記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Our previous NECO phase II studies on high-grade osteosarcoma suggested that administering ifosfamide (IF; 16 g/m2 [4g/m2 once on day 1, then 2g/m2 once on days 2-7] × six) to patients showing a poor response (PrRsp) to preoperative chemotherapy with methotrexate, doxorubicin, and cisplatin (MAP) improves their prognoses. In this Japan Clinical Oncology Group (JCOG) study, JCOG0905, we aimed to investigate the efficacy and safety of IF in patients with PrRsp. METHODS: JCOG0905 is a multicenter, open-label, multi-institutional, randomized trial. Eligible patients (50 years and younger) had resectable, high-grade osteosarcoma (stage II or III, Union for International Cancer Control TNM) of the extremities, limb girdles, and thoracic wall. After two MAP cycles and tumor resection, patients with PrRsp were randomly assigned to either the MAP or MAP plus 15 g/m2 (3g/m2 once daily on days 1-5) × six IF (MAP + IF [MAPIF]) group. The primary end point was disease-free survival (DFS); secondary end points were overall survival (OS) and safety. The planned sample size was 100 patients with a one-sided α of .1 and a power of 0.7, assuming a 3-year DFS of 50% and 65% for MAP and MAPIF, respectively. This trial is registered with the Japan Registry of Clinical Trials (jRCT; jRCTs031180126). RESULTS: Of the 287 patients registered between February 2010 and August 2020, 51 and 52 patients with PrRsp were assigned to the MAP and MAPIF groups, respectively. As of March 2022, DFS did not differ between groups (hazard ratio [HR], 1.05 [95% CI, 0.55 to 1.98]) and OS was numerically inferior in the MAPIF group (HR, 1.48 [95% CI, 0.68 to 3.22]). Nine and zero patients in the MAPIF and MAP groups discontinued treatment because of adverse events, respectively. CONCLUSION: Evidence from JCOG0905 does not support the addition of IF for patients with PrRsp.

DOI： 10.1200/JCO-24-01281

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Total knee arthroplasty (TKA) has demonstrated long-term durability, with a significant reduction in revisions due to polyethylene wear and component loosening. However, mid-flexion instability (MFI) is a key factor in early TKA revisions, affecting patient satisfaction and implant longevity. Recent advancements in robotic-assisted TKA (raTKA) provide precise joint line (JL) restoration and component positioning, potentially reducing MFI. This prospective study evaluated the impact of image-free raTKA on MFI and JL restoration. METHODS: This prospective cohort study included 59 knees undergoing primary TKA using the image-free robotic systems NAVIO® and CORI® and the JOURNEY II® Bi-Cruciate Stabilized knee system. Intraoperative component gap (CG) measurements at 0°, 30°, 60° and 105° of flexion were taken, and JL changes were assessed pre- and post-operatively using computed tomography (CT)-based three-dimensional (3D) models with the 3D-3D matching technique. The distal femoral JL was quantified. RESULTS: Both the medial and lateral CG at 30° and 60° were significantly smaller compared to those at 0° and 105°. Post-operative JL showed distalization of 1.5 mm at the medial femur and 2.0 mm at the lateral femur compared to preoperative JL. CONCLUSIONS: This study is the first to assess JL restoration in raTKA using CT-based bone landmarks, offering precise insights. Image-free raTKA facilitates precise JL restoration, optimizing knee kinematics and enhancing stability. These findings suggest that this technique contributes to improved post-operative joint function and greater patient satisfaction. LEVEL OF EVIDENCE: Level II, prospective cohort study.

DOI： 10.1002/jeo2.70239

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The primary aim of this study was to compare the surgical invasiveness of internal fixation for pathological fractures caused by metastatic bone tumors with that for traumatic fractures. The secondary aim was to identify factors contributing to the complexity of surgeries for metastatic bone disease and provide insights for improving surgical strategies by analyzing operative time and blood loss. METHODS: Patients undergoing internal fixation for femoral fractures at 10 institutions between January 2021 and December 2023 were included. Traumatic and metastatic pathological fractures were analyzed, excluding patients aged <18 years and those with benign or atypical fractures. Factors influencing blood loss and operative time were assessed using univariate regression and multivariate modeling (P < 0.05). RESULTS: A total of 275 patients (male = 97, female = 178) with a mean age of 76 years were included. Patients had 230 traumatic and 45 metastatic fractures, with proximal fractures being the most common (n = 225). Intramedullary nailing was the predominant fixation method (n = 231). Blood loss and operative times were significantly affected by the fracture cause, site, and reduction procedures (P < 0.05). Metastatic, distal, or diaphyseal fractures and reduction procedures resulted in higher blood loss and longer operative times. Multivariate analysis confirmed these factors as significant predictors. CONCLUSIONS: Surgeries for metastatic fractures are more invasive than those for traumatic fractures because of compromised bone integrity and procedural complexity. Operative time is a key indicator of surgical invasiveness, highlighting the need for tailored surgical approaches to manage metastatic bone disease effectively.

DOI： 10.1093/jjco/hyaf039

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Objectives: The phase angle (PhA), as measured using bioelectrical impedance analysis (BIA), indicates muscle mass and quality. However, its relationship with age-related muscle changes and motor function and effective BIA assessment/intervention sites remains unclear. Herein, we evaluated age-related changes in PhA, explored the relationship between PhA and muscle mass, and identified effective sites for BIA. Methods: We included 131 healthy community-dwelling adults divided into older (≥65 years) and control (≤65 years) groups. PhA and muscle mass were measured using BIA with a device determining electrical resistance by transmitting a weak alternating current <90 μA. Motor function was measured using ground reaction force index, gait function, and grip strength. The relationships between muscle mass, PhA, and motor function were analyzed. Results: All values, excluding upper limb muscle mass, were lower in the older group, as were the rates of change in muscle mass and PhA in the lower limbs vs. the upper limbs. Lower limb PhA showed negative and positive correlations with the Timed Up and Go test and standing function, respectively; it was significantly associated with all motor functions. Conclusions: Regardless of age, muscle mass and PhA measured by BIA were high and low in the lower limbs, respectively, and lower limb PhA was related to walking and standing function. The decrease in lower limb muscle mass and PhA may accelerate with age. Given global population aging, easy-to-assess lower limb PhA linked to the movements necessary for independent living may be an effective site for assessment and intervention in clinical practice.

DOI： 10.3390/jcm14031023

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出版者・発行元：南江堂  

DOI： 10.15106/j_seikei76_75

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その他リンク： https://ndlsearch.ndl.go.jp/books/R000000004-I033887493

記述言語：日本語   出版者・発行元：(一社)日本膝関節学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Well-differentiated liposarcoma (WDLPS) is a locally aggressive soft tissue sarcoma characterized by the amplification of MDM2 and/or CDK4. IgG4-related disease (IgG4-RD) is a rare fibroinflammatory disease characterized by elevated serum IgG4 levels and histologically fibrous tissues with IgG4-positive immune cell infiltration. Although IgG4-RD often mimics other diseases, including malignant neoplasms, the association between IgG4-RD and WDLPS has not been fully elucidated. Here, we present two cases of IgG4-RD occurring within WDLPS. CASE PRESENTATION: A 56-year-old man presented with a left retroperitoneal mass, and a 64-year-old woman presented with a non-tender mass in her right thigh. Magnetic resonance imaging revealed that the tumors were composed of adipose and non-adipose areas with homogeneous enhancement. A biopsy revealed that the tumor consisted of adipose cells of various sizes and fibrous tissue with IgG4-positive cell infiltration. MDM2 amplification was detected using fluorescence in situ hybridization in both the adipose and fibrous areas. In addition, serum IgG4 levels were elevated in both patients, and IgG4-RD within the WDLPS were diagnosed. Wide resection was performed as radical treatment. After resection, the serum IgG4 level decreased to normal. No recurrence or metastasis has been observed for >19 months. CONCLUSION: Our cases highlight the importance of careful biopsy for the accurate diagnosis of patients with IgG4-RD within WDLPS. Moreover, although the main treatment for IgG4-RD is systemic corticosteroids, IgG4-RD within WDLPS should be treated with surgical resection.

DOI： 10.3389/fonc.2025.1596391

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記述言語：日本語   出版者・発行元：(一社)日本骨粗鬆症学会  

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記述言語：日本語   出版者・発行元：(一社)日本骨粗鬆症学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: No report has proven how tibial and femoral joint-line inclinations affect thigh and shank motion, respectively, according to Kellgren-Lawrence grade in motion analysis with a sufficient sample size. Therefore, this study aimed to evaluate the motion of the thigh and shank individually from the ground and the relative motion between bones in a large-sample motion analysis to determine the differences between normal and osteoarthritic knees and examine the effects of tibial and femoral joint-line inclination on motion according to osteoarthritis (OA) grade. METHODS: Of 459 participants with healthy knees and varus knee OA undergoing three-dimensional gait analysis, 383 (218 females and 165 males) with an average age of 68 ± 13 years were selected. Gait analysis was performed using a motion-capture system. The six degrees of freedom motion parameters of the knee in the Grood and world coordinate systems and the joint-line inclination in the standing radiographs were measured. RESULTS: Osteoarthritic knees demonstrated a relative motion different from that of normal knees, with responsibility for the thigh in the sagittal and rotational planes and the thigh and shank in the coronal plane. The involvement of joint-line inclination in motion was mainly on the tibial side, and the effect was minimal in normal knees. CONCLUSIONS: The details of the relative motion of both the thigh and shank can be clarified by analysing individual motions to determine the responsible part. The tibial joint-line affected knee motion: however, the effect was minimal in normal knees. This finding implies that if physical ability can be improved, the negative effects of deformity in osteoarthritic knees may be compensated for. LEVEL OF EVIDENCE: Level Ⅱ.

DOI： 10.1002/jeo2.12040

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Long-leg frontal radiographs of the lower extremities are used to assess knee osteoarthritis. Given the three-dimensional (3D) nature of alignment changes in osteoarthritis, postural alterations in the femur and tibia extend beyond the coronal plane (in-plane) to include the transverse and sagittal planes (out-of-plane). This study investigates the impact of these out-of-plane factors on in-plane knee alignment parameters observed in frontal radiographs. METHODS: A total of 97 osteoarthritic knees in women were examined. Using a 3D-to-two-dimensional (2D) image matching technique, we evaluated the 3D postures of the femur and tibia in the standing position as viewed from frontal radiographs in the world coordinate system. Statistical analyses were conducted to explore associations between these 3D postures and 2D alignment parameters obtained from frontal radiographs under identical conditions. FINDINGS: The femur exhibited a medial inclination of 2.7°, a posterior inclination of 3.9°, and an internal rotation of 4.2°, whereas the tibia showed a lateral inclination of 6.4°, an anterior inclination of 6.7°, and an internal rotation of 6.7°. Both coronal and rotational postures of femur and tibia influenced the hip-knee-ankle angle, mechanical axis percentage, and medial proximal tibial angle. However, only coronal factors of tibia impacted tibial joint line obliquity relative to the floor. INTERPRETATION: Attention should be paid to the potential impact of the out-of-plane postures of the femur and tibia on parameters assessed in plain frontal radiographs of the lower extremities.

DOI： 10.1016/j.clinbiomech.2024.106297

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purpose of this study was to clarify (1) the differences in cortical bone thickness (CBT) of the tibial diaphysis between healthy and osteoarthritic knees and (2) the influences of the femorotibial angle (FTA) and inclination of the medial compartment of the proximal tibia (MCT) on tibial CBT. METHODS: The study assessed 60 subjects with varus knee osteoarthritis (OA) (22 males and 38 females; mean age, 74 ± 7 years) and 53 healthy elderly subjects (28 males and 25 females; mean age, 70 ± 6 years). Three-dimensional estimated CBT of the tibial diaphysis was automatically calculated for 2752-11,296 points using high-resolution measurements from CT. The standardized CBT was assessed in 24 regions by combining six heights and four areas. Additionally, the association between the CBT, each FTA, and MCT inclination was investigated. RESULTS: The OA group showed a thicker CBT in the medial areas than in the lateral areas of the proximal tibia, while the healthy group had a thicker lateral CBT. The medial-to-lateral ratio of the proximal tibia was significantly higher in the OA group than in the healthy group. The proximal-medial CBT correlated with FTA and MCT inclinations in the OA group. CONCLUSIONS: This study demonstrated that varus osteoarthritic knees showed a different trend of proximal-medial CBT with associations in FTA and MCT inclination from healthy knees, possibly due to medial load concentration.

DOI： 10.1186/s13018-024-04849-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Rectal implantation cysts can occur at anastomotic sites after low anterior resection (LAR) for rectal cancer. Herein, we report a case of primary adenocarcinoma arising from a rectal implantation cyst after LAR for rectal cancer. A 70-year-old woman was referred to our hospital for diagnosis and treatment of a growing cystic lesion. She had LAR performed for rectal cancer 29 years previously and had a rectal implantation cyst detected 13 years previously. On the first visit to our hospital, serum CEA and CA19-9 levels were elevated, and computed tomography (CT) scans revealed a cystic lesion near the anastomosis. CT-guided biopsy revealed no cancer tissue in the cystic lesion. After that, the cystic lesion naturally shrank, and serum CEA and CA19-9 levels became normal. Follow-up included 3 monthly serum CEA and CA19-9 testing and 6 monthly CT scans. Two years later, serum CEA and CA19-9 levels were elevated again. Colonoscopy revealed an ulcerative lesion at the anastomotic site, in which adenocarcinoma was confirmed. Abdominoperineal resection with sacral resection was performed, and postoperative histopathological examination revealed a primary adenocarcinoma with mucinous component at the implantation cyst. Since rectal implantation cysts can become malignant after extended periods, clinicians need to be aware of this disease.

DOI： 10.1007/s12328-024-02002-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

[Purpose] Quadriceps muscle strength is essential for daily living activities. Therefore, we developed a compact and simple lower limb muscle strength measuring device (LocomoScan [LCS]). This study aimed to compare LCS with other instruments to analyze its simplicity, reproducibility, and accuracy. [Participants and Methods] One hundred and four healthy university students (56 males and 48 females) were included in the study. The knee extension force was measured using LCS, and the knee extension torque was measured using other devices (Cybex). In addition, lower leg muscle mass was measured using a body composition meter. The reproducibility of LCS and the correlation between the knee extension torque and lower leg muscle mass were evaluated. [Results] The measurement reproducibility of LCS was significantly higher. The knee extension force confirmed the proportional relative reliability of Cybex with knee extension torque. A relationship between knee extension force and lower limb muscle mass was also observed, indicating that muscle mass cannot be estimated as muscle strength. [Conclusion] The high reproducibility of the knee extension force measurement using LCS demonstrates its potential as a portable alternative instrument for muscle strength measurement in clinical practice. Therefore, LCS device is a simple and effective tool for assessing muscle strength.

DOI： 10.1589/jpts.36.343

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Cataract and chronic kidney disease (CKD) occur with increasing frequency with age and share common risk factors including smoking, diabetes, and hypertension. We evaluated the risk of incident cataract surgery in patients with non-dialysis-dependent CKD and dialysis-dependent CKD compared to non-CKD patients, while taking into account the competing risk of death. Methods The participants included 1,839 patients from Sado General Hospital enrolled in the Project in Sado for Total Health (PROST) between June 2008 and December 2016 (54% men; mean age, 69 years). Among these patients, 50%, 44%, and 6% had non-CKD, non-dialysis-dependent CKD, and dialysis-dependent CKD, respectively. Results During a median follow-up of 5.6 years (interquartile range, 4.7-7.1), 193 participants underwent cataract surgery [18.7 (95% confidence interval (CI), 16.2-21.5)/1,000 person-years] and 425 participants died without undergoing cataract surgery [41.0 (95% CI, 37.4-45.2)/1,000 person-years]. The cumulative incidence of cataract surgery was the highest in the dialysis-dependent CKD group, followed by the non-dialysis-dependent CKD and non-CKD groups (log-rank p=0.002). After adjusting for potential confounding factors, the dialysis-dependent CKD group [hazard ratio (HR) 2.48; 95% CI 1.43-4.31], but not the non-dialysis-dependent CKD group (HR, 1.01; 95% CI 0.74-1.38), had a higher risk of cataract surgery than the non-CKD group. However, this association was no longer significant according to a competing risk analysis (sub-hazard ratio, 1.67; 95% CI 0.93-3.03). Conclusion Dialysis-dependent CKD patients were found to have an increased risk of cataract surgery; however, the association was attenuated and no longer significant when death was considered a competing risk.

DOI： 10.2169/internalmedicine.2176-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Total knee arthroplasty (TKA), which has medial pivot and mobile-bearing mechanisms, has been developed and clinically used. However, the in vivo dynamic kinematics of the mobile medial pivot-type TKA (MMPTKA) is unclear. This study analysed the in vivo kinematics of MMPTKA in weight-bearing and nonweight-bearing conditions. METHODS: The study included 10 knees that underwent primary TKA using MMPTKA. After TKA, lateral view radiographs of the knee in full extension, 90° of flexion and passive full flexion were taken under general anaesthesia in the nonweight-bearing condition. At least 6 months postoperatively, knee motion during squatting from a weight-bearing standing position was observed using a flat-panel detector and analysed using the three-dimensional-to-two-dimensional image registration technique. RESULTS: Under anaesthesia: in passive full flexion, the anteroposterior (AP) locations of the femoral component's medial and lateral distal points were 10.2 and 16.0 mm posterior, and the rotational angles of the femoral component's X-axis (FCX) and insert were 8.1° external rotation and 18.5° internal rotation to full extension, respectively. Squatting: the AP translations of the femoral component's medial and lateral most distal points were 2.2 and 6.4 mm, and the rotational angles of the FCX and insert were 5.7° and 1.6° external rotation, respectively. Significant differences were observed in the AP translation of the femoral component's medial and lateral most distal points and changes in the insert's rotational angle when comparing under anaesthesia and squatting. CONCLUSIONS: The kinematics of the insert in MMPTKA was significantly influenced by loading and muscle contraction. The femoral component exhibited substantial external rotation and posterior translation under anaesthesia, which may contribute to achieving an optimal range of motion. The insert remained relatively stable during squatting and minimal rotation was observed, indicating good stability. MMPTKA was expected to demonstrate rational kinematics by incorporating mobile and medial pivot mechanisms. LEVEL OF EVIDENCE: Level IV, prospective biomechanical case series study.

DOI： 10.1002/ksa.12147

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: This retrospective cross-sectional study investigated the cutoff values (COVs) for developmental dysplasia of the hip (DDH) using a three-dimensional (3D) pelvic model reconstructed using computed tomography (CT). We included 107 healthy Japanese participants and 73 patients who had undergone curved periacetabular osteotomy (CPO) for DDH between 2012 and 2017. Methods: The hip CT images were adjusted to the anterior pelvic plane (APP), functional pelvic plane (FPP), sagittal anterior center-edge angle (ACEA), and sagittal posterior center-edge angle (PCEA). The lateral center-edge angle (LCEA), acetabular roof obliquity (ARO), anterior acetabular sector angle (AASA), and posterior acetabular sector angle (PASA) were measured. Receiver operating characteristic (ROC) curves were used to calculate the COVs, and the association between the parameters was analyzed using multiple logistic regression. Results: The ARO (≥10.2°) and LCEA (≤22.2°) were independent influencing factors for the APP, whereas the AASA (≤53.1°) and LCEA (≤24.5°) were independent influencing factors for the FPP. Conclusions: The 3D criteria for the diagnosis of DDH in Japanese individuals can identify DDH with insufficient anterior coverage, which anteroposterior plain radiographs cannot visualize, and can help determine indications for acetabular osteotomy.

