研究者詳細 - 竹上　靖彦

論文 - 竹上　靖彦

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Mortality and clinical outcomes of Vancouver type B periprosthetic femoral fractures 査読有り国際誌 Open Access

Takami, H; Takegami, Y; Tokutake, K; Kurokawa, H; Iwata, M; Terasawa, S; Oguchi, T; Imagama, S

BONE & JOINT OPEN 4 巻 ( 1 ) 頁： 38 - 45 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：Bone and Joint Open

Aims The objectives of this study were to investigate the patient characteristics and mortality of Vancouver type B periprosthetic femoral fractures (PFF) subgroups divided into two groups according to femoral component stability and to compare postoperative clinical outcomes according to treatment in Vancouver type B2 and B3 fractures. Methods A total of 126 Vancouver type B fractures were analyzed from 2010 to 2019 in 11 associated centres' database (named TRON). We divided the patients into two Vancouver type B subtypes according to implant stability. Patient demographics and functional scores were assessed in the Vancouver type B subtypes. We estimated the mortality according to various patient characteristics and clinical outcomes between the open reduction internal fixation (ORIF) and revision arthroplasty (revision) groups in patients with unstable subtype. Results The one-year mortality rate of the stable and unstable subtype of Vancouver type B was 9.4% and 16.4%. Patient demographic factors, including residential status and pre-injury mobility were associated with mortality. There was no significant difference in mortality between patients treated with ORIF and Revision in either Vancouver B subtype. Patients treated with revision had significantly higher Parker Mobility Score (PMS) values (5.48 vs 3.43; p = 0.00461) and a significantly lower visual analogue scale (VAS) values (1.06 vs 1.94; p = 0.0399) for pain than ORIF in the unstable subtype. Conclusion Among patients with Vancouver type B fractures, frail patients, such as those with worse scores for residential status and pre-injury mobility, had a high mortality rate. There was no significant difference in mortality between patients treated with ORIF and those treated with revision. However, in the unstable subtype, the PMS and VAS values at the final follow-up examination were significantly better in patients who received revision. Based on postoperative activities of daily life, we therefore recommend evision in instances when either treatment option is feasible.

DOI： 10.1302/2633-1462.41.BJO-2022-0145.R1

Do heel-unloading orthoses improve clinical outcomes in patients after surgical treatment of calcaneal fracture? A propensity-matched, multicenter analysis of the TRON database 査読有り国際誌

Kagami, Y; Tokutake, K; Takegami, Y; Okui, N; Sakai, T; Inoue, H; Kanemura, T; Hanabayashi, M; Ito, O; Kanayama, Y; Maruyama, K; Yoshida, H; Ando, T; Sugimoto, R; Sugimoto, T; Imagama, S

PROSTHETICS AND ORTHOTICS INTERNATIONAL 46 巻 ( 6 ) 頁： 569 - 575 2022年12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：Prosthetics and Orthotics International

Background:Postoperative protocols after surgical treatment of calcaneal fracture have not been standardized to date. There are only a few reports on the efficacy of heel-unloading orthoses (HUOs; Mars shoe, Graffin orthosis), and thier efficacy is uncertain.Objectives:The purpose of this study was to compare postoperative radiologic and clinical outcomes in patients with calcaneal fractures who used Graffin orthosis.Study design:Multicenter retrospective study.Methods:We finally extracted 182 patients from a database of the Trauma Research Group of Nagoya and divided them into two groups: group C (underwent casting or splinting only) and group O (Graffin orthosis was used). A propensity score algorithm was used to match group C to group O in a 1:1 ratio. We evaluated American Orthopaedic Foot and Ankle Society (AOFAS) score at three and six months after surgery and at final follow-up. Differences in reduction of the Böhler angle between the two groups were evaluated radiographically. All data were analyzed with a t-Test or Fisher's exact test. P <.05 was considered statistically significant.Results:The AOFAS score 3 months after surgery in group O was significantly higher than that in group C (69.57 vs. 77.22; P =.004). However, there were no statistically significant differences between group C vs. group O in AOFAS scores at 6 months after surgery and at final follow-up (81.92 vs. 85.67 and 89.18 vs. 88.13; P =.087 and 0.597, respectively). There was no significant statistical difference in the reduction of the Böhler angle (5.07 vs. 5.89; P =.529).Conclusions:At 3 months postoperatively, the orthosis group showed predominantly better functional results. We believe that heel-unloading orthoses are useful for patients who require an early return to work and to daily life.

