.6; p = 0.009) and shorter meniscal width (OR 1.5; p = 0.003) were predictive factors. CONCLUSIONS: To prevent postoperative OCD after DLM surgeries, achieving stabilization with adequate meniscal width is necessary for juvenile knees. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-019-05750-6

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BACKGROUND: Identifying the time course of rotational knee alignment is crucial for elucidating the etiology in knee osteoarthritis. OBJECTIVE: The aim of this study was to propose new rotational indices for calculating the change in relative rotational angles between the femur and tibia in standing anteroposterior (AP) radiographs. METHODS: Forty healthy elderly volunteers (20 women and 20 men; mean age, 70 ± 6 years) were assessed. The evaluation parameters were as follows: (1) femoral rotational index: the distance between the sphere center of the medial posterior femoral condyle and the lateral edge of the patella, and (2) tibial rotational index: the distance between the medial eminence of the tibia and the lateral edge of the fibula head. The indices were standardized by the diameter of the sphere of the medial posterior femoral condyle. This study (1) identified the relationship between changes in rotational indices and the simulated rotational knee angles in the standing position, (2) proposed a regression equation for the change in relative rotational angles between the femur and tibia in standing AP radiographs, and (3) verified the accuracy of the regression equation. RESULTS: The rotational indices increased in direct proportion to simulated rotational knee angles (femoral index: r > 0.9,p < 0.0001; tibial index: r > 0.9, p < 0.0001). Based on the results, the regression equation with the accuracy of 0.45 ± 0.26° was determined. CONCLUSIONS: The proposed regression equations can potentially predict the change in relative rotational angles between the femur and tibia in a pair of standing AP radiographs taken at different dates in longitudinal studies.

DOI： 10.3233/BME-201138

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Language：Japanese   Publisher：社団法人 日本理学療法士協会関東甲信越ブロック協議会  

【はじめに】リバース型人工肩関節置換術(reverse shoulder arthroplasty：RSA)は従来まで治療が困難であった症例に対する治療効果が期待されている．腱板断裂性変形性肩関節症に対してRSA を施行された一症例の術後理学療法を経験したので報告する．

【倫理的配慮】症例提示に関して対象者本人からの同意を得た．匿名性への配慮を行った．

【症例報告】74 歳女性．右利き．1 年以上前から両肩関節痛を認め，疼痛の増悪を繰り返していた．今回，右肩関節の夜間痛と洗体時に反対側の腋窩へ手を伸ばすときに肩前方痛を訴えており，当院にてRSA を施行となった．手術進入はdelto-pectral approach 法で行い，術後4 週間はウルトラスリングにて固定した．手術翌日より肩関節の他動・自動介助運動と肩甲胸郭関節運動を開始し，術後4 週より肩関節の自動運動を開始した．術後1 か月で退院し，外来で理学療法を継続してきた．術前/術後3 か月/術後半年における自動運動での可動域は屈曲100°/140° /150°，外転80°/110°/125°，1st 外旋0°/10°/15°，結帯動作は殿部以下/殿部/L5 となり，洗体動作も疼痛なく可能な状態となった．合併症は認めなかった．また，術前/術後半年における患者立脚肩関節評価法Shoulder36 は疼痛3.5/4，可動域3.4/4，筋力3.3/4，健康感3.2/4，日常生活機能3.3/4 となり，各スコアに改善が認められた．

【考察】RSA は回転中心を内下方へ引き下げ三角筋のレバーアームを伸ばし，その張力で上肢を挙上させる特徴を有している．そのため，ステムの構造上，三角筋の起始部と停止部を引き離すため，三角筋が過緊張位となりやすい傾向にある．本症例は術後早期より適切なポジショニングやリラクセーションにより三角筋の過緊張の緩和を行い，筋性の疼痛が生じなかったことが安全で可及的な肩関節機能の改善に繋がったと考えられる．しかし，まだ症例数が少ないため，今後の調査が必要である．

DOI： 10.14901/ptkanbloc.40.0_82

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PURPOSE: The purpose of this study was to three-dimensionally analyse the size and shape of the femoral posterior condyles of the normal knee. METHODS: A total of 62 healthy Japanese volunteers (37 males and 25 females) providing a sample of 124 normal knee joints, who had no knee-related symptoms and no history of major trauma, underwent computed tomography scans of the bilateral femur and tibia. Three-dimensional digital models of the femur were constructed from computed tomography data using visualisation and modelling software. The following parameters were evaluated: (1) the radii of the posterior condyles approximated to spheres and (2) the inclination angle of the posterior condyles in the coronal plane of the femoral coordinate system. RESULTS: The radii of the medial and lateral condyles approximated to spheres were 17.0 ± 1.6 and 17.1 ± 1.8 mm, respectively and were not different. The inclination angles of the medial and lateral condyles in the coronal plane were - 0.6° ± 4.6° and 9.7° ± 5.7°, respectively. The medial condyle was almost vertical, whereas the lateral one was medially tilted. CONCLUSIONS: This study found an asymmetrical inclination between medial and lateral condyles. This may be related to the asymmetrical motion of the knee, which is known as medial pivot motion. This finding provides valuable morphological information and may be useful for implant designs for total knee arthroplasty. LEVEL OF EVIDENCE: IV.

DOI： 10.1007/s00167-020-05856-2

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PURPOSE: Accurate assessment of the locations of patellar avulsion fractures in acute patellar dislocations is clinically relevant for decision making for treatment. The study aim was to classify the locations of patellar avulsion fractures with a focus on the ligament attachments of medial stabilizing structures. METHODS: Out of 131 first-time acute traumatic patellar dislocations, 61 patients had patellar fractures. Subsequently, 10 patients with isolated osteochondral fractures of the articular surface in the patella were excluded. Finally, 51 patients (34 females and 17 males, average age: 18.5 years, 95% CI 16.1-20.9) were included in the study cohort. Based on the locations of the patellar attachment, the patients were divided into three groups: the superior group [medial patellofemoral ligament (MPFL) attachment], inferior group [medial patellotibial ligament (MPTL)/medial patellomeniscal ligament (MPML) attachment], and mixed group. RESULTS: In the patellar avulsion group (51 patients), the superior group, mixed group, and inferior group contained 8/51 (16%), 12/51 (24%), and 31/51 (61%) patients, respectively. CONCLUSIONS: This study showed that 84% of the patellar avulsion fractures were located in the inferomedial patellar border, which consisted of MPTL/MPML attachments that were clearly different from the true "MPFL" attachment at the superomedial patellar border. In terms of the clinical relevance, the acute surgical repair of MPTL/MPML attachments in the inferomedial patellar border may not sufficiently control the patella if optimal management of the MPFL is not performed. LEVEL OF EVIDENCE: IV.

DOI： 10.1007/s00167-020-05853-5

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PURPOSE: Whether the inclined articular surface on the medial proximal tibia and the external knee adduction moment (KAM) correlate remains unclear. The hypothesis was that a steeper inclined articular surface correlated with a larger KAM in advanced knee osteoarthritis (OA). METHODS: A total of 44 females (non-OA, 9 knees; early OA, 14 knees; advanced OA, 21 knees; mean age, 58 ± 16 years) were examined. Three-dimensional (3D) assessment was used on biplanar long-leg radiographs and 3D bone models using a 3D to 2D image registration technique. The approximation plane in the proximal tibia was determined using the least-square method. The joint moments were mathematically calculated in a gait analysis, applying a motion capture system and force plates. The main evaluation parameters were the femorotibial angle (FTA), the coronal inclination of the approximation plane in the medial proximal tibia (coronal inclination), and internal knee joint moments. The KAM means the external moments balanced with the internal knee abduction moments. RESULTS: The advanced OA showed a larger internal abduction moment (p = 0.017) at the loading response than the other groups. The larger FTA and steeper coronal inclination correlated with the larger internal abduction moment (FTA, p < 0.001; coronal inclination, p = 0.003) at the loading response. CONCLUSIONS: As the clinical relevance, the association among the coronal inclination of the medial proximal tibia, lower extremity alignment, and KAM is one of the key factors to help better understand the etiology of knee OA. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-020-06323-8

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PURPOSE: This study aimed to evaluate the age- and sex-related characteristics in cortical thickness of the tibial diaphysis between non-obese healthy young and elderly subjects as reference data. METHODS: The study investigated 31 young subjects (12 men and 19 women; mean age, 25 ± 8 years) and 54 elderly subjects (29 men and 25 women; mean age, 70 ± 6 years). Three-dimensional estimated cortical thickness of the tibial diaphysis was automatically calculated for 5000-9000 measurement points using the high-resolution cortical thickness measurement from clinical computed tomography data. In 12 assessment regions created by combining three heights (proximal, central, and distal diaphysis) and four areas of the axial plane at 90° (medial, anterior, lateral, and posterior areas) in the tibial coordinate system, the standardized thickness was assessed using the tibial length. RESULTS: As structural characteristics, there were no differences in the medial and lateral thicknesses, while the anterior thickness was greater than the posterior thickness in all groups. The sex-related difference was not shown. As an age-related difference, elderly subjects showed greater or lesser cortical thickness than the young subjects, depending on the regions of the tibia. CONCLUSIONS: Cortical thickness was different depending on sex, age, and regions in the tibia. The results of this study are of clinical relevance as reference points to clarify the causes of various pathological conditions for diseases. LEVEL OF EVIDENCE: Level 3.

DOI： 10.1186/s40634-020-00297-9

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PURPOSE: To test the hypothesis that an inclined articular surface on the medial proximal tibia is aligned more parallel to the ground in three-dimensional (3D) space under weight-bearing (WB) conditions (parallel phenomenon) than under non-WB (NWB) conditions in healthy and varus osteoarthritic knees. METHODS: We examined 55 healthy knees (26 women, 29 men; mean age, 70 ± 6 years) and 108 varus osteoarthritic knees (66 women, 16 men; mean age, 74 ± 7 years). For the evaluation under WB conditions, a 3D assessment system was used on biplanar long-leg radiographs and 3D bone models using a 3D-to-2D image registration technique. In addition, the least square method was used to determine the approximation plane. The angles between the normal vector for the approximation plane of an articular surface on the medial proximal tibia and each axis of the tibial or world coordinate system were calculated. RESULTS: Morphologically, the inclination of the approximation plane was steeper in osteoarthritic knees than in healthy knees (p < 0.0001). The approximation plane was aligned more parallel to the ground under WB conditions than under NWB conditions in healthy (p < 0.0001) and osteoarthritic knees (p < 0.0001). CONCLUSIONS: The parallel phenomenon in the medial proximal tibia was confirmed for healthy and varus osteoarthritic knees. The medial proximal tibia plays an important role in the parallel phenomenon, assumingly associated with varus alignment and varus thrust. The inclination of the medial proximal tibia may become a new parameter for imaging investigations. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-019-05829-0

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

吹き流し膝は内反型膝関節症の対側が外反型を呈する稀な疾患である。本研究では、いずれも右外反、左内反を呈する女性吹き流し膝患者2名に対し、三次元アライメント評価と床反力の大きさおよび作用方向の解析を行った。被験者は両脚立位で二方向スロットラジオグラフィー撮影と床反力測定を同時に行った。下肢機能軸と床反力ベクトルの大きさおよび脛骨関節面での通過位置を評価した。両被験者とも大腿骨前捻角に左右差があり、右脚に偏った荷重割合を示した。下肢機能軸と床反力ベクトルの通過点は右脚において機能軸に比べ床反力ベクトルが大きく膝後方に位置していた。この結果、本症において外反膝を伴う股関節疾患において指摘されている骨盤のアライメントの影響が存在すると推察され、本症の病因について骨盤を含めた下肢全体のアライメント評価が必要であることが示唆された。(著者抄録)

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変形性膝関節症(膝OA)は下肢アライメント内反変形に伴い、脛骨内側への荷重が増加する。脛骨近位部は骨幹部と比較して海綿骨の割合が多く、三次元的に変形しやすい環境で、脛骨近位部の変形が膝OAの発症・進行へ影響すると考えられる。そこで、初期OAにおける脛骨近位部の力学応答について有限要素解析を行った。K-L分類grade 0から2の女性8例のCT画像から脛骨の有限要素モデルを構築し、荷重を脛骨内外側関節面に内側60%:外側40%の割合で作用させ、脛骨骨長の近位30%に生じるひずみエネルギー密度について検討した。健常に比べ初期OAで脛骨骨幹部の内側および後方でひずみエネルギー密度の高い領域が増加した。一方、骨幹端部より近位や脛骨前方および外側ではひずみエネルギー密度の高い領域は少なかった。内側優位の荷重により、脛骨骨幹部内側および後方で力学的負荷が増加することが推察された。(著者抄録)

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変形性膝関節症において右外反、左内反を呈する女性患者2名に対し、病態解明のため三次元下肢アライメント測定と超音波ストレインエラストグラフィを用いて腸脛靱帯のひずみ量から剛性を評価し、緊張度について検討した。仰臥位で股関節伸展位において超音波診断装置を用い、大転子直上部で同一荷重下における腸脛靱帯のひずみ量をストレインエラストグラフィによって測定し、左右の剛性の比として評価した。腸脛靱帯の剛性は2症例共に内反膝である左側腸脛靱帯が外反側である右側に比して高い値で、相対的に右側腸脛靱帯の剛性が高いことを示した。アライメント評価で骨盤、大腿骨・脛骨の解剖学的座標系の相対位置を評価した結果、骨盤が下肢に対して右回旋を生じていた。このことが腸脛靱帯の緊張と外反膝を生じている原因と推測した。(著者抄録)

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Authors would like correct the errors in figure.