DOI： 10.3390/jcm13092536

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis. CASE PRESENTATION: A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits. DISCUSSION: Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.

DOI： 10.1038/s41394-024-00639-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We aimed to determine the clinical significance of neck and shoulder pain (NSP) 10 years after posterior spinal fusion (PSF) for thoracic adolescent idiopathic scoliosis (AIS) and the relationship between radiographic parameters and NSP. METHODS: Of 72 patients who underwent PSF for thoracic AIS (Lenke 1 or 2) between 2000 and 2013, we included 52 (46 females; Lenke type 1 in 34 patients and type 2 in 18; mean age, 25.6 years) who underwent NSP evaluation using visual analog scale (VAS, 10 cm) 10 years postoperatively (follow-up rate, 72.2%). Correlation analyses were performed using Spearman's rank correlation coefficient (r). RESULTS: The VAS for NSP was 2.6 cm in median and 3.4 cm in mean at 10 years. The VAS had significant negative correlations with several SRS-22 domain scores (rs = - 0.348 for pain, - 0.347 for function,  -  0.308 for mental health, and - 0.372 for total) (p < 0.05). In addition, the VAS score was significantly correlated with cervical lordosis (CL) (rs = 0.296), lumbar lordosis (rs = - 0.299), and sacral slope (rs = 0.362) (p < 0.05). Furthermore, at the 10-year follow-up, CL was significantly negatively correlated with T1 slope (rs = - 0.763) and thoracic kyphosis (TK) (- 0.554 for T1-12 and - 0.344 for T5-12) (p < 0.02). CONCLUSION: NSP was associated with deterioration in SRS-22 scores, indicating that NSP is a clinically significant long-term issue in PSF for thoracic AIS. Restoring or maintaining the TK and T1 slopes, which are controllable factors during PSF, may improve cervical lordosis and alleviate NSP at 10-year follow-up.

DOI： 10.1007/s00586-024-08233-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and objectives Mixed reality (MR) is one of the image processing technologies that allows the user to manipulate three-dimensional (3D) virtual images (hologram). The aim of this study was to evaluate the accuracy of MR-based pedicle screw (PS) placement using 3D spine models. Materials and methods Using the preoperative CT data of a patient with adolescent idiopathic scoliosis (AIS) who had undergone posterior spinal fusion in our hospital, a 3D-printed spine model was created. On the other hand, a 3D hologram of the same patient was automatically created using the preoperative CT data uploaded to the Holoeyes MD service website (Holoeyes Inc., Tokyo, Japan). Using a Magic Leap One® headset (Magic Leap Inc., Plantation, FL), the 3D hologram with lines of predetermined PS trajectories was superimposed onto the 3D-printed spine model and PS were inserted bilaterally along with the trajectory lines from T5 to L3. As a control, we used a readymade 3D spine model of AIS and inserted PS bilaterally with a freehand technique from T4 to L3. The rate of pedicle violation was compared between the MR-based and freehand techniques. Results A total of 22 and 24 PS were placed into the 3D-printed spine model of our patient and the readymade 3D spine model, respectively. The rate of pedicle violation was 4.5% (1/22 screws) in the MR-based technique and 29.2% (7/24 screws) in the freehand technique (P = 0.049). Conclusions We demonstrated a significantly lower rate of PS misplacement in the MR-based technique than in the freehand technique. Therefore, an MR-assisted system is a promising tool for PS placement in terms of feasibility, safety, and accuracy, warranting further studies including cadaveric and clinical studies.

DOI： 10.7759/cureus.59240

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Objectives: The incidence of osteoporotic hip fractures in Niigata Prefecture, Japan, has been studied approximately every 5 years since 1985. In 2020, as in previous surveys, a prefecture-wide survey was initiated as planned; however, the global outbreak of the coronavirus disease 2019 (COVID-19) began simultaneously. This study aimed to compare the results of the 2015 and 2020 Niigata Prefecture Fragility Hip Fracture Surveys to determine whether the COVID-19 pandemic affected the occurrence and treatment of proximal femoral fractures throughout Niigata Prefecture. Materials and Methods: In this study, data from the 2015 and 2020 Niigata Prefecture Fragility Hip Fracture Surveys were used. Data were obtained from registration forms returned by hospitals and clinics in Niigata Prefecture for patients living therein who were diagnosed with osteoporotic hip fractures over a 1-year period in 2015 and 2020. Results: In Niigata Prefecture, the total annual number of fractures increased from 3181 in 2015 to 3369 in 2020, whereas the age-adjusted fracture rate decreased. Regarding the location of the fractures, the proportion of outdoor fractures was lower than that of indoor fractures. The proportion of outdoor fractures decreased over the year as a whole, but in particular, the proportion of outdoor fractures decreased significantly under the issued emergency declarations. The most common reasons for delayed surgery related to COVID-19 were "waiting for PCR results" and "quarantine for fever," accounting for approximately 1.9% of all causes. Conclusions: In Niigata Prefecture, Japan, the effect of the COVID-19 pandemic on the number and rate of fractures was minuscule. The proportion of indoor fractures to outdoor fractures increased during the emergency declaration period. Considering that the number of fragility fractures remains the same during an infectious disease pandemic such as COVID-19, it is necessary to ensure that healthcare resources are available to deal with them.

DOI： 10.3390/medicina60040573

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Objectives: Global femoral offset (GFO) and leg length discrepancy (LLD) affect outcomes after total hip arthroplasty (THA). Moreover, the sum of the difference in GFO between the THA and non-surgical sides and LLD (SGL) reportedly affects the outcomes in a two-dimensional evaluation. We examined the association of the GFO, LLD, and SGL with the Harris Hip Score (HHS) using a three-dimensional (3D) evaluation. Methods: We retrospectively surveyed 172 patients with hemilateral hip osteoarthritis who underwent THA. The GFO, LLD, and SGL were measured using the 3D pelvis and femur models; these models were adjusted for the pelvis and femur, and the coordinate systems were parallelized. Furthermore, their relationship with the modified HHS (mHHS) 1 year after THA was determined. Results: Significant correlations were found among mHHS, GFO, and SGL in the binomial group, whereas LLD was not significantly correlated. The optimal values of GFO and SGL were 1.01 mm and 0.18 mm/100 cm body height, respectively, which were considered optimal when the SGL values were approximately equal to those of the non-operative side. The optimal ranges for GFO and SGL were -1.65 to 3.67 mm and -4.78 to 5.14 mm/100 cm, respectively. Conclusions: Our findings were obtained after adjusting the pelvis and femur to a unified coordinate system. Therefore, the results of this study can be directly applied to 3D planning.

DOI： 10.3390/jcm13061698

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Vitamin D deficiency causes osteoporosis, bone mineralization disorders, and osteomalacia. Osteomalacia is diagnosed using blood biochemical tests, clinical symptoms, and imaging; however, accurate detection of mineralization disorders requires tissue observation. We investigated the prevalence of bone mineralization disorders and their relationship with serum 25-hydroxyvitamin D (25OHD) levels in patients with untreated osteoporosis with femoral neck fractures. MATERIALS AND METHODS: A non-demineralized specimen was prepared from the femoral head removed during surgery in 65 patients. Bone histomorphometry of cancerous bone in the femoral head center was conducted. Osteoid volume per bone volume (OV/BV) and osteoid thickness (O.Th) were measured as indicators of mineralization disorder. RESULTS: The mean serum 25OHD level (11.9 ± 5.7 ng/mL) was in the deficiency range (< 12 ng/mL). There were no clinically diagnosed cases of osteomalacia (OV/BV > 10% and O.Th > 12.5 µm); however, one case of mineralization disorder, considered histologically pre-osteomalacia (OV/BV > 5% and O.Th < 12.5 µm), was observed (OB/BV, 17.6%; O.Th, 12.3 µm). Excluding this case, those with severe (25OHD < 12 ng/mL, at risk of osteomalacia; n = 39) and non-severe deficiency (25OHD ≥ 12 ng/mL; n = 25) did not significantly differ in OV/BV (%; 0.77 ± 0.54 vs. 0.69 ± 0.38, p = 0.484) or O.Th (µm; 5.32 ± 1.04 vs. 5.13 ± 0.78, p = 0.410). Further, 25OHD and OV/BV were not significantly correlated (R = - 0.124, p = 0.327). CONCLUSION: This is the first study in the twenty-first century to examine serum 25OHD concentrations and bone mineralization disorders in Japanese patients with osteoporosis. The results indicate that vitamin D deficiency does not necessarily cause bone mineralization disorders and rarely leads to osteomalacia.

DOI： 10.1007/s00774-024-01495-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

UNLABELLED: Backgroumd: There have been few reports on the long-term survival of computed tomography (CT)-navigated total hip arthroplasty (THA), which should lead to a lower incidence of dislocation and loosening. In this study, we examined survivorship, dislocation, and loosening incidence using plain radiographs over a minimum 15-year follow-up after CT-navigated THA. METHODS: We retrospectively reviewed 145 consecutive CT-navigated THAs for >15 years. We surveyed the angles placed in both the acetabular and femoral components, survivorship, the occurrence of dislocation, the revision rate, and the fixation grade of the acetabular component. RESULTS: The mean follow-up duration was 18.4 years. Overall, 73.8% of THAs were within the safe zone of Lewinnek. There were four dislocations (2.8%), with three occurring within 1 month after surgery and the other within 7 years after surgery. Revision THA was performed in one case (0.69%); consequently, the survival rate was 99.3%. The fixation grade was evaluated in 144 hips, and those were evaluated as having "no loosening". CONCLUSIONS: CT-navigated THA was speculated to contribute to long-term survivorship, with a low rate of loosening, even after 18 years of follow-up. It was speculated that the acetabular component was placed at an acceptable insertion angle and a suitable position for stable initial fixation.

DOI： 10.3390/jcm13051374

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 15-year-old girl had experienced hip pain at 11 years of age. At 15 years of age, the patient complained of persistent generalised pain. Her rheumatoid factor and serum matrix metalloproteinase-3 levels were below standard values; there were no inflammatory responses, and the human leukocyte antigen test was negative for B27 and positive for B52 and B62. The bath ankylosing spondylitis disease activity index (BASDAI) value was 8.0 at the time of induction and 3.1 at 6 months after the introduction of adalimumab (at a dose of 40 mg). The BASDAI value improved with an increase in the dose of adalimumab to 80 mg at 8 months after the initial introduction of adalimumab (at 40 mg), although it remained at 4.8 at 16 months after the dose increase. The BASDAI value was 2.6 at 6 months, 2.7 at 1 year, and 1.8 at 1.5 years after the introduction of infliximab, indicating that the patient had progressed well without any adverse events. Based on this case, juvenile ankylosing spondylitis is a differential diagnosis for low back pain and generalised pain since childhood. Tumour necrosis factor (TNF) inhibitors were promptly introduced in this case, although it took 4 years from the initial presentation. TNF inhibitors were effective in treating juvenile ankylosing spondylitis in the present case without any adverse events. This case is notable because juvenile onset ankylosing spondylitis is one of the reasons for severe lumbago since childhood and because TNF inhibitors were administered promptly after diagnosis.

DOI： 10.1093/mrcr/rxae006

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記述言語：日本語   出版者・発行元：克誠堂出版(株)  

症例は29歳女性で、右胸壁の腫瘤と疼痛を主訴とした。22歳時に胸壁動静脈奇形(AVM)の診断を受け、3回の経動脈的塞栓術の既往があるが、腫瘤はその後も増大し14×10cmとなった。3D-CT画像とMRIからAVMの主体は肋骨より浅層に存在し、肋骨への強い癒着はないと推察された。全身麻酔下で手術を施行し、周囲二重結紮法で周囲からの流入流出血管を止血しつつ切除を進めた。肋骨とAVMの接する部分からの出血が多かったため、肋骨周囲の出血点に繰り返し縫合結紮を行い、濃厚赤血球4単位の輸血を要したが、肋骨より浅層の腫瘤を一塊として摘出できた。術後15年経過して腫瘤や疼痛の再発は見られない。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00398&link_issn=&doc_id=20240209080006&doc_link_id=10.18916%2Fkeisei.2024020006&url=https%3A%2F%2Fdoi.org%2F10.18916%2Fkeisei.2024020006&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Deep dermatophytosis is an invasive and sometimes life-threatening fungal infection mainly reported in immunocompromised patients. However, a caspase recruitment domain-containing protein 9 (CARD9) deficiency has recently been reported to cause deep dermatophytosis. Herein, we report the first Japanese case of deep dermatophytosis associated with CARD9 deficiency. An 80-year-old Japanese man with tinea corporis presented with subcutaneous nodules on his left sole. Histopathological findings revealed marked epithelioid cell granulomas with filamentous fungal structures in the deep dermis and subcutis, and the patient was diagnosed with deep dermatophytosis. Despite antifungal therapy, the subcutaneous nodule on his left sole gradually enlarged, his left calcaneal bone was invaded, and the patient finally underwent amputation of his left leg. Genetic analysis revealed a homozygous CARD9 c.586 A > G (p. Lys196Glu) variant, suggesting a CARD9 deficiency. Here, we discuss the clinical features of CARD9 deficiency-associated deep dermatophytosis with a case report and review of the literature.

DOI： 10.1111/1346-8138.16995

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Opioids often need to be discontinued because they cause nausea, whereas the administration of intravenous acetaminophen (APAP) causes less nausea and vomiting. This study aimed to compare the effects of fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and intravenous APAP on pain and nausea after total hip arthroplasty (THA). METHODS: We prospectively investigated primary THA patients who underwent the anterolateral supine approach at four centers between October 2021 and October 2022. The patients (n = 178) were divided randomly into IV-PCA (n = 88) and APAP groups (n = 90). Rest pain, motion pain, and nausea were assessed using NRS scores. RESULTS: Compared with the APAP group, the IV-PCA group experienced significantly greater resting pain and nausea on postoperative day 1. A correlation was found between preoperative and postoperative pain. Postoperative nausea at 8 h was significantly correlated with pain at rest at 4 h (r = 0.193), 8 h (r = 0.194), day 1 (r = 0.245), and day 2 (r = 0.188) after surgery. Early postoperative pain and nausea correlated with subsequent pain and nausea. CONCLUSIONS: Intravenous APAP is associated with less pain and nausea and is superior to IV-PCA.

DOI： 10.3390/jcm12237445

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Gait disturbance due to compressive cervical myelopathy has been previously described. However, data on how gait disturbance varies with the degree of lower extremity motor impairment are limited. Therefore, we investigated the characteristics of gait analysis based on severity and determined how gait disturbance progresses in compressive cervical myelopathy. METHODS: We enrolled 44 patients (32 men and 12 women; mean age, 65.0 years) out of 108 consecutive patients with compressive cervical myelopathy who underwent spinal cord decompression surgery in our hospital. The exclusion criteria were inability to gait and complications affecting gait. Twenty-two patients with Japanese Orthopaedic Association scores 1 or 2 for lower extremity motor functions were assigned to the severe group, and 22 patients who scored 3 or 4 were assigned to the moderate group. Gait analysis was performed preoperatively using a long thin-type sensor sheet, and 25 healthy volunteers were assigned to the control group. RESULTS: Stride length, swing phase, and gait speed decreased whereas step angle, stance phase, and double support duration increased as myelopathy progressed. Step width was significantly larger in the severe group than in the moderate and control groups. The cutoff values based on severe myelopathy with the inability to ascend or descend stairs without support were 60% for the stride length percentage of body height and 100 cm/s for gait speed. CONCLUSIONS: Decreases in stride length, swing phase, and gait speed and increases in step angle, stance phase, and double support duration are compensatory changes as cervical myelopathy progresses. Step width is a compensatory change that is not significantly altered in moderate myelopathy but increases when gait becomes affected, such that the patient cannot ascend or descend stairs without support.

DOI： 10.22603/ssrr.2023-0104

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tumor-devitalized autografts treated with deep freezing, pasteurization, and irradiation are biological reconstruction methods after tumor excision for aggressive or malignant bone or soft tissue tumors that involve a major long bone. Tumor-devitalized autografts do not require a bone bank, they carry no risk of viral or bacterial disease transmission, they are associated with a smaller immunologic response, and they have a better shape and size match to the site in which they are implanted. However, they are associated with disadvantages as well; it is not possible to assess margins and tumor necrosis, the devitalized bone is not normal and has limited healing potential, and the biomechanical strength is decreased owing to processing and tumor-related bone loss. Because this technique is not used in many countries, there are few reports on the results of this procedure such as complications, graft survival, and limb function. QUESTIONS/PURPOSES: (1) What was the rate of complications such as fracture, nonunion, infection, or recurrence in a tumor-devitalized autograft treated with deep freezing, pasteurization, and irradiation, and what factors were associated with the complication? (2) What were the 5-year and 10-year grafted bone survival (free from graft bone removal) of the three methods used to devitalize a tumor-containing autograft, and what factors were associated with grafted bone survival? (3) What was the proportion of patients with union of the tumor-devitalized autograft and what factors were associated with union of the graft-host bone junction? (4) What was the limb function after the tumor-devitalized autograft, and what factors were related to favorable limb function? METHODS: This was a retrospective, multicenter, observational study that included data from 26 tertiary sarcoma centers affiliated with the Japanese Musculoskeletal Oncology Group. From January 1993 to December 2018, 494 patients with benign or malignant tumors of the long bones were treated with tumor-devitalized autografts (using deep freezing, pasteurization, or irradiation techniques). Patients who were treated with intercalary or composite (an osteoarticular autograft with a total joint arthroplasty) tumor-devitalized autografts and followed for at least 2 years were considered eligible for inclusion. Accordingly, 7% (37 of 494) of the patients were excluded because they died within 2 years; in 19% (96), an osteoarticular graft was used, and another 10% (51) were lost to follow-up or had incomplete datasets. We did not collect information on those who died or were lost to follow-up. Considering this, 63% of the patients (310 of 494) were included in the analysis. The median follow-up was 92 months (range 24 to 348 months), the median age was 27 years (range 4 to 84), and 48% (148 of 310) were female; freezing was performed for 47% (147) of patients, pasteurization for 29% (89), and irradiation for 24% (74). The primary endpoints of this study were the cumulative incidence rate of complications and the cumulative survival of grafted bone, assessed by the Kaplan-Meier method. We used the classification of complications and graft failures proposed by the International Society of Limb Salvage. Factors relating to complications and grafted autograft removal were analyzed. The secondary endpoints were the proportion of bony union and better limb function, evaluated by the Musculoskeletal Tumor Society score. Factors relating to bony union and limb function were also analyzed. Data were investigated in each center by a record review and transferred to Kanazawa University. RESULTS: The cumulative incidence rate of any complication was 42% at 5 years and 51% at 10 years. The most frequent complications were nonunion in 36 patients and infection in 34 patients. Long resection (≥ 15 cm) was associated with an increased risk of any complication based on the multivariate analyses (RR 1.8 [95% CI 1.3 to 2.5]; p < 0.01). There was no difference in the rate of complications among the three devitalizing methods. The cumulative graft survival rates were 87% at 5 years and 81% at 10 years. After controlling for potential confounding variables including sex, resection length, reconstruction type, procedure type, and chemotherapy, we found that long resection (≥ 15 cm) and composite reconstruction were associated with an increased risk of grafted autograft removal (RR 2.5 [95% CI 1.4 to 4.5]; p < 0.01 and RR 2.3 [95% CI 1.3 to 4.1]; p < 0.01). The pedicle freezing procedure showed better graft survival than the extracorporeal devitalizing procedures (94% versus 85% in 5 years; RR 3.1 [95% CI 1.1 to 9.0]; p = 0.03). No difference was observed in graft survival among the three devitalizing methods. Further, 78% (156 of 200 patients) of patients in the intercalary group and 87% (39 of 45 patients) of those in the composite group achieved primary union within 2 years. Male sex and the use of nonvascularized grafts were associated with an increased risk of nonunion (RR 2.8 [95% CI 1.3 to 6.1]; p < 0.01 and 0.28 [95% CI 0.1 to 1.0]; p = 0.04, respectively) in the intercalary group after controlling for confounding variables, including sex, site, chemotherapy, resection length, graft type, operation time, and fixation type. The median Musculoskeletal Tumor Society score was 83% (range 12% to 100%). After controlling for confounding variables including age, site, resection length, event occurrence, and graft removal, age younger than 40 years (RR 2.0 [95% CI 1.1 to 3.7]; p = 0.03), tibia (RR 6.9 [95% CI 2.7 to 17.5]; p < 0.01), femur (RR 4.8 [95% CI 1.9 to 11.7]; p < 0.01), no event (RR 2.2 [95% CI 1.1 to 4.5]; p = 0.03), and no graft removal (RR 2.9 [95% CI 1.2 to 7.3]; p = 0.03) were associated with an increased limb function. The composite graft was associated with decreased limb function (RR 0.4 [95% CI 0.2 to 0.7]; p < 0.01). CONCLUSION: This multicenter study revealed that frozen, irradiated, and pasteurized tumor-bearing autografts had similar rates of complications and graft survival and all resulted in similar limb function. The recurrence rate was 10%; however, no tumor recurred with the devitalized autograft. The pedicle freezing procedure reduces the osteotomy site, which may contribute to better graft survival. Furthermore, tumor-devitalized autografts had reasonable survival and favorable limb function, which are comparable to findings reported for bone allografts. Overall, tumor-devitalized autografts are a useful option for biological reconstruction and are suitable for osteoblastic tumors or osteolytic tumors without severe loss of mechanical bone strength. Tumor-devitalized autografts could be considered when obtaining allografts is difficult and when a patient is unwilling to have a tumor prosthesis and allograft for various reasons such as cost or socioreligious reasons. LEVEL OF EVIDENCE: Level III, therapeutic study.

