研究者詳細 - 竹上　靖彦

Locked Tension Band Wiring for Mayo IIA Olecranon Fractures: Modified Surgical Technique and Retrospective Comparative Study of Clinical Outcomes and Cost-effectiveness with Locking Plate 査読有り国際誌

Kuwahara, Y; Takegami, Y; Mitsuya, S; Tokutake, K; Yamauchi, K; Imagama, S

JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME 28 巻 ( 02 ) 頁： 205 - 213 2023年4月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Hand Surgery Asian-Pacific Volume

Background: Tension band wiring (TBW) has traditionally been used for simple olecranon fractures, but due to its many complications, locking plate (LP) is increasingly being employed. To reduce the complications, we developed a modified technique for olecranon fracture repair, locked TBW (LTBW). The study aimed to compare (1) the frequency of complications and re-operations between LP and LTBW techniques, (2) clinical outcomes and the cost efficacy. Methods: We retrospectively evaluated data of 336 patients who underwent surgical treatment for simple and displaced olecranon fractures (Mayo Type II A) in the hospitals of a trauma research group. We excluded open fractures and polytrauma. We investigated complication and re-operation rates as primary outcomes. As secondary outcomes, Mayo Elbow Performance Index (MEPI) and the total cost, including surgery, outpatients and re-operation, were examined between the two groups. Results: We identified 34 patients in the LP group and 29 patients in the LTBW group. The mean follow-up period was 14.2 ± 3.9 months. The complication rate in the LTBW group was comparable to that in the LP group (10.3% vs. 17.6%; p = 0.49). Re-operation and removal rates were not significantly different between the groups (6.9% vs. 8.8%; p = 1.000 and 41.4% vs. 58.8%; p = 1.00, respectively). Mean MEPI at 3 months was significantly lower in the LTBW group (69.7 vs. 82.6; p < 0.01), but mean MEPI at 6 and 12 months were not significantly different (90.6 vs. 85.2; p = 0.06, 93.9 vs. 95.2; p = 0.51, respectively). The mean cost/patient of the total cost in the LTBW group were significantly lower than those in the LP group ($5,249 vs. $6,138; p < 0.001). Conclusions: This study showed that LTBW achieved clinical outcomes equivalent to those of LP and was significantly more cost effective than LP in the retrospective cohort.

DOI： 10.1142/S2424835523500224

思春期小児前腕骨骨幹部骨折に対する髄内釘とPlateでの治療成績の比較査読有り

石原典子, 徳武克浩, 竹上靖彦, 矢崎尚哉, 熊谷寛明, 太田英之

日本手外科学会雑誌 40 巻 ( 1 ) 頁： O17 - 1 2023年4月

Longer time of implantation using the buried pin technique for intramedullary nailing would decrease refracture in the diaphyseal forearm fracture in children-retrospective multicenter (TRON) study 査読有り国際誌

Ohshima, K; Tokutake, K; Takegami, Y; Asami, Y; Matsubara, Y; Natsume, T; Kimura, Y; Ishihara, N; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 54 巻 ( 3 ) 頁： 924 - 929 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Injury