DOI： 10.1007/s00167-020-06227-7

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PURPOSE: The study aim was to clarify the risk factors for postoperative meniscal extrusion in a middle portion in juvenile and adolescent knees with DLM. METHODS: Forty-six patients with symptomatic DLM who underwent surgery were retrospectively assessed. Inclusion criteria were set as follows: (1) aged ≤ 17 years with an open growth plate, (2) preoperative and postoperative follow-up MRI, and 3) reshaping surgeries comprising of saucerization alone or with meniscal repair. Average (95%CI) age during surgery, body mass index (BMI), and follow-up duration were 12 years (11-13), 19.9 kg/m2 (18.7-21.0), and 26.4 months (19.5-33.3), respectively. Age, sex, sports activities, BMI, postoperative rehabilitation, preoperative shift of DLM by Ahn's classification, surgical procedures, postoperative meniscal width of all portions, and meniscal healing were analyzed. RESULTS: Postoperatively, eight knees in the no-extrusion group and 38 knees in the extrusion group were observed. In the univariate logistic regression analysis, shorter meniscal width in a middle portion (OR = 1.580, p = 0.006), shorter minimum width of all portions (OR = 1.674, p = 0.024), and meniscal healing (OR = 0.160, p = 0.028) were the risk factors for meniscal extrusion in a middle portion. Multiple logistic regression analysis demonstrated that shorter meniscal width in a middle portion was the risk factor. CONCLUSIONS: As the clinical relevance, to prevent postoperative meniscal extrusion of the middle portion with DLM, surgeons are necessary to pay attention to maintain the adequate meniscal width for juvenile and adolescent knees. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-020-06188-x

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INTRODUCTION: Cortical thickness of the femoral diaphysis is assumed to be a preferred parameter in the assessment of the structural adaptation by mechanical use and biological factors. This study aimed to investigate the age- and sex-specific characteristics in cortical thickness of the femoral diaphysis between young and elderly non-obese people. MATERIALS AND METHODS: This study investigated 34 young subjects (21 men and 13 women; mean age: 27 ± 8 years) and 52 elderly subjects (29 men and 23 women; mean age: 70 ± 6 years). Three-dimensional (3D) cortical thickness of the femoral diaphysis was automatically calculated for 5000-8000 measurement points using the high-resolution cortical thickness measurement from clinical CT data. In 12 assessment regions created by combining three heights (proximal, central, and distal diaphysis) and four areas of the axial plane at 90° (medial, anterior, lateral, and posterior areas) in the femoral coordinate system, the standardized thickness was assessed using the femoral length. RESULTS: As per the trends, (1) there were no differences in medial and lateral thicknesses, while the posterior thickness was greater than the anterior thickness, (2) the thickness in men was higher than that in women, and (3) the thickness in young subjects was higher than that in elderly subjects. CONCLUSIONS: The results of this study are of clinical relevance as reference points to clarify the causes of various pathological conditions for diseases of the lower extremities.

DOI： 10.1007/s00774-019-01079-9

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BACKGROUND: In first-time acute traumatic patellar dislocations, numerous anatomic and clinical factors are complicatedly associated and should be comprehensively considered for the optimal management of conservative or surgical intervention. The purpose of this study was to establish a scoring system, using a concept that is not complicated and easily used in clinic. METHODS: Of 131 first-time acute traumatic patellar dislocations, 81 patients (51 females, 30 males) with an average age of 19.6 (95%CI, 17.5-21.6) years and an average follow-up duration of 17.1 (95% CI, 12.3-21.9) months, who underwent conservative treatment after first-time dislocations, were reviewed. Based on the odds ratios applying logistic regression analysis, the scoring system was established. RESULTS: The scoring system (total: 10 points) had simple composition of age <20 (2 points), sports injury (1 points), hemarthrosis (1 points), and image findings of a bony fragment (3 points), lateral shift of the patella (1 points), and trochlear dysplasia (2 points). A threshold score of 6.5 was determined using the area under receiver operating characteristic curve of 0.893 (p < 0.0001). In logistic regression analysis, a score of ≥7 was shown to be a dominant factor for recurrence (OR = 27.1, p < 0.0001). Furthermore, the association between the score and recurrence risk was as follows: a score of ≤4 = low risk (1/21 cases, 5%); a score of 5-7 = medium risk (13/27 cases, 48%); a score of ≥8 = high risk (30/33 cases, 91%). CONCLUSIONS: Based on the simple scoring system, patients who scored ≥8 were considered suitable for surgical treatment because of the high rate of recurrence, whereas those who scored ≤4 were considered suitable for conservative treatment because of the low rate of recurrence.

DOI： 10.1016/j.jos.2019.03.009

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BACKGROUND: The inclination of the medial compartment of the proximal tibia (MCT) is assumed to be a critical factor for varus alignment in advanced knee osteoarthritis (OA). This study was aimed at investigating; (1) whether the inclination of MCT is aligned parallel to the ground under weight-bearing (WB) conditions; (2) whether this is associated with the change in alignment and the relative position between the bones; and (3) whether the tibia or femur mainly contributes to the changes. METHODS: We examined 102 knees (84 women, 18 men; mean 75 years). A three-dimensional (3D) assessment system was applied on biplanar whole lower extremity radiographies using 3D-to-2D image registration technique. The evaluation parameters were 1) MCT angle, 2) femorotibial angle (FTA), 3) medial-lateral femoral location to the tibia (M-L femoral location), 4) WB line passing point, and 5) tibial position to WB line (tibial position) and 6) femoral postion to WB line (femoral position). Each parameter was evaluated in non-WB and WB conditions, and the differences (Δ-parameters). RESULTS: MCT angle in the world coordinate system was larger than that in the tibial coordinate system (p <  0.0001). ΔMCT angle was correlated with ΔFTA (p = 0.002) and ΔM-L femoral location (p = 0.004). The tibial position was the more dominant factor for ΔMCT angle (p = 0.001), ΔFTA (p <  0.0001), and ΔWB line passing point (p <  0.0001) . CONCLUSIONS: The inclination in MCT was aligned parallel to the ground under WB conditions (tibial parallel phenomenon). The parallel phenomenon was associated with the change of alignment and the relative position between the bones in the coronal plane. These phenomena were produced mainly by the tibia, not the femur. LEVEL OF EVIDENCE: Level IV.

DOI： 10.1186/s40634-019-0180-x

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PURPOSE: Abnormalities of lower extremity alignment (LEA) in recurrent patella dislocation (RPD) have been studied mostly by two-dimensional (2D) procedures leaving three-dimensional (3D) factors unknown. This study aimed to three-dimensionally examine risk factors for RPD in lower extremity alignment under the weight-bearing conditions. METHODS: The alignment of 21 limbs in 15 RPD subjects was compared to the alignment of 24 limbs of 12 healthy young control subjects by an our previously reported 2D-3D image-matching technique. The sagittal, coronal, and transverse alignment in full extension as well as the torsional position of the femur (anteversion) and tibia (tibial torsion) under weight-bearing standing conditions were assessed by our previously reported 3D technique. The correlations between lower extremity alignment and RPD were assessed using multiple logistic regression analysis. The difference of lower extremity alignment in RPD between under the weight-bearing conditions and under the non-weight-bearing conditions was assessed. RESULTS: In the sagittal and coronal planes, there was no relationship (statistically or by clinically important difference) between lower extremity alignment angle and RPD. However, in the transverse plane, increased external tibial rotation [odds ratio (OR) 1.819; 95% confidence interval (CI) 1.282-2.581], increased femoral anteversion (OR 1.183; 95% CI 1.029-1.360), and increased external tibial torsion (OR 0.880; 95% CI 0.782-0.991) were all correlated with RPD. The tibia was more rotated relative to femur at the knee joint in the RPD group under the weight-bearing conditions compared to under the non-weight-bearing conditions (p < 0.05). CONCLUSIONS: This study showed that during weight-bearing, alignment parameters in the transverse plane related to the risk of RPD, while in the sagittal and coronal plane alignment parameters did not correlate with RPD. The clinical importance of this study is that the 3D measurements more directly, precisely, and sensitively detect rotational parameters associated with RPD and hence predict risk of RPD. LEVEL OF EVIDENCE: III.

DOI： 10.1007/s00167-017-4806-1

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The bilateral shoulder pain of an 81-year-old Japanese woman due to falls persisted despite celecoxib treatment, and plain X-rays later showed bilateral collapsed humeral heads. After ruling out osteoarthritis, infectious arthritis, crystal-induced arthritis, neuropathic arthropathy, and osteonecrosis, we diagnosed bilateral shoulder joint rapidly destructive arthrosis (RDA). Lumbar bone mineral density showed very low T-score (-4.1). Primary osteoporosis was observed. Histology of biopsied humeral head indicated the features of fracture healing process: callus formation and osteoclasts without empty lacunae. Her history thus included an insufficiency fracture due to severe osteoporosis. Bilateral humeral head replacement was performed; her shoulder joint function improved. This case is extremely rare in that RDA was caused by simultaneous bilateral shoulder joint collapse within a very short time, with minimal or low mechanical stress and severe osteoporosis.

DOI： 10.18926/AMO/56252

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BACKGROUND: Humans support their bodies exclusively by vertical balance in bipedal locomotion, and the body, especially the lower extremity, generally changes with age. Sex and body constitution are assumed to be associated with lower extremity alignment, but this association remains to be elucidated. This study sought to clarify this association in healthy, elderly, non-obese humans in a Japanese population. METHODS: The present study investigated 55 healthy volunteers (mean age: 70 ± 6 years). A 3D extremity alignment system was applied under weight-bearing conditions on biplane long lower extremities X-rays using a 3D-to-2D image registration technique. The evaluation parameters included 3D hip-knee-ankle angle (3DHKA) alignment in the coronal (coronal alignment) and sagittal planes (sagittal alignment) and rotational alignment between the femur and tibia. The influences of sex and body constitution on all the alignment were analyzed. RESULTS: Multiple linear regression analysis with the dependent variable of each alignment showed that sex was the dominant factor for coronal and rotational alignment (coronal: p <  0.01; rotational: p <  0.01), and body weight was the dominant factor for sagittal alignment (p <  0.01). CONCLUSIONS: The association of sex with coronal and rotational alignment and of body constitution with sagittal alignment were proved in healthy, elderly, non-obese humans in a Japanese population. This finding can lead to further understanding of the etiology of many diseases and age-related changes.

DOI： 10.1186/s40634-018-0147-3

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The author would like to correct the errors in the publication of the original article. The corrected detail is given below for your reading.