DOI： 10.1097/CORR.0000000000002720

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Intraoperative pathological diagnosis has a major influence on the intra- and postoperative management of spinal cord tumors. Thus, the aim of this study was to assess the reliability of intraoperative pathological diagnosis for spinal cord lesions by comparing it with the final pathological diagnosis and to determine its usefulness and limitations. METHOD: Three-hundred and three consecutive patients (mean age, 53.9 years) with neoplastic spinal cord lesions who underwent initial surgery between 2000 and 2021 were included. The anatomical locations of the spinal cord tumors and the implementation rate of intraoperative pathological diagnosis in each tumor type were evaluated. As the primary outcome, we determined the concordance rates between the intraoperative pathological diagnosis and the final diagnosis. When the intraoperative pathological diagnosis and final diagnosis were the same, the diagnosis was defined as a "match." Otherwise, the diagnosis was defined as a "mismatch." RESULTS: The overall implementation rate of intraoperative pathological diagnosis was 53%, with implementation rates of 71%, 45%, 47%, and 50% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively. The overall concordance rate was 87.6%, with concordance rates of 80%, 95%, 75%, and 90% for intramedullary, intradural extramedullary, extradural, and dumbbell tumors, respectively (p < 0.05). The diagnoses of ependymomas, low-grade astrocytomas, and high-grade astrocytomas was occasionally difficult among intramedullary tumors. Among intradural extramedullary tumors, differentiation between grade 1 meningioma and high-grade meningioma was difficult using intraoperative pathological diagnosis. CONCLUSIONS: Surgeons must recognize the lower accuracy of intraoperative pathological diagnosis for intramedullary and extradural lesions and make a final decision by considering the intraoperative gross findings, preoperative clinical course, and imaging.

DOI： 10.1016/j.jos.2023.08.011

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Adult spinal deformity has a substantially debilitating effect on older people's physical and mental health. However, the impact of sagittal malalignment on locomotive syndrome (LS), sarcopenia, and physical function in community-dwelling older women has not yet been clarified. This study aimed to investigate the association between these factors in community-dwelling middle aged and older women. METHODS: A total of 361 women were recruited from participants performing aquatic exercises in a rural area of Japan. The body mass index, skeletal muscle mass index, trunk muscle mass, spinal inclination angle (SIA), grip strength, timed up-and-go test (TUG), maximum stride of the participants, and one-leg standing time were measured. Low back pain (LBP)- and health-related quality of life (HRQOL) were evaluated using the Oswestry Disability Index (ODI) and the Short-Form 8 questionnaire. Associations between the global sagittal alignment using SIA and investigating parameters were analyzed. RESULTS: The prevalence of sarcopenia was 3.6%. The prevalence of LS (stages 1, 2, and 3) was 43.8% (158 of 361), and the number of participants in each LS stage was 203 (stage 0), 95 (stage 1), 28 (stage 2), and 35 (stage 3). The SIA was significantly correlated with the 25-question geriatric locomotive function scale (r' = 0.292, p < 0.001), ODI (r' = 0.267, p < 0.001), and TUG (r' = 0.453, p < 0.001) after adjusting for age. In the receiver-operating characteristic curve analysis, the cutoff values of SIA for LS ≥ stage 2 and ODI ≥ 20% were 5°. CONCLUSIONS: LBP-related QOL and physical performance were significantly associated with global sagittal alignment. Global sagittal alignment was correlated with the three-stage category of LS. The spinal inclination of 5° was a cutoff value to predict exacerbation of mobility function and HRQOL status.

DOI： 10.1186/s12891-023-06686-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: A 2015 study showed a decreasing trend in the incidence of osteoporotic hip fractures in Niigata Prefecture, Japan, which had been increasing. This study aimed to investigate the incidence of osteoporotic hip fractures in 2020, determine the long-term change in the incidence of hip fractures from 1985 to 2020, and assess whether the decline in fracture incidence since 2010 has continued. MATERIALS AND METHODS: We obtained data from the registration forms submitted by hospitals and clinics of patients who lived in Niigata Prefecture and were diagnosed with osteoporotic hip fracture through a survey conducted from January 1, 2020 to December 31, 2020. RESULTS: In 2020, 3,369 hip fractures were recorded in Niigata Prefecture. Although the overall incidence of age-specific hip fractures decreased, it increased in patients aged ≥ 90 years, regardless of sex. The proportion of patients receiving anti-osteoporosis drugs prior to hip fracture increased from 7.6% in 2004 to 17.3% in 2020. Notably, surgical treatment should be performed as early as possible, and the preoperative waiting time was 2.9 days, which was mainly due to holidays. CONCLUSION: The incidence of hip fractures in Niigata Prefecture has gradually increased over the past 35 years, with an increasing change observed in the very elderly recently in 2020. Although the treatment of osteoporotic hip fractures in Niigata Prefecture is adequate, improvements may include increasing the rate of adoption of osteoporosis treatment further and decreasing the number of days of preoperative waiting.

DOI： 10.1007/s00774-023-01421-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Patients with advanced chronic kidney disease (CKD) are generally discouraged from consuming high amounts of vegetables and fruits given the potential risk of hyperkalemia. In the general population, however, lower vegetable and fruit intake is associated with higher mortality. This Japanese hospital-based prospective cohort study including non-CKD and CKD participants examined whether the frequency of vegetable and fruit intake is associated with mortality, and whether the presence of CKD modifies this association. METHODS: Participants were 2,006 patients who visited the outpatient department of a general hospital between June 2008 and December 2016 (55% men; mean age, 69 years). Among these participants, 902 (45%) and 131 (7%) were non-dialysis-dependent patients with CKD and hemodialysis patients, respectively. The frequency of vegetable and fruit intake was determined by a self-report questionnaire using an ordinal scale, "never or rarely," "sometimes," and "every day." Multivariable Cox proportional hazards analysis was conducted, adjusting for potential confounders. RESULTS: Vegetable and fruit intake frequency decreased with worsening CKD stage (P for trend < .001). Baseline serum potassium levels stratified by CKD stage were similar across the three vegetable and fruit intake frequency groups. During a median follow-up of 5.7 years, 561 participants died (47.1/1,000 person-years). Adjusted hazard ratios relative to the "every day" group were 1.25 (95% confidence interval, 1.04-1.52) and 1.60 (95% confidence interval, 1.23-2.08) for the "sometimes" and "never or rarely" groups, respectively, after adjusting for demographic factors, comorbidities, and CKD status. When stratified by CKD status, a similar, albeit non-significant, dose-dependent relationship was observed between vegetable and fruit intake frequency and all-cause mortality irrespective of CKD status, with no effect modification by CKD status (Pinteraction = .69). CONCLUSION: A lower frequency of vegetable and fruit intake is significantly associated with a higher risk of death regardless of CKD status.

DOI： 10.1053/j.jrn.2023.01.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Surgical smoke is a vaporous by-product generated during tissue incision and cauterization with an electric scalpel. This smoke contains tissue- and blood/vascular-derived substances, bacteria, viruses, and chemical substances. Among them, it contains many fine particles called particulate matter (PM) 2.5, which are harmful and hazardous to the human body. We aimed to investigate the occurrence of PM2.5 in surgical smoke produced during spinal surgery and to evaluate the efficacy of an electric scalpel with a smoke evacuation pencil. METHODS: In this retrospective observational study, 89 patients who underwent spinal surgery between June 2019 and May 2021 were included. A dust monitor was installed in the operating room to measure the PM2.5 air concentration during the surgery. During each surgery, the total amount of PM2.5, the maximum PM2.5 air concentration, the exposure time to PM2.5, and the average value of PM2.5 air concentration from the start to the end of the surgery were calculated. RESULTS: We found that in 29 of the 89 cases (32.6%), the air concentration of PM2.5 increased to a level that could cause health damage during the surgery. Twelve cases (13.4%) reached the level that could cause serious health damage, and 8 cases (9%) reached an emergency warning level. The total amount and the maximum and average levels of PM2.5 were significantly suppressed in the surgery with a smoke evacuation pencil group than in the surgery without a smoke evacuation pencil group. CONCLUSION: We detected hazardous levels of PM2.5 in the air during spinal surgery, highlighting the importance of considering smoke control or reduction during spinal surgery. We recommend using an electric scalpel with a smoke evacuation pencil for regulating PM2.5 levels in the operating room.

DOI： 10.1016/j.jos.2022.04.010

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

2000～2019年に単一施設で腎癌脊椎転移に対して姑息的手術が行われた22例のうち、術後1年以上あるいは死亡まで追跡可能であった19例を対象とし、術後生存期間が1年以上であった群(12例)と1年未満群(7例)に分け、「手術時年齢」「性別」「術前の徳橋スコア」「術前の血液検査値」「主要臓器転移の合併率」などについて比較検討した。血液検査値の調査項目は「Alb」「LDH」「T-Bil」「補正Ca」「WBC」「Hb」「Plt」「好中球/リンパ球比(NLR)」「CRP」とした。検討の結果、術後生存期間が1年以上の群は1年未満群に比べて、術前の「徳橋スコア」が有意に高く、血液検査では「Alb値」が有意に高く、「NLR」が有意に低かった。術後生命予後不良のカットオフ値として、過去の報告から「徳橋スコア12点未満」「Alb<3.7g/dl」「NLR>3」を採用し、術後生命予後1年未満の予測について感度と特異度を算出した。結果、「徳橋スコア」単独では、感度は100%であったものの特異度は50%にとどまった。「徳橋スコア」に「Alb<3.7g/dlあるいはNLR>3のいずれかを満たす」を加えると、感度は100%のままで特異度は75%に上昇した。「Alb<3.7g/dlおよびNLR>3を満たす」を加えた場合には、感度は85.7%に低下したものの特異度は91.7%に上昇した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A significant increase in the older adult population in Japan will significantly increase healthcare costs. This study aimed to examine the risk factors contributing to robustness transitioning to frailty in older residents. METHODS: Participants were aged 70 in 2016 and 76 in 2022. Participants were evaluated using the Kihon Checklist (KCL). RESULTS: Participants for this longitudinal study included 444 older persons who completed the KCL surveys in 2016 and 2022. The follow-up rate was 80.6%; therefore, 358 participants were included in the analysis. The median KCL score increased significantly from 2 to 2016 to 3 in 2022 (p < 0.001). The prevalence of robustness significantly decreased from 60.9 to 48.6% (p = 0.042). In a stepwise logistic regression analysis, robustness was independently associated with regular continuous walks for 15 min and a body mass index of above 18.5%. The following variables were associated with the transition to prefrailty: experiencing a fall in the past year and not going out at least once a week. For the transition to frailty, the variables were turned to family or friends for advice, experienced a fall in the past year, and felt helpless in the last two weeks. The independent factor for the transition from prefrailty to frailty was having a BMI of less than 18.5. In contrast, the independent factor for improving from frailty to robustness or prefrailty was going out at least once a week. CONCLUSIONS: We recommend maintaining continuous walking for more than 15 min, maintaining a BMI of at least 18.5, and going out more than once a week to improve being house-bounded and depressive mood, not only to prevent the transition to prefrailty or frailty but also to improve frailty.

DOI： 10.1186/s12877-023-04055-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Objectives: In the field of orthopedic surgery, novel techniques of three-dimensional shape modeling using two-dimensional tomographic images are used for bone-shape measurements, preoperative planning in joint-replacement surgery, and postoperative evaluation. ZedView® (three-dimensional measurement instrument and preoperative-planning software) had previously been developed. Our group is also using ZedView® for preoperative planning and postoperative evaluation for more accurate implant placement and osteotomy. This study aimed to evaluate the measurement error in this software in comparison to a three-dimensional measuring instrument (3DMI) using human bones. Materials and Methods: The study was conducted using three bones from cadavers: the pelvic bone, femur, and tibia. Three markers were attached to each bone. Study 1: The bones with markers were fixed on the 3DMI. For each bone, the coordinates of the center point of the markers were measured, and the distances and angles between these three points were calculated and defined as "true values." Study 2: The posterior surface of the femur was placed face down on the 3DMI, and the distances from the table to the center of each marker were measured and defined as "true values." In each study, the same bone was imaged using computed tomography, measured with this software, and the measurement error from the corresponding "true values" was calculated. Results: Study 1: The mean diameter of the same marker using the 3DMI was 23.951 ± 0.055 mm. Comparisons between measurements using the 3DMI and this software revealed that the mean error in length was <0.3 mm, and the error in angle was <0.25°. Study 2: In the bones adjusted to the retrocondylar plane with the 3DMI and this software, the average error in the distance from the planes to each marker was 0.43 (0.32-0.58) mm. Conclusion: This surgical planning software could measure the distance and angle between the centers of the markers with high accuracy; therefore, this is very useful for pre- and postoperative evaluation.

DOI： 10.3390/medicina59061030

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The Japanese Orthopaedic Association (JOA) introduced the concept of locomotive syndrome (LS), which indicates a decline in mobility function by musculoskeletal disorders with new 3-staged category. Additionally, sarcopenia indicates a decline in the quantity and/or quality of skeletal muscle. However, the relationship between low back pain (LBP) and LS or sarcopenia in older people has not been sufficiently understood. This study aimed to investigate the association between them through a cross-sectional locomotorium survey. METHODS: A total of 302 participants were drawn from the aquatic exercise participants in a rural area of Japan. The body mass index, body fat percentage, skeletal muscle mass index (SMI), spinal inclination angle (SIA), grip strength, timed up-and-go test (TUG), and maximum stride of the participants were measured. LBP and LBP-related quality of life (QOL) were evaluated using the Oswestry Disability Index (ODI), visual analogue scale (VAS) of LBP, and the Short-Form 8 (SF-8). Associations between the investigating parameters and sarcopenia or LS were analyzed. RESULTS: There were no significant differences in the findings except grip strength between the non-sarcopenia and sarcopenia groups. However, the LS group showed significantly larger SIA, higher ODI, higher VAS of LBP, lower physical component score (PCS) of the SF-8, longer time in TUG, and lower value in maximum stride than the non-LS group. In addition, the ODI and PCS of the SF-8 significantly deteriorated as the LS stage progressed, and the GLFS-25 score was significantly correlated with ODI (r = 0.706, p < 0.001) and PCS (r = -0.643, p < 0.001) scores. CONCLUSIONS: LBP, LBP-related QOL, and physical performance were found to be significantly associated with LS, not sarcopenia, with LBP-related QOL and physical function being closely correlated with 3-stage categories of LS. Thus, these results suggested that LBP is a key factor for LS prevalence.

DOI： 10.1016/j.jos.2022.03.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We aimed to investigate the marital status and childbirth in adolescent idiopathic scoliosis (AIS) patients. METHODS: This study included women who were treated surgically or non-surgically for AIS with a scoliosis magnitude ≥ 30° before surgery or at skeletal maturity and were followed up until age 30 years or older. Patients were divided into surgically treated (S-AIS, n = 55) and non-surgically treated AIS groups (N-AIS, n = 86). Data from the national fertility survey were used as control values. RESULTS: There were no significant differences in age at the final follow-up between the S- (40.7 years) and N-AIS (42.1 years) groups. The unmarried rate among all women and the nulliparous rate among married women in the S-AIS group (29.1% and 18.4%, respectively) were similar to those in the N-AIS group (26.7% and 16.1%, respectively). The mean number of children per married woman also did not differ between the S- and N-AIS groups (1.5 vs 1.4). Compared to the control group, after adjusting for age, the common odds ratio in the AIS group was 1.56 (p = 0.031) for unmarried status and 1.88 (p = 0.026) for nulliparity among married women. Moreover, the mean number of children per married woman was significantly lower in the AIS group than in the control group (1.3 vs 1.7, p < 0.001). CONCLUSION: Surgically and non-surgically treated women with AIS had a similar status with regard to marriage and childbirth, while women with AIS were more likely to be unmarried and nulliparous and to have fewer children compared to the nationwide population.