DOI： 10.1097/PXR.0000000000000168

Gain-of-Function of FGFR3 Accelerates Bone Repair Following Ischemic Osteonecrosis in Juvenile Mice 査読有り国際誌

Kato, D; Matsushita, M; Takegami, Y; Mishima, K; Kamiya, N; Osawa, Y; Imagama, S; Kitoh, H

CALCIFIED TISSUE INTERNATIONAL 111 巻 ( 6 ) 頁： 622 - 633 2022年12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：Calcified Tissue International

Bone collapse, bone deformity, and a long treatment period are major clinical problems associated with juvenile ischemic osteonecrosis (JIO). Accelerating the process of bone repair in JIO is expected to shorten the treatment duration and better maintain morphology. We previously indicated that both bone formation and resorption were accelerated following distraction osteogenesis-mediated limb lengthening in genetically engineered mutant mice with a gain-of-function mutation in fibroblast growth factor receptor 3 (FGFR3) gene (i.e., Fgfr3 mice). The purpose of this study was to investigate the role of FGFR3 in the bone repair process following surgically induced ischemic osteonecrosis in the mutant mice. Epiphyseal deformity was less in the Fgfr3 mice compared to the wild-type mice at 6 weeks following ischemic osteonecrosis in skeletally immature age. Assessment of the morphology by micro-computed tomography (CT) revealed that the trabecular bone volume was increased in the Fgfr3 mice. Dynamic bone histomorphometry revealed increased rates of bone formation and mineral apposition in the Fgfr3 mice at 4 weeks post-surgery. The number of tartrate-resistant acid phosphatase (TRAP)-positive cells rapidly increased, and the numbers of TdT-mediated dUTP nick-end labeling (TUNEL)-positive cells rapidly decreased in the Fgfr3 mice. Vascular endothelial growth factor (VEGF) expression was increased at the earlier phase post-surgery in the Fgfr3 mice. The activation of FGFR3 signaling shortens the time needed for bone repair after ischemic osteonecrosis by accelerating revascularization, bone resorption, and new bone formation. Our findings are clinically relevant as a new potential strategy for the treatment of JIO.

DOI： 10.1007/s00223-022-01019-2

Does surgical treatment for unstable fragility fracture of the pelvis promote early mobilization and improve survival rate and postoperative clinical function? 査読有り国際誌

Saito, Y; Tokutake, K; Takegami, Y; Yoshida, M; Omichi, T; Imagama, S

EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY 48 巻 ( 5 ) 頁： 3747 - 3756 2022年10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：European Journal of Trauma and Emergency Surgery

Purpose: This retrospective multicenter study aimed to compare rates of early mobilization and survival and functional outcome of surgical treatment (S) with that of conservative treatment (C) according to each unstable fragility fracture of the pelvis (FFP) classification type with displacement of the posterior component ≥ 5 mm. Methods: We analyzed 64 patients with unstable type III and IV FFP who could move and transfer themselves before injury and had ≥ 5 mm displacement of the posterior component. We compared survival rate, early mobilization, walking ability at final follow-up, and complications at admission for each type of surgical and conservative treatment. Results: Most of the unstable FFP were type IIIa and IVb in the study population. Type III comprised 40 cases (group S:13/group C:27) and type IV comprised 24 cases (group S:7/group C:17). There were no significant differences in 3 month and 1 year survival rates, although group C (III) had the tendency of higher mortality rate (p = 0.08). Mobilization (transferring to a wheelchair) was enabled significantly earlier in group S (III) than in group C (III) (p = 0.02), but in type IV, most patients enabled early mobilization even without surgical intervention. There were no significant differences in hospital complications and walking ability at final follow-up. Conclusion: In this study, the superiority of surgical treatment for unstable FFP was not proven. However, the results suggest that type IVb may be a relatively stable type compared to type III and that type IVb should be considered separately from bilaterally complete unstable sacral fractures due to high-energy trauma.