DOI： 10.1007/s00167-017-4822-1

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BACKGROUND: This study aimed to identify the factors affecting postoperative rotational limb alignment of the tibia relative to the femur. We hypothesized that not only component positions but also several intrinsic factors were associated with postoperative rotational limb alignment. METHODS: This study included 99 knees (90 women and 9 men) with a mean age of 77 ± 6 years. A three-dimensional (3D) assessment system was applied under weight-bearing conditions to biplanar long-leg radiographs using 3D-to-2D image registration technique. The evaluation parameters were (1) component position; (2) preoperative and postoperative coronal, sagittal, and rotational limb alignment; (3) preoperative bony deformity, including femoral torsion, condylar twist angle, and tibial torsion; and (4) preoperative and postoperative range of motion (ROM). RESULTS: In multiple linear regression analysis using a stepwise procedure, postoperative rotational limb alignment was associated with the following: (1) rotation of the component position (tibia: β = 0.371, P < .0001; femur: β = -0.327, P < .0001), (2) preoperative rotational limb alignment (β = 0.253, P = .001), (3) postoperative flexion angle (β = 0.195, P = .007), and (4) tibial torsion (β = 0.193, P = .010). CONCLUSION: In addition to component positions, the intrinsic factors, such as preoperative rotational limb alignment, ROM, and tibial torsion, affected postoperative rotational limb alignment. On a premise of correct component positions, the intrinsic factors that can be controlled by surgeons should be taken care. In particular, ROM is necessary to be improved within the possible range to acquire better postoperative rotational limb alignment.

DOI： 10.1016/j.arth.2018.02.009

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BACKGROUND: Studies on the epidemiology of pediatric fractures have been scarce in recent years although fractures are very common in childhood. Boys have a higher incidence of fractures than girls. Currently, societal trends have seemed to influence the difference in activity patterns between boys and girls, but the sex difference regarding longitudinal changes in fracture incidence is not well known. METHODS: We analyzed the school accident report in Niigata city, Japan and compared the incidence of fractures in elementary and junior high school students and the sex-related risk ratio between two 9-year periods separated by 20 years from their start and end points (1999-2007 and 1979-1987). RESULTS: The study included 383,273 students from 1999 to 2007 and 561,109 students from 1979 to 1987. Comparing these periods, the fracture incidence increased significantly by 2.4 times in boys vs 2.1 times in girls from elementary school and by 2.2 times in boys vs 2.9 times in girls from junior high school (all p ＜ 0.001). The sex-related risk ratio of boys to girls increased significantly from 1.47 to 1.64 in elementary school students. In contrast, it decreased significantly from 3.29 to 2.52 in junior high school students and the change was markedly significant because of the drastic increase in fracture incidence in junior high school girls. CONCLUSIONS: The reasons proposed for the increase in schoolchildren's fractures were an improvement in diagnosis owing to social background and increased participation in sports activities despite the general decline in children's physical fitness and exercise ability. In junior high school girls, in particular, there was an increase in fracture risk due to increased participation in sports activities.

DOI： 10.1016/j.jos.2017.09.005

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INTRODUCTION: Posterior tibial slope (PTS) and sagittal alignment are important factors in the etiology of knee osteoarthritis and knee surgery. Clinically, sagittal alignment, which indicates flexion contracture of the knee, contributes to knee function in weight-bearing (WB) conditions. PTS and sagittal alignment under WB conditions in varus osteoarthritic knees are presumed to affect each other, but their association remains unclear. In this study, we aimed to clarify the association. MATERIAL AND METHODS: In total, 140 osteoarthritic varus knees were investigated. Under WB conditions, a three-dimensional (3D) alignment assessment system was applied via biplanar long-leg X-rays, using 3D-to-2D image registration technique. The evaluation parameters were as follows: 1) 3D mechanical flexion angle (3DMFA) in regards to sagittal alignment, 2) passing point in the WB line (PP), and 3) medial and lateral PTS. RESULTS: The medial and lateral PTS showed a positive correlation with 3DMFA and PP, respectively (medial PTS-3DMFA, p = 0.001; medial PTS-PP, p < 0.0001; lateral PTS-3DMFA, p < 0.0001; lateral PTS-PP, p = 0.002). The flexion contracture group with 3DMFA >5° demonstrated greater PTS than non-flexion contracture group (medial PTS, p = 0.006; lateral PTS, p = 0.006). CONCLUSIONS: Both medial and lateral PTS were correlated with sagittal alignment under WB conditions and were larger in the flexion contracture group. This finding can explain the function to take the load articular surface parallel to the ground for holding the balance in WB conditions in the sagittal plane for osteoarthritic knees. Moreover, surgeons may be required to decrease the PTS during knee arthroplasty to restore full extension in knees of patients with fixed flexion contracture.

DOI： 10.1371/journal.pone.0202488

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INTRODUCTION: Instability after total knee arthroplasty is a critical problem. The purpose of this study was to clarify the stability of implanted knees during walking by comparing differences in dynamic instability during knee acceleration between individuals with or without previously experienced subjective instability, as measured by self-reported questionnaire. MATERIALS AND METHODS: We examined 92 knees with medial pivot implants. Mean patient age and follow-up duration were 78.4 years and 32.8 months, respectively. An accelerometer was used to investigate the accelerations along three axes; that is, vertical (VT), mediolateral (ML), and anteroposterior (AP) directions in 3-dimensional (3D) space. The analysis in the stance phase and gait cycle was performed by: (1) root mean square (RMS) values of acceleration and (2) frequency domain analysis using fast Fourier transformation (FFT). A self-reported knee instability score was used for the subjective feeling of instability. RESULTS: A total of 76 knees did not feel unstable (group 0), but 16 knees felt unstable (group 1) in patients during activities of daily living. Regarding the RMS, there were no differences in each direction between the groups. For FFT, the cumulative amplitude in the frequency < 30 Hz also showed no significant differences in all directions between the groups during the stance phase (VT, p = 0.335; ML, p = 0.219; AP, p = 0.523) or gait cycle (VT, p = 0.077; ML, p = 0.082; AP, p = 0.499). DISCUSSION: Gait analysis based on the acceleration data showed that there were no between-group differences in objective dynamic instability during acceleration of the knee, with or without reports of previously experienced subjective instability, as assessed by the self-reported questionnaire.

DOI： 10.1371/journal.pone.0194221

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PURPOSE: Flexion instability following total knee arthroplasty (TKA) is a common indication of early revision. The association between the objective anteroposterior (AP) laxity direction in mid-range flexion and the subjective healing of instability remains unclear; thus, this study aimed to clarify this association. METHODS: In this study, 110 knees (74 females, 92 knees; 16 males, 18 knees) with medial pivot implants were examined with a median age of 79 (range 60-92) years for a median follow-up duration of 22 (range 6-125) months. AP laxity was measured using a KT-1000 arthrometer. Self-reported knee instability score was used for the subjective healing of instability. RESULTS: Eighty-seven knees did not feel unstable (Group 0), whereas 23 knees felt unstable (Group 1). There was a significant difference in AP displacement [Group 0: median 6 mm; range 2-15 mm and Group 1: median 8 mm; range 4-14; p < 0.0001]. The threshold value of 7 mm was determined using the area under receiver operating characteristic curve of 0.79 [95% confidence interval (CI) 0.69-0.88, p < 0.0001]. In multivariate analysis, AP displacement of ≥7 mm was an independent risk factor for feelings of instability (odds ratio 7.695; 95% CI 2.306-25.674; p = 0.001). CONCLUSIONS: AP laxity of ≥7 mm represents a known cause of feelings of instability. By controlling AP laxity in TKAs, without stiffness in the knee, it is possible to prevent feelings of instability. The clinical relevance is that AP laxity of <7 mm is one of the target areas in TKA. LEVEL OF EVIDENCE: IV.

DOI： 10.1007/s00167-016-4375-8

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INTRODUCTION: The relative torsional angle of the distal tibia is dependent on a deformity of the proximal tibia, and it is a commonly used torsional parameter to describe deformities of the tibia; however, this parameter cannot show the location and direction of the torsional deformity in the entire tibia. This study aimed to identify the detailed deformity in the entire tibia via a coordinate system based on the diaphysis of the tibia by comparing varus osteoarthritic knees to healthy knees. METHODS: In total, 61 limbs in 58 healthy subjects (age: 54 ± 18 years) and 55 limbs in 50 varus osteoarthritis (OA) subjects (age: 72 ± 7 years) were evaluated. The original coordinate system based on anatomic points only from the tibial diaphysis was established. The evaluation parameters were 1) the relative torsion in the distal tibia to the proximal tibia, 2) the proximal tibial torsion relative to the tibial diaphysis, and 3) the distal tibial torsion relative to the tibial diaphysis. RESULTS: The relative torsion in the distal tibia to the proximal tibia showed external torsion in both groups, while the external torsion was lower in the OA group than in the healthy group (p < 0.0001). The proximal tibial torsion relative to the tibial diaphysis had a higher external torsion in the OA group (p = 0.012), and the distal tibial torsion relative to the tibial diaphysis had a higher internal torsion in the OA group (p = 0.004) in comparison to the healthy group. CONCLUSION: The reverse torsional deformity, showing a higher external torsion in the proximal tibia and a higher internal torsion in the distal tibia, occurred independently in the OA group in comparison to the healthy group. Clinically, this finding may prove to be a pathogenic factor in varus osteoarthritic knees. LEVEL OF EVIDENCE: Level Ⅲ.

DOI： 10.1016/j.jos.2017.01.002

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The Niigata Prefectural Central Hospital (NPCH) is one of the main hospitals for the cities of Joetsu and Myoko, Niigata Prefecture, Japan, an area with a population of 240,141, of whom 26.7 % were aged ≥65 years in 2009. In the NPCH, patients with hip fractures are admitted to an orthopedic ward within 4 h, 89.2 % of patients are operated on within 48 h during working hours, and the prevalence of pressure ulcers is 1.5 %. To reduce the incidence of hip fractures, two major challenges emphasizing secondary fracture prevention were initiated in 2012. The first challenge used a team approach-hospital pharmacists asked patients about their drug use histories, orthopedic surgeons began drug therapy for osteoporosis after explaining to patients its importance for the prevention of secondary hip fractures, nurses assessed the risk of falling, and physiotherapists conducted rehabilitation with the aim of preventing falls. The second challenge focused on maintaining treatment for osteoporosis after discharge, when patients were under the oversight of family doctors. The percentages of patients with primary hip fractures who were taking anti-osteoporosis medications at the time of discharge in 2009, 2012, 2013 and 2014 were 21, 33, 41, and 43 %, respectively. The 12-month incidences of hip fractures on the unaffected side in 2009, 2012, 2013 and 2014 were 7.4, 2.2, 0, and 2.4 %, respectively, and the 24-month incidences of such fractures in 2009, 2012 and 2013 were 12, 7.6, and 5.2 %, respectively. Our challenges were effective at decreasing the incidence of secondary fractures.

DOI： 10.1007/s00774-016-0758-7

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Language：Japanese   Publisher：南江堂  

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PURPOSE: To characterize femoral deformities and determine sex differences in varus knee osteoarthritis (OA), femoral morphology and limb alignment were evaluated by using three-dimensional (3D) assessment, comparing healthy, elderly volunteers with osteoarthritic knees. METHODS: A total of 178 lower limbs of 169 subjects with knee osteoarthritis (136 women, 33 men; mean age 74.9 ± 5.2 years) and 80 lower limbs of 45 healthy, elderly subjects (24 women, 21 men; mean age 65 ± 4.9 years) were examined. A 3D extremity alignment assessment system was used to examine the subjects under weight-bearing conditions on biplanar long-leg radiographs using a 3D-to-2D image registration technique. The evaluation parameters were (1) femoral bowing in the coronal plane, (2) femoral bowing in the sagittal plane, (3) femoral neck anteversion, (4) hip-knee-ankle angle, and (5) femoral torsion. RESULTS: Higher femoral lateral bowing and slightly higher femoral internal torsion in the proximal diaphysis were observed in women with OA compared with healthy subjects. No difference in the higher varus malalignment, no alteration in the femoral anterior bowing, and no difference in the lower femoral neck anteversion were found between men and women when comparing healthy and OA subjects. CONCLUSIONS: The higher femoral lateral bowing and slightly higher femoral internal torsion in the proximal diaphysis in women are possibly a structural adaptation to mechanical use. The clinical significance is that the femoral deformities and the sex differences in knee OA have the potential to improve the understanding of the aetiology of primary varus knee OA. LEVEL OF EVIDENCE: IV.