DOI： 10.1007/s43390-023-00648-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study aimed to establish biomarkers to predict the progression of ossification by examining ossification volume and bone metabolism dynamics in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS: We assessed OPLL progression using computed tomography-based three-dimensional (3D) image analysis and examined bone metabolism dynamics in 107 patients with OPLL (men, 72; women, 35; mean age, 63.6 years). The volume of OPLL was calculated twice during the follow-up period, and OPLL progression was evaluated by the annual rate of ossification increase. Bone metabolism dynamics were assessed by routine blood tests and analysis of various serum biomarkers (including 25-hydroxyvitamin D, intact parathyroid hormone, fibroblast growth factor 23, intact N-terminal propeptide of type 1, tartrate-resistant acid phosphatase isoform 5b, sclerostin, and Dickkopf-1) and bone mineral density (BMD). Patients were classified into the progression (P) or non-progression (NP) group according to the annual rate of increase in previous 3D image analyses, and associated factors between these groups were compared. RESULTS: The P and NP groups consisted of 29 patients (23 men and 6 women) and 78 patients (49 men and 29 women), respectively. Univariate analysis revealed significant differences in terms of age, body mass index, serum phosphorus, serum sclerostin, and BMD. In multivariate analysis, age, serum phosphorus, and serum sclerostin were identified as independent factors associated with OPLL progression. CONCLUSION: Younger age, hypophosphatemia, and high serum sclerostin are risk factors for OPLL progression. Serum phosphorus and sclerostin could serve as important biomarkers for predicting ossification progression.

DOI： 10.1007/s00586-023-07565-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Malignant peripheral nerve sheath tumors (MPNSTs) are soft-tissue sarcomas of the peripheral nervous system that develop either sporadically or in the context of neurofibromatosis type 1 (NF1). MPNST diagnosis can be challenging and treatment outcomes are poor. We present here a resource consisting of the genomic characterization of 9 widely used human MPNST cell lines for their use in translational research. NF1-related cell lines recapitulated primary MPNST copy number profiles, exhibited NF1, CDKN2A, and SUZ12/EED tumor suppressor gene (TSG) inactivation, and presented no gain-of-function mutations. In contrast, sporadic cell lines collectively displayed different TSG inactivation patterns and presented kinase-activating mutations, fusion genes, altered mutational frequencies and COSMIC signatures, and different methylome-based classifications. Cell lines re-classified as melanomas and other sarcomas exhibited a different drug-treatment response. Deep genomic analysis, methylome-based classification, and cell-identity marker expression, challenged the identity of common MPNST cell lines, opening an opportunity to revise MPNST differential diagnosis.

DOI： 10.1016/j.isci.2023.106096

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記述言語：日本語   出版者・発行元：日本レックリングハウゼン病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Global femoral offset (GFO) and femoral offset (FO) reportedly affect outcomes following total hip arthroplasty (THA). However, FO assessed using plain radiography is affected by internal and external rotations of the hip joint. We investigated the relationship between leg length discrepancy and Harris hip score (HHS), and their influence on acetabular offset (AO), FO, GFO, anterior femoral offset, and outcomes after THA. We retrospectively evaluated 140 patients with hip osteoarthritis who underwent THA. A three-dimensional (3D) pelvis and femur model created from computed tomography (data using ZedHip software was used to investigate these parameters. The modified (m)HHS scores were significantly improved from 49.0 to 88.8 in total mHHS, 20.0-44.5 in pain, and 28.9-44.4 points in function. Significant correlations were found between the differences in AO, FO, GFO, and pain score in binominal, with maximum values of - 1.24, + 1.54, and + 0.90 mm/100 cm body height, respectively. The maximum value of GFO and mHHS in binominal was + 1.17 mm/100 cm body height (BH). The optimal range of difference of GFO was - 1.75 to 4.09 mm/100 cm BH. This is the first report using a 3D method for assessing FO. Preoperative planning using the system could improve postoperative function.

DOI： 10.1038/s41598-023-28863-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Multiple subcutaneous extensor tendon ruptures in more than the ulnar three fingers sometimes occur in patients with rheumatoid arthritis accompanied by wrist deformity. In these situations, the flexor digitorum superficialis tendon of the middle finger (the FDS3 tendon) and that of the ring finger (the FDS4 tendon) are used for the transferred tendon (modified Boyes' procedure). Here, we treated two patients with rheumatoid arthritis, whose extensor tendons of more than three fingers were ruptured, using the modified Boyes' procedure. Case 1 had ruptures in four fingers (index through little), and Case 2 had ruptures in three fingers (middle through little). The FDS3 and FDS4 tendons were passed subcutaneously around the radial side of the wrist to the extensor sides and interlaced with the distal stump of the ruptured tendons. Switching of the finger movement was achieved smoothly in both cases. The post-operative evaluation showed an extension lag of -15° for the index finger 0° for the middle through the little fingers in Case 1, and 0° for the middle finger and -5° for the ring and little fingers in Case 2. The average post-operative extension lag was -3.5°. However, median nerve palsy occurred in both cases, and it gradually recovered. Stretching of the nerve by the correction of the wrist deformity and increased pressure in the carpal tunnel were supposed to be causes of this palsy. Modified Boyes' procedure is a useful method for more than three ulnar finger extensor tendon ruptures; however, post-operative median nerve palsy should be considered.

DOI： 10.1093/mrcr/rxac050

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

症例は78歳女性で、上腕、大腿部を中心とした筋痛、左膝関節周囲痛、手指のこわばりを主訴とした。1994年に第12胸椎椎体骨折を受傷し、脆弱性骨折として骨粗鬆症治療薬が開始されるも効果は乏しかった。重症骨粗鬆症と判断してロモソズマブ210mg皮下注を開始した。その結果、投与翌日から両大腿部、腰部の筋痛、3時間以上続くこわばりが出現し、血液検査でCRPの上昇を認めた。膝などの関節に化膿性関節炎を示唆する所見はなく、アセトアミノフェン投与で経過を観察したが、両大腿部、腰部の筋痛は改善せず、両上肢の筋痛や体重減少が生じたため、ACR/EULAR基準に準じてリウマチ性多発筋痛症と診断した。NSAIDsとプレドニゾロンの投与により症状とCRPは速やかに改善し、リウマチ性多発筋痛症として典型的な経過であった。

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

脊椎後方固定術(PSF)を行った10歳以上の特発性側彎症48例を対象としてPSF術後の理学療法が術後回復過程に及ぼす効果について検討した。理学療法導入の有無により理学療法群24例(R群)と対照群24例(C群)に分け、患者背景、術式、画像所見、術中・術後の鎮痛剤使用量、術後回復過程を比較した。その結果、R群ではPonte骨切りの併用率が高い傾向にあり、術後の主カーブCobb角が有意に小さく、側彎矯正率が有意に大きかった。R群では手術翌日から経口摂取が可能で、鎮痛薬内服への早期切り替えと麻薬使用量の減少が得られており、尿道カテーテル留置期間と歩行開始までの期間は有意に短かったが、術後入院期間に有意差はなかった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: T-cell receptor-engineered T-cell therapies have achieved promising response rates against synovial sarcoma in clinical trials, but their applicability is limited owing to the HLA matching requirement. Chimeric antigen receptor (CAR) can redirect primary T cells to tumor-associated antigens without requiring HLA matching. However, various obstacles, including the paucity of targetable antigens, must be addressed for synovial sarcoma. Ligands for natural killer (NK) cell-activating receptors are highly expressed by tumor cells. METHODS: The surface expression of ligands for NK cell-activating receptors in synovial sarcoma cell lines was analyzed. We analyzed RNA sequencing data deposited in a public database to evaluate NKp44-ligand expression. Primary T cells retrovirally transduced with CAR targeting NKp44 ligands were evaluated for their functions in synovial sarcoma cells. Alterations induced by various stimuli, including a histone deacetylase inhibitor, a hypomethylating agent, inflammatory cytokines, and ionizing radiation, in the expression levels of NKp44 ligands were investigated. RESULTS: Ligands for NKp44 and NKp30 were expressed in all cell lines. NKG2D ligands were barely expressed in a single cell line. None of the cell lines expressed NKp46 ligand. Primary synovial sarcoma cells expressed the mRNA of the truncated isoform of MLL5, a known cellular ligand for NKp44. NKp44-based CAR T cells specifically recognize synovial sarcoma cells, secrete interferon-γ, and exert suppressive effects on tumor cell growth. No stimulus altered the expression of NKp44 ligands. CONCLUSION: NKp44-based CAR T cells can redirect primary human T cells to synovial sarcoma cells. CAR-based cell therapies may be an option for treating synovial sarcomas.

DOI： 10.1016/j.tranon.2022.101521

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This randomised phase II/III trial aimed to determine whether perioperative chemotherapy with gemcitabine plus docetaxel (GD) is non-inferior to the standard Adriamycin plus ifosfamide (AI) in terms of overall survival (OS) in patients with soft tissue sarcoma (STS). METHODS: Patients with localised high-risk STS in the extremities or trunk were randomised to receive AI or GD. The treatments were repeated for three preoperative and two postoperative courses. The primary endpoint was OS. RESULTS: Among 143 enrolled patients who received AI (70 patients) compared to GD (73 patients), the estimated 3-year OS was 91.4% for AI and 79.2% for GD (hazard ratio 2.55, 95% confidence interval: 0.80-8.14, P = 0.78), exceeding the prespecified non-inferiority margin in the second interim analysis. The estimated 3-year progression-free survival was 79.1% for AI and 59.1% for GD. The most common Grade 3-4 adverse events in the preoperative period were neutropenia (88.4%), anaemia (49.3%), and febrile neutropenia (36.2%) for AI and neutropenia (79.5%) and febrile neutropenia (17.8%) for GD. CONCLUSIONS: Although GD had relatively mild toxicity, the regimen-as administered in this study-should not be considered a standard treatment of perioperative chemotherapy for high-risk STS in the extremities and trunk. CLINICAL TRIAL REGISTRATION: jRCTs031180003.

DOI： 10.1038/s41416-022-01912-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Low-grade osteosarcomas, namely parosteal osteosarcoma (POS) and low-grade central osteosarcoma (LGCOS), occasionally dedifferentiate into high-grade malignancy, referred to as dedifferentiation in low-grade osteosarcoma (DLOS). This study aimed to elucidate the clinicopathologic features of DLOS, which are poorly described to date due to the extreme rarity of the disease. METHODS: A total of 33 patients with DLOS were included. Clinical characteristics, including the diagnostic accuracy of tumor biopsy, multimodal treatments, and clinical course, were retrospectively reviewed. Univariate analysis was performed to identify prognostic factors associated with overall survival (OS) and metastasis-free survival (MFS). RESULTS: The tumor subtypes comprised 10 cases (30.3%) of LGCOS and 23 cases (69.7%) of POS. The timing of dedifferentiation was synchronous in 25 (75.8%) and metachronous in 8 (24.2%) patients. The rates of preoperative diagnosis of DLOS were 40.0% and 65.4% for core needle biopsy and incisional biopsy, respectively. All patients underwent surgery and 25 patients received perioperative chemotherapy. Of the 13 patients who received neoadjuvant chemotherapy, 11 exhibited a poor histological response. The 5-year OS and MFS rates were 88.1% and 77.7%, respectively. Univariate analysis revealed that local recurrence was associated with poor OS (P < 0.01) and MFS (P < 0.01). Perioperative chemotherapy did not affect OS or MFS. CONCLUSIONS: The diagnostic accuracy of tumor biopsy for DLOS was lower than that for bone sarcomas, as reported previously. In contrast to conventional osteosarcomas with high chemosensitivity, both histological responses and survival analysis revealed low efficacy of chemotherapy for DLOS.

DOI： 10.1007/s10147-022-02223-8

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記述言語：日本語   出版者・発行元：(株)南江堂  

当院で人工股関節置換術(THA)を行った患者のうち、CT-based navigation下にセメントカップを設置した28例28関節(男性7例、女性21例、平均年齢69.2±12.4歳)のカップ設置角精度について検討した。その結果、セメントカップの絶対値誤差はRI 2.6±2.4°、RA 2.9±2.3°であった。また、BMIと誤差に相関はなく、初回THAと再置換、Paprosky分類において誤差に有意差はみられなかった。本法の結果はCT-based navigationを使用して設置したセメンレスカップに近い設置精度であることが示唆された。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20221111070004&doc_link_id=issn%3D0030-5901%26volume%3D73%26issue%3D11%26spage%3D1139&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0030-5901%26volume%3D73%26issue%3D11%26spage%3D1139&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J04037&link_issn=&doc_id=20221027340025&doc_link_id=10.15106%2Fj_besei82_128&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_besei82_128&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Near-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block. METHODS: Continuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated. RESULTS: A total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3. CONCLUSION: ACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls.

DOI： 10.1186/s12891-022-05735-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

INTRODUCTION: Fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) can provide tissue samples for the diagnoses of bone and soft tissue tumors. We evaluated the diagnostic accuracy of FNAC and CNB, the usefulness of the image-guided needle procedures, and assessed whether a discordance can influence the prognosis. PATIENTS AND METHODS: We retrospectively examined the accuracy rates of FNAC and CNB procedures by analyzing results of 405 specimens of 389 patients. We evaluated the diagnostic accuracy of FNAC and CNB, compared the clinical effectiveness between the image-guided procedures and the blind procedures, and also compared survival rates between the true positive and the false negative cases for patients with high-grade malignant tumors. RESULTS: The accuracy rates of FNAC were 86.6% and 93.8% for CNB. In cases with non-palpable masses, there were significantly low sampling error rates in the image-guided procedure. There were no significant differences in progression-free-survival and overall survival rates in patients between the false negative and true positive cases. CONCLUSION: Both FNAC and CNB procedures had high accuracy rates. Limited to cases with no palpable masses, the image-guided procedure had a low sampling error rate and was an effective method for obtaining tissue samples.

DOI： 10.1016/j.anndiagpath.2022.151936

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記述言語：日本語   出版者・発行元：(一社)日本骨粗鬆症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: This prospective cohort study aimed to (i) examine stroke incidence and stroke subtypes by chronic kidney disease (CKD) stage, (ii) examine whether CKD patients with or without proteinuria have a high risk of stroke independent of traditional cardiovascular risk factors, and (iii) determine precise estimates of stroke risk by CKD stage while accounting for competing mortality risk. METHODS: Participants were 2023 patients enrolled in the Project in Sado for Total Health between June 2008 and December 2016 (55% men; mean age, 69 years), of whom 52% had CKD (stage 1-2, 10%; G3a, 48%; G3b, 17%; G4-5, 11% and G5D, 14%). RESULTS: During a median follow-up of 5.7 years, 157 participants developed stroke and 448 died without developing stroke. Most stroke cases were ischaemic among non-dialysis-dependent CKD participants, but the relative frequency of ischaemic stroke was near that of intracerebral haemorrhage among dialysis-dependent CKD participants. After adjustment, stage 1-2 (hazard ratio [HR], 2.97; 95% confidence interval [CI], 1.60-5.51) and stage G3-5 participants with proteinuria (HR, 2.50; 95% CI, 1.56-4.02), but not stage G3-5 participants without proteinuria (HR, 0.64; 95% CI, 0.38-1.08), had a higher stroke risk compared to non-CKD participants. In competing risk analyses, the association was attenuated but remained significant. CONCLUSION: Although the distribution of stroke subtypes differed, CKD participants with proteinuria and those with CKD stage 5D had a 2- and 4-times higher risk of stroke, respectively, than that of non-CKD participants, after accounting for competing mortality risk and traditional risk factors.

DOI： 10.1111/nep.14049

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Chondrosarcoma is the second most common primary malignant bone tumor. In this multicenter study, we sought to evaluate the disease-specific survival (DSS) and disease-free survival (DFS), and prognostic factors in patients with dedifferentiated chondrosarcoma (DDCS) or grade 3 chondrosarcoma (G3CS) in Japan. We retrospectively investigated the treatment outcomes and prognostic factors in 62 patients with DDCS and 19 patients with G3CS at 15 institutions participating in the Japanese Musculoskeletal Oncology Group. We also clarified significant clinicopathological factors for oncological outcomes. In surgery for primary lesions aimed at cure, a histologically negative margin (R0) was obtained in 93% (14/15) of patients with G3CS and 100% (49/49) of patients with DDCS. The 5-year DSS was 18.5% in patients with DDCS and 41.7% in patients with G3CS (p = 0.13). Local control was obtained in 80% (12/15) and 79.6% (39/49) of patients with G3CS and DDCS in the primary lesion after surgery with a wide surgical margin, respectively. In multivariate analysis, stage and no treatment/palliative treatment for the primary lesion were independent prognostic factors for DSS of DDCS, and age and no treatment/palliative treatment for DSS of G3CS. The 5-year DFS rate was 22.8% in 26 patients with DDCS who did not receive adjuvant chemotherapy, and 21.4% in 14 patients who received adjuvant chemotherapy. The prognosis of DDCS remains poor, although R0 resection was carried out in most cases. Effective and/or intensive chemotherapeutic regimens or agents should be considered or developed for patients with high-grade chondrosarcoma, particularly for those with DDCS.

DOI： 10.1111/cas.15382

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

This study aimed to retrospectively analyze the clinical outcomes of patients with pelvic and retroperitoneal bone and soft tissue sarcoma (BSTS). Overall, 187 patients with BSTS in the pelvis and retroperitoneal region treated at 19 specialized sarcoma centers in Japan were included. The prognostic factors related to overall survival (OS), local control (LC), and progression-free survival (PFS) were evaluated. The 3-year OS and LC rates in the 187 patients were 71.7% and 79.1%, respectively. The 3-year PFS in 166 patients without any distant metastases at the time of primary tumor diagnosis was 48.6%. Osteosarcoma showed significantly worse OS and PFS than other sarcomas of the pelvis and retroperitoneum. In the univariate analyses, larger primary tumor size, soft tissue tumor, distant metastasis at the time of primary tumor diagnosis, P2 location, chemotherapy, and osteosarcoma were poor prognostic factors correlated with OS. Larger primary tumor size, higher age, soft tissue tumor, chemotherapy, and osteosarcoma were poor prognostic factors correlated with PFS in patients without any metastasis at the initial presentation. Larger primary tumor size was the only poor prognostic factor correlation with LC. This study has clarified the epidemiology and prognosis of patients with pelvic and retroperitoneal BSTS in Japan.

DOI： 10.3390/cancers14123023

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Teriparatide (TPTD) administration has a potent osteogenic action and promotes the healing of osteoporotic vertebral fractures (OVFs). We aimed to investigate the outcomes of vertebroplasty with posterior spinal fusion (VP + PSF) and determine the impact of perioperative TPTD administration. We included 73 patients (18 male and 55 female patients; mean age: 78 years) with thoracolumbar OVFs who underwent VP + PSF and were followed-up for at least 2 years. Twenty-three patients who received TPTD perioperatively for > 3 months were included in the TPTD group, and the remaining 50 patients were included in the non-TPTD group. Radiographic findings regarding sagittal alignment and clinical outcomes in both groups were compared. The mean duration of TPTD administration was 17.5 ± 5.0 months (range 4-24 months). The mean loss of correction of local kyphosis angle in the TPTD group (4.0°) was lesser than that in the non-TPTD group (7.5°; p < 0.05); however, no significant differences were observed between the groups regarding global sagittal alignment, the occurrence of subsequent vertebral fractures, pedicle screw loosening and treatment-efficacy rates of clinical outcomes. Local kyphosis correction in patients who underwent VP + PSF for OVFs could be maintained through perioperative TPTD administration; however, TPTD administration had little effect on clinical outcomes.