DOI： 10.1007/s00068-021-01729-6

Plate fixation through the lateral extensile approach versus cannulated screw fixation through the sinus tarsi approach for calcaneal fracture: a multicenter, propensity score-matched TRON study 査読有り国際誌

Sugimoto, T; Tokutake, K; Takegami, Y; Okui, N; Kanayama, Y; Inoue, H; Sugimoto, R; Kagami, Y; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 32 巻 ( 7 ) 頁： 1333 - 1340 2022年10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：European Journal of Orthopaedic Surgery and Traumatology

Purpose: For calcaneal fracture, plate fixation through lateral extensive approach (LEP) is the most common procedure performed to achieve anatomic reduction. However, wound complications sometimes occur after LEP. To reduce complications, minimally invasive operative methods with cannulated screw fixation through sinus tarsi approach (STS) were developed. The aim of this multicenter propensity-matched study was to compare the clinical and radiographic outcomes of LEP to those of STS for calcaneal fracture and to evaluate the incidence of postoperative complications including surgical site infection (SSI). Methods: We extracted 271 patients with calcaneal fracture undergoing surgery between January 2014 and March 2019 from our multicenter TRON database. We assessed the American Orthopedic Foot and Ankle Society (AOFAS) score at the final follow-up as the clinical outcome. We obtained the Bohler and Preis angles as radiographic parameters and also recorded the complications. We divided the subjects into two groups: LEP group and STS group. To adjust for baseline differences between the groups, a propensity score matching algorithm was used in a 1:1 ratio. Results: After matching, there were 32 fractures in each group. There was no significant difference between the LEP versus STS group in AOFAS score at final follow-up (90 vs 90 points, p = 0.98) and in the Bohler and Pries angles (19.2 vs. 18.0 degrees, p = 0.74 and 16.0 vs. 17.5 degrees, p = 0.47). The rate of SSI in the LEP group was higher than that in the STS group (21.9% vs. 0.0%, p = 0.01). Conclusion: For calcaneal fracture, STS provides similar fixation effectiveness and functional outcomes as LEP while reducing the likelihood of infection.

DOI： 10.1007/s00590-021-03115-9

Effect of trochanter displacement on impingement and bone contact in total hip arthroplasty performed after curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head: a simulation study 査読有り国際誌 Open Access

Okamoto, M; Seki, T; Takegami, Y; Osawa, Y; Imagama, S

BMC MUSCULOSKELETAL DISORDERS 23 巻 ( 1 ) 頁： 850 - 850 2022年9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：BMC Musculoskeletal Disorders

Background: Curved intertrochanteric varus osteotomy (CVO) is a useful treatment option for osteonecrosis of the femoral head (ONFH). However, the effect of proximal femoral deformity in cases of CVO converted to total hip arthroplasty (THA) remains unclear. The aim of this study was to evaluate the effect of trochanter displacement on impingement and the contact state of the implant and femur in THA. Methods: Thirty-eight hips that had undergone CVO for ONFH were reviewed and compared with a control group of 30 contralateral hips that had not undergone surgery. The range of motion (ROM) and impingement patterns and the percentage of cortical bone in the stem placement within the femur were measured by simulation using CT-based three-dimensional template software. We also measured the ROM and the number of joints that achieved the ROM required for activities of daily living when the upward displaced apex of the greater trochanter with osteotomy was resected and compared the findings with those obtained when the apex was not resected. Results: The CVO group showed a significantly greater bony impingement in external rotation (68.4% vs. 43.3%, p = 0.033) and abduction (78.9% vs. 33.3%, p < 0.001) than in the control group. The CVO group showed a significantly smaller range of external rotation (19.0° [interquartile range; 4.0–28.8] vs. 38.0° [interquartile range; 36.0–41.8], p < 0.001) and abduction (23.0° [interquartile range; 8.5–38.8] vs. 56.0° [interquartile range; 50.3–60.0], p < 0.001) than in the control group. Significantly more joints achieved the ROM necessary for activities of daily living when the apex was resected than when it was not (10.5% vs. 63.2%, p < 0.001). The percentage of cortical bone in the stem placement position was significantly higher in the CVO group than in the control group in the proximal portion of the stem (25.5% vs. 0.0%, p < 0.001). Conclusion: In cases requiring conversion to THA, we recommend resecting the upward displaced apex to achieve a sufficient ROM and carefully resecting the bone to avoid malignment of the stem.