DOI： 10.1007/s00167-016-4166-2

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BACKGROUND: The extensor mechanism may be the key to kinematic alignment of total knee arthroplasty. The purpose of this study was to determine any differences in the direction of the quadriceps vector based on gender or ethnicity and to determine which anatomically derived alignment axis is closest to the quadriceps vector. METHODS: Computed tomography scans and patient records for 14 Caucasians (9 men and 5 women) and 40 Japanese (19 men and 21 women) were evaluated. Three axes of alignment-anatomic, mechanical, and spherical-were identified, measured, and compared to the quadriceps vector in each case. Principal component analysis was used to determine the quadriceps vector by using 3-dimensional models of muscles on computed tomography scans. RESULTS: No statistically significant differences in the orientation of the quadriceps vector were found based on gender or ethnicity, and the quadriceps vector was most closely aligned with the spherical axis. CONCLUSION: Because the quadriceps is the primary knee extensor, the spherical axis therefore may be a ubiquitous guide to alignment of the arthroplasty knee based on motion.

DOI： 10.1016/j.arth.2016.02.044

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BACKGROUND: Anterior cruciate ligament (ACL) injury often leads to symptoms of instability, which may cause meniscus injury, osteochondral lesions, and degenerative changes. For thorough evaluation of the effects of abnormal motion of ACL-deficient (ACLD) knees on the meniscus and articular cartilage, it is necessary to assess tibiofemoral motion in the medial and lateral compartments separately. Our aim was to determine if in vivo three-dimensional (3D) dynamic motion of ACLD knees differs from that of contralateral uninjured knees by assessing knee motion in the medial and lateral compartments respectively. METHODS: A total of 22 patients with an isolated ACL-injured knee were examined. 3D to two-dimensional registration was used to determine 3D knee motion during squatting from full knee extension to full flexion for both ACLD and contralateral uninjured knees. The knee motion was evaluated by the movement of the geometric center axis of the femur projected onto the tibial axial plane. RESULTS: In ACLD knees the lateral femoral condyle was located significantly more posteriorly during nearly full extension than in contralateral uninjured knees. The range of anteroposterior translation of the medial femoral condyle was significantly greater than those of contralateral uninjured knees. Almost all of the contralateral uninjured knees demonstrated medial pivot motion, while the ACLD knees showed higher variance. CONCLUSIONS: The ACLD knees exhibited a motion pattern different from those of contralateral uninjured knees with higher variance. During nearly full extension of the ACLD knees, the lateral femoral condyle translated posteriorly and the screw-home movement seemed to be impaired. The ACL might have an important role in maintaining normal knee function, especially during the early flexion phase. The larger range of anteroposterior translation of the medial femoral condyle in ACLD knees may be associated with a risk of secondary meniscal injury and degenerative change in the articular cartilage. LEVEL OF EVIDENCE: Level IV.

DOI： 10.1016/j.jos.2015.11.001

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PURPOSE: The purpose of this study was to investigate the hypothesis that a medial unicompartmental knee arthroplasty might restore the functional flexion axis of a knee to normal. The flexion axis can be indirectly identified by tracking the vertical translation of anatomic landmarks that basically move around the flexion axis during a knee motion. If a unicompartmental knee could help restore the normal flexion axis, the anatomic landmarks after the arthroplasty would show the vertical translation similar to those of normal knees during a knee flexion. METHODS: While performing a squatting motion, the kinematics of 17 knees were determined before and after a medial unicompartmental arthroplasty to calculate the vertical translation of a clinical epicondylar axis, using a three- to two-dimensional registration technique through a single-plane fluoroscopic system incorporating a biplanar static radiography. The results were compared with a normal data, and a statistical analysis including a two-way repeated-measured analysis of variance was performed. RESULTS: For the medial end, from 10° to 100° knee flexion, normal, osteoarthritic, and unicompartmental knees had the average superior vertical translation of 7.3 ± 4.2, 4.3 ± 7.2, and 2.4 ± 3.1 mm, respectively, with statistical significance between normal and unicompartmental knees (p < 0.001). The vertical translation did not return to normal post-implantation. CONCLUSIONS: A unicompartmental knee could not reproduce the normal flexion axis. As for clinical relevance, the changes of the implant design and surgical procedure may be necessary to obtain the normal flexion axis reproducing a normal motion. LEVEL OF EVIDENCE: IV.

DOI： 10.1007/s00167-014-3296-7

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PURPOSE: It is common to assert that restoration of normal knee kinematics is essential for the best functional result after knee arthroplasty. Previous studies using the progression of the geometric centre axis have suggested that kinematics after unicompartmental arthroplasty is markedly different from the normal. For this study, the transepicondylar axis was used because this axis is closer to the flexion axis and should be a better reference for motion. The following hypothesis was tested: the transepicondylar axis would again show that the postoperative kinematics does not restore normal motion and is closer to that before replacement. METHODS: Seventeen osteoarthritic knees were tested before and after unicompartmental arthroplasty using a three-dimensional to two-dimensional registration technique tracking the transepicondylar axis to calculate translation and rotation of this axis. Results were compared for the seventeen knees before and after arthroplasty and were compared to the normal knee as measured in our previous study. RESULTS: Similar motion patterns in the pre- and postoperative knees were shown but both the pre- and postoperative motion were markedly different from the normal knee. CONCLUSIONS: This result supported our hypothesis. The clinical relevance is that medial unicompartmental arthroplasty cannot restore the motion of the knee to normal in the living knee. Therefore, it would be expected that the patient for unicompartmental knee might not feel normal. It may not be possible depending on ligaments alone to restore the knee to normal, and the changes in the articular shapes and the surgical procedure may also be necessary.

DOI： 10.1007/s00167-013-2767-6

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BACKGROUND: The functional flexion axis (FFA) is the principal axis around which the knee moves and thus, by definition, does not move in vertical displacement relative to the tibia. The transepicondylar axis (TEA) has been reported to coincide with the FFA. If that is not true, the TEA should show vertical displacement during motion, and this hypothesis was investigated. METHODS: Three-dimensional knee kinematics of 20 healthy volunteers were determined during a squatting motion via a 3-dimensional to 2-dimensional image registration technique by calculating the vertical displacement of the clinical epicondylar axis (CEA) through the full range of motion. RESULTS: From 0° to 90° knee flexion, the average vertical displacement of the lateral end of the CEA was <3 mm, whereas that of the medial end was large (7.6 mm). DISCUSSION: The large vertical displacement of the medial end of the CEA suggests that the CEA is not the FFA. This finding implies that the CEA may not be an appropriate axis for a TKA prosthesis having a "single radius" design. EVIDENCE LEVEL: Level IV.

DOI： 10.1007/s00776-014-0536-0

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PURPOSE: The transepicondylar axis (TEA) has been used as a flexion axis of the knee and a reference of the rotational alignment of the femoral component. However, no study has showed dynamic normal knee kinematics employing TEA as the evaluation parameter throughout the full range of motion in vivo. The purpose of this study was to analyze dynamic kinematics of the normal knee through the full range of motion via the 3-dimensional to 2-dimensional registration technique employing TEA as the evaluation parameter. METHODS: Dynamic motion of the right knee was analyzed in 20 healthy volunteers (10 female, 10 male; mean age 37.2 years). Knee motion was observed as subjects squatted from standing with knee fully extended to maximum flexion. The following parameters were determined: (1) Anteroposterior translations of the medial and lateral ends of the TEA; and (2) changes in the angle of the TEA on the tibial axial plane (rotation angle). RESULTS: The medial end of the TEA demonstrated anterior translation (3.6 ± 3.0 mm) from full extension to 30° flexion and demonstrated posterior translation (18.1 ± 3.7 mm) after 30°, while the lateral end of the TEA demonstrated consistent posterior translation (31.1 ± 7.3 mm) throughout knee flexion. All subjects exhibited femoral external rotation (16.9 ± 6.2°) relative to the tibia throughout knee flexion. CONCLUSION: Compared to previously used parameters, the TEA showed bicondylar posterior translation from early flexion phase. These results provide control data for dynamic kinematic analyses of pathologic knees in the future and will be useful in the design of total knee prostheses.

DOI： 10.1007/s00167-012-2010-x

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Language：Japanese   Publisher：一般社団法人日本外科学会  

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BACKGROUND: Pre- and postoperative knee kinematics in unicompartmental knee arthroplasty (UKA) can be theoretically related to clinical outcome and longevity after UKA with regard to ligament function and the degree of arthritic changes. However, the preoperative knee kinematics of patients indicated for UKA remain to be elucidated, and it is also unclear whether the preoperative kinematics can be maintained by the UKA procedure. The objective of this study was to examine the in vivo pre- and postoperative three-dimensional knee kinematics in UKA while referencing the normal knee kinematics reported in our previous study. METHODS: We analyzed the knee kinematics in 17 knees (14 patients) undergoing UKA via a three-dimensional to two-dimensional registration technique employing femoral condylar translation and femoral axial rotation. The pre- and postoperative knee kinematics during squat motion were evaluated in the same subjects, employing consistent evaluation parameters. RESULTS: On average, both pre- and postoperative knee kinematics in the range 10-100° of knee flexion demonstrated near-consistent femoral external rotation and anterior translation of the medial condyle and posterior translation of the lateral condyle. However, the mean femoral external rotation angle and the posterior translation of the lateral condyle postoperatively were significantly smaller than the values observed preoperatively. DISCUSSION: Although the patterns of preoperative knee motion were similar to those seen in normal knees, the magnitude of this motion varied widely between patients, so it was not necessarily representative of normal knees. These variations may be due to the varying degrees of arthritic changes caused by osteoarthritis. Although the patterns of knee kinematics were largely maintained by the UKA procedure, the causes of the significant reductions in the magnitude of motion upon performing the UKA procedure should be investigated in subsequent studies with a larger number of patients.

DOI： 10.1007/s00776-012-0322-9

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BACKGROUND: Analysis of the movement of anatomically defined reference axes at the femoral condyles relative to the tibia is appropriate for evaluating knee kinematics. However, such parameters have been previously employed only in studies utilizing stop-motion techniques. The purpose of this study was to evaluate in vivo dynamic kinematics for full range of motion in normal knees using the three-dimensional to two-dimensional registration technique and to compare them with previously reported normal knee kinematics obtained via stop-motion techniques. METHODS: Dynamic motion of the right knee was analyzed in 20 healthy volunteers (10 female, 10 male; mean age 37.2 years). Knee motion was observed when subjects squatted from standing with the knee fully extended to maximum flexion. We determined the following parameters: (1) changes to angles of the geometric center axis (GCA) on the tibial axial plane (rotation angle); (2) anteroposterior translations of the medial and lateral ends of the GCA; and (3) motion patterns in each phase during knee flexion. RESULTS: All subjects exhibited femoral external rotation (26.1°) relative to the tibia throughout knee flexion. The medial femoral condyle demonstrated anterior translation (5.5 mm) from full extension to 100° flexion, and demonstrated posterior translation (3.9 mm) after 100°, while the lateral femoral condyle demonstrated consistent posterior translation (15.6 mm) throughout knee flexion. All subjects showed medial pivot motion from full extension to nearly 120° flexion. From 120° flexion, bicondylar rollback motion was observed. DISCUSSION: Although the behavior of the medial femoral condyle in our analysis differed somewhat from that seen in previous cadaver studies, the results obtained using dynamic analysis were generally equivalent to those obtained in previous studies employing stop-motion techniques. These results provide control data for future dynamic kinematic analyses of pathological knees.