DOI： 10.1038/s41598-022-12655-x

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記述言語：英語  

DOI： 10.1007/s00774-022-01315-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To investigate the outcomes of the modified Thompson-Littler (m-TL) method, a corrective surgical method utilising a dynamic tenodesis, in patients with rheumatoid swan-neck deformity. METHODS: Twenty-seven fingers in 10 patients with rheumatoid arthritis (RA) underwent surgical correction. The mean age at the time of surgery was 60.3 (45-77) years, the mean duration of RA was 19.3 (4-34) years, and the mean postoperative follow-up period was 2.4 (0.5-6) years. RESULTS: The deformity was corrected and the proximal interphalangeal (PIP) joint pain disappeared in all operated fingers. The mean pinch power between the thumb and the operated finger increased. The active extension decreased, the active flexion increased, and the total arc of motion decreased. Comparing the range of motion by Nalebuff's type classification, the postoperative arc of motion decreased as the type advanced. CONCLUSIONS: The m-TL method provided a favourable outcome in cases of Type ≤III rheumatoid swan-neck deformity without severe joint deterioration at the PIP joint. Aesthetic and functional improvements were observed and the patients were satisfied with the operation.

DOI： 10.1093/mr/roab015

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Teriparatide (TPTD) is a potent promoter of early-stage osteogenesis and may be a useful adjuvant therapy to reduce complications related to bone fragility in spinal surgery patients with osteoporosis. However, effective neoadjuvant TPTD therapy regimens remain poorly understood. This study aimed to examine the effect of preoperative TPTD administration on cancellous bone with bone histomorphometry and to clarify the timing of preoperative TPTD administration for patients with spinal fusion and osteoporosis. METHODS: In this longitudinal multicenter study, 57 patients with spinal fusion and osteoporosis, who consented to undergo iliac biopsy, were allocated to the following treatment groups: neoadjuvant TPTD therapy group (n = 42) and no neoadjuvant therapy (NTC) group (n = 15). Patients in the TPTD group were categorized into subgroups on the basis of duration of preoperative TPTD administration, as follows: 1 month (n = 9), 2 months (n = 8), 3 months (n = 9), 4 months (n = 7), and 6 months (n = 9). All patient samples were preoperatively double labeled with tetracycline, and iliac biopsies were performed during spinal fusion surgery. Histomorphometric analyses were performed on nondecalcified, thin-sliced specimens. Specimens were classified on the basis of TPTD administration duration and subsequently compared with those of the NTC group. Postoperative complications and Oswestry Disability Index scores were evaluated at 1 and 2 years after surgery. RESULTS: There were no demographic differences between groups. Mineralizing surface/bone surface, a key parameter of dynamic bone formation, started to increase after 1 month of TPTD administration; this increase became significant after 3 months of administration and peaked at 4 months, with a 6-fold increase relative to that of the NTC group. The patients who received preoperative TPTD for 3 months or more had superior clinical results in terms of the osteoporotic complication rate and Oswestry Disability Index scores, except for bisphosphonate-pretreated patients. CONCLUSIONS: When considering neoadjuvant TPTD therapy, the authors recommend at least 3 months of preoperative administration to provide a more substantial anabolic effect from the early postoperative stage.

DOI： 10.3171/2021.5.SPINE202003

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J03098&link_issn=&doc_id=20220425530007&doc_link_id=%2Fdx3eastj%2F2022%2F003401%2F008%2F0033-0036%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdx3eastj%2F2022%2F003401%2F008%2F0033-0036%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)南江堂  

症例は60歳女性で、左大腿部の腫瘤を主訴に、前医を経て当科紹介となった。初診時画像所見・開放生検で多形型平滑筋肉腫と診断し、ゲムシタビン塩酸塩・ドセタキセル水和物療法を3コース施行するもSD判定であったため、広範切除術を行った。術後ゲムシタビン塩酸塩・ドセタキセル水和物療法を2コース行った。その後、両側の多発肺転移を生じたが、アドリアマイシン単剤療法を7コース施行し消失が得られた。さらに脳転移を生じたため全脳照射を開始したが、Trousseau症候群を発症しヘパリン持続静注を開始するも、発症約2ヵ月で死亡した。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20220131230013&doc_link_id=issn%3D0030-5901%26volume%3D73%26issue%3D2%26spage%3D141&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0030-5901%26volume%3D73%26issue%3D2%26spage%3D141&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語  

Herein, we present two cases of older adult patients with highly destructive changes in ankle joints (Larsen grade IV) who underwent retrograde intramedullary ankle nail fixation with fins. In both patients, bony union was achieved, and full weight-bearing was attained at 3 months after surgery.

DOI： 10.1002/ccr3.5348

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Preoperative chemotherapy is widely applied to high-grade localized soft tissue sarcomas (STSs); however, the prognostic significance of histological response to chemotherapy remains controversial. This study aimed to standardize evaluation method of histological response to chemotherapy with high agreement score among pathologists, and to establish a cut-off value closely related to prognosis. METHODS: Using data and specimens from the patients who had registered in the Japan Clinical Oncology Group study, JCOG0304, a phase II trial evaluating the efficacy of perioperative chemotherapy with doxorubicin (DOX) and ifosfamide (IFO), we evaluated histological response to preoperative chemotherapy at the central review board. RESULTS: A total of 64 patients were eligible for this study. The percentage of viable tumor area ranged from 0.1% to 97.0%, with median value of 35.7%. Regarding concordance proportion between pathologists, the weighted kappa coefficient (κ) score in all patients was 0.71, indicating that the established evaluation method achieved substantial agreement score. When the cut-off value of the percentage of the residual tumor area was set as 25%, the p-value for the difference in overall survival showed the minimum value. Hazard ratio of the non-responder with percentage of the residual tumor < 25%, to the responder was 4.029 (95% confidence interval 0.893-18.188, p = 0.070). CONCLUSION: The standardized evaluation method of pathological response to preoperative chemotherapy showed a substantial agreement in the weighted κ score. The evaluation method established here was useful for estimating of the prognosis in STS patients who were administered perioperative chemotherapy with DOX and IFO. TRIAL REGISTRATION: UMIN Clinical Trials Registry C000000096. Registered 30 August, 2005 (retrospectively registered).

DOI： 10.1186/s12885-022-09195-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Polypharmacy is associated with an increased risk of fracture in aging populations, but no study has accounted for the impact of kidney function on this association. This study aimed to examine the association between polypharmacy and incident fragility fracture based on chronic kidney disease (CKD) status. MATERIALS AND METHODS: Participants were 2023 patients (55% men; mean age, 69 years) of Sado General Hospital enrolled in the Project in Sado for Total Health (PROST) between June 2008 and December 2016. Among these, 65%, 28%, and 7% had non-CKD, non-dialysis-dependent CKD, and dialysis-dependent CKD, respectively. Multivariable Cox proportional hazards analysis was conducted with adjustments for potential confounders. RESULTS: Prevalences of polypharmacy (≥ 5 medications) and hyperpolypharmacy (≥ 10 medications) among participants were 43% and 9% for non-CKD, 62% and 23% for non-dialysis-dependent CKD, and 85% and 34% for dialysis-dependent CKD, respectively. During a median follow-up of 5.6 years, 256 fractures occurred. More medications were associated with a higher risk of fractures. Specifically, compared to participants without polypharmacy, adjusted hazard ratios were 1.32 (95% CI 0.96-1.79) and 1.99 (1.35-2.92) for those with polypharmacy and hyperpolypharmacy, respectively, after adjusting for osteoporosis risk factors, CKD status, and comorbidities. No effect modification by CKD status was observed (interaction P = 0.51). Population-attributable fractions of hyperpolypharmacy for fracture were 9.9% in the total cohort and 42.1% in dialysis-dependent CKD patients. CONCLUSION: Hyperpolypharmacy is associated with an increased risk of fragility fracture regardless of CKD status, and has a strong impact on incident fragility fractures in dialysis-dependent CKD patients.

DOI： 10.1007/s00774-021-01272-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To evaluate the impact of the flexibility of thoracolumbar or lumbar (TL/L) curves on low back pain (LBP) and disc degeneration in adult patients nonoperatively treated for adolescent idiopathic scoliosis (AIS). METHODS: Forty-seven adult patients (46 women; mean age, 40.5 years) nonoperatively treated for AIS with TL/L curves were included. The patients completed radiological examinations, magnetic resonance imaging, and a questionnaire survey for LBP evaluation. The flexibility of the spinal deformity was evaluated using supine side-bending radiographs. Radiographic measurements were correlated with scores for LBP and disc degeneration. RESULTS: The average magnitude and flexibility of the TL/L curve were 49.0° and 56%, respectively. The magnitudes of the TL/L curve and disc wedging were significantly correlated with LBP (|r|= 0.3-0.4). The flexibility of the TL/L curve and disc wedging, and the lumbar lateral range of motion (ROM) were significantly correlated with LBP and disc degeneration (|r|= 0.3-0.5). After controlling for the magnitudes of the TL/L curve and disc wedging, the flexibility of L4/5 disc wedging and the lumbar lateral ROM remained significantly correlated with the Scoliosis Research Society-22 pain score (partial correlation coefficient [r'] = 0.5 and 0.3), Oswestry Disability Index (- 0.3 and - 0.3), and disc degeneration (- 0.4 and 0.3). CONCLUSION: In AIS patients with TL/L curves, the flexibility of L4/5 disc wedging and the lumbar lateral ROM were significantly correlated with LBP and disc degeneration, independent of the magnitudes of the coronal deformities. Our findings indicate that maintaining or improving lumbar flexibility may be beneficial for preventing or treating LBP.

DOI： 10.1007/s43390-021-00402-7

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記述言語：日本語   出版者・発行元：新潟県医師会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The characteristics of the tumor immune microenvironment remains unclear in liposarcomas, and here we aimed to determine the prognostic impact of the tumor immune microenvironment across separate liposarcomas subtypes. A total of 70 liposarcoma patients with three subtypes: myxoid liposarcoma (n = 45), dedifferentiated liposarcoma (n = 17), and pleomorphic liposarcoma (n = 8) were enrolled. The presence of tumor infiltrating lymphocytes (CD4+ , CD8+ , FOXP3+ lymphocytes) and CD163+ macrophages and expression of HLA class I and PD-L1 were assessed by immunohistochemistry in the diagnostic samples; overall survival and progression-free survival were estimated from outcome data. For infiltrating lymphocytes and macrophages, dedifferentiated liposarcoma and pleomorphic liposarcoma patients had a significantly higher number than myxoid liposarcoma patients. While myxoid liposarcoma patients with a high number of macrophages were associated with worse overall and progression-free survival, dedifferentiated liposarcoma patients with high macrophage numbers showed a trend toward favorable prognosis. Expression of HLA class I was negative in 35 of 45 (77.8%) myxoid liposarcoma tumors, whereas all dedifferentiated liposarcoma and pleomorphic liposarcoma tumors expressed HLA class I. The subset of myxoid liposarcoma patients with high HLA class I expression had significantly poor overall and progression-free survival, while dedifferentiated liposarcoma patients with high HLA class I expression tended to have favorable outcomes. Only four of 17 (23.5%) dedifferentiated liposarcomas, two of eight (25%) pleomorphic liposarcomas, and no myxoid liposarcoma tumors expressed PD-L1. Our results demonstrate the unique immune microenvironment of myxoid liposarcomas compared to other subtypes of liposarcomas, suggesting that the approach for immunotherapy in liposarcomas should be based on subtype.

DOI： 10.1007/s00262-021-02928-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Synovial sarcoma is a rare malignant soft-tissue tumor that is prevalent in adolescents and young adults, and poor prognosis has been reported in patients with metastatic lesions. Chimeric antigen receptor (CAR) T-cell therapy is an emerging novel therapy for solid tumors; however, its application in synovial sarcoma has not yet been explored. METHODS: A novel human epidermal growth factor receptor 2 (HER2)-targeted CAR containing scFv-FRP5, CD8α hinge and transmembrane domains as well as 4-1BB costimulatory and CD3ζ signaling domains was developed. Three synovial sarcoma cell lines that expressed the fusion transcript SS18-SSX1/2/4 were used in the study. Cytokine secretion assay, cytotoxicity assay, and real-time cell analysis experiments were conducted to confirm the function of T cells transduced with the CAR gene. RESULTS: High cell-surface expression of HER2 was observed in all the cell lines. HER2-targeted/4-1BB-costimulated CAR T cells specifically recognized the synovial sarcoma cells, secreted interferon gamma and tumor necrosis factor alpha, and exerted cytotoxic effects in these cells. CONCLUSION: To the best of our knowledge, this is the first study to indicate that HER2-targeted CAR T cells are directly effective against molecularly defined synovial sarcoma cells. Furthermore, our findings might set the basis for developing improved CAR T cell-based therapies for chemo-refractory or relapsed synovial sarcoma.

DOI： 10.1016/j.tranon.2021.101227

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

新潟県立中央病院の外来に通院中のRA患者のうち、2010年4月～2018年3月にアバタセプトが導入された33例を対象とし、導入時年齢が65歳未満の群(18例)と65歳以上群(15例)に分け、導入後2年間の「CRP」「ESR」「DAS28-ESR」「MTX使用量」「PSL使用量」の経時的変化について群間ごとに調査した。結果、「CRP」は65歳未満群では導入時に比べて導入後3ヵ月以降に有意に改善し、65歳以上群では導入時に比べて導入後1ヵ月以降に有意に改善していた。「ESR」は65歳未満群では導入時に比べて導入後3ヵ月以降に有意に改善し、65歳以上群では導入後6ヵ月以降に有意に改善していた。「DAS28-ESR」は両群とも導入後3ヵ月以降に有意に改善していた。「MTX使用量」は65歳未満群では有意な変化なく、65歳以上群では導入後6ヵ月以降に有意に減少していた。「PSL使用量」は両群とも有意な変化はみられなかった。アバタセプトの継続率について調査した結果、1年継続率は65歳未満群72.2%、65歳以上群86.7%、2年継続率はそれぞれ72.2%、78.8%であり、1年・2年とも有意な群間差はみられなかった。

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

THA周術期のDVT予防方法として弾性包帯(EB)法は下腿マッサージ(CaM)法等に比べて簡便な方法であり、米国胸部外科学会ガイドラインではEB法において足関節圧30～40mmHgで圧迫することを推奨している。当科でもEB法を導入したが、その手順は術前にEBを患肢に巻いた後に足関節圧を計測し、圧計測器は術前に抜去しているため、術中の足関節圧は不明である。そこで今回、術前にどれくらいの圧でEBを巻けば術中に30～40mmHgとなるのか明らかにするため、健常人4名を対象とし、EBを巻いた後に二つの体圧計で足関節圧を計測し、計測後に一つを除去し、その後、もう一つで再度計測を行い、初回計測値との差を調べた。その結果、二つ装着しているときに比べて一つ除去すると足関節圧は平均8%減少していたことから、EBを巻く圧は34～43mmHgと定めた。EB法の効果について検討するため、2018～2021年に初回THAを施行した患者163例を対象とし、DVT予防法別にCaM群(149例)とEB群(14例)に分け、VTE発生率やPTE発生率を比較した。結果、VTE発生率はCaM群5.0%、EB群7.1%で、EB群のほうが若干高かったが統計学的有意差はなく、PTEの発生は両群ともなかった。

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

当院で2007～2013年に初回THAを施行した症例のうち、術前と術後1・3・5年時に腰椎の臥位側面X線と立位側面X線を撮影した50例(片側28例、両側22例)を対象に検討した。結果、立位での骨盤傾斜の変化は、片側例・両側例とも経年的に後傾していた。臥位での骨盤傾斜も経年的に後傾する傾向にあったが、術前に比べて有意差を認めたのは片側例では術後5年時のみであり、両側例では2回目術前と術後3年時のみであった。術前臥位での仙骨傾斜角(SS)に比べて術後5年時の立位SSが15°以上後傾していた群では、そうでない群に比べて、術前立位での前骨盤平面角(APPA)が有意に後傾していた。そこで、SSが術後15°以上後傾する術前APPA後傾のカットオフ値をROC解析により求めたところ、「11.5°後傾」と算出された。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The main function of skeletal muscles is to generate force. The force developed by myofiber contraction is transmitted to the tendon. There are two pathways of force transmission from myofibers to tendons: longitudinal transmission that depends on tension elicited via the myotendinous junction and lateral transmission that depends on shear elicited via the interface between the myofiber surface and surrounding connective tissue. Experiments using animal muscle and mathematical models indicated that lateral transmission is the dominant pathway in muscle force transmission. Studies using rat muscle showed that the efficiency of lateral force transmission declines with age. Here, the lateral transmission of force was measured using the extensor digitorum longus muscle from young and old mice. Dependence on longitudinal transmission increased in the old muscle, and there was a trend for lower efficiency of lateral force transmission in the old muscle compared to the young muscle. There was a noticeable increase in the connective tissue volume in the old muscle; however, there was no significant change in the expression of dystrophin, a critical molecule for the link between the myofiber cytoskeleton and extracellular matrix. This study demonstrates the measurement of lateral force transmission in mouse muscles and that alteration in force transmission property may underlie age-related muscle weakness.

DOI： 10.3390/ijms222212356

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記述言語：日本語   出版者・発行元：(株)北隆館  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pustulotic arthro-osteitis (PAO) is a major complication of palmoplantar pustulosis (PPP). In orthopedic surgery outpatient clinics, PPP patients with osteoarticular symptoms are seen frequently, but PAO's clinical features remain not well known. To determine Japanese patients' clinical features and treatment status with PAO, we conducted a single-center retrospective epidemiologic survey. Clinical features, including gender, age, smoking habit, the onset pattern, interval between skin manifestation and osteoarticular symptoms, and the incidence of sternoclavicular joint lesions, axial and peripheral joint lesions, were examined. The association between physical status and image findings by X-ray, computed tomography, bone scintigraphy with Technetium99 , or magnetic resonance imaging was evaluated. The distribution pattern of peripheral joint lesions and the treatment status were evaluated. We identified 51 patients, 10 men and 41 women, with PAO. The average age was 48 years and 59% were smokers. The frequency of onset patterns was skin-leading type (63%), simultaneous onset (18%), and osteoarticular leading type (16%). The average interval between skin involvement and osteoarticular involvement in skin-leading type was significantly longer than that in osteoarticular leading type (7.1 years vs. 2.0 years). A sternoclavicular joint (SCJ) lesion was detected in 65% cases, and the physical findings of SCJ were significantly related to the image findings. Axial and peripheral joint lesions were detected in the same ratio (23 cases, 45%). In the peripheral joints, the finger joint was the most common (26%), followed by the shoulder joint (21%). Patients were treated with nonsteroidal anti-inflammatory drugs (76%), followed by conventional synthetic disease-modifying antirheumatic drugs (DMARDs) (29%) and biological DMARDs (9.8%). Tonsillectomy was performed in 11 cases. In conclusion, PAO more frequently involves SCJ in middle-aged women who smoke. Given that osteoarticular leading type was detected in 16% cases, seronegative oligoarthritis patients should be monitored for PPP, leading to a diagnosis of PAO.