DOI： 10.1186/s12891-022-05803-x

Mortality and functional outcomes of fragility fractures of the pelvis by fracture type with conservative treatment: a retrospective, multicenter TRON study 査読有り国際誌

Omichi, T; Takegami, Y; Tokutake, K; Saito, Y; Ito, O; Ando, T; Imagama, S

EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY 48 巻 ( 4 ) 頁： 2897 - 2904 2022年8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：European Journal of Trauma and Emergency Surgery

Purpose: Fragility fractures of the pelvis (FFP) are becoming a commonly encountered disease in aging societies. We aimed to (1) clarify the overall survival rate of FFP, (2) compare survival rates by Rommens and Hofmann classification FFP type, (3) investigate the complications during hospitalization, and (4) investigate walking ability before and after injury depending on the type of fracture in patients with FFP treated conservatively. Methods: This retrospective, multicenter study included 867 patients with FFP treated conservatively between 2014 and 2018 and excluded patients with insufficient follow-up for two years, lost data, and operative cases. This is a retrospective multicenter study. We established the database, which is named as TRON. We evaluated survival rate by fracture type using the log-rank test. We compared walking ability as defined by a new mobility score and the modified Majeed Pelvic Score among fracture types. Results: We reviewed 552 cases (98 males and 454 females) with conservative treatment. The overall survival rates of patients with FFP treated conservatively were 0.90 at 1 year and 0.83 at 2 years. Although the survival rate was the lowest in FFP Type III, there was no significant difference in survival rates between fracture types (P = 0.143). The rates of complications during hospitalization were high for both Type III and Type IV fractures. Walking ability post-injury was worse in the patients with Type III fracture. Conclusions: The survival rate of patients treated by conservative treatment was relatively good. Type III in the Rommens and Hofmann classification was related to lower life expectancy and loss of walking ability.

DOI： 10.1007/s00068-021-01839-1

Risk factors for fracture-related infection after open reduction and internal fixation of proximal humerus fractures: A multicenter retrospective study of 496 fractures (TRON group study) 査読有り国際誌

Makihara, K; Takegami, Y; Tokutake, K; Yamauchi, K; Hiramatsu, Y; Matsuura, Y; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 53 巻 ( 7 ) 頁： 2573 - 2578 2022年7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：Injury

Introduction: One of the complications of the surgical therapy for proximal humerus fractures is fracture-related infection (FRI). This multicenter study aimed to investigate the incidence of FRI and clarify the risk factors associated with FRI in patients receiving open reduction and internal fixation for proximal humerus fracture. Material and methods: Among 684 patients diagnosed as having proximal humerus fracture and who were treated by surgical therapy in 13 institutions (named TRON group) from 2015 through 2020, 496 patients (men, n = 134, women, n = 362; mean [SD] age, 68.5 [14.5] years; mean [SD] body mass index [BMI], 23.0 [4.4] kg/m2) were included as subjects. Excluded were 188 patients due to less than 12 month's follow-up, patients who underwent osteosynthesis using neither plate nor nail and those with open fracture. We extracted the following as risk factors of FRI: sex, BMI, smoking status, diabetes, glenohumeral fracture dislocation, fracture classification, approach, implant, waiting period, type of anesthesia, operative time and blood loss during surgery. We conducted logistic regression analysis to investigate the risk factors of FRI using these extracted items as explanatory variables and the presence or absence of FRI as the response variable. Result: FRI occurred after surgery for proximal humerus fracture in 9 of the 496 patients (1.8%). The causative organism was methicillin-susceptible Staphylococcus aureus in 4 patients, Pseudomonas aeruginosa in one patient and Enterococcus faecalis in one patient. In the other 3 patients, causative organisms were not detected. The univariate analysis showed significant differences for present of glenohumeral fracture dislocation (p = 0.004). Logistic regression analysis showed glenohumeral fracture dislocation to be the significant explanatory factor for FRI (odds ratio 12.3, p = 0.0375). Conclusion: This study revealed an infection rate following open reduction and internal fixation of proximal humerus fracture of 1.8% (9 patients) and that Staphylococcus was the most frequent causative organism. Glenohumeral fracture dislocation is a significant risk for postoperative FRI.