DOI： 10.1007/s00776-011-0149-9

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Language：Japanese   Publisher：東北整形災害外科学会  

症例1は12歳男児で、走り高跳びの踏切の際に受傷し、単純X線、単純CT画像より左脛骨粗面剥離骨折、Watson-Jones分類1型と診断した。受傷後2日目に手術を施行し、中空海綿骨スクリューとフラットワッシャーを用いて骨接合術を施行した。術後3週の非荷重期間を設け、術後3ヵ月で体育参加を許可し、術後6ヵ月で骨癒合したため8ヵ月で抜釘を施行した。症例2は14歳男児で、症例1と同様に受傷し、右脛骨粗面剥離骨折、Watson-Jones分類1型と診断した。さらにMRIで内側膝蓋支帯の損傷が疑われ、受傷後4日目の手術前の膝関節鏡検査でも同様の所見であった。脛骨粗面骨片は中空海綿骨スクリュー2本とフラットワッシャーで接合し、さらにSUTUREFIX Ultraで膝蓋靱帯を補強し、内側膝蓋脛骨靱帯断裂は前方関節包ごと縫合して修復した。術後は2週間の非荷重とし、術後3ヵ月で陸上競技に復帰し、術後8ヵ月で癒合を確認したため術後1年で抜釘を施行した。

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

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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53歳男。1000ccのバイクで走行時に停車した際、倒れそうになったバイクを支えようとして、膝関節伸展、股関節屈曲の肢位で踏ん張り、過度な遠心性収縮により受傷した。職業は運送業、趣味はジムでのトレーニングと活動性の高い患者であったため治療方法は保存療法ではなく手術療法を選択・施行し、術後約4ヵ月で就労復帰させることができた。本邦ではハムストリング肉離れの治療方法としてアスリートに対する手術療法の報告は散見されるが、非アスリートに対する手術療法の報告は限定的である。しかし、早期手術療法の成績は保存療法の成績を上回ると報告されていることから、非アスリートであっても活動性の高い患者には手術療法も選択肢の一つとして考慮すべきと思われた。

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Language：Japanese   Publisher：新潟整形外科研究会  

APSは次世代型の多血小板血漿といわれており、当院では2020年5月からジンマーバイオメット社のAPSキットを変形性膝関節症患者に使用している。今回、APS投与後3ヵ月以上観察しえた13例14膝の成績について検討した。投与後1・3・6ヵ月時の臨床成績についてKOOSを指標に調査した結果、各項目とも平均スコアが経時的に改善しており、特に「こわばり」「痛み」「スポーツ」は有意に改善していた。合計スコアは投与前65.6±13.8が投与後3ヵ月時72.0±16.0と有意に改善していた。K-L分類grade II・III群(4膝)とgrade IV群(10膝)に分けて検討すると、II・III群の合計スコア平均は投与後1ヵ月時に比べて3ヵ月時に有意に改善し、IV群の合計スコアは投与前に比べて投与後1ヵ月時に有意に改善していた。II・III群とIV群とで合計スコアを比較すると、投与前から投与後3ヵ月時まではII・III群のほうが有意に高かったが、投与後6ヵ月時には有意差を認めなかった。

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

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

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症(膝OA)の自然経過と危険因子を把握するために疫学調査が重要であり、我々は長期縦断集団膝検診を行ってきた。そのX線定量評価から進行予測をするため、基盤となる疫学要因について12年間3年間隔5回の連続受診者170名を対象に検討した。膝外側角及び疫学要因である体格指数、股関節内旋可動域、膝伸展筋力、膝屈曲拘縮について、項目ごとに膝OA病期(Kellgren-Lawrence:K-L分類)のgrade別に比較をした。また、12年間のgrade変化を基準に非進行群と進行群に分け、群別経時的変化の比較を行った。全ての項目において男女ともgradeとの関連を認めた。今後膝OA進行予測には、年齢及び進行した時間的経過等を含めた項目間の関連や、個別疫学要因についても関節裂隙等のX線定量評価に対する総合的検討が必要と考える。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J05471&link_issn=&doc_id=20211007090006&doc_link_id=%2Fcx9biomc%2F2021%2F004200%2F007%2F0033-0038%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2021%2F004200%2F007%2F0033-0038%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

本研究の目的は踏み出し脚の前足底接地からボールリリース区間の踏み出し脚の膝・股関節・骨盤の運動が投球リリースポイント(RP)ばらつきに与える影響を検討することである。高校野球部の投手10名を対象に、マウンドプレートから12m先、右打者の外角と内角低めを的として10球ごとに休息し、合計20球を全力投球して3次元測定を行い、20球の平均値を各選手の投球動作結果とした。RPばらつきと投球動作の膝・股関節・骨盤の運動量との関係性をSpearmanの順位相関係数で検討した。前後方向ばらつきは膝関節屈伸量(r=0.68、p=0.03)と骨盤回旋量(r=0.73、p=0.02)に、側方方向ばらつきは股関節内外転量(r=-0.69、p=0.003)に有意な相関を示した。前足底接地からボールリリース区間で膝関節屈伸量と骨盤回旋量はRP前後方向のばらつきに影響し、股関節内外転量はRP側方のばらつきに影響することが示唆された。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J05471&link_issn=&doc_id=20211007090001&doc_link_id=%2Fcx9biomc%2F2021%2F004200%2F002%2F0001-0007%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2021%2F004200%2F002%2F0001-0007%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

健常者の大腿骨皮質骨幅は性差や加齢の影響で異なる。皮質骨幅は加齢の影響で経時的に変化すると想定されるが、有限要素解析を用いた研究は多くない。本研究では形状最適化手法を用いて経年変化を再現した解析を行った。健常の男性3名(29.7±0.5歳)、女性3名(34.3±3.4歳)のCT画像から有限要素モデルを構築し、形状最適化手法を用いて経年変化を再現した。近位、中央、遠位の各断面を内側、外側、前方、後方の4つに分けて各領域の平均皮質骨幅を算出し、解析前後で比較した。全体として各部位の皮質骨幅は減少傾向を示した。一方で、女性においては近位内側と中央内側で皮質骨幅が増加する結果となり、一部の部位では男女で経年変化における皮質骨幅変化に異なる傾向がみられた。本研究では、骨粗鬆症による影響を考慮していないため、形態と荷重線の関係によって、経年変化による皮質骨幅変化が引き起こされる可能性が示唆された。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J05471&link_issn=&doc_id=20211007090013&doc_link_id=%2Fcx9biomc%2F2021%2F004200%2F014%2F0073-0078%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2021%2F004200%2F014%2F0073-0078%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症(膝OA)の異常運動lateral thrust(LT)はOA進行要因として主に歩行解析や筋力との関連で検討される。3次元アライメント評価を行った非OAと進行期OA女性各15例に対し、非荷重位(臥位:CT撮像位)と荷重位(立位:2方向X線画像と骨3DCTモデルのマッチング)間における大腿骨・脛骨間の相対位置変化を冠状面方向で評価した。非OA、OAの両例において非荷重位と立位荷重位を比較すると、荷重により脛骨内側関節面が大腿骨関節面に接近した位置にあり、脛骨は大腿骨に対して外側に位置していた。また、側方への移動量は非OAに比してOAが大きいことを確認した。膝OAのLTは脛骨近位内側関節面への偏荷重を荷重面水平化の方向に位置修正を行い、その際大腿骨内側関節接触点を中心とした脛骨の相対位置移動としての評価が可能なことを示唆した。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

大規模集団検診(松代膝検診)で確認した変形性膝関節症(膝OA)進行に伴う膝前後単純X線画像上の下腿骨位置や形状の定量的評価で膝OA進行度判定が可能と考え、半自動評価システムを開発した。松代膝検診第5回(2007年)から12年間の5回をすべて受診した対象のうち、任意で抽出した男女各10名の単純X線画像を対象に測定の信頼性を評価および従来の手動デジタイズ法との測定精度と測定時間を比較検討した。測定の信頼性として検者内では級内相関係数:ICC=0.98、検者間ではICC=0.96、従来法との比較でもICC=0.96と高い信頼性を示した。また、評価指標で、脛骨関節面傾斜、関節裂隙幅比の減少、脛骨内側皮質骨幅比の増加、FTAの増加など過去に報告した膝OA進行に伴う変化が算出された。特に、骨の参照軸の自動抽出により測定値の安定とこれによる測定時間が約1/3に短縮した。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J05471&link_issn=&doc_id=20211007090007&doc_link_id=%2Fcx9biomc%2F2021%2F004200%2F008%2F0039-0043%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2021%2F004200%2F008%2F0039-0043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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Language：Japanese   Publisher：東日本整形災害外科学会  

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

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

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

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

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

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

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

当院では2017年4月より術後14日で退院または転院となる、新人工膝関節全置換術(TKA)術後パス(新パス)の運用を開始した。しかし、早期退院に伴う膝関節可動域(ROM)の悪化やQOLの低下などの有害事象が懸念されたため、患者教育に着目した入院リハビリテーション(教育リハ)を導入した。本研究は、新パス導入前後の術後在院日数変化と、教育リハが術後早期の身体機能・ADL・QOL等に与えた影響を明らかにした。2015年4月〜2019年11月に当院でTKAを施行した変形性膝関節症患者75名78膝(男性13膝、女性65膝、平均73.2±9.3歳)を対象とした。旧パス群33膝、新パス群45膝に群分けし、各群の術後在院日数の中央値(最小-最大)を算出し、差を比較した。次いで、新パス群より除外基準を除いた18膝(男性1名、女性17名、平均69.7±7.9歳)で教育リハの効果検証を実施した。術後平均在院日数は、旧パス群20日、新パス群145日と有意に短縮した。教育リハ定着率は73.4%であった。教育パス定着率と退院時膝屈曲角度に正の相関、退院時起立時痛と負の相関を示した。また、術後1ヵ月の起立時痛、歩行時痛、階段昇降時痛に負の相関を示した。その他の評価項目とは相関関係を示さなかった。

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症の初期における下肢アライメントや骨形態変化を明らかにするために、大規模集団検診(松代膝検診)の第5回から8回目(2007年から2016年)においてK-L分類grade 0および1からgrade 2へと移行した142名237膝(男性65名111膝、女性77名126膝、平均年齢71.2±7.4歳)の立位膝前後X線画像を調査した。1)内外側関節裂隙幅比、2)脛骨軸傾斜角度、3)FTA、4)大腿骨と脛骨間の相対的な回旋角度を縦断的に評価した。その結果、内側関節裂隙の狭小、外側の拡大、FTAの増加、脛骨軸傾斜角度の減少はgradeの進行に伴いすべて有意な変化を示し、加えて大腿骨が脛骨に対して外旋する傾向がみられた。また、脛骨軸傾斜がFTAと外側関節裂隙幅比との相関を示し、脛骨の内側傾斜の増大が膝関節の内反変形の初期変化として、大腿-脛骨間のアライメント変化に影響を及ぼし、内反変形の進行の一因となっていることが示唆された。(著者抄録)

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

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

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

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症において右外反、左内反を呈する女性患者2名に対し、病態解明のため三次元下肢アライメント測定と超音波ストレインエラストグラフィを用いて腸脛靱帯のひずみ量から剛性を評価し、緊張度について検討した。仰臥位で股関節伸展位において超音波診断装置を用い、大転子直上部で同一荷重下における腸脛靱帯のひずみ量をストレインエラストグラフィによって測定し、左右の剛性の比として評価した。腸脛靱帯の剛性は2症例共に内反膝である左側腸脛靱帯が外反側である右側に比して高い値で、相対的に右側腸脛靱帯の剛性が高いことを示した。アライメント評価で骨盤、大腿骨・脛骨の解剖学的座標系の相対位置を評価した結果、骨盤が下肢に対して右回旋を生じていた。このことが腸脛靱帯の緊張と外反膝を生じている原因と推測した。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

吹き流し膝は内反型膝関節症の対側が外反型を呈する稀な疾患である。本研究では、いずれも右外反、左内反を呈する女性吹き流し膝患者2名に対し、三次元アライメント評価と床反力の大きさおよび作用方向の解析を行った。被験者は両脚立位で二方向スロットラジオグラフィー撮影と床反力測定を同時に行った。下肢機能軸と床反力ベクトルの大きさおよび脛骨関節面での通過位置を評価した。両被験者とも大腿骨前捻角に左右差があり、右脚に偏った荷重割合を示した。下肢機能軸と床反力ベクトルの通過点は右脚において機能軸に比べ床反力ベクトルが大きく膝後方に位置していた。この結果、本症において外反膝を伴う股関節疾患において指摘されている骨盤のアライメントの影響が存在すると推察され、本症の病因について骨盤を含めた下肢全体のアライメント評価が必要であることが示唆された。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症(膝OA)は下肢アライメント内反変形に伴い、脛骨内側への荷重が増加する。脛骨近位部は骨幹部と比較して海綿骨の割合が多く、三次元的に変形しやすい環境で、脛骨近位部の変形が膝OAの発症・進行へ影響すると考えられる。そこで、初期OAにおける脛骨近位部の力学応答について有限要素解析を行った。K-L分類grade 0から2の女性8例のCT画像から脛骨の有限要素モデルを構築し、荷重を脛骨内外側関節面に内側60%:外側40%の割合で作用させ、脛骨骨長の近位30%に生じるひずみエネルギー密度について検討した。健常に比べ初期OAで脛骨骨幹部の内側および後方でひずみエネルギー密度の高い領域が増加した。一方、骨幹端部より近位や脛骨前方および外側ではひずみエネルギー密度の高い領域は少なかった。内側優位の荷重により、脛骨骨幹部内側および後方で力学的負荷が増加することが推察された。(著者抄録)