Background: Intramedullary nailing using Kirschner wires in pediatric diaphyseal forearm fractures is often performed as a less invasive treatment than plate fixation, but it remains controversial whether the tips of Kirschner wires are buried or exposed. The purpose of this study was to investigate the relationship between whether the tips are buried or exposed and complications, especially of refracture. Methods: Data of 405 patients under 16 years who underwent surgical treatment for diaphyseal forearm fractures in our 11 hospitals between 2010 and 2020 were collected. Finally, 143 patients who underwent intramedullary nailing with at least 6-month follow-up were analyzed. We investigated difference in complication rates depending on whether the Kirschner wire tips were buried (Group B: n = 79) or exposed (Group E: n = 64). Regarding refractures, we also examined time of onset and status of bone union before the refracture occurred. Results: The duration before implant removal in Group B was more than 4 times longer than that in Group E (mean 187.9 vs. 41.4 days, p<0.001), although there was no significant difference in the progression of bone union between the two groups. Regarding postoperative complications, Group B had a significantly lower rate of refractures than Group E (7.9% vs. 32.8%, p<0.001), although the rate of irritation pain was significantly higher (15.2% vs. 1.6%, p = 0.006). The infection rate was also lower in Group B than Group E, but not significantly so (3.8% vs. 10.9%, p = 0.112). Refractures between 3 and 9 months after surgery accounted for 66.7% of all refractures, and those within 3 months accounted for 14.5% of all fractures. There was no significant difference in the status of bone union before the refracture occurred between patients with and without refracture. Conclusions: The present study showed that longer time of implantation using the buried pin technique for intramedullary nailing reduces refracture of pediatric diaphyseal forearm fractures. Because of the risk of refracture during remodeling, we recommend the implantation of intramedullary nailing for 6–9 months and the instruction for the patients and the parents to pay more attention to refracture at least within 9 months postoperatively. Level of Evidence: Level Ⅲ, Multicenter retrospective study.

DOI： 10.1016/j.injury.2023.01.025

高齢者橈骨遠位端骨折に伴う尺骨遠位端骨折に対する鋼線固定手術と尺骨頭切除術の比較多施設後ろ向き研究(TRON study) 査読有り

Comparison of the Relationship between Visual Acuity and Motor Function in Non-Elderly and Elderly Adults 査読有り国際誌 Open Access

Ito, S; Nakashima, H; Machino, M; Segi, N; Ishizuka, S; Takegami, Y; Takeuchi, J; Ouchida, J; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE 12 巻 ( 5 ) 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Clinical Medicine

This study aimed to clarify the relationship between visual acuity and motor function in younger and elderly participants and to compare differences between non-elderly and elderly participants. In total, 295 participants who underwent visual and motor functional examinations were included; participants with visual acuity ≥0.7 were assigned to the normal group (N group) and those with visual acuity ≤0.7 were assigned to the low-visual-acuity group (L group). Motor function was compared between the N and L groups; the analysis was performed by grouping participants into those aged >65 years (elderly) and those aged <65 years (non-elderly). The non-elderly group (average age, 55.6 ± 6.7 years) had 105 and 35 participants in the N and L groups, respectively. Back muscle strength was significantly lower in the L group than in the N group. The elderly group (average age, 71.1 ± 5.1 years) had 102 and 53 participants in the N and L groups, respectively. Gait speed was significantly lower in the L group than in the N group. These results reveal differences in the relationship between vision and motor function in non-elderly and elderly adults and indicate that poor vision is associated with lower back-muscle strength and walking speed in younger and elderly participants, respectively.

DOI： 10.3390/jcm12052008

柴田隆太郎, 徳武克浩, 竹上靖彦, 三矢聡, 山内健一, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 2 ) 頁： S134 - S134 2023年3月

テーパーウェッジステムで治療された高齢大腿骨頸部骨折患者におけるcanal fill ratioとステム沈下との関連査読有り

中島良, 竹上靖彦, 徳武克浩, 山本茂人, 内藤健太, 小倉啓介, 金村徳相, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S1161 - S1161 2023年3月

上腕骨遠位端関節内骨折(AO/OTA type C)術後の尺骨神経麻痺の発生に関わる因子の検討多施設共同研究TRON study 査読有り

大鹿泰嵩, 竹上靖彦, 徳武克浩, 岩瀬賢哉, 田中耕平, 横山弘樹, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S938 - S938 2023年3月

上腕骨遠位端骨折に対するdouble-plating固定法の臨床成績の比較多施設共同研究(TRON Study) 査読有り

横山弘樹, 竹上靖彦, 徳武克浩, 大鹿泰嵩, 田中耕平, 岩瀬賢哉, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S935 - S935 2023年3月

人工股関節周囲骨折に対する手術治療後の死亡率とその予後にかかわる因子の検討多施設共同後ろ向き研究(TRON study) 査読有り

黒川寛, 竹上靖彦, 徳武克浩, 高見英臣, 岩田愛斗, 寺澤慧, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S1076 - S1076 2023年3月

