研究者詳細 - 竹上　靖彦

Nutritional Influences on Locomotive Syndrome 査読有り国際誌 Open Access

Ito, S; Nakashima, H; Ando, K; Machino, M; Seki, T; Ishizuka, S; Takegami, Y; Wakai, K; Hasegawa, Y; Imagama, S

JOURNAL OF CLINICAL MEDICINE 11 巻 ( 3 ) 2022年2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

Healthy dietary habits are important to prevent locomotive syndrome (LS). We investi-gated the relationship between LS and nutritional intake using community health checkup data. We included 368 participants who underwent LS staging, blood sampling, and nutritional intake assessments. Participants (163 adults < 65: 205 older adults ≥ 65) were divided into normal (N; LS stage 0) and LS (L; LS stage 1–2) groups, and blood sample data and nutritional intake were compared between groups. Among adults (N group, 71; L group, 92), low-density lipoprotein cholesterol (LDL-C) was significantly lower, and Vitamin B1 intake was significantly higher in the L than in the N group; LDL-C, p = 0.033; Vitamin B1, 0.029. Among older adults (N group, 85; L group, 120), hemoglobin (Hb), albumin, and calcium levels were significantly lower, and sodium, monounsatu-rated fatty acids (MUFA), and n-6 polyunsaturated fatty acids (n-6 PUFA) were significantly higher in the L than the N group; Hb, p = 0.036; albumin, 0.030; calcium, 0.025; sodium; 0.029; MUFA; 0.047, n-6 PUFA; 0.0233). Logistic regression analysis indicated that sodium was the risk factor for the L group (exp (B) 1.001, 95% CI: 1–1.001, p = 0.032). In conclusion, salt intake was associated with LS.

DOI： 10.3390/jcm11030610

How does intraoperative fracture malalignment affect postoperative function and bone healing following distal femoral fracture? A RETROSPECTIVE MULTICENTRE STUDY 査読有り国際誌 Open Access

Kuwahara, Y; Takegami, Y; Tokutake, K; Yamada, Y; Komaki, K; Ichikawa, T; Imagama, S

BONE & JOINT OPEN 3 巻 ( 2 ) 頁： 165 - 172 2022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：Bone and Joint Open

Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes. Methods In total, 140 patients were retrospectively identified from data obtained from a database of hospitals participating in a trauma research group. We divided them into two groups ac-cording to coronal plane malalignment of more than 5°: 108 had satisfactory fracture alignment (< 5°, group S), and 32 had unsatisfactory alignment (> 5°, group U). Patient character-istics and injury-related factors were recorded. We compared the rates of nonunion, implant failure, and reoperation as healing outcomes and Knee Society Score (KSS) at three, six, and 12 months as functional outcomes. We also performed a sub-analysis to assess the effect of fracture malalignment by plates and nails on postoperative outcomes. Results The rates of nonunion and reoperation in group U were worse than those in group S (25.0% vs 14.3%; 15.6% vs 5.6%), but the differences were not significant (p = 0.180 and p = 0.126, respectively). Mean KSS in group U at all follow-up periods was significantly worse that in group S (75.7 (SD 18.8) vs 86.0 (SD 8.7); p < 0.001; 78.9 (SD 17.2) vs 89.1 (SD 9.8); p < 0.001; 85.0 (SD 11.9) vs 91.1 (SD 7.2); p = 0.002, respectively). In the sub-analysis of plates, mean KSS was significantly worse in group U at three and six months. In the sub-analysis of nails, the rate of reoperation was significantly higher in group U (28.6% vs 5.8%; p = 0.025), and mean KSS at six and 12 months was significantly worse in Group U. Conclusion To obtain good postoperative functional results, intraoperative alignment of the coronal plane should be accurately restored to less than 5°.

DOI： 10.1302/2633-1462.32.BJO-2021-0191.R1

The development of knee osteoarthritis and serum carotenoid levels among community-dwelling people in Japan 査読有り国際誌

Takemoto, G; Seki, T; Takegami, Y; Osawa, Y; Makida, K; Ochiai, S; Ishizuka, S; Suzuki, K; Hasegawa, Y; Imagama, S

MODERN RHEUMATOLOGY 32 巻 ( 1 ) 頁： 205 - 212 2022年1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：Modern Rheumatology