DOI： 10.1016/j.injury.2022.05.022

The Association of Bohler's Angle With Postoperative Pain and Gender for Displaced Intra-Articular Calcaneal Fracture, Multicenter Retrospective Study-TRON Study 査読有り国際誌 Open Access

Sugimoto, R; Tokutake, K; Takegami, Y; Kanayama, Y; Okui, N; Sakai, T; Kagami, Y; Sugimoto, T; Imagama, S

JOURNAL OF FOOT & ANKLE SURGERY 61 巻 ( 4 ) 頁： 766 - 770 2022年7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 Foot and Ankle Surgery

A relationship between Böhler angle (BA) before or after surgery and clinical outcomes remains unclear. This retrospective multicenter cohort study aimed to compare pain and functional outcomes between a group in which the reduction angle was preserved and a group in which the reduction angle was lost during follow-up, and to clarify the risk factors leading to loss of last follow-up BA. From 2014 to 2018, 271 cases of calcaneal fractures were surgically treated at ten facilities. We divided patients into Group L (lost reduction of fracture) and Group P (preserved reduction of fracture). We matched subjects between the 2 groups according to age, sex and BA before surgery and compared American Orthopedic Foot and Ankle Society (AOFAS) score between the groups. We investigated the correlation between the amount of BA loss and postoperative pain. The factors leading to loss of last follow-up BA were examined by logistic regression analysis. Ultimately, 112 patients were eligible. After matching, each group included 38 patients. There was no difference between the 2 groups in total AOFAS score. However, the pain component of AOFAS score at 6 months and 12 months were worse in group L than in group P (p = .011, p = .031, respectively). We also showed a weak correlation between the amount of BA loss and postoperative pain. Logistic regression analysis revealed that female and BA before surgery independently predicted loss of reduction (odds ratios: 4.66, 95% CI: 1.15-18.9 and odds ratios: 0.90, 95% CI: 0.82-0.99, respectively). We clarified that reduction and preservation of BA within its normal range should lead to decrease postoperative pain. Female and lower pre-BA were risk factors leading to loss of reduction of BA in operative treatment of calcaneal fractures.

DOI： 10.1053/j.jfas.2021.11.011

大腿骨遠位端関節外骨折におけるロッキングプレートと逆行性髄内釘の治療成績比較査読有り

桑原悠太郎, 竹上靖彦, 徳武克浩, 山田陽太郎, 小牧健太郎, 今釜史郎

骨折 44 巻 ( Suppl. ) 頁： S262 - S262 2022年6月

A preliminary examination of the association between locomotive syndrome and circulating miRNA-199 in community-dwelling people: The Yakumo study 査読有り Open Access

Takegami, Y; Seki, T; Osawa, Y; Makida, K; Ochiai, S; Nakashima, H; Fujii, R; Yamada, H; Suzuki, K; Hasegawa, Y; Imagama, S

JOURNAL OF ORTHOPAEDIC SCIENCE 27 巻 ( 3 ) 頁： 696 - 700 2022年5月

担当区分：筆頭著者,　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 Orthopaedic Science

Background: The risk of locomotive syndrome (LS) has been proposed as a criterion for evaluating physical ability. The expression levels of circulating miRNAs (c-miRNAs) are predictors of various diseases. This preliminary study aimed to evaluate the relationship between serum levels of several miRNAs and LS. Methods: We enrolled 423 participants in whom we conducted a survey with the 25-question Geriatric Locomotive Function Scale (GLFS-25) and measured the serum levels of 21 c-miRNAs. The relationship between the GLFS-25 and each c-miRNA was evaluated with a linear regression analysis, and independent associations between the GLFS-25 and each c-miRNA were assessed with a multiple regression analysis using various independent variables. Results: Only the serum level of miR-199 was significantly associated with LS after adjustment for age, BMI, sex, and all comorbidities. The receiver operating characteristics curve for the predictive value of the miR-199 level to indicate the presence or absence of LS risk had an area under the curve (AUC) of 0.576 (95% confidence interval: 0.501–0.651). Conclusion: The expression level of miRNA-199 was associated with the risk of LS in community-dwelling Japanese people.

DOI： 10.1016/j.jos.2021.02.003

Comparison of periprosthetic femoral fracture torque and strain pattern of three types of femoral components in experimental model 国際誌 Open Access

Takegami, Y; Seki, T; Osawa, Y; Imagama, S

BONE & JOINT RESEARCH 11 巻 ( 5 ) 頁： 270 - 277 2022年5月

担当区分：筆頭著者,　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：Bone and Joint Research