松野優司, 竹上靖彦, 徳武克浩, 高見英臣, 黒川寛, 岩田愛斗, 寺澤慧, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 2 ) 頁： S156 - S156 2023年3月

人工関節周囲大腿骨骨折のVancouver type Bの治療成績多施設共同後ろ向き研究(TRON Study) 査読有り

高見英臣, 竹上靖彦, 徳武克浩, 岩田愛斗, 寺澤慧, 黒川寛, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S1169 - S1169 2023年3月

整形外科領域におけるAI 胸部X線写真から骨密度を推測するAI医療機器の開発査読有り

佐藤洋一, 高原俊介, 山本乃利男, 稲垣直哉, 朝本学宗, 牧聡, 竹上靖彦, 斎藤充, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S656 - S656 2023年3月

肘頭骨折に対するLocked tension band wiringと従来法との比較多施設共同研究査読有り

桑原悠太郎, 竹上靖彦, 徳武克浩, 小口武, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S936 - S936 2023年3月

高齢者の橈骨遠位端骨折プレート固定後のリハビリでの自宅療法と作業療法の中期的な機能成績の比較 TRON study 査読有り

斎藤雄馬, 竹上靖彦, 徳武克浩, 柴田隆太郎, 森悠祐, 嵯峨咲, 川崎雅史, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 2 ) 頁： S337 - S337 2023年3月

整形外科インプラントの物流にかかるコストの基礎研究査読有り

山下暁士, 大山慎太郎, 山下佳子, 池田健一, 石塚真哉, 竹上靖彦, 今釜史郎

日本整形外科学会雑誌 97 巻 ( 3 ) 頁： S1215 - S1215 2023年3月

Retrospective Comparative Study of Clinical Outcomes and Cost-Effectiveness with Bone Substitutes on Volar Locking Plate Fixation of Unstable Distal Radial Fractures in the Elderly 査読有り国際誌

Mori, Y; Takegami, Y; Tokutake, K; Oka, Y; Imagama, S

JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME 28 巻 ( 1 ) 頁： 61 - 68 2023年2月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Hand Surgery Asian-Pacific Volume

Background: This multicenter retrospective study aimed to compare clinical outcomes and cost-effectiveness with bone substitutes on volar locking plate (VLP) fixation of unstable distal radial fractures (DRF) in the elderly. Methods: The data of 1,980 patients of ≥65 years of age who underwent surgery for the DRF with a VLP in 2015-2019 were extracted from a database (named TRON). Patients lost to follow-up or who received autologous bone grafting were excluded. The patients (n = 1,735) were divided into the VLP fixation alone (Group VLA) and VLP fixation with bone substitutes (Group VLS). Propensity score matching of background characteristics (ratio, 4:1) was performed. The modified Mayo wrist scores (MMWS) were evaluated as clinical outcomes. The implant failure rate, bone union rate, volar tilt (VT), radial inclination (RI), ulnar variance (UV) and distal dorsal cortical distance (DDD) were evaluated as radiologic parameters. We also compared the initial surgery cost and total cost for each group. Results: After matching, the backgrounds of Groups VLA (n = 388) and VLS (n = 97) were not significantly different. The MMWS values of the groups were not significantly different. Radiographic evaluation revealed no implant failure in either group. Bone union was confirmed in all patients in both groups. The VT, RI, UV and DDD values of the groups were not significantly different. The initial surgery cost and total cost in the VLS group were significantly higher than those in the VLA group ($3,515 vs. $3,068, p < 0.001). Conclusions: In patients of ≥65 years of age with DRF, the clinical and radiological outcomes of VLP fixation with bone substitutes did not differ from those of VLP fixation alone, yet the additional use of bone augmentation was associated with higher medical costs. The indications for bone substitutes should be more strictly considered in the elderly with DRF. Level of Evidence: Level IV (Therapeutic)

