Details of a Researcher

The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan

Yokoe T., Tajima T., Yamaguchi N., Morita Y., Chosa E.

BMC Musculoskeletal Disorders 22 ( 1 ) 636 2021.12

Language：English Publishing type：Research paper (scientific journal) Publisher：BMC Musculoskeletal Disorders

Background: Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries. Numerous studies regarding LAS have been performed. However, there are few studies evaluating the current clinical practice of orthopaedic surgeons regarding LAS. The purpose of this study was to evaluate the current clinical practice of general orthopaedic surgeons in the treatment of LAS. Methods: A questionnaire survey was conducted from September 2020 to December 2020 in Miyazaki, Japan, to evaluate the clinical practice of general orthopaedic surgeons in the treatment of LAS. The survey was composed of 12 questions that were developed with consideration of the recommendations in the current clinical practice guidelines (CPGs) published by