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

変形性膝関節症の初期における下肢アライメントや骨形態変化を明らかにするために、大規模集団検診(松代膝検診)の第5回から8回目(2007年から2016年)においてK-L分類grade 0および1からgrade 2へと移行した142名237膝(男性65名111膝、女性77名126膝、平均年齢71.2±7.4歳)の立位膝前後X線画像を調査した。1)内外側関節裂隙幅比、2)脛骨軸傾斜角度、3)FTA、4)大腿骨と脛骨間の相対的な回旋角度を縦断的に評価した。その結果、内側関節裂隙の狭小、外側の拡大、FTAの増加、脛骨軸傾斜角度の減少はgradeの進行に伴いすべて有意な変化を示し、加えて大腿骨が脛骨に対して外旋する傾向がみられた。また、脛骨軸傾斜がFTAと外側関節裂隙幅比との相関を示し、脛骨の内側傾斜の増大が膝関節の内反変形の初期変化として、大腿-脛骨間のアライメント変化に影響を及ぼし、内反変形の進行の一因となっていることが示唆された。(著者抄録)

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

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

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

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Language：Japanese   Publisher：金原出版(株)  

＜文献概要＞新潟県高等学校野球連盟(新潟県高野連)から提案された高校野球における球数制限の是非が話題になって議論が進んだ結果,野球界全体に投球障害予防の概念が広がっていった。深刻な関節障害をもたらす野球肘は多因子が関与しており,その予防には多面的なアプローチが必要である。その中で投球数の制限は成長期に必要であり,年齢が若い世代ほどさらにその意義は重要性を増す。スポーツ現場と医療が相互理解を深め,連携して正しい情報共有と適切な行動喚起につながることでスポーツ環境の向上が実現し,子どもたちの育成により大きな効果をもたらすことが可能となる。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00767&link_issn=&doc_id=20200818160011&doc_link_id=10.18888%2Fse.0000001421&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fse.0000001421&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

過去5年間に、化膿性関節炎(SA)、人工関節周囲感染(PJI)の疑いで関節液培養に血液培養瓶を使用した24例(男性16関節、女性8関節、膝20関節、肩4関節、平均年齢68.2±9.8歳)を対象に、SA、PJIの関節液培養における血液培養瓶の有用性について検討した。その結果、診断基準を満たした陽性群7例、満たさなかった陰性群17例であった。陽性群は、血液培養瓶培養は感度100%、通常培養は感度57%、組織培養は感度86%で、通常培養と組織培養で偽陰性を認めた。以上より、血液培養瓶培養は通常培養、組織培養と比較して感度が高く、菌検出困難例に対する有用性が示唆された。

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

人工膝関節置換術の術後疼痛に対して術中の関節周囲カクテル注射に中時間作用型ステロイド(ソルメドロール)を添加することによる周術期血糖値への影響を検討した。対象は耐糖能異常のない患者20例であり、入室時・帰室時と術後3日間の血糖値を測定した結果、術後1日目の血糖値は135mg/dlで術後2、3日目よりも有意に高かったが、術後2日目と3日目の血糖値に有意差は認めず、術後3日間の平均血糖値は124mg/dlと良好であった。また、術前と術後3日目の膝自動最大屈曲角度とVASの測定では術後3日目に最も高いVASを示し、VASの上昇に伴って自動最大屈曲角度の低下を認めた。

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

早期膝OAの概念が提唱され、膝関節の初期構造変化に関心が高まっている。初期構造変化はMRIにより評価可能であるが、簡便な質問票で初期構造変化を予測できれば診療の効率化につながると考えられる。今回、JKOM質問票の有用性について検討するため、MRI所見との相関性を解析した。対象はKellgren-Lawrence分類0/1の早期膝OA患者56例とした。MRIではWhole-Organ MRI Score(WORMS)に基づいて「関節軟骨」「骨髄浮腫」「内・外側の半月板」を半定量的に評価し、JKOM各項目との相関をSpearmanの順位相関係数で検定した。結果、「関節軟骨」「骨髄浮腫」とJKOM項目Iとの相関係数はそれぞれ0.275、0.295と弱い正の相関が認められた。また「関節軟骨」は項目IIとの相関係数0.327と弱い正の相関が認められ、「内側半月板」は項目II、項目IIIとの相関係数がそれぞれ0.356、0.35と弱い正の相関が認められた。相関があった組み合わせについて、MRIの有意所見をWORMSの点数から「関節軟骨」3点以上、「骨髄浮腫」2点以上、「内側半月板」2点以上と定義し、それらのJKOMによる検出予測値をROC曲線で算出したところ、「関節軟骨」は項目Iで22点、項目IIで12点、「骨髄浮腫」は項目Iで62点、「内側半月板」は項目IIで15点、項目IIIで14点となった。

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

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

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

昨年度、腓骨の脛骨外側支持が脛骨関節面の荷重分散に影響し、腓骨骨切りにより脛骨内側荷重が軽減される可能性を報告した。また、腓骨骨切りを伴う閉鎖式高位脛骨骨切り術(closed wedge HTO)において術後、内側膝関節裂隙の拡大を生じるという報告がなされている。しかし、下肢アライメントを変化させた際の大腿脛骨間の相対位置関係に腓骨が及ぼす影響は不明であるためこの影響を実験的に検討した。ヒト切断肢2肢を対象とし、HTOを模した骨切りによる外反アライメントの再現を含む4条件で圧縮試験を行った。モーションキャプチャーシステムを用い、膝関節の接触領域および裂隙幅を算出した。腓骨骨切りを伴う条件において、接触領域は内側減少、外側増加、裂隙幅は内側が拡大、外側が狭小化する傾向を確認、下肢アライメントを変化させた際の大腿脛骨間の相対位置関係に腓骨による脛骨外側支持が影響していると推察された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05471&link_issn=&doc_id=20191009100013&doc_link_id=%2Fcx9biomc%2F2019%2F004000%2F014%2F0081-0086%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2019%2F004000%2F014%2F0081-0086%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

二次元X線画像から大腿・脛骨間の相対的な回旋を評価するため、変形性膝関節症疫学調査(松代膝検診)の第5回から8回(2007年から2016年)においてK-L分類grade 0からgrade 2へ移行した26名41膝の立位膝X線像を対象とし、大腿骨内側顆長軸の長さ(M)、大腿骨内側顆長軸から膝蓋骨外側縁までの距離(P)、脛骨内側顆間隆起近位端から腓骨頭外側縁までの距離(F)を用いた「大腿骨回旋指標(P/M)」および「脛骨回旋指標(F/M)」を用いて大腿・脛骨間の相対回旋角度を算出した。その結果、grade 0からgrade 2へと進行する過程で、41膝中31膝(76%)が大腿骨に対して脛骨が内旋傾向であった。健常から早期OAへの過程で大腿骨・脛骨間の相対的な回旋変化がOAの進行の要因の一つとして推察され、内反変形との関連の調査が必要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05471&link_issn=&doc_id=20191009100017&doc_link_id=%2Fcx9biomc%2F2019%2F004000%2F018%2F0107-0111%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2019%2F004000%2F018%2F0107-0111%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

脛骨近位部は骨幹部に比較して海綿骨の割合が多く、内側型膝関節症において腓骨の荷重分担による影響を受けて三次元的に変形をきたすと考えられる。本研究は有限要素解析を用い、脛骨近位部の力学応答を解析し、腓骨による脛骨への荷重支持の効果の検討を目的とした。高齢健常者のCT画像から脛骨・腓骨の有限要素モデルを構築し、荷重は脛骨内外側関節面に配分の異なる荷重を作用させた。評価は脛骨近位部の横断面4領域、冠状面3領域の各領域に生じるひずみエネルギー密度を検討した。その結果、内側荷重増加に伴い、ひずみエネルギー密度は脛骨近位5-10%では前方・後方・内側、10-20%では外側、20-30%では後方・内側・外側で有意に変化した。腓骨をなくした脛骨では、脛骨近位10-20%以遠の領域でひずみエネルギー密度が増加した。以上より、腓骨は脛骨近位10-20%以遠において、外側への荷重を支持していることが示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J05471&link_issn=&doc_id=20191009100014&doc_link_id=%2Fcx9biomc%2F2019%2F004000%2F015%2F0087-0093%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2019%2F004000%2F015%2F0087-0093%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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

大規模住民コホートを用いた疫学調査は、膝OAの病態を解明するうえできわめて重要な研究であり、これまでにさまざまな知見が得られてきた。近年、新しく多様化した研究手法の導入により、これまで疫学研究では解明が困難であった膝OAの病態メカニズムに迫る新しい知見が得られるようになっている。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00282&link_issn=&doc_id=20190603060002&doc_link_id=10.18885%2FJ00282.2019374733&url=https%3A%2F%2Fdoi.org%2F10.18885%2FJ00282.2019374733&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Language：Japanese   Publisher：スポーツ傷害フォーラム  

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Language：Japanese   Publisher：スポーツ傷害フォーラム  

ACL-RSIは、ACL再建術後の再損傷への恐怖感の評価スケールとして広く用いられ、ACL-RSIスコアが低いと競技復帰が難しいことが報告されている。今回、当院で初回ACL再建術を施行したスポーツ選手11例を対象とし、術後のACL-RSIスコアと膝関節機能との関連性について検討した。膝関節機能の評価項目は「屈曲・伸展可動域」「Heel Height Difference」「Flexion Lag」「等速性屈曲筋力欠損率」「等速性伸展筋力欠損率」とした。検討の結果、ACL-RSIスコアは「等速性屈曲筋力欠損率」と有意な負の相関を示した。また、「等速性屈曲筋力欠損率」は「Flexion Lag」と有意な正の相関を示した。

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Language：Japanese   Publisher：スポーツ傷害フォーラム  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

内側型変形性膝関節症の手術療法として近年、腓骨骨切り術の良好な短期成績が報告されている。しかし、腓骨骨切りによって起こる脛骨内外側の荷重変化については不明な点が多い。本研究では、脛骨に対する荷重の影響を腓骨骨切り前後で調査し、骨表面ひずみに注目し腓骨支柱効果について実験的に検討することを目的とした。ヒト切断肢2肢を用い圧縮試験を行った。腓骨骨切り前後の状態を再現するために骨切り後、切除腓骨に合わせたレジン片を作製し切除部に補填、それを抜き取った。ひずみゲージで脛骨表面ひずみを測定するとともにモーションキャプチャーを用いて下肢アライメントを腓骨骨切り前後で測定した。下肢アライメントに腓骨骨切り前後での変化は認めなかったが、脛骨表面ひずみは、外側は圧縮方向、内側は引っ張り方向への変化を認めた。腓骨骨切り単独で脛骨内側荷重が軽減したと考えられ、腓骨支柱が脛骨内側荷重に影響していると推察された。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J05471&link_issn=&doc_id=20181011070021&doc_link_id=%2Fcx9biomc%2F2018%2F003900%2F021%2F0131-0135%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2018%2F003900%2F021%2F0131-0135%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

我々は膝X線前後画像からの大腿骨・脛骨間の回旋評価を目的として、三次元骨モデルを用いて「大腿骨内側顆長軸の長さ(M)」、「内側顆長軸から膝蓋骨外側縁までの距離(P)」、「脛骨内側顆間隆起先端から腓骨頭外側縁までの距離(F)」を用いた大腿骨回旋指標(P/M)および脛骨回旋指標(F/M)を提案した。しかし、X線画像を用いて大腿骨と脛骨の回旋を評価する場合、二次元画像上の評価指標が三次元的に正確であるかは不明である。そこで、二次元画像を再現するためにCTデータからDigitally Reconstructed Radiography(DRR)画像を作成し、健常男女各20名に対し本法の精度を検証した。その結果(M)は、回旋角度の変化によらず一定の値を示し、大腿骨回旋指標(P/M)および脛骨回旋指標(F/M)は、男女とも回旋に対して強い相関を示した。二次元の立位膝X線画像から、膝OAのアライメント初期変化としての大腿骨・脛骨間の回旋状態の検討が可能であり、疫学調査などへの応用が可能と考える。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J05471&link_issn=&doc_id=20181011070020&doc_link_id=%2Fcx9biomc%2F2018%2F003900%2F020%2F0125-0129%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2018%2F003900%2F020%2F0125-0129%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