DOI： 10.1142/S2424835523500091

Differences in peri-hip articular pain after total hip arthroplasty between taper wedge stem and fit-and-fill stem 査読有り国際誌 Open Access

Kato, D; Takegami, Y; Seki, T; Osawa, Y; Takemoto, G; Okamoto, M; Iida, H; Imagama, S

JOURNAL OF ORTHOPAEDICS 35 巻頁： 58 - 63 2023年1月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Orthopaedics

Background: Total hip arthroplasty (THA) for hip disorders helps to alleviate pain and improve active daily life. When determining the effects of medical therapy and the subsequent clinical results, patient quality of life (QOL) also needs to be assessed. Recently, patient-reported outcomes (PRO) have become important as evaluation criteria. This study aimed to evaluate patient QOL and various PRO between different types of cementless stems and to clarify the relationship between PRO and stem-cortical bone contact. Methods: The study comprised 138 consecutive patients undergoing cementless THA for hip osteoarthritis. We assessed three different types of PRO: the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), patient's joint perception, and peri-hip articular joint pain (PHAP). We measured the state of contact between femur and implant by density mapping. Results: No significant difference was noted in PRO between stem types based on the JHEQ and patient's joint perception. PHAP occurred more frequently in the patients with a taper wedge stem versus a fit-and-fill stem. In both groups, distal contact was associated with PHAP but not with JHEQ results and patient's joint perception. Conclusion: The difference in PHAP between the two stem types groups was significant, with postoperative PHAP being higher with the taper wedge stem because of the more distal contact between the taper wedge stem and femur cortical bone.

DOI： 10.1016/j.jor.2022.10.014

Are the Clinical Results of Locking Plate Fixation for Distal Radius Fractures Inferior in Patients over 80 Years of Age? A Multicentre (TRON Group) Study 査読有り国際誌 Open Access

Sakurai, S; Takegami, Y; Tokutake, K; Kuwahara, Y; Shibata, R; Ota, H; Kumagai, H; Imagama, S

INDIAN JOURNAL OF ORTHOPAEDICS 57 巻 ( 1 ) 頁： 117 - 123 2023年1月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Indian Journal of Orthopaedics

Introduction: With the aging of the population, the proportion of distal radius fracture patients who are > 80 years of age is increasing. In this study, we compared the postoperative clinical and radiographic outcomes between super-elderly patients (age: ≥ 80 years) and middle-elderly (age: 65–79 years) who were treated with volar locking plate (VLP) fixation for distal radius fractures. Patients and Methods: Patients of > 65 years of age with distal radius fractures treated by VLP fixation between 2015 and 2019, and who were followed for at least 6 months after surgery were included in our database (named TRON). Patients with open fractures, multiple-trauma, or who received fixation with implants other than a VLP were excluded. We evaluated postoperative complications, Mayo wrist score (MWS), and radiographic outcomes. Results: We identified 589 patients in this study; 452 were 65–79 years of age (Group A) and 137 were ≥ 80 years of age (Group B). After propensity score matching, we evaluated 309 patients in Group A and 103 patients in Group B. The mean follow-up period was 10.7 ± 4.6 months. Twenty-eight patients (9.1%) in Group A and 5 patients in Group B (4.9%) experienced post-operative complications (non-significant: p = 0.212). The postoperative MWS at 1, 3, and 6 months, respectively, was 65.4 ± 11.7, 75.2 ± 11.0, and 79.6 ± 10.5 in Group A and 67.1 ± 9.61, 75.7 ± 10.7, and 80.6 ± 9.7 in Group B (non-significant: p = 0.418, 0.893, 0.452, respectively). The differences in volar tilt, radial inclination, ulnar variance between the postoperative and last follow-up radiographs did not differ between the two groups to a statistically significant extent (p = 0.053, 0.437, 0.529, respectively). Conclusion: Our study showed that the clinical and radiographic outcomes of distal radius fractures treated with VLP in super-elderly patients were comparable to those in middle-elderly patients.

DOI： 10.1007/s43465-022-00788-0