Aims Periprosthetic hip fractures (PPFs) after total hip arthroplasty are difficult to treat. Therefore, it is important to identify modifiable risk factors such as stem selection to reduce the occurrence of PPFs. This study aimed to clarify differences in fracture torque, surface strain, and fracture type analysis between three different types of cemented stems. Methods We conducted biomechanical testing of bone analogues using six cemented stems of three different types: collarless polished tapered (CPT) stem, Versys Advocate (Versys) stem, and Charnley-Marcel- Kerboull (CMK) stem. Experienced surgeons implanted each of these types of stems into six bone analogues, and the analogues were compressed and internally rotated until failure. Torque to fracture and fracture type were recorded. We also measured surface strain distribution using triaxial rosettes. Results There was a significant difference in fracture torque between the three stem types (p = 0.036). Particularly, the median fracture torque for the CPT stem was significantly lower than that for the CMK stem (CPT vs CMK: 164.5 Nm vs 200.5 Nm; p = 0.046). The strain values for the CPT stem were higher than those for the other two stems at the most proximal site. The fracture pattern of the CPT and Versys stems was Vancouver type B, whereas that of the CMK stem was type C. Conclusion Our study suggested that the cobalt-chromium alloy material, polished surface finish, acute-square proximal form, and the absence of a collar may be associated with lower fracture torque, which may be related to PPF.

DOI： 10.1302/2046-3758.115.BJR-2021-0375.R2

Displaced humeral head after intramedullary nailing for proximal humeral fracture is associated with worse short-term outcomes-a multicenter TRON study. 査読有り国際誌 Open Access

Hiramatsu Y, Takegami Y, Katsuhiro T, Matsuura Y, Makihara K, Kanemura T, Imagama S

JSES international 6 巻 ( 3 ) 頁： 374 - 379 2022年5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：JSES International

Background: In recent years, complex and unstable proximal humeral fractures (PHFs) are treated with intramedullary nails (IMNs) in the elderly; however, the postoperative radiographic findings related to the clinical outcome are not clear. This study evaluated the association of clinical outcomes with the radiographic findings of PHFs treated with IMNs. Methods: We collected data of patients aged >60 years with PHFs treated with IMNs from 2015 to 2019 in 13 associated centers' database (named TRON). We excluded patients lost to follow-up of <6 months postoperatively (PO6M). We evaluated clinical outcomes with the University of California at Los Angeles (UCLA) score at PO6M and defined a score of <27 as poor. We assessed the radiographic findings on the anteroposterior view of the humeral head postoperatively, and each radiographic finding such as humeral head height (HHH), head shaft angle, and cranialization of the greater tuberosity was divided into two groups: poor and good. Factors associated with poor UCLA at PO6M were extracted by logistic regression analysis, and the factors were divided into two groups (poor and good) and matched for age, sex, and fracture type. The UCLA score at PO6M between the groups was examined by the Mann-Whitney U test, and the significance level was set at 0.05. The minimal clinical important difference in the UCLA score was set 2 points. Results: The study included 243 patients (mean age, 76 years; range, 60-95 years). The mean follow-up period was 12 months (range, 6-56 months). The correlation coefficients indicated that there was either no or only a weak correlation between HHH, head shaft angle, and cranialization of the greater tuberosity. A poor HHH (HHH <0 or >10 mm) was extracted as a factor associated with a poor UCLA score at PO6M by logistic regression analysis (odds ratio: 5.78, 95% confidence interval = 1.2-27.7, P = .0287). In matched pair analysis, the UCLA score at PO6M was significantly lower in the poor HHH group (26 [range: 9-33] vs. 24 [range: 10-35], P = .0458). Conclusion: We revealed that the HHH was an independent risk factor for poor short-term outcomes. There was a significant difference in the UCLA score between groups divided by the HHH in cases treated with IMNs. The HHH can be used intraoperatively or postoperatively as a reliable parameter to predict clinical outcomes in PHFs treated with IMNs.

DOI： 10.1016/j.jseint.2021.12.009

【整形外科画像診断・評価の進歩】人工知能(AI),深層学習人工知能を用いた骨折診断招待有り

佐藤洋一, 竹上靖彦

整形外科 73 巻 ( 6 ) 頁： 707 - 710 2022年5月

担当区分：最終著者記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：(株)南江堂

＜文献概要＞はじめに人工知能(AI)は今や社会生活の一部となり欠かせないものとなっている.整形外科分野もその例外ではない.本稿では,骨折診断AIに関する文献のレビューを行い,現状の研究開発状況の整理,そして社会実装を含めた今後の展望を述べる.