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

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

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

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

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

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

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

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

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

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

内側型変形性膝関節症の診断にてCruciate retaining型TKAを施行した49膝(男性9膝、女性40膝、平均74.3歳)を対象に、脛骨骨切り高位と後十字靱帯(PCL)の温存について検討した。骨切り高位として、腓骨頭頂部で骨切りする腓骨頭群、外側関節面から10mmで骨切りする10mm群、10mm群から2mm分の軟骨の厚さを加味して外側軟骨下骨を8mm骨切りする8mm群、medial bottomで骨切りする内側群の4群を設定した。PCLの温存についての判定は3D-CTを用い、PCL付着部陥凹部が確認できる場合をPCL温存、完全に消失している場合をPCL消失と判定した。PCL消失率は腓骨頭群が22%、10mm群が47%、8mm群が16%、内側群が16%であった。PCL残存率は腓骨頭群が44%、10mm群が27%、8mm群が48%、内側群が59%であった。残存率においても10mm群で有意にPCL残存率が低かった。外側関節面を骨切りの基準にする際、外側関節面に変性を認める症例ではPCLの消失に注意が必要と思われた。

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

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

Fibrin clotを用いた半月板修復術は、半月板治癒困難例への半月板修復術の適応拡大が期待され、近年ではその良好な成績が報告されている。当科でも、これまでは半月板部分切除を余儀なくされていたような治癒困難例に対して、2011年からfibrin clotを併用して半月板修復術を施行し、良好な短期成績が得られている。本稿では、同法について紹介するとともにその短期成績について報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00282&link_issn=&doc_id=20180221130007&doc_link_id=10.18885%2FJ00282.2018156969&url=https%3A%2F%2Fdoi.org%2F10.18885%2FJ00282.2018156969&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

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

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

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

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

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

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

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

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

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J-GLOBAL

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Language：Japanese   Publisher：新潟整形外科研究会  

症例は80歳女性で、右上腕骨頭壊死に対する人工骨頭挿入術の施行目的で入院した。術前の全身状態は良好で、全身麻酔に関するリスクは指摘されていなかった。手術は全身麻酔と伝達麻酔(腕神経叢ブロック)の併用で行った。術中、特に問題なく手術を終了した。術後1日目、経過良好でリハビリを開始した。夕方(術後36時間経過)から体温上昇がみられ、覚醒度も悪化した。術後2日目、高熱が持続、最高で体温40.2℃を記録(術後44時間経過)、JCS II桁の意識障害と酸素化不良もみられた。徐々に解熱、意識レベルも改善した。術後4日目、後遺症なく回復し、リハビリを再開した。血液検査でCK、AST、ALTの上昇、検尿でミオグロビン尿を疑わせる褐色尿があったことから、横紋筋融解の存在を疑い、かつ40℃を超える術後の熱型、突然の臨床症状軽快など、総合的に判断し遅発性に発症した術後悪性高熱症を疑った。術後17日目に筋生検を施行し、遅発性に発症した術後悪性高熱症として矛盾しなかった。術後26日目、独歩で自宅退院した。

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

立位膝前後X線像から大腿骨と脛骨の相対的かつ経時的な回旋変化を評価するための指標を求める目的で、膝OA患者2例(男性1例、女性1例)のデータを用いて解析を行った。結果、標準化指標として「大腿骨内側顆における長軸の長さ」、大腿骨回旋指標として「内顆長軸から膝蓋骨外縁までの距離」、脛骨回旋指標として「脛骨内側顆間隆起先端から腓骨頭外側縁までの距離」を使用することで回旋位置変化を相対的に定量化できると考えられ、三次元CT骨モデルを用いたシミュレーションによってその妥当性が示された。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05471&link_issn=&doc_id=20171016110048&doc_link_id=%2Fcx9biomc%2F2017%2F003800%2F048%2F0313-0318%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcx9biomc%2F2017%2F003800%2F048%2F0313-0318%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本臨床スポーツ医学会  

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

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

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

【症例】14歳女性.生下時より左大腿骨の短縮(脚長差2cm)を指摘され,先天性大腿骨短縮症の診断で前医にて経過観察を開始された.補高にて保存的に経過観察されたが,経時的に脚長差が拡大し7cmとなった13歳時にイリザロフ創外固定器を用いた大腿骨骨延長術が開始された.延長中に膝関節の外側脱臼を生じたため下腿へ固定器を延長し脱臼を整復し,1年3ヵ月で延長終了・抜釘するも高度の膝関節拘縮と恒久性膝蓋骨脱臼となり,14歳時に紹介受診となった.左膝関節ROM(伸展/屈曲°)は+5/40であったが高校進学後の治療を希望されたため,ROM訓練で経過観察,15歳時ROM +5/95にて手術治療を計画した.初回手術でまず骨延長に伴う四頭筋の癒着の解離を行ってROMを獲得したうえで,二期的に近位・遠位リアライメントを含む膝蓋骨整復を行う予定とした.初回手術で関節鏡検査・拘縮解離を行って麻酔下ROM +5/135を獲得後,持続大腿神経ブロック(FNB)併用にて翌日から理学療法を開始し,術後4週でROM +5/120で退院した.その後,ROMが保たれた状態で1年後に外側支帯切離,脛骨結節前内側移行,拘縮解離の際に切除した腸脛靱帯を用いた内側膝蓋大腿靱帯再建,内側広筋前進術,四頭筋腱のV-Y前進術を行った.術中屈曲90°までは脱臼しないことを確認し,FNB併用で術後2日目からCPMを徐々に開始した.術後2週で屈曲80°,4週で115°を獲得して退院し,リハビリを継続した.学校生活には運動以外とくに支障なく復帰し,術後半年で膝蓋骨脱臼なく屈曲140°を獲得し,癒合した脛骨結節部のスクリューを抜釘した.術後1年半の現在も脱臼なく屈曲140°を維持しているがextension lag 10°,大腿周囲径(膝蓋骨上10cm)の患健差5cmと四頭筋萎縮が残存し,筋力の回復は十分でなかった.単純X線では術後に得られた膝蓋骨のアライメントは良好に保たれていた.先天性大腿骨短縮症は稀であるが,その骨延長の際の合併症は高率であり十分な注意を要する.合併症としての膝関節拘縮と恒久性膝蓋骨脱臼に対し二期的手術を行い,良好なROMと膝蓋骨のアライメントが獲得できた.まだ若年であり,今後の関節症変化の発生など経過観察が必要である.(著者抄録)

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：金原出版(株)  

2015年10月〜2016年2月に外来において外旋で肩関節前面痛を認めた肩関節周囲炎10例10肩(男5例、女5例、平均年齢62.7歳)を対象に、エコーガイド下に肩甲下筋表層と三角筋間に烏口突起基部にかけて生理食塩水10mlを注入し、注入前後で外旋角度と疼痛VASスコアを比較した。その結果、下垂位外旋角度は平均26°から45°に、VASスコアは中央値10が0.5に、いずれも有意に改善した。外旋制限と肩前面痛の症例に本法は有効な治療となりうると考えられた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00767&link_issn=&doc_id=20170615100013&doc_link_id=10.18888%2Fse.0000000063&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fse.0000000063&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：東北整形災害外科学会  

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

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

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

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

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

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

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

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

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

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

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

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

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：日本臨床バイオメカニクス学会  

著者等が立てた「変形性膝関節症(膝OA)進行に伴う脛骨のねじれ変形は、骨断面積に占める皮質骨面積が少ない脛骨近位部付近で生じ始める」という仮説を検証するため、脛骨のねじれ変形の位置を三次元的に分析する座標系を考案し、この座標系を用いて健常群と膝OA群の脛骨を分析し、健常群に対する膝OA群のねじれ変形を評価した。健常群は男性30脚(平均年齢52.3±20.5歳)、女性32脚(55.8±15.0歳)、膝OA群は男性25脚(57.2±20.1歳)、女性57脚(62.7±18.9歳)で、対象の仰臥位下肢全長を1mm厚のスライスでCT撮影し、得られた断層像から三次元脛骨モデルを作成した。膝OA群の近位関節面回旋角は健常群に比べて小さく、有意に外旋していた。遠位関節面回旋角と骨幹部回旋角の差は認められなかった。膝OA群の脛骨ねじれ変形は、近位骨端部の外捻化が原因である可能性がある。

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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

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

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

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

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

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

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

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Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

中高齢者の運動習慣の獲得は、生活習慣病を予防して健康長寿を維持するために、超高齢社会となった日本の最重要項目である。日常生活での運動の開始と継続のために整形外科医が運動器疾患への留意点を啓発しながら、より安全で効果的な運動療法を実現することにより運動習慣の向上に寄与できると考えられる。その具体例として、病院が運営するメディカルフィットネスにより、安全面で運動障害のリスクを回避しながらより質の高い運動処方を提供し、継続させることが可能になる。(著者抄録)

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

手術治療を行った4-part骨折3例3肩(男性1例、女性2例、35〜73歳)を対象に、初回手術時に腸骨ブロック移植を併用した骨接合術を行い、術後成績について検討した。3例ともアライメント矯正損失はなく、全例、骨癒合が得られ、良好な成績であった。骨頭壊死は1例のみ認めたが、ごく小範囲の壊死であった。解剖学的整復位の獲得やアライメント保持に有用であった。以上より、骨頭壊死のリスクを軽減する可能性が示唆された。

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

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Language：Japanese   Publisher：(一社)中部日本整形外科災害外科学会  

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

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

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

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Language：Japanese   Publisher：新潟医学会  

大関節発症の関節炎症例は診断に難渋する。今回いずれもACR/EULARの関節リウマチ分類基準によるスコアが低く、抗CCP抗体、リウマトイド因子が陰性の4症例(最終診断は関節リウマチ(RA)2例、変形性関節症(OA)1例、色素性絨毛結節性滑膜炎(PVNS)1例)を対象として採取した血清、滑液、滑膜組織をもとに診断に迫る試みを行った。血清MMP-3濃度は診断に有用であった。滑液MMP-3濃度は相対的にRA症例で高かった。滑膜組織のMMP-3mRNA発現量はPVNSで高値を示した。血清IL-6濃度はRA1例、OA1例でいずれも基準値以内であった。さらなる解析を要するが採取した臨床検体のサイトカイン濃度や発現量を調査することで、より正確な関節炎の診断に迫ることができると考える。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00990&link_issn=&doc_id=20160712210004&doc_link_id=%2Fdg3nigta%2F2016%2F013001%2F004%2F0012-0015%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2016%2F013001%2F004%2F0012-0015%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

最近3年間で著者らの施設にてTAEあるいは固定術を要した不安定型骨盤骨折10例(男性7例、女性3例、平均年齢64.8歳)について検討した。その結果、1)受傷機転は転落受傷7例、交通外傷3例で、AO分類による骨折型はB1が1例、B2が6例、B3が2例、C3が1例であった。2)初期輸液に対する反応はresponderが3例、transient responderが1例、non responderが6例であった。3)TAE施行例は8例で、創外固定はType B2からC3までの骨盤不安定性を有する5例で行われた。一方、内固定例は4例であった。4)平均入院期間は76.7日で、退院時歩行能力は杖歩行が4例、歩行器歩行が2例、車椅子が2例、臥床が1例、死亡が1例であった。

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

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

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

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

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Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

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

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：東北整形災害外科学会  

非定型大腿骨骨折(AFF)患者11例を対象に、ビスフォスフォネート製剤(BP剤)内服の有無と同時に大腿骨彎曲度を測定し、検討した。その結果、AFF患者では9例でBP剤を内服していたのに対し、コントロール群では16例全例で内服していなかった。大腿骨彎曲度については、AFF患者ではコントロール群と比較して、大腿骨が有意に彎曲していることが示された。

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J-GLOBAL

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

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

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

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

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

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

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Language：Japanese   Publisher：新潟整形外科研究会  