Objectives: Carotenoids are plant pigments found in many vegetables, functioning as antioxidants scavenging singlet molecular oxygen and peroxyl radicals. No longitudinal study exists on the relationship between carotenoids and knee osteoarthritis (KOA) development. We aimed to determine the incidence of KOA development for 10 years in community-dwelling people in Japan and assess its association with serum carotenoids. Methods: Data of 440 participants (174 men, 266 women) with health-screening records for at least 10 years were analysed. We defined KOA development as advancing from K/L grade 0/1 at the initial check-up to grade ≥2 in a unilateral knee during a 10-year follow-up period. Serum carotenoid levels were measured using high-performance liquid chromatography. We used the Cox hazard model for multivariate analysis and investigated each carotenoid's impact on KOA development. Results: KOA developed in 33.4% of patients; the annual KOA development rate was significantly higher among women than among men (p <. 01; 3.4% vs. 1.6%). Among the carotenoids measured, only retinol was associated with KOA development in women using multivariable analysis. KOA development was not associated with any carotenoids in men. Conclusion: The annual rate of KOA development was higher in women, and retinol was associated with KOA development in women.

DOI： 10.1080/14397595.2021.1900030

Effects of additional neck cut of the femur on the range of motion in total hip arthroplasty for hip dislocation: a computer simulation study 査読有り国際誌

Makida, K; Seki, T; Osawa, Y; Takegami, Y; Higuchi, Y; Kusano, T; Ishiguro, N

HIP INTERNATIONAL 32 巻 ( 1 ) 頁： 39 - 44 2022年1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：HIP International

Background: Subtrochanteric shortening osteotomy (SSO) is commonly performed in total hip arthroplasty (THA) for high hip dislocation. However, this procedure is technically difficult and includes complications. Additional neck cut (ANC) of the femur is a procedure that involves femoral shortening by possibly eliminating the need for SSO in THA for high hip dislocation. Herein, we evaluated the effect and the depth limit of ANC of the femur on the range of motion (ROM) in THA for high hip dislocation. Methods: ROM was measured in 26 patients with high hip dislocation using computer software. The stem was deeply positioned at 5-mm intervals from 0 mm to 30 mm (7 groups). The ROM before impingement was measured during flexion, internal rotation (IR) at 90° flexion, external rotation (ER) and abduction. Receiver operator coefficient (ROC) curves for abduction were generated. The cut-off value of ANC where the required ROM was achieved was also determined. Results: Deeper ANCs increased the ROM values during flexion and IR, but they decreased the ROM values during ER and abduction. The ROM values during ER were also limited in 0-mm ANCs. According to the result of the ROC curve for abduction, 15 mm was considered as the permissible range of ANC. Conclusions: In THA for high hip dislocation additional neck cut should be taken into consideration for hips requiring less than 15-mm shortening. For more extended corrections a subtrochanteric shortening osteotomy should be performed.

DOI： 10.1177/1120700020938657

Prediction of delayed union of tibial shaft fracture treated with intramedullary nailing: multicenter-study analysis and literature review -the TRON study 査読有り国際誌

Kawasaki, N; Takegami, Y; Sakai, R; Todoroki, K; Uemi, R; Imagama, S

EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 32 巻 ( 1 ) 頁： 129 - 135 2022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：European Journal of Orthopaedic Surgery and Traumatology

Purpose: We aimed to 1) identify predictors of delayed and nonunion of tibial shaft fractures in patients treated with intramedullary nailing (IMN), including patient demographics and surgical factors, and 2) determine whether the nail/shaft ratio is associated with delayed and nonunion. Methods: This retrospective, multicenter study included 315 patients with tibial shaft fracture treated with IMN between 2014 and 2019 and excluded patients with insufficient follow-up for 12 months, lost data and inadequate radiographs. Finally, we analyzed 258 patients (184 males; 74 females). Main outcome measurements were delayed union at 6 and nonunion at 12 months after surgery as determined on anteroposterior and lateral radiographs. We extracted the following as risk factors of delayed and nonunion: age, sex, BMI, fracture site, fracture type, injury energy, smoking history, and nail/shaft ratio. We conducted logistic regression analysis to investigate risk factors of delayed and nonunion using these extracted items as explanatory variables. Results: Type C fracture was independently associated with delayed union (odds ratio 2.9, 95% confidential interval: 1.04–8.09, P = 0.04). Nail/shaft ratio was not an independent factor of delayed union. No independent explanatory factors were related to nonunion. Conclusions: Type C fractures, which were unstable and fragmented, was associated with delayed union in tibia fractures treated with IMN, whereas nail thickness was not associated with delayed or nonunion fractures.