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00764&link_issn=&doc_id=20220527300040&doc_link_id=10.15106%2Fj_seikei73_707&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_seikei73_707&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Factors influencing inconsistent leg length discrepancy in dysplastic hip osteoarthritis: a retrospective study 査読有り国際誌 Open Access

Takemoto, G; Osawa, Y; Seki, T; Takegami, Y; Ochiai, S; Kato, D; Imagama, S

BMC MUSCULOSKELETAL DISORDERS 23 巻 ( 1 ) 頁： 381 - 381 2022年4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：BMC Musculoskeletal Disorders

Background: We aimed to examine the inconsistency between radiographic leg length discrepancy (R-LLD) and perceived LLD (P-LLD) in patients with dysplastic hip osteoarthritis and to evaluate the factors that can cause such inconsistency. Methods: We conducted a retrospective study on 120 patients. An inconsistent LLD was defined as a condition in which the P-LLD was shorter than the R-LLD by > 5 mm. We compared relevant data on the general characteristics of the patients and the radiological findings between consistent (group E, 92 cases [76.7%]) and inconsistent LLDs (group S, 28 cases [23.3%]). Results: The number of patients with a history of hip surgery on the affected side and the Japanese Orthopedic Association classification pain scores were significantly higher in group S than in group E (32.1% vs. 10.8%, respectively; P = 0.015, and 21.7 ± 7.0 vs. 17.5 ± 8.2, respectively; P = 0.036). The pelvic oblique angle and length of the R-LLD were significantly higher in group S than in group E (2.9 ± 2.5° vs. 0.3 ± 2.3°, respectively; P < 0.01, and 17.2 ± 8.9 mm vs. 6.3 ± 8.4 mm, respectively; P < 0.01). Multivariate logistic analysis revealed that the pelvic oblique angle (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.28–2.52; P < 0.01) and length of the R-LLD (OR: 2.75, 95% CI: 1.24–6.12; P = 0.013) were independent risk factors of inconsistent LLD. Conclusion: The pelvic oblique angle and a long R-LLD were independent risk factors of inconsistent LLD in patients with dysplastic hip osteoarthritis. Therefore, hip surgeons should consider P-LLD rather than R-LLD to understand the need for conservative intervention.

DOI： 10.1186/s12891-022-05348-z

Associations Between Neck and Shoulder Pain and Neuropathic Pain in a Middle-aged Community-living Population 査読有り国際誌

Machino, M; Ando, K; Kobayashi, K; Nakashima, H; Ito, S; Morozumi, M; Kanbara, S; Segi, N; Tomita, H; Koshimizu, H; Seki, T; Ishizuka, S; Takegami, Y; Hasegawa, Y; Imagama, S

SPINE 47 巻 ( 8 ) 頁： 632 - 639 2022年4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：Spine

Study Design.A cross-sectional study.Objective.The present study aimed to investigate the prevalence of NeP in subjects suffering from NSP to reveal the impact of NeP on the health-related QOL (HRQOL) in middle-Aged and elderly people with NSP in a health checkup.Summary of Background Data.No previous studies have established the relationship between NSP and NeP as potential risk factors contributing to a decreased QOL in the general population.Methods.The present study involved 203 participants (men: 84, women: 119; mean age: 63.3 yr). For each subject, anthro-pometric measurements, physical function examinations, and blood testing were performed. A cut-off score of >0 on the short-form spine painDETECT questionnaire defined the presence of NeP. Subsequently, the NSP (+) subjects were divided into 2 sub-groups: The NeP (+) and NeP (-) groups. For the assessment of QOL, the short form 36 health survey and the EuroQol 5 dimension 5 level version (EQ-5D-5L) tool were used.Results.The study included 100 NSP (+) and 103 NSP (-) subjects. Among the NSP (+) subjects, 46 and 54 subjects were found to be NeP (+) and NeP (-), respectively. For the short form 36 health survey, the multivariate regression analysis revealed that the prevalence of NeP was associated with a lower physical QOL (OR 3.56) and lower mental QOL (OR 4.04). Similarly, the NeP prevalence was found to be the predictor for low QOL scores in EQ-5D-5L (EQ-5D-5L index value <0.875; OR 3.61).Conclusion.The prevalence of NeP was reported to be 46.0% in healthy middle-Aged and elderly population suffering from NSP, where it was associated with poor HRQOL. Therefore, strategies aimed at alleviating NeP may contribute significantly to the improvement of QOL in middle-Aged and elderly people with NSP.Level of Evidence: 2.