症例1(16歳、高校生男子)。野球練習中に左下腿前面の運動痛を自覚していたが、受験で放置していた。高校入学後、疼痛が増強したため近医を受診、左跳躍型脛骨疲労骨折と診断され、保存治療が行われていたが、症状の改善は得られず、今回、手術目的で著者らの施設へ受診となった。所見ではX線で左脛骨中央遠位部前面に骨皮質の肥厚および疲労骨折と思われる骨折線が認められ、髄内釘挿入術が施行された。その結果、術後3ヵ月時点では骨折線は残存していたが、その後は治癒傾向を示し不明瞭となっていった。症例2(16歳、高校生女子)。バレーボールの練習中に右下腿前面の運動時痛が出現し近医を受診、右跳躍型脛骨疲労骨折と診断され、スポーツ活動を制限し経過観察されていた。だが、症状の改善は得られず、手術目的で著者らの施設へ紹介となった。X線にて右脛骨中央部前面に骨皮質の肥厚および疲労骨折と思われる骨折線が認められたため、髄内釘挿入術を施行したところ、術後3ヵ月の時点では骨折線は残存していたが、その後は不明瞭となり、術後6ヵ月時には消失した。症例3(20歳、大学生男性)。ハンドボール競技中に左下腿前面の運動時痛を自覚するも、競技続行が可能な症状であったためプレーを続けていた。だが、その後も症状改善は認められず、他院にて左跳躍型脛骨疲労骨折と診断され、手術目的で著者らの施設へ受診となった。所見では左脛骨中央部前面に骨皮質の肥厚および疲労骨折と思われる骨折線が認められ、髄内釘挿入術を施行したところ、術後8ヵ月の時点でも骨折線は残存していたが、スポーツに影響はみられなかった。

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Language：Japanese   Publisher：(一社)日本外科学会  

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J-GLOBAL

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

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

人工膝単顆置換術を施行した内側型変形性膝関節症9例11膝(男3膝、女9膝、平均75.3歳)を対象に、術前後の下肢アライメント変化と置換側コンパートメントJoint line変化との関係について検討した。下肢アライメント変化は、三次元下肢アライメント測定システムを使用し、術前のCTから三次元モデルを構築して座標軸を設定後、下肢全長立位2方向CR像に三次元骨形成モデルを重ね合わせて評価した。大腿骨および脛骨のmechanical axisのなす角であるHip Knee Ankle angle(HKA)は、術前平均188.1°が術後184.2°に、荷重軸%通過位置は内側66.3%が35.5%に変化し、アライメントは術後有意に外反化していた。置換側コンパートメントの脛骨joint line変化量は、平均2.1mm、最大6.4mm上昇していた。術前後のHKA変化量および荷重軸%通過位置の変化量と、脛骨joint line変化量とは有意な相関が認められた。

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Language：Japanese   Publisher：(一社)日本関節病学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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

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

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

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

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Language：Japanese   Publisher：東北整形災害外科学会  

末梢動脈疾患による足壊疽15例15足(男13例・女2例・49〜91歳)を対象に、経皮的血管形成術(PTA)による再建術を施行した9足と非施行の6足(コントロール群)で治療成績を比較した。コントロール群の内訳は、PTA導入(2008年4月)以前に足関節以遠で切断していたのが4足、バルーン付きカテーテルが閉塞部を通過せずPTA不可能であったのが2足であった。PTA群では、PTA施行後に表層までの壊疽で自然脱落が期待できるものは保存療法を行い、深部に及ぶ壊疽には壊疽部付近での切断またはデブリドマンを行った。PTA群の創治癒率は88.8%であった。最終診察時におけるmajor amputation回避率は、PTA群100%、コントロール群50%と有意差を認めた。以上、足壊疽が足の一部に限局している症例に対しPTAを事前に行うことで、創は十分に治癒し、major amputationも回避可能となることが示唆された。

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Language：Japanese   Publisher：新潟整形外科研究会  

3兄弟に発生した膝離断性骨軟骨炎(OCD)を報告した。発症は症例1:15歳時(長男)、症例2:12歳時(次男)、症例3:13歳時(三男)であった。主訴はそれぞれ、左膝関節痛、両膝関節痛、左膝関節痛であった。それぞれMRIにて分離期から遊離期、透亮期、透亮期と診断し、症例1のみ骨軟骨柱・海綿骨移植を併用した固定術を行い、症例2・3は保存療法を行った。3例とも良好な結果を得た。

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

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

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

従来の方法で人工膝関節全置換術(TKA)を施行した大腿骨における、大腿骨上顆軸(TEA)からみた三次元的な関節表面までの距離とインプラントの三次元的設置角度を評価し、Single radius型のインプラント設置法を再検討した。TKAを施行した40例40膝を対象とした。TKA後、下肢全長2方向CR像に骨とインプラントの三次元形状モデルを重ね合わせ、実際の設置状態を正確に再現した骨-インプラントの三次元モデル複合体を生成した。術後の大腿骨インプラント内外側穎部最遠位点からTEAまでの距離(遠位径)と同最後方点からのTEAまでの距離(後方径)と、インプラント三次元設置角度を評価した。内側においては遠位径-後方径間に有意差は認めなかったが、外側においては後方径が遠位径に比して有意に短かった。内外反・屈曲伸展は概ね良好であったが、回旋角度がTEAに対して内旋傾向であった。

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Language：Japanese   Publisher：新潟整形外科研究会  

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

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

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

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会  

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

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Language：Japanese   Publisher：日本関節鏡学会  

36歳女性。患者はバイク走行中に転倒し近医を受診、左上腕骨近位端骨折の診断で保存的加療を受けるも、半年経過で疼痛、可動域制限が強くなり、著者らの施設へ紹介となった。受診時、可動域は挙上140°、外転140°、外旋10°、内旋 臀部、水平内転5°、JOAスコアは46点であった。一方、X線前後像では内反変形とDouble shadow、軸写像で変形治癒した小結節骨片が認められ、CTでは小結節骨片が肩甲骨と前方でインピンジメントを起こしている像、3DCTでは内側前方に突出した骨片が確認された。また、MRIでは変形治癒小結節骨片の一部は関節内にあり、関節内骨片先端に肩甲下筋腱は付着していなかった。以上より、術中鏡視で変形治癒した小結節骨片が関節内に突出し、関節窩とインピンジメントする状態を動的に確認して関節内突出骨片を切除した結果、拘縮を認めて前下方関節包の拘縮解離が行われたものの、術後1年経過で可動域は改善し、JOAスコアは89点となった。

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Language：Japanese   Publisher：新潟整形外科研究会  

鏡視下修復術を施行し、1年以上経過観察可能であった腱板完全断裂36症例の術後成績について検討した。術中に確認した断裂サイズは、1cm以下の小断裂3例、1〜3cm以下の中断列16例、3〜5cm以下の大断裂14例、5cm以上の広範囲断裂3例であった。JOA scoreは術前平均63.6点が術後93.4点へと有意に改善した。断裂サイズ別では、小断裂から大断裂は90点台と良好であったが、広範囲断裂は76.2点と成績不良であった。術前の棘下筋脂肪変性は、Goutallier分類Stage 0:6例、Stage 1:17例、Stage 2:7例、Stage 3:4例、Stage 4:2例であった。大断裂および広範囲断裂17例のJOA scoreは、Stage 0〜2の11例は術前63.1点が術後96.2点に、Stage 3・4の6例は術前53.2点が術後81.9点へと有意に改善した。しかし、術前の脂肪変性が高度なStage 3・4は81.9点と、Stage 2以下と比較して有意に成績不良であった。術後のcuff integrityは、菅谷分類のType I:19例、Type II:7例、Type III:1例、Type IV:5例、Type V:2例であった。術後cuff integrityが良好なType I・II・IIIは術後JOA scoreが95.4点と良好で、一部再断裂のType IVも93点と良好であったが、広範な再断裂のType Vは68.8点と有意に成績が劣っていた。術後MRIによる再断裂のType IV・Vは、術中大断裂14例のうち5例、術中広範囲断裂3例のうち2例に認めた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J02254&link_issn=&doc_id=20090205090006&doc_link_id=%2Few6niise%2F2008%2F002402%2F006%2F0071-0074%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Few6niise%2F2008%2F002402%2F006%2F0071-0074%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

在胎37週3日の単胎女児。母体が乗用車運転中に対向車と正面衝突し、受傷直後に陣痛発来して破膜し、血性羊水と胎児仮死にて吸引分娩を行い、呼吸障害のため救急搬送された。児の出生時体重は2600gで、来院時は低血糖、無呼吸発作、四肢の硬直および痙攣があり、刺激しても呼吸再開がなく挿管人工呼吸管理となった。X線で左大腿骨近位1/3での斜骨折を認め、近位骨片は屈曲・外転し明らかな外旋変形は指摘できないが、骨折部での短縮を認めた。出生4、7、11日で転位は進行し、出生14日で転位最大となり、約40°の屈曲変形と10mmの短縮を認めた。出生18日目に仮骨形成がみられ、骨癒合は順調に進み、自然矯正もみられた。出生6ヵ月時点で、健側に比して患側で35°の屈曲変形と17°の外反変形を認めた。出生9ヵ月の時点で、屈曲変形は33°、外反変形は6°まで矯正され、完全な骨癒合を認めた。最終診察時の1歳8ヵ月時、外見上の脚長差や回旋変形、膝関節の可動域制限は認めなかった。X線では過成長は認めず、大腿骨正面像で側方変形ははぼ0°に矯正され、側面像では27°の屈曲変形が残存していた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2008&ichushi_jid=J02254&link_issn=&doc_id=20090205090001&doc_link_id=%2Few6niise%2F2008%2F002402%2F001%2F0049-0052%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Few6niise%2F2008%2F002402%2F001%2F0049-0052%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese  

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Language：Japanese   Publisher：金原出版(株)  

1979〜1992年に膝周囲骨腫瘍に対して膝固定術を施行した5症例の長期成績を報告した。平均観察期間は19年で、病理組織診断は骨肉腫2例、骨巨細胞腫(GCT)3例であった。病変局在は骨肉腫が大腿骨、脛骨各1例、GCTは全例大腿骨であった。手術方法は内固定とし、全例髄内釘を使用し、外反5°、屈曲10°の肢位で固定した。骨欠損部には自家骨移植を施行した。その結果、1)骨癒合は全例で得られ、軟部組織切除量に関係なく長期間安定した成績が得られていた。2)1例で術後15ヵ月目に疲労骨折が認められたが、再手術後は安定した成績が得られた。3)骨癒合後の合併症は感染症1例のみで、抜釘後感染は沈静化していた。4)患肢機能評価は満足度を除いた疼痛、機能、支持性、歩行能力、歩容の5項目は平均88%と良好であった。5)社会生活での不便なことが多く、全例満足度は低かった。

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Language：Japanese   Publisher：(NPO)日本医療マネジメント学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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

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

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

2003〜2005年に腓腹神経を含む逆行性浅腓腹動脈皮弁を採取した5例を対象に知覚障害の有無・程度を調査した。知覚障害の評価にはSemmes-Weinstein monofilaments test(SWT)を用い、1回目のSWTを術後5〜25ヵ月時、2回目のSWTを術後10〜32ヵ月時に施行した(2回目は4例のみ施行)。結果、1回目のSWTで5例とも足部外側に「purple」〜「red-lined」の知覚低下が認められ、2回目のSWTでも全例に知覚低下が認められた。

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Language：Japanese   Publisher：東北整形災害外科学会  

複数指の手指PIP関節側副靱帯断裂4例8指(男性1例、女性3例;平均年齢63.5歳)の靱帯修復術について検討した。術前ストレス角は平均33度で、Mitek mini suture anchorにて全指修復した。河野の評価基準では良6指、可2指で、不安定性は認めなかった。特徴は、受傷原因が転倒や転落が多く、全例が中指と環指の橈側の損傷で、PIP関節の伸展制限やDIP関節の可動域制限を認めた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2007&ichushi_jid=J04112&link_issn=&doc_id=20070620420018&doc_link_id=%2Fdl6tohok%2F2007%2F005101%2F018%2F0078-0081%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl6tohok%2F2007%2F005101%2F018%2F0078-0081%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：東北整形災害外科学会  

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Language：Japanese   Publisher：(一社)日本整形外科スポーツ医学会  

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Language：Japanese   Publisher：新潟整形外科研究会  

中手骨頸部骨折に対して髄内固定法(本法)を行った4例(男性3例、女性1例;平均年齢33歳)を対象に、治療成績について検討した。骨折部位は第3中手骨1例、第5中手骨2例、第4・5中手骨複数損傷1例である。全例で骨癒合を認めた。森本らの評価で、優3例、良1例で、掌屈および側屈転位は改善し、概ね良好な成績を得られた。鋼線の穿孔により再手術を要した例、キルシュナー鋼線刺入部の伸筋腱への干渉によるMP関節の伸展不全の残存例を各1例認めたが、これらの合併症に留意すれば、より良好な結果を得る事が可能である。

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Language：Japanese   Publisher：新潟整形外科研究会  

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Language：Japanese   Publisher：新潟整形外科研究会