DOI： 10.1007/s00590-021-02939-9

Collapse Progression or Cessation Affects the Natural History of Contralateral Osteonecrosis of the Femoral Head 査読有り国際誌

Osawa, Y; Seki, T; Takegami, Y; Makida, K; Ochiai, S; Imagama, S

JOURNAL OF ARTHROPLASTY 36 巻 ( 12 ) 頁： 3839 - 3844 2021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：Journal of Arthroplasty

Background: It is unclear how the condition of one side of the hip joint affects the natural history of contralateral osteonecrosis of the femoral head (ONFH). This study aimed to investigate the natural progression of bilateral ONFH on the asymptomatic side between patients with collapse progression and cessation on the symptomatic side. Methods: The study included 109 patients with bilateral ONFH at the first visit, who were divided into two groups in accordance with the symptomatic side based on the collapse progression of ≥3 mm (progressive group: 74 hips) and collapse cessation of <3 mm (stable group: 35 hips) with a minimum follow-up of 3 years. The assessment parameters included age, gender, body mass index, etiology, type classification, and survival rates of the asymptomatic side with radiographic failure as the endpoints. Results: Age, gender, body mass index, and etiology were not different between the two groups; however, a difference was observed in the type classification of the symptomatic side. The 4-year survival rates were significantly different between the progressive (34.3%) and stable groups (85.7%). Multivariate Cox regression analysis showed that age <40 years (vs ≥40 years; hazard ratio [HR], 2.439), type C2 (vs B + C1; HR, 2.865), and collapse progression on the symptomatic side (vs collapse cessation; HR, 7.751) were independent factors determining collapse on the asymptomatic side. Conclusion: Collapse progression on the symptomatic side is a poor prognostic factor for the natural history of contralateral ONFH.

DOI： 10.1016/j.arth.2021.08.005

神経ブロックを併用した人工股関節置換術後に腓骨神経麻痺を呈し診断に苦慮した1例査読有り

絹川友章, 田村高廣, 竹上靖彦, 関泰輔, 西脇公俊

日本ペインクリニック学会誌 28 巻 ( 9 ) 頁： 194 - 198 2021年9月

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：(一社)日本ペインクリニック学会

【症例】46歳女性,身長157cm,体重58kg.20歳ごろより両股関節痛を生じ,変形性関節症と診断され保存的に加療していた.当院整形外科紹介受診し,左人工股関節置換術施行予定となった.腰神経叢ブロックと傍仙骨部の坐骨神経ブロックを施行後,全身麻酔導入し,手術を行った.術後のレントゲンで脚延長は20mmであった.覚醒後,両下肢に運動障害と感覚障害があった.症状は数時間以内に改善し,腰神経叢ブロックが硬膜外ブロックになったと考えられ,画像検査で血種による神経圧迫などを除外した上で経過観察となった.その後,感覚障害と運動障害は改善傾向であったが左足関節の背屈運動のみ回復が遅れ,術28日後の筋電図検査にて腓骨頭レベルでの軽度腓骨神経障害と診断された.術32日後,杖歩行安定し退院した.【まとめ】本症例の神経症状は,腓骨頭レベルでの神経障害であることから,腓骨神経の過伸展等の物理的因子に起因することが推察されるが,腰神経叢ブロックが硬膜外ブロックになったことにより麻痺症状が初期段階ではマスクされた.また今回の神経ブロックが麻痺に影響した可能性も否定できない.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J03612&link_issn=&doc_id=20210928360003&doc_link_id=10.11321%2Fjjspc.21-0029&url=https%3A%2F%2Fdoi.org%2F10.11321%2Fjjspc.21-0029&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

The association of the progression of knee osteoarthritis with high-sensitivity CRP in community-dwelling people-the Yakumo study 査読有り国際誌

Kondo, F; Takegami, Y; Ishizuka, S; Hasegawa, Y; Imagama, S

CLINICAL RHEUMATOLOGY 40 巻 ( 7 ) 頁： 2643 - 2649 2021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：Clinical Rheumatology