DOI： 10.1111/1346-8138.16107

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記述言語：日本語   出版者・発行元：(株)医学書院  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01554&link_issn=&doc_id=20211028060018&doc_link_id=10.11477%2Fmf.1408202188&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1408202188&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: It has been reported that C7 and C8 nerve root impairment can cause drop finger; however, the clinical characteristics of each injured nerve root and post-operative outcomes remain unclear. This study aimed to investigate the detailed features and surgery-related prognostic factors of drop finger caused by cervical radiculopathy. METHODS: We retrospectively investigated the clinical characteristics, paralysis patterns and surgery-related prognostic factors of 23 patients with drop finger caused by cervical radiculopathy who underwent posterior cervical foraminotomy. We classified paralysis into three patterns based on the fingers predominantly exhibiting extensor digitorum communis (EDC) muscle weakness: index finger side-dominant, middle and ring fingers-dominant and little finger side-dominant. RESULTS: The aetiologies were cervical disc hernia (CDH) in ten patients, cervical spondylotic radiculopathy (CSR) in eight and both CDH and CSR in five. The levels of the decompressed root were C7 in one patient, C8 in 11 and both C7 and C8 in 11. Scapular pain was frequently observed as the initial symptom (78%), especially in patients with only C8 nerve root disorder (91%). Drop finger recovered to a score of ≥ 3 on manual muscle testing in 17 patients; patients with the little finger side-dominant pattern tended to have poor recoveries. Patients with CDH improved significantly than those with CSR or both CDH and CSR (p < 0.05). CONCLUSIONS: Good surgical recovery of drop finger can be expected in patients with CDH and in those with index fingers-dominant and middle and ring fingers-dominant patterns.

DOI： 10.1007/s00264-021-05197-w

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記述言語：日本語   出版者・発行元：(一社)日本臨床バイオメカニクス学会  

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その他リンク： https://search.jamas.or.jp/default/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

記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1200/jco.2021.39.15_suppl.tps11580

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jos.2018.09.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 21-year-old man consulted our hospital for treatment of a spinal giant cell tumor (GCT) of Enneking stage III. Lower lumbar-spine tumors and severe spinal canal stenosis are associated with high risk for surgical mor-bidity. Stability was temporarily secured with a percutaneous pedicle screw fixation in combination with deno-sumab, which shrank the tumor. Total en bloc spondylectomy was then performed 6 months after initiation of denosumab, and the patient was followed for 3 years. There was no local recurrence, and bony fusion was obtained. Minimally invasive surgery and denosumab allowed safer and easier treatment of a collapsing lower lumbar extra-compartmental GCT.

DOI： 10.18926/AMO/61442

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

過去10年3ヵ月間の特発性側彎症に対する椎弓根スクリューによる後方矯正固定術(PSF)症例172例(男性16例、女性156例、手術時年齢10～20歳、平均15.2±2.0歳)を対象に、周術期疼痛管理および術後回復過程について後方視的に検討した。その結果、術後疼痛管理は平均4.1日間のフェンタニル持続静注(平均17.6μg/kg/日)で行われ、自立歩行は術後平均6.2日で開始、退院は術後平均11.0日であった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Clear cell chondrosarcoma is an extremely rare chondrosarcoma subtype; thus, its treatment outcomes and associated factors have not been widely studied. Knowing more about it is potentially important because clear cell chondrosarcomas are often misdiagnosed as other benign lesions and subsequently treated and followed inappropriately. QUESTIONS/PURPOSES: (1) What are the patient- and tumor-related characteristics of clear cell chondrosarcoma? (2) What proportion of patients with clear cell chondrosarcoma initially had a misdiagnosis or a misleading initial biopsy result? (3) What is the survivorship of patients with clear cell chondrosarcoma free from death, local recurrence, and distant metastasis, and what factors are associated with greater survivorship or a reduced risk of local recurrence? METHODS: Between 1985 and 2018, 12 Japanese Musculoskeletal Oncology Group (JMOG) hospitals treated 42 patients with a diagnosis of clear cell chondrosarcoma. All 42 patients had complete medical records at a minimum of 1 year or death, and were included in this multicenter, retrospective, observational study. No patients were lost to follow-up within 5 years of treatment but four were lost to follow-up greater than 5 years after treatment because their physicians thought their follow-up was sufficient. Clinical data were collected by chart review. The median (range) follow-up period was 69 months (2 to 392). In general, when a possibly malignant bone tumor was found on imaging studies, the histological diagnosis was made by biopsy before initiating treatment. Once the diagnosis had been made, the patients were treated by surgery only, complete resection if technically possible, because chondrosarcomas are known to be resistant to chemotherapy and radiotherapy. Unresectable tumors were treated with particle-beam radiation therapy. When patients with chondrosarcoma were referred after unplanned surgical procedures with inadequate surgical margins, immediate additional wide resection was considered before local recurrence developed. This diagnostic and treatment strategy is common to all JMOG hospitals and did not change during the study period. Primary wide resection was performed in 79% (33 of 42) patients, additional wide resection after initial inadequate surgery in 12% (five of 42), curettage and bone grafting in 5% (two of 42) patients, and radiotherapy was administered to 5% (two of 42). Surgical margins among the 40 patients who underwent surgery at JMOG hospitals were no residual tumor in 93% (37 of 42) of patients, microscopic residual tumor in 2% (one of 42), and macroscopic residual tumor or state after curettage or intralesional excision in 5% (two of 42). The oncological endpoints of interest were 5- and 10- year overall survival, disease-free survival, survival free of local recurrence, and survival free of distant metastases; these were calculated using the Kaplan-Meier method and compared using the log-rank test. Risk ratios with their respective 95% confidence intervals (CIs) were estimated in a Cox regression model. The Bonferroni adjustment was used for multiple testing correction. RESULTS: The sex distribution was 74% men and 26% women (31 and 11 of 42, respectively), with a mean age of 47 ± 17 years. Eighty one percent (34 of 42) of tumors occurred at the ends of long bones, and the proximal femur was the most common site accounting for 60% (25 of 42). The mean size of the primary tumors was 6.3 ± 2.7 cm. Definite pathologic fractures were present in 26% (10 of 42) and another 26% (10 of 42) had extraskeletal involvement. None had metastases at presentation. Twenty four percent (six of 25) tumors in the proximal femur were misdiagnosed as benign lesions and treated inadequately without biopsy. Twenty nine percent (10 of 35) patients had initial misdiagnoses by biopsy and core needle biopsies had a greater risk of resulting in inaccurate histological diagnoses. The study patients' 5- and 10-year overall survival rates were 89% (95% CI 74 to 96) and 89% (95% CI 74 to 96), respectively; 5- and 10- year disease-free survival rates 77% (95% CI 58 to 89) and 57% (95% CI 36 to 75), respectively; 5- and 10-year local recurrence-free survival rates 86% (95% CI 68 to 95) and 71% (95% CI 49 to 86), respectively; and 5- and 10-year distant metastasis-free survival rates 84% (95% CI 67 to 93) and 74% (95% CI 53 to 88), respectively. Notably, bone metastases (17%, seven of 42) were as common as pulmonary metastases (14%, six of 42); four patients developed both bone and pulmonary metastases. The difference between 10-year overall survival rates and 10-year disease-free survival indicated very late recurrence more than 5 years after the initial treatment. After controlling for multiple comparisons, the only factor we found that was associated with local recurrence-free survival was initial treatment (positive margin versus primary wide resection) (risk ratio 8.83 [95% CI 1.47 to 53.1]; p = 0.022 after the Bonferroni adjustment). Additional wide resection reduced the risk of local recurrence. CONCLUSIONS: The femoral head was the most common location of clear cell chondrosarcoma and had a high risk of misdiagnosis as common benign lesions that resulted in initial inadequate surgery and a consequent high risk of local recurrence. Immediate additional wide resection should be considered in patients who had initial inadequate surgery to reduce the risk of local recurrence. Because clear cell chondrosarcoma can recur locally or distantly in the bones and lungs in the long term, patients should be informed of the risk of very late recurrence and the necessity of decades-long with surveillance for local recurrence and lung and bone metastases. LEVEL OF EVIDENCE: Level IV, therapeutic study.

DOI： 10.1097/CORR.0000000000001266

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The treatment modality for desmoid-type fibromatosis has shifted from surgery to conservative treatment. The guideline committee for clinical care of extra-abdominal desmoid-type fibromatosis in Japan conducted a systematic review of treatment with doxorubicin-based chemotherapy for desmoid-type fibromatosis. METHODS: We searched the pertinent literature. Two reviewers evaluated and screened it independently for eligibility and extracted data. They rated each report according to the grading of recommendations development and evaluation methodology. Based on the 'body of evidence', which the reviewers created, the clinical guideline committee decided a recommendation for the clinical question, 'Is doxorubicin-based chemotherapy effective for patients with extra-abdominal desmoid-type fibromatosis?' RESULTS: Fifty-three articles were extracted by the literature search, and one from hand search. After the first and second screenings, five articles were subjected to the final evaluation. There were no randomized controlled trials. According to response evaluation criteria in solid tumors criteria, the response rates of doxorubicin-based regimens and liposomal doxorubicin were 44% (28.6-54) and 33.3% (0-75) on average, respectively. In two reports, the response rates of doxorubicin-based regimens were higher than those of non-doxorubicin-based ones; 54% vs 12%, 40% vs 11%, respectively. The rates of G3 or G4 complications according to common terminology criteria for adverse events were 28% and 13% with doxorubicin-based and liposomal doxorubicin chemotherapy, respectively, including neutropenia or cardiac dysfunction. None of the reports addressed the issue of QOL. CONCLUSION: Although the evidence level was low in the evaluated studies, doxorubicin-based and liposomal doxorubicin chemotherapy was observed to be effective. However, doxorubicin-based chemotherapy is associated with non-ignorable adverse events, and is not covered by insurance in Japan. We weakly recommend doxorubicin-based chemotherapy for patients with extra-abdominal desmoid-type fibromatosis in cases resistant to other treatments.

DOI： 10.1093/jjco/hyaa125

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jtcvs.2019.04.015

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: The pathophysiology of rheumatoid arthritis (RA) is characterized by excess production of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) by neutrophils and macrophages in synovium. Additionally, these cytokines promote the production of reactive oxygen species (ROS), and increased production of matrix metalloproteinases (MMPs), including MMP-3, in synoviocytes that result in joint destruction. There is limited information on how proteolytic enzymes such as MMP-3 can be regulated. We evaluated the effect of the antioxidant N-acetylcysteine (NAC) on RA and identified the relationship between the c-Jun N terminal kinase (JNK) pathway and MMP-3. We hypothesized that elucidating this relationship would lead to novel therapeutic approaches to RA treatment and management. METHODS: We investigated the effect of administering a low dose (1000 μM or less) of an antioxidant (NAC) to human rheumatoid fibroblast-like synoviocytes (MH7A cells). We also investigated the response of antioxidant genes such as nuclear factor erythroid -derived 2-related factor 2 (Nrf2) and Sequestosome 1 (p62). The influence of MMP-3 expression on the JNK pathway leading to joint destruction and the mechanisms underlying this relationship were investigated through primary dispersion culture cells collected from the synovial membranes of RA patients, consisting of rheumatoid arthritis-fibroblast-like synoviocytes (RA-FLS). RESULTS: Low-dose NAC (1000 μM) increased the expression of Nrf2 and phospho-p62 in MH7A cells, activating antioxidant genes, suppressing the expression of MMP-3, and inhibiting the phosphorylation of JNK. ROS, MMP-3 expression, and IL-6 was suppressed by administering 30 μM of SP600125 (a JNK inhibitor) in MH7A cells. Furthermore, the administration of SP600125 (30 μM) to RA-FLS suppressed MMP-3. CONCLUSIONS: We demonstrated the existence of an MMP-3 suppression mechanism that utilizes the JNK pathway in RA-FLS. We consider that the JNK pathway could be a target for future RA therapies.

DOI： 10.1186/s13018-020-01595-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Primary osteosarcoma in elderly patients are rare malignant tumors. Its optimal treatment has not yet been determined. METHODS: This retrospective study included 104 patients aged >50 years with resectable, non-metastatic osteosarcoma treated by the members of the Bone and Soft Tissue Tumor Study Group of the Japan Clinical Oncology Group. The effects of adjuvant chemotherapy were estimated by comparing outcomes in patients who received surgery plus chemotherapy with those who underwent surgery alone. RESULTS: Median age at presentation was 59 years. Neoadjuvant and adjuvant chemotherapy was administered to 83 (79.8%) patients. Patients who underwent surgery plus chemotherapy and those who underwent surgery alone had 5-year overall survival (OS) rates of 68.6% and 71.7%, respectively (p = 0.780), and 5-year relapse free survival (RFS) rates of 48.2% and 43.6%, respectively (p = 0.64). Univariate analysis showed that resection with wide margins was significantly correlated with better prognosis. CONCLUSIONS: The addition of chemotherapy to surgery did not improve OS or RFS in patients aged >50 years with resectable, non-metastatic osteosarcoma. Surgery with wide margins was only significantly prognostic of improved survival. The effect of chemotherapy in elderly osteosarcoma patients was unclear.

DOI： 10.1016/j.jos.2019.04.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.18999/nagjms.82.1.85

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Stanniocalcin-1 (STC1) is a glycoprotein that was originally identified as a calcium-regulating hormone in bony fish, and that has been shown to also critically mediate cell growth, proliferation and differentiation, etc. in humans. Increased STC1 expression levels have been previously detected in different human cancer samples, such as those isolated from lung, breast, ovary, colon, pancreas, and liver tumors; thus, the present study evaluated STC1 expression in various soft-tissue tumors. STC1 mRNA isolated from 16 cell lines and 186 clinical soft-tissue tumor specimens were analyzed via quantitative real-time PCR, and the calculated expression levels were normalized to those exhibited by STC1-expressing MDA-MB-231 cells. The results of these analyses did not reveal any specific histological tumor types that displayed significantly increased STC1 expression; however, they did not indicate that STC1 expression was significantly higher in malignant compared to benign soft-tissue tumors. Furthermore, in adipocytic tumors, STC1 expression in dedifferentiated liposarcomas was found to be highest and lowest in lipoma tissues, respectively, suggesting that adipocytic tumors may express increasely high levels of STC1 mRNA as they become histologically more advanced. STC1 expression correlates with the malignancy grade in soft-tissue tumors.

DOI： 10.18999/nagjms.82.1.85

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patellar tendon autograft after intraoperative extracorporeal radiotherapy has been used for reconstruction of the extensor mechanism following limb-sparing wide tumor resection around the knee. The purpose of this study was to determine the clinical outcome of this reconstruction technique. METHODS: We retrospectively reviewed six consecutive patients with peripatellar tendon and proximal tibial sarcoma who underwent reconstruction of the knee extensor mechanism. The resection area was planned to be contained with the patellar tendon in order to obtain a wide margin. First, the patella was osteotomized at the midline, and the inferior half of patella, patellar tendon, and tibial tuberosity were excised en bloc. The resected segments were devitalized with intraoperative extracorporeal radiotherapy and reimplanted into the original site. A follow-up evaluation included an assessment of the range of motion, extensor lag, the International Society of Limb Salvage score, and complications. RESULTS: Six patients were followed up for 121-270 months. One patient underwent an additional reconstruction with total knee arthroplasty due to a collapse of the tibial subchondral bone. A supracondylar fracture of the femur occurred in two patients, and a delayed union of the osteosynthesis site of the tibial shaft was observed in one patient. At the latest follow up, extensor lag had a median of five degrees, and International Society of Limb Salvage scores had a median of 83%. No local recurrence or rupture of the patellar tendon was observed. CONCLUSIONS: Reconstruction of the knee extensor mechanism using a patellar tendon treated with intraoperative radiotherapy is a reliable and successful method.

DOI： 10.1016/j.knee.2019.10.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The outcomes of unplanned surgery for bone sarcomas have not been frequently discussed. However, it is important to recognize patterns, treatment, and clinical outcomes of unplanned surgeries for patients with bone sarcomas. This multicenter study aimed to characterize the clinical outcomes of patients with bone sarcomas who underwent unplanned surgeries. PATIENTS AND METHODS: Data of 43 patients with bone sarcomas who underwent unplanned surgery between 2006 and 2017 were obtained from 23 hospitals in Japan. These included 18 cases of osteosarcoma, 9 of Ewing sarcoma, 8 of chondrosarcoma, and 6 of undifferentiated pleomorphic sarcoma. The study included 28 men and 15 women, with a mean age of 46 years. The mean follow-up duration was 59 months. RESULTS: The main primary tumor sites were the femur (n = 19), spine (n = 6), pelvis (n = 5), tibia (n = 3), and humerus (n = 3). The primary diagnoses were benign bone tumor (n = 24), trauma (n = 7), bone metastasis (n = 5), osteomyelitis (n = 4), degeneration (n=2), and unknown (n = 1). As unplanned surgeries, curettage, with or without bone graft, was performed in 26 patients; internal fixation was performed in 7; spinal surgery in 5; arthroplasty in 4; and arthroscopy in one. Thirty-eight patients received additional standard treatments. Thirty-four of these patients underwent surgical tumor resections, including amputation (n = 10), and the remaining 4 received radiotherapy or carbon ion radiotherapy as additional standard treatments. The 5-year disease-specific survival (DSS) rates in patients with osteosarcoma, Ewing sarcoma, and chondrosarcoma were 65.5%, 58.3%, and 72.9%, respectively. Twelve (27.9%) patients developed local recurrences (LR); among the total 43 patients studied, the 5-year DSS rates were significantly worse for those who developed LR compared to those who did not (p = 0.03). The 5-year DSS rates in patients with and without LR were 44% and 73.8%, respectively. CONCLUSION: We recommend that patients who have undergone unplanned surgery be administered standard treatment, including the option of amputation because herein, LR was shown to be a risk factor for decreased DSS.

DOI： 10.2147/CMAR.S270178

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Porphyromonas gingivalis infection can lead to periodontitis and dysbiosis, which are known risk factors for rheumatoid arthritis (RA). We investigated whether P. gingivalis administration affected bone regeneration in mice with or without arthritis. We administered P. gingivalis to male DBA/1 J mice that were or were not sensitised to type II collagen-induced arthritis (CIA). All mice underwent drilling of bilateral femurs. We histologically evaluated new bone regeneration (bone volume of the defect [BVd]/tissue volume of the defect [TVd]) using micro-computed tomography (micro-CT), osteoclast number/bone area, and active osteoblast surface/bone surface (Ob.S/BS). We measured serum cytokine levels and bone mineral density of the proximal tibia using micro-CT. CIA resulted in significantly reduced bone regeneration (BVd/TVd) at all time-points, whereas P. gingivalis administration showed similar effects at 2 weeks postoperatively. CIA resulted in higher osteoclast number/bone area and lower Ob.S/BS at 2 and 3 weeks postoperatively, respectively. However, P. gingivalis administration resulted in lower Ob.S/BS only at 2 weeks postoperatively. During later-stage bone regeneration, CIA and P. gingivalis administration synergistically decreased BVd/TVd, increased serum tumour necrosis factor-α, and resulted in the lowest bone mineral density. Therefore, RA and dysbiosis could be risk factors for prolonged fracture healing.