DOI： 10.1097/BRS.0000000000004207

Risk factors for second hip fracture in elderly patients: an age, sex, and fracture type matched case-control study 査読有り国際誌

Fujita, T; Takegami, Y; Ando, K; Sakai, Y; Nakashima, H; Takatsu, S; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 32 巻 ( 3 ) 頁： 437 - 442 2022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：European Journal of Orthopaedic Surgery and Traumatology

Purpose: Prevention of second hip fracture is mandatory for orthopedic surgeons. We aimed to clarify the incidence and duration of second hip fracture, to compare survival rate and walking ability of patients with a second hip fracture to that of patients with a unilateral fracture, and to identify risk factors for second hip fracture using matched case–control methods. Methods: This retrospective study conducted in a single tertiary emergency center comprised 119 patients with second hip fractures who underwent bilateral operations at our institution from 2007 to 2017 (second hip fracture group [Group A]). The control group (Group B) comprised 357 patients matched to Group A for age, sex, and fracture type. Results: The incidence of second hip fracture was 7.6%, and the average interval from initial fracture to second hip fracture was 22.8 months. Significantly more patients in Group A had decreased postoperative walking ability. Five-year survival rates from initial fracture were 65.0% in Group A and 50.6% in Group B (P = 0.346). Dementia and heart disease were identified as independent risk factors (dementia: HR 2.08, 95% CI 1.27–3.41, P = 0.004; heart disease: HR 1.27, 95% CI1.11–3.22, P = 0.019). Valvular disease was also revealed to be a risk factor for heart disease (P = 0.0272). Conclusions: The incidence of second hip fracture was not low. Although survival rates did not differ between the patients with or without second hip fracture, walking ability of patients with second hip fracture worsened. Dementia and cardiac disease could be risk factors for second hip fracture in elderly patients, and valvular disease might be associated with second hip fracture in patients with heart disease.

DOI： 10.1007/s00590-021-02996-0

Predictive factors for mortality after distal femoral fractures in the elderly: A retrospective multicenter (TRON group) study 査読有り国際誌 Open Access

Yamada, Y; Takegami, Y; Tokutake, K; Taguchi, K; Kuwahara, Y; Komaki, K; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 53 巻 ( 3 ) 頁： 1225 - 1230 2022年3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：Injury

Purpose: This retrospective multicenter study aimed to assess the 1-year mortality rate in elderly patients with distal femoral fractures (DFFs) and identify potential risk factors for mortality. Methods: We analyzed 321 patients aged 65 years and older with DFFs treated surgically between 2012 and 2019 in 13 hospitals. Patient demographics and surgical characteristics were extracted from medical records and radiographs. We used univariable and multivariable Cox regression analyses to identify the factors affecting mortality. Results: The mortality rate for DFFs in elderly patients at 1 year was 9.0%. Multivariable Cox regression analysis revealed older age, male sex, underweight (body mass index [BMI] <18.5 kg/m2), bedridden status, and nursing home residency to be independent predictors for mortality (older age: hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03–1.11, P<0.001; male sex: HR 3.08, 95% CI 1.23–7.71, P=0.015; underweight: HR 1.93, 95% CI 1.01–3.68, P=0.045; bedridden status: HR 4.59, 95% CI 1.61–13.07, P=0.0042; and nursing home residency: HR 2.63, 95% CI 1.18–5.83, P=0.017). None of the factors associated with surgery including types of fixation, time from initial visit to surgery, blood loss during operation, and operation time was an independent predictor for mortality. Conclusion: The 1-year mortality rate in elderly patients with DFFs was relatively low at 9.0%. Older age, lower BMI, and nursing home residency were associated with mortality after surgery for DFFs. Factors associated with the surgical procedure were not significant predictors.

DOI： 10.1016/j.injury.2022.01.002

高齢者の橈骨遠位端骨折プレート固定術後の早期運動開始群と短期間固定群の比較多施設共同研究(TRONStudy) 査読有り

斎藤雄馬, 竹上靖彦, 徳武克浩, 柴田隆太郎, 森悠祐, 櫻井咲, 松原浩之, 今釜史郎

日本整形外科学会雑誌 96 巻 ( 3 ) 頁： S656 - S656 2022年3月

大腿骨遠位部骨折の逆行性髄内釘固定術後において、荷重時期は術後成績に影響するか多施設共同研究 TRON study 査読有り

小牧健太郎, 竹上靖彦, 徳武克浩, 花林雅裕, 桑原悠太郎, 山田陽太郎, 今釜史郎

日本整形外科学会雑誌 96 巻 ( 3 ) 頁： S1028 - S1028 2022年3月

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