Objective: We aimed to investigate the relationship between high-sensitivity CRP (hs-CRP) levels and the knee osteoarthritis (KOA) status and whether high hs-CRP levels predict the progression of clinical KOA in community-dwelling people. Methods: We enrolled 247 subjects (male, n = 99; female, n = 148) who participated in the “Yakumo study” at least twice from 2003 to 2008. The KOA was evaluated by knee X-ray using the knee osteoarthritis computer-aided diagnosis (KOACAD) measurement system to obtain the mJSW, the size of the osteophyte area (OPA), and femorotibial angle (FTA). The pain intensity of the knee joint was measured using a visual analog scale (VAS, 0–100). First, we performed a multiple regression analysis to assess the relationship between the initial hs-CRP and mJSW, OPA, FTA, and VAS. Second, we examined the correlated coefficients between the amount of change hs-CRP and radiographic progressions and VAS changes. Third, we divided into two groups. Group H elevated hs-CRP levels (> 0.1 mg/dl). We picked up the subject matched to Group H according to BMI, age, sex, and medial mJSW at baseline in a 1:1 ratio; these participants were classified as the control group (Group L). The Mann-Whitney U test was used to compare the demographic data between the two groups. P values of < 0.05 were considered to indicate statistical significance. Results: The initial hs-CRP was a significant explanatory factor for mJSW and VAS change in multiple regression analysis. The change of VAS value negatively correlated with the change of hs-CRP. Besides, the change of hs-CRP did not correlate with the radiographical change. Among these subjects, 55 had elevated hs-CRP levels (> 0.1 mg/dl) (Group H). Among the 192 subjects whose hs-CRP levels were ≤ 0.1 mg/dl, 55 subjects were matched to patients in Group H according to the age, sex, BMI, and average minimum joint space width (mJSW) at baseline and were used as a control group (Group L). The narrowing of the medial mJSW and the amount of change in OPA in group H were significantly greater than group L. The amount of change in FTA and VAS scores did not differ between the two groups. Conclusion: Hs-CRP levels would be significantly associated with the progression of knee osteoarthritis.Key Points• We investigated the relationship between hs-CRP levels and the progression and the pain of osteoarthritis knee.• We used a KOACAD system, which can measure the medial and lateral joint space narrowing, osteophyte, and femoral-tibia angle from plain radiographs automatically.• Hs-CRP levels were significantly associated with the progression of knee osteoarthritis.

DOI： 10.1007/s10067-020-05541-2

Smoking and trimalleolar fractures are risk factors for infection after open reduction and internal fixation of closed ankle fractures: A multicenter retrospective study of 1,201 fractures * 査読有り国際誌

Sato, T; Takegami, Y; Sugino, T; Bando, K; Fujita, T; Imagama, S

INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 52 巻 ( 7 ) 頁： 1959 - 1963 2021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 ankle fractures includes wound infection. This study aimed to evaluate postoperative function and clarify the risk factors associated with postoperative wound infection in patients receiving the open reduction and internal fixation for ankle fracture through a multicenter study. Subjects and method: Among 1421 patients diagnosed as having closed ankle fracture and who were treated by surgical therapy in 11 institutions from 2014 through 2019, 1201 patients (men, n = 512, women, n = 689; the mean (SD) age, 50.9 (15.6) years; the mean body mass index [BMI] (SD), 24.3 (4.2) kg/m2) were included as subjects. Excluded were 220 patients due to self-termination of treatment, inability to follow up after discharge, open fracture, distal tibia shaft fracture, and pilon fracture. We extracted the following as risk factors of wound infection: age, sex, BMI, fracture type, injury energy and histories of smoking, diabetes, arteriosclerosis, heart failure and myocardial infarction. We conducted logistic regression analysis to investigate the risk factors of wound infection using these extracted items as explanatory variables and the presence or absence of wound infection as the response variable. Results: Wound infection occurred after surgery for closed ankle fracture in 69 the 1201 patients (5.7%). The causative organism was methicillin-susceptible Staphylococcus aureus (MSSA) in 15 patients, methicillin-resistant S. aureus (MRSA) in 4 patients, Finegoldia magna in one patient, and S. haemolyticus in one patient. In the other patients, causative organisms were not detected, culture of the causative organisms was not conducted, or they were unknown. The univariate analysis showed significant differences in sex (p = 0.01) and for smoking (p = 0.002), fracture type (p = 0.02) and heart failure (p = 0.042). Logistic regression analysis showed that smoking and type of fracture (trimalleolar fracture) were significant explanatory factors for infection (odds ratio 1.83 and 1.98, p = 0.040 and 0.042, respectively). Conclusions: At 5.7%, the rate of postoperative wound infection in closed ankle fracture was not low. Staphylococcus was the most frequent causative organism. The surgeon should pay attention infection after surgery in the patients who had a trimalleolar fracture or smoking habits.

DOI： 10.1016/j.injury.2021.04.017