DOI： 10.1038/s41598-019-56265-6

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J00764&link_issn=&doc_id=20191129240016&doc_link_id=10.15106%2Fj_seikei70_1385&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_seikei70_1385&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Musculoskeletal sarcomas (MSSs) are rare cancers and often aggressive tumors that originate from mesenchymal tissue. Patients with advanced MSS often report difficulties with symptom burden, which can reduce their health-related quality-of-life. Objective: The aim of this study was to describe the patterns of the physical symptoms of MSS patients in the palliative setting and to detail the palliative treatment used in the last two weeks of life. Design: Retrospective study using the electronic patient records from a single institution. Setting/Subjects: A retrospective study was carried out in a sample of 46 consecutive MSS patients with locally advanced/metastatic disease, who were hospitalized and died in our department. The median age of these patients was 56 years at death. Measurements: Symptom burden and medical intervention during the last two weeks of life were collected. Results: The most frequent physical symptoms were pain and dyspnea in 93% and 78% of patients, respectively, while only 17% of patients suffered from nausea. A total of 98% of patients required opioids, and most patients were treated with morphine through either subcutaneous or intravenous continuous injection. Nonsteroidal anti-inflammatory drugs and acetaminophen were administered to 79% of patients. Corticosteroids were administered for the relief of dyspnea to 83% of patients. Of the patients, 46% received palliative chemotherapy within the last two weeks of life, and the oral treatment was continued until a median of 5.6 days before death. In addition, 39% of patients received a sedative treatment during the last two weeks of life for uncontrolled refractory symptoms. Conclusions: The symptom burden experienced by advanced MSS patients is profound at the end of life for all palliative approaches. Therefore, palliative medicine is an important and even crucial component of the continuum of care, allowing for aggressive symptom management with a variety of medical interventions, including palliative sedation.

DOI： 10.1089/jpm.2018.0415

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Tohoku University Medical Press  

Bone and soft tissue tumors are derived from mesenchymal cells, and they are hard to treat. Receptor-activator of nuclear factor-kappa B ligand (RANKL) is an essential cytokine for osteoclast differentiation and activation and is expressed on the surface of osteoblasts or stromal cells. In this study, to explore the potential of denosumab treatment for soft tissue tumors, we analyzed the expression profiles of RANKL mRNA in 425 tumor specimens of 33 histological types by real-time RT-PCR. Denosumab is a monoclonal antibody that prevents the binding of RANKL to receptor-activator of nuclear factor-kappa B (RANK). For comparison, the relative expression levels of RANK and osteoprotegerin (OPG) mRNAs were also measured. OPG functions as a soluble decoy receptor for RANKL. Higher expression levels of RANKL mRNA were detected in calcifying aponeurotic fibroma, fibrosarcoma, calcifying epithelioma, myositis ossificans, heterotopic calcification, giant cell tumor of the tendon sheath (GCTTS), and pigmented villonodular synovitis (PVNS), compared with the levels of other tumor types. Moreover, the expression levels of RANK mRNA were highest in GCTTS, followed by myositis ossificans and PVNS, whereas the expression levels of OPG mRNA were greatly varied among these histological types. We then analyzed RANKL protein expression by immunohistochemistry in 57 tumor specimens with higher expression levels of RANKL mRNA. RANKL-positive cells were detected in GCTTS, PVNS, myositis ossificans, heterotopic calcification, and calcifying aponeurotic fibroma. In conclusion, RANKL is expressed in subsets of soft tissue tumors with calcification, and denosumab is a potential therapeutic option for soft tissue tumors expressing RANKL.

DOI： 10.1620/tjem.248.87

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記述言語：日本語   出版者・発行元：日本手術医学会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

症例1は14歳女性で、左大腿骨転子下骨折を繰り返し、10歳時に大腿骨の矯正外反骨切り術とプレート固定術を施行した。13歳時にプレートを抜去したが2週間で同部骨折を生じ、矯正外反骨切り術と髄内釘固定を行った。術後4ヵ月で遠位横止めスクリューを抜去して骨癒合が得られた。症例2は30歳女性で、12歳時に右大腿骨転子下矯正外反骨切り術とA-O condylar angle plate固定を行った。13歳時からパミドロン酸3日間連続点滴投与を半年に一度2年間継続し、その後は内反変形の進行なく自立歩行可能である。症例3は87歳女性で、38歳時にMcLanghling nail固定と遊離腓骨柱移植で内固定を行い、術後32年でMcLanghling nail固定を抜去し、A-O dynamic condylar screw plate固定を行った。71歳時より疼痛コントロール目的にアレドロン酸の連日内服を開始し、軽度内反進行は認めるが掴まり歩行にて自宅で生活している。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The natural history of asymptomatic retroperitoneal schwannomas is poorly understood. This study aimed at investigating the natural history of incidental retroperitoneal schwannomas. The medical charts and imaging studies of 22 asymptomatic patients under observation for at least 12 months for retroperitoneal schwannomas were reviewed. The duration of follow-up ranged between 13 and 176 months (mean 48 months). In the 22 patients managed by the "wait and see" approach, the average tumor size at initial presentation was 51 mm, which increased to 57 mm at final follow-up. During the final follow-up, 2 patients required surgical treatment for tumor enlargement, while the remaining patients remained asymptomatic without surgery. The average growth rate of the tumors was 1.9 mm/year (range: -1.9 to 8.7 mm/year). The majority of asymptomatic retroperitoneal schwannomas demonstrate minimal growth and may be suitable for management with the "wait and see" approach.

DOI： 10.1371/journal.pone.0215336

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記述言語：英語  

A 34-year-old woman was diagnosed with acute promyelocytic leukemia. Chemotherapy was administered following the JALSG APL204 protocol. Induction therapy with all-trans retinoic acid resulted in complete remission on day 49. She developed coccygeal pain from day 18, which spread to the spine and cheekbones and lasted 5 weeks. She had similar bone pain on days 7-10 of the first consolidation therapy and on days 4-12 of the second consolidation therapy. Oral loxoprofen was prescribed for pain relief. On day 33 of the third consolidation, white blood cell and neutrophil counts were 320/μL and 20/μL, respectively. After she developed epigastralgia and hematemesis, she developed septic shock. Gastroendoscopy revealed markedly thickened folds and diffusely damaged mucosa with blood oozing. Computed tomography revealed thickened walls of the antrum and the pylorus. Despite emergency treatments, she died. Bacterial culture of the gastric fluid yielded Enterobacter cloacae and enterococci growth. Collectively, she was diagnosed with phlegmonous gastritis. Retrospective examination of serial bone marrow biopsy specimens demonstrated progressive bone marrow fibrosis, which may have caused prolonged myelosuppression. Thus, evaluation of bone marrow fibrosis by bone marrow biopsy after each treatment cycle might serve as a predictor of persistent myelosuppression induced by chemotherapy.

DOI： 10.1155/2019/1616237

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Erdheim-Chester disease is a rare histiocytosis with insufficient clinical data. To clarify the clinical features and prognostic factors of Erdheim-Chester disease, we conducted a nationwide survey to collect the detailed data of 44 patients with Erdheim-Chester disease in Japan. The median age of onset of the participants was 51 (range: 23-76) years, and the median number of involved organs per patient was 4 (range: 1-11). The existence of central nervous system disease was correlated with older age (P=0.033), the presence of cardiovascular lesions (P=0.015), and an increased number of involved organs (P=0.0042). The median survival from the onset was 10.4 years, and >3.0 mg/dL C-reactive protein level at onset was associated with worse outcome (median survival, 14.6 vs. 7.4 years; P=0.0016). In a multivariate analysis, age >60 years (hazard ratio, 25.9; 95% confidence interval, 2.82-237; P=0.0040) and the presence of digestive organ involvement (hazard ratio, 4.74; 95% confidence interval, 1.05-21.4; P=0.043) were correlated with worse survival. Fourteen patients had available histological samples of Erdheim- Chester disease lesions. BRAFV600E mutation was detected in 11 patients (78%) by Sanger sequencing. A correlation between BRAF mutation status and clinical factors was not observed. Our study revealed that age and digestive organ involvement influence the outcome of Erdheim-Chester disease patients, and an inflammatory marker, such as C-reactive protein, might reflect the activity of this inflammatory myeloid neoplasm.

DOI： 10.3324/haematol.2018.190728

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/cas.13769

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/mco.2017.1489

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s12185-017-2202-8

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

2005〜2015年までに、無治療のまま1ヵ月以上の間隔で複数回の画像評価を行った骨・軟部肉腫症例20例(男性14例、女性6例、年齢14〜85歳)を対象に、CTあるいはMRIのDICOMで腫瘍倍加時間を測定した。その結果、組織診断は未分化多型肉腫4例、高分化型脂肪肉腫、悪性末梢神経鞘腫瘍、平滑筋肉腫が各2例、その他10例で、骨腫瘍3例、軟部腫瘍17例であった。倍加時間は23〜858日、推定腫瘍発生時期は2.4〜84.7年前、推定腫瘍発生年齢は-8〜79歳であった。4例は先天性発生と推定され(生下時3例、-8歳1例)、そのうち2例は高齢者であった。最終転帰は腫瘍死9例、有病生存4例、無病生存7例で、腫瘍倍加時間が100日以内の6例は腫瘍死5例、多発転移1例で予後不良であった。

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その他リンク： http://search.jamas.or.jp/link/ui/2017355781

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.knee.2016.11.005

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記述言語：日本語   出版者・発行元：(一社)日本小児血液・がん学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J06030&link_issn=&doc_id=20170907100013&doc_link_id=%2Fex9syoga%2F2017%2F005402%2F013%2F0157-0160%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex9syoga%2F2017%2F005402%2F013%2F0157-0160%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：東北整形災害外科学会  

小児骨肉腫治療を行った51例(男児24例、女児27例、初診時平均年齢12.1歳)を対象に、二次がん(SMN)発生状況とその特徴について検討した。平均観察期間13.2年の結果、SMNの発生率は7.8%(4例)であった。SMN発生例は全て女児であり、女児はリスク因子と考えられた。また、全例で疾患特異的な融合遺伝子や染色体転座を認め、化学療法の影響が示唆された。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12957-017-1161-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2017.5696

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00256-016-2505-5

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記述言語：英語  

DOI： 10.1007/s10147-016-1051-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergen.2016.10.005

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

1988年〜2014年の間に施行された腫瘍用下肢人工関節151例中、20年以上にわたり経過観察が可能であった12例を対象に治療成績について検討した。その結果、12例中、7例(58.3%)で平均1.4回の再置換があった。様々な合併症により再置換の必要な場合があったが、歩行機能をはじめとする患肢機能は良好で、患者の満足度も高かった。就業調査では軽作業への配置転換や定年退職があったものの、失業中の症例はなく、社会復帰は順調であった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10147-016-0949-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1371/journal.pone.0156991

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

骨芽細胞様細胞である骨肉腫細胞株由来Saos-2とNOS-1を使用し、これまで癌骨転移などで報告されているインターロイキン-6(IL-6)/IL-6受容体(gp130)/STAT経路の活性化によるκ-Bリガンド核内転写因子受容体活性化因子(RANKL)産生のメカニズムが、Saos-2とNOS-1においても同様に作用しているか検討した。Saos-2、NOS-1の両細胞株においてIL-6受容体(gp130)が発現していることは定量的RT-PCR法によって確認できた。細胞培養液へのIL-6添加によりRANKLの発現量はSaos-2とNOS-1の両細胞株において経時的に増加し、特に72時間後には非添加群に比べSaos-2においては約2倍、NOS-1においては約2.5倍高値を示し、IL-6によるRANKLの発現増強効果が認められた。リン酸化特異的な抗体を用いたウエスタンブロット法により、細胞内におけるIL-6受容体の下流シグナルの変化について検討した。IL-6受容体添加後にSaos-2とNOS-1の両細胞株においてリン酸化STAT3の発現が高くなっていることが確認された。しかし、リン酸化AktとERK1/2の発現に大きな変化はみられなかった。Saos-2、NOS-1において、細胞はIL-6受容体を発現し、培養液にIL-6を添加することによりRANKL産生が促進され、そのメカニズムとしてSTAT3の活性化に伴う細胞内シグナルの関与が示唆された。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1371/journal.pone.0154680

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s13277-015-4232-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2015.3858

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2015.3506

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記述言語：日本語   出版者・発行元：(株)医学書院  

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その他リンク： http://search.jamas.or.jp/link/ui/2015404646

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2015.3257

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

16歳男性。誘因なく労作時左股関節痛が出現した。今回、徐々に増悪し、安静時痛や歩行困難が生じたため近医を受診、単純X線にて骨腫瘍を疑われ、著者らの施設へ紹介となった。臨床症状および画像所見より類骨骨腫と診断され、保存療法を行うも改善が得られず、約半年経過後、CTガイド下にてnidus摘出術と焼灼術を施行した。その結果、術後22日目に患肢部分荷重を開始し、術後83日目の最終観察時には患肢全荷重で日常生活に支障なく、歩行時痛も再発もみられなかった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1371/journal.pone.0123967

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00256-014-1897-3

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記述言語：英語  

DOI： 10.1212/WNL.0000000000000714

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2014.2082

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

2006年〜2012年に骨腫瘍の疑いで受診し、最終診断が骨髄炎であった6例(男児3例、女児3例、9〜17歳)を対象に、骨腫瘍と骨髄炎の鑑別について検討した。骨髄炎は高熱や局所の腫脹疼痛、血液検査でのWBC、CRP上昇といった強い炎症反応を伴うものから、これらがほとんどみられないものまで臨床症状は多彩である。炎症反応を伴わないあるいは軽微な場合に骨腫瘍との鑑別にしばしば苦労する。鑑別点は好発部位は骨髄炎は長管骨骨幹端、骨腫瘍は症例により多彩、MRIで骨髄炎は周囲のT2高信号、変化が強い、骨腫瘍は骨内外に腫瘤性病変を形成しやすい等である。いずれも迅速な診断が必須で、開放生検、細菌培養を速やかに施行することが重要である。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1471-2407-14-468

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：日本レックリングハウゼン病学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2014244734

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/cas.12208

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

尖足拘縮を生じた腓腹筋内血管腫1例と膝屈曲制限を生じた大腿四頭筋内血管腫1例について報告した。症例1は11歳男で、左腓腹部筋外側頭の圧痛と硬結を認め、膝伸展位での左足関節可動域は-45°であった。MRIでは左腓腹筋外側頭にT1強調画像で筋肉と等信号と高信号が混在し、T2強調画像では高信号と低信号が混在する腫瘍があり、管腔構造の造影効果を認めた。症例2は37歳男で、右大腿前面の硬結と圧痛、右膝関節可動域制限があり、MRIでは中間広筋内にT1強調画像で等信号、T2強調画像で高信号、内部に管腔構造の造影効果を伴う腫瘍を認めた。いずれも周囲筋肉と血管腫の切除により関節可動域は改善し、病理組織所見では周囲筋組織の線維化を認め、筋肉内血管腫と診断された。

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

37歳男性。左鼠径部から臀部側腹部にかけて18×9×2cm大の可動性不良な軟腫瘤を皮下に認め、軟部肉腫と診断され、広範切除術が施行された。その際、鼠径部は大腿動静脈神経の露出および24×17cmの皮膚軟部組織欠損を生じたため、有茎腹直筋皮弁を挙上移行し、左下腹部から左鼠径部の欠損を被覆した。また、左側腹部の腹膜露出部に対しては左大腿直筋弁、左大腿筋膜、左大腿筋膜張筋を左外側大腿回旋動静脈を茎とし、一塊として挙上後、腹膜側が筋膜側に接するように翻転し、欠損部を被覆補強した。更に大腿直筋は筋膜とともに腹膜露出部に縫合固定後、筋・筋膜弁上に左大腿からの分層植皮を施行した。その結果、病理診断では粘液線維肉腫もしくは粘液型悪性線維性組織球腫と診断された。術後は再発はなかったが、腹直筋採取部と植皮部の肥厚性瘢痕および下腹部のbulgingが認められた。尚、目下は膝の伸展・歩行に関しては日常生活に不自由を感じていないが、階段の昇りにやや困難を感じている。

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2012372566

記述言語：日本語   出版者・発行元：(一社)日本皮膚悪性腫瘍学会  

DOI： 10.5227/skincancer.26.311

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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その他リンク： http://search.jamas.or.jp/link/ui/2012161645

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2011.369

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1440-1827.2011.02683.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00432-010-0969-6

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

膝関節荷重部に発生した骨巨細胞腫26例(男13例・女13例・平均38歳)の治療成績を検討した。初回手術として腫瘍切除または掻爬後に再建術を行い、再発などに対する追加手術を含め最終手術は人工骨充填術13例、セメント充填術8例、固定術3例、腫瘍型人工関節置換術2例であった。観察期間2〜280ヵ月で、再建術後の新たなX線学的関節症性変化の出現は人工骨群1例、セメント群3例に認めた。International Society of Limb Salvage(ISOLS)患肢機能評価で平均点が他の群より低かったのは、painではセメント群4点、functionでは人工関節群3点、emotional acceptanceでは関節固定群1.3点、supportでは人工関節群4点、walkingでは人工関節群3.5点、gaitでは人工関節群3点であった。ISOLS患肢機能評価の総合平均は89%で、人工骨群97%、セメント群85%、関節固定群71%、人工関節群73%であった。人工骨群では、12例中10例が総合100%と良好であった。

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/or.2011.1141

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol.2011.246

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00776-010-0001-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jse.2010.05.017

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

表在性の軟部腫瘍や骨外性病変が触知できる骨腫瘍では触診しながら腫瘍または骨外病変を直接穿刺し、通常の骨腫瘍はX線透視下に穿刺を行った。深部の骨・軟部腫瘍に対してはCTガイド下に穿刺を行った。骨腫瘍および軟部腫瘍に対して行われた針生検983例のうち、最終的に切除材料または開放生検で確認ができた穿刺吸引細胞診(FNAC)359例(骨腫瘍90例、軟部腫瘍269例)、針組織生検(CNB)127例(骨腫瘍40例、軟部腫瘍87例)を対象とした。FNACでは、誤診はすべて偽陰性で3例に認めた。感度、特異度、偽陽性率、偽陰性率はそれぞれび94.3%、100%、0%、5%で、正診率は96.7%であった。CNBでは、臨床所見より判定が正しいものと判断された。誤診例はなかった。感度、特異度、偽陽性率、偽陰性率はそれぞれ100%、100%、0%、0%であり、正診率は100%であった。

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

症例1は30歳女性で、左膝痛が出現し徐々に増悪していたが原因がはっきりしなかった。症状が改善しないため5年後受診し、MRIで血管腫が疑われ受診した。左大腿遠位前面に疼痛・圧痛を認めたが明らかな腫瘤は触知せず、皮膚所見、左膝関節可動域は正常であった。単純X線で特記すべき所見はなく、MRIで左内側広筋内にT1、T2共に筋肉と比べ高信号と低信号が混在する造影効果のある腫瘤を認めた。血管腫を疑い辺縁切除術を施行した。病理診断は筋肉内血管腫で、術後、症状は消失し、3年経過時点で症状の再燃を認めていない。症例2は28歳男性で、左大腿痛が出現し、受診したが原因が分からず、症状は消失と出現を繰り返した。4年後、症状が強くなり、MRIで血管腫を疑われ受診した。左大腿遠位前面に圧痛を認めたが明らかな腫瘤は触知せず、皮膚所見、左膝関節可動域は正常であった。単純X線で特記すべき所見はなく、MRIで左内側広筋内にT1で筋肉と比べやや高信号、T2で筋肉と比べ高信号を呈する造影効果のある内部不均一な腫瘤を認めた。血管腫を疑い辺縁切除術を施行した。病理診断は静脈型血管腫で、術後、症状は消失した。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1440-1827.2009.02510.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00432-009-0678-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3892/ol_00000024

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記述言語：日本語   出版者・発行元：整形外科バイオマテリアル研究会  

下肢骨端の良性腫瘍に対する掻爬とβ-リン酸三カルシウム(β-TCP)移植の効果を後ろ向きに調べた。患者10名(男7名、女3名、手術時平均29歳)を対象とした。組織型は骨巨細胞腫が7名、軟骨芽細胞腫が3名であった。まず病巣に大きな開窓を施し、病巣を掻爬後、アルゴンビームレーザーと電気メスで掻爬壁を焼灼した。その後骨髄液を添加したβ-TCPを移植した。大腿骨頭例には血管付腸骨移植を、骨皮質の欠損した膝関節症例には遊離腸骨移植を実施した。手術後に再発を認めず、いずれも術後平均3ヵ月目には移植β-TCPと周囲正常骨の境界が不明瞭となり、移植β-TCPは自家骨へと置換されていた。関節可動域は健側と同程度に回復し、両側変形性膝関節症の既往を有する1名以外は疼痛もなく日常生活を送っている。以上より、下肢関節周辺に発生した骨腫瘍に対するβ-TCP移植は長期に安定した成績を期待できる治療法である。

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

歩行中に右股関節痛が出現した44歳女性症例について検討した。26歳時にIgM型骨髄腫、41歳時にマクログロブリン血症とそれに伴うアミロイドーシスの既往歴があった。単純X線像では右大腿骨頸部骨折および両側大腿骨頸部骨透亮像を認めた。MRI T1強調像では、両側大腿骨頸部および周囲筋内の低信号病変を認めた。画像所見、既往歴からアミロイド沈着による病的骨折の可能性が疑われ、両側大腿骨に人工骨頭置換術、経皮的ピンニング術を行った。摘出標本はアミロイド沈着陽性であった。M蛋白血症を合併する全身性アミロイドーシス患者の骨折は、アミロイド沈着による病的骨折の可能性を考慮すべきであると思われた。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergencyto.2009.02.011

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1471-2407-9-166

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergencyto.2008.11.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1756-9966-28-44

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DOI： 10.1186/1756-9966-28-44

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

切除不能な再発あるいは転移を有する骨・軟部腫瘍症例で、同意が得られた8症例に対しシクロスファミド(CPM)100mgの内服を中心とした外来化学療法を施行しており、その短期成績を報告した。症例により、ドキソルビジン(DOX)の静注を月一回施行した。DOX投与後2、3日は食欲不振を来たすことがあり、吐き気や不快感がある場合は、QOLの維持に主眼を置くためDOX静注は早めに中止した。高齢者の1例、長期の入院抗癌剤治療後の2例は好中球減少が生じてCPMを減量したが、血液毒性は軽度であり、連日投与が可能であった。薬剤投与に関しては外来で十分管理可能であった。投与2ヵ月後では部分奏功1例、安定5例、進行2例であった。部分奏功例では施行後1年間は腫瘍の十分な抑制効果がみられたが、DOXが極量となり、CPM内服単独となって再増悪した。腫瘍進行までの期間は1〜11ヵ月で、最終追跡時3例が有病生存で内服を継続中であり、5例が腫瘍死した。

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

症例1:49歳男。18歳時に第5頸髄を損傷し、完全四肢麻痺、不全呼吸麻痺となり、気管切開され人工呼吸器管理となった。受傷直後より仙骨部褥瘡を認めており、3年前に褥瘡部に隆起性腫瘤が出現し、徐々に増大した。入院時、仙骨部褥瘡に径約20cmの隆起した腫瘤があり、大量の排膿があった。CTにて右臀部から腸骨、仙骨まで浸潤する腫瘍、両肺に転移巣を認めた。右鼠径リンパ節の吸引細胞診にてリンパ節転移と診断され、腫瘍切除および右股関節離断、右大腿部筋皮弁を用いた欠損部再建を行った。病理診断は扁平上皮癌であった。術後肺転移が増大、呼吸状態悪化し、術後35日に死亡した。症例2:55歳男。21歳時に第4胸髄を損傷し、完全対麻痺となった。受傷直後より仙骨部褥瘡があり、約2年前に褥瘡内左半分に腫瘤性病変を認め、fibrous polyposisの診断で腫瘤切除された。その後、再び褥瘡内に腫瘤が出現し、急激に増大し、CTにて右臀部から骨盤内にかけて巨大な腫瘍性病変を認めた。入院時、仙骨部の褥瘡内部に易出血性の腫瘤があり、大量出血と排膿があった。生検で卵円形、紡錘形の細胞を認め、悪性線維性組織球腫と診断され、腫瘍切除および右半骨盤切除を施行し、大腿部筋皮弁を用いて再建した。術後1ヵ月に肺転移、局所再発を認め、化学療法を行ったが腫瘍は皮膚へ浸潤し、全身状態が悪化して術後56日に死亡した。

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記述言語：日本語   出版者・発行元：(株)医学書院  

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その他リンク： http://search.jamas.or.jp/link/ui/2008306918

記述言語：日本語   出版者・発行元：東北整形災害外科学会  

1988〜2006年にかけ著者らにより仙骨切断術が施行され、温存できた神経が術中において肉眼で確認できた仙骨脊索腫6症例を対象に、仙髄神経根と膀胱直腸機能の関係を検討した。その結果、1)S3神経根が膀胱直腸機能の維持に重要であることが確認された。2)両側S2神経根を温存した4例すべてに膀胱直腸障害が認められた。3)尿路変更、人工肛門例を除いた5例の自覚症状は、排尿している時の感覚の減弱、尿意の減弱、夜間の失禁、便秘が多かった。4)膀胱と直腸の知覚が低下し、膀胱収縮が減弱した状態であったことから、主に骨盤神経の障害によるものと考えられた。5)これらのことは骨盤神経障害が陰部神経障害より優位に出現していると考えられる傾向であり、過去に指摘されていない事実であった。6)脊索腫に限らず、腫瘍高位によってS3神経根の温存不可能な場合、術後の膀胱直腸機能障害は必発と考えられ、温存不可能な場合は術前に十分な説明が必要であると思われた。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00256-007-0318-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00428-007-0426-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergencyto.2007.04.016

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10165-007-0597-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergencyto.2007.04.009

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

40歳男。3歳時よりネフローゼ症候群のため内科で加療中であった。38歳時の胸部X線で右第5肋骨と左第6肋骨に骨硬化性の結節影を指摘され、骨島の疑いで経過観察されたが、40歳時に同結節影に増大傾向があり、当科紹介受診した。胸部X線像の経過をみると、17歳時には結節影を認めなかったが、38歳時では右第5肋骨と左第6肋骨に骨硬化性の結節影を認め、40歳時にはそれらが増大していた。骨盤部X線検査では両腸骨・右仙腸関節部、両恥骨、両坐骨、両大腿骨頸部、右大腿骨転子部に小斑状〜結節状の多発性骨硬化像を認め、胸部CT検査では肋骨・胸椎椎体の骨髄内に散在する結節性骨硬化像を認めた。血液検査ではネフローゼ症候群によると思われる低蛋白血症と軽度低リン血症を認めた。左腸骨の開放生検を行い、病理組織学的に海綿骨内に緻密骨を認め、骨島の所見であった。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1158/0008-5472.CAN-06-1483

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.biomaterials.2005.08.034

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.arth.2005.07.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1136/jcp.2004.024430

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergencyto.2005.02.003

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

症例1:16歳男.右大腿部腫脹があり,血腫除去術を施行された.術後創部からの出血が持続し,病理検査にて血腫は肉腫と多量の壊死組織であることが判明し,この時点で骨盤内腫瘤は転移巣であり,かつ多発肺転移の存在が判明した.アドリアシン,イフォマイドを施行したが,呼吸不全のため死亡した.最終的に骨外性Ewing肉腫と診断した.症例2:26歳女.後腹膜巨大嚢腫の診断で嚢腫除去術を施行し,術後Ewing肉腫と判明したため多剤併用化学療法を開始した.8年経過し無病生存中である.症例3:34歳男.左胸部皮下腫瘤があり,針生検でEwing肉腫が疑われたため多剤併用化学療法を開始した.1サイクル終了後に広範切除術を行い,現在無病生存中である.症例4:78歳女.左大腿軟部腫瘤があり,大腿動静脈温存腫瘍内切除術を行った.術後Ewing肉腫と判明したが,肺転移による呼吸不全のため死亡した

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1200/JCO.2005.05.042

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergentyto.2004.08.031

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1302/0301-620X.87B3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jbm.b.30136

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jbm.b.30136

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

78歳女.左大腿骨骨幹部骨折を受傷し,観血的骨接合術が施行された.しかし皮膚と筋膜の切開のみで3000mlの出血があり,臀部から下肢全体に広がる血管腫と判明した.X線所見で大腿骨骨幹部に横骨折を認め,骨折部周囲の皮下組織内に小さな石灰化を数個認めた.側面像では大腿骨の横径が小さく,骨硬化像を伴っていた.MRI-T2強調画像にて骨を含む大腿部全体に,高信号領域と低信号領域が混在し,血管腫と考えられる病変を認めた.創外固定術を施行し,術中出血は20mlであったが,術後も筋層内への出血と考えられる大腿軟部の腫脹を認めた.濃厚赤血球と新鮮凍結血漿を4単位ずつ輸血したが,術後1週で貧血が残存し,濃厚赤血球と新鮮凍結血漿を2単位ずつ更に輸血した.骨折受傷から約2年後に抜釘術を行い,再骨折防止目的で大ギプスを装着した.抜釘後8ヵ月現在も骨癒合良好で,膝の可動域は伸展0°,屈曲50°で疼痛もなく日常生活を送っている

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/jjco/hyh072

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cancergenyto.2003.11.007

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1158/1078-0432.CCR-03-0345

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1128/MCB.24.8.3460-3472.2004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00256-003-0701-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/S0046-8177(03)00430-1

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

症例1:51歳男.主訴は右腋窩部腫瘤.MRIでは尺骨神経と思われる部位にT1強調で筋肉と比し等〜高輝度,T2強調で辺縁が著明に高輝度で,内部がやや低輝度ないわゆるTarget signを呈する多房性の腫瘤が認められた.多発性神経鞘腫を疑い腫瘍核出術を施行した.大小6個の黄白色を呈する腫瘤が摘出され,病理組織診断は良性神経鞘腫であった.腫瘍は紡錘形細胞が密に存在し,充実性のAntoni Aと細胞密度が疎で粘液状のAntoni Bが混在してみられた.症例2:37歳女.主訴は左上肢腫瘤,疼痛.左前腕部のMRIではT1強調で筋肉に比し低輝度,T2強調でTarget sign陽性,T1〜Gdにてよく造影される多房性の腫瘤がみられた.多発性神経鞘腫を疑い腫瘍核出術を施行した.大小6個の黄白色を呈する腫瘤が摘出され,病理組織診断は神経鞘腫であった.本例もAntoni AとAntoni Bが混在してみられた.術後,橈骨神経領域にMMT1〜3程度の筋力低下が出現した.術後1年半経過した現在,筋力はほぼ回復しADL上不自由なくなっている

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記述言語：日本語   出版者・発行元：(NPO)日本小児がん学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/01.BRS.0000092344.14376.D9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/sj.gt.3302060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1349-7006.2003.tb01354.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Japan  

DOI： 10.1007/s10776-003-0650-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000071199

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

上肢悪性腫瘍に対する三角筋筋膜皮弁を用いた肩甲帯離断術を行った3例を経験した.症例1は61歳男性.右環指爪下部原発の悪性黒色腫で,腫瘍は尺骨,正中,筋皮神経内に浸潤していた.リンパ節以外の転移を認めず,三角筋筋膜皮弁で断端被覆を行う肩甲帯離断術を施行した.しかし,術後8年後に後腹膜腔への転移で死亡した.症例2は54歳男性.小児期の前腕部火傷瘢痕部に生じた扁平上皮癌で,前医に広範切除・脇窩リンパ節郭清を施行されたが,腋窩部で再発を来して受診した.症例1と同様に腋窩部切除の皮切デザインで手術を行ったが,術後約11ヵ月後に多発肺転移にて死亡した.症例3は76歳女性.乳癌切除後の左上肢リンパ血管肉腫で,左上腕内側の紫斑が上肢全体に拡大し,潰瘍も形成され受診した.腫瘍は上肢全体に進展し,左上背部,左前胸部までの浸潤を疑い,本術式を行った.術後約11ヵ月経過で再発,転移はない

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

足部に原発し悪性化した多発性内軟骨腫症の2例を経験した.症例1は初診時17歳男性.左足部痛が持続,内軟骨腫症の診断で左脛骨遠位部,母趾基節に掻爬骨移植施行した.31歳時に脛骨に再発し,舟状骨の腫瘍出現で掻爬骨移植を施行したが,32歳時に舟状骨部の疼痛出現,X線,CTで舟状骨外への浸潤を認め,悪性化と判断して左下腿切断を施行した.術後9年経過で再発,転移はない.症例2は初診時52歳男性で,左足部痛で受診し,X線で左第4,5趾,第5中足骨,踵骨,立方骨に透亮像を認め,多発性内軟骨腫症の診断で第4,5趾はMTP関節離断,第5中足骨と踵骨は掻爬骨移植を行った.組織診断は内軟骨腫であった.その後,69歳時に左足部の持続疼痛出現し,X線で立方骨の透亮像増大,骨皮骨の破壊と踵骨再発を認め,左下腿切断を施行した.術後半年経過で再発,転移はない.両症例とも下腿切断時の組織診断は軟骨肉腫であった

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jbm.10380

Web of Science

PubMed

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

21歳女の第1子である女児.妊娠25週,妊婦検診時の超音波検査で左下腿腫瘤を指摘された.妊娠29週より心不全徴候が出現したため経母体的投与によるジギタリス療法を開始し,妊娠31週,胎児仮死のため帝王切開で出生した.出生時,左下肢に径15×16cmの巨大な充実性腫瘤を認めた.腫瘍への血流の供給によると思われる心不全が出現した.針生検を行い,左下肢腫瘤を線維肉腫と診断した.心不全に加え,腫瘍そのものの増大と腫瘍上の皮膚の壊死傾向を認め,全身状態のすみやかな改善が必要と判断し,大腿切断術を施行した.術後よりすみやかに心不全は改善した.現在,術後112日の時点で局所再発,遠隔転移を疑わせる所見は認めていない

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記述言語：日本語   出版者・発行元：(一社)日本皮膚悪性腫瘍学会  

75歳男.左母指背側に隆起性腫瘤が出現した.左母指DIP関節背側の3.5×3.2cm大の暗紫紅色の腫瘤は,類円形で表面平滑,一部血痂を付着し,弾性軟,脆弱で易出血性,疼痛を伴っていた.胸部X線,CTで右上肺葉に径10cmを越える腫瘤陰影を認めた.強い疼痛と腫瘤の急速な増大で左母指切断術を施行した.病理組織では,腫瘍は核の濃染した小型な類円形細胞を主体とし,一部管腔様構造も認めた.また,組織の一部に腺腔様構造を取り囲む様に,または数珠状に配列する大型の上皮様細胞や,柵状に配列する紡錘形細胞を認め,二相性構造であった.免疫組織では,小型および紡錘形細胞はビメンチン陽性,上皮様細胞はCAM5.2陽性で,左母指の腫瘤は低分化型滑膜肉腫と診断し,肺腫瘤はその転移と考えた.全身状態より手術適応がないと判断し,肺腫瘤には放射線療法を開始したが,発症後6ヵ月で呼吸不全のため永眠した

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Japan  

DOI： 10.1007/s007760100046

Scopus

PubMed

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

症例は76歳の男性で主訴は多関節痛,両下腿紅斑,腫脹である.入院時,MRI所見は左膝T1強調像では脛骨で虫食い状の高低輝度混在,T2強調像でも同様で,一部低輝度に変化した部分が認められた.また右手のMRI T1強調像では,中指,環指,小指に低輝度陰影がみられた.入院時,アミラーゼ,リパーゼが異常高値で非定型的膵炎と考えメチル酸ガベキサート(FOY)を投与し,関節痛は膵炎合併骨内脂肪壊死と判断した.その後FOYによる膵炎治療の結果徐徐に疼痛が軽減し,アミラーゼ,リパーゼの正常化と共に疼痛消滅,独歩可能となった

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

30歳女.嚢腫を基部で切離し,嚢腫壁を縫縮することにより良好な結果を得た

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

坐骨腫瘍3例(外骨腫,血管腫,動脈瘤様骨嚢腫),恥骨腫瘍6例(軟骨肉腫3例,骨肉腫1例,Ewing肉腫1例,外骨腫1例)の治療成績を報告した.いずれも局所再発は無く,機能も極めて良好であった.Ewing肉腫の1例のみ腫瘍死したが,他の悪性腫瘍4例は無病生存していた.恥骨の一期的再建は不要と思われた

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

1)外傷性骨折後偽関節に対し,手術治療を行った20例を検討した. 2)初回偽関節手術で骨癒合が得られたのは,人工骨頭置換術2例を除く18例中15例. 3)偽関節手術として,骨移植+圧迫プレート法は,確実性のある術式である. 4)感染を伴わない難治性の偽関節に対しては,血管柄付き腓骨移植を行うことにより,ほぼ良好な経過を得た

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

1)片麻痺を合併した大腿骨頸部骨折症例について検討した. 2)臨床像としては,麻痺側の骨折率は80%と高く,性別では健常群に比べ男性の割合が高いという特徴があった. 3)麻痺合併症例は入院日数が長期化する傾向があり,退院時歩行再獲得率も低いことから,リハビリ病院等の中間施設の整備の必要性が示唆された

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

1)性別では麻痺側群は男性の割合が高いのに対し,健側群は全例女性であり有意差を認めた.この要因の一つとして,それぞれ麻痺側の易骨折性の関与,骨粗鬆症の関与が考えられた. 2)麻痺側群は歩行能力再獲得率に差はないものの,入院日数が長期化する傾向があった.これは麻痺と同一側に骨折が加わることにより,歩行機能を回復する迄に長い期間を要したためと考えられた

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記述言語：日本語

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00282&link_issn=&doc_id=20220126080015&doc_link_id=%2Fap4kange%2F2022%2F004102%2F014%2F0189-0194%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fap4kange%2F2022%2F004102%2F014%2F0189-0194%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語

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記述言語：日本語

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01133&link_issn=&doc_id=20220208130009&doc_link_id=%2Ffj2ortho%2F2022%2F009601%2F010%2F0053-0062%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffj2ortho%2F2022%2F009601%2F010%2F0053-0062%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20220111260016&doc_link_id=issn%3D0030-5901%26volume%3D73%26issue%3D1%26spage%3D56&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0030-5901%26volume%3D73%26issue%3D1%26spage%3D56&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：新潟整形外科研究会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

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記述言語：日本語   出版者・発行元：新潟整形外科研究会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：東日本整形災害外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本運動器疼痛学会  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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記述言語：日本語   出版者・発行元：(公社)日本整形外科学会  

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

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記述言語：日本語   出版者・発行元：東北整形災害外科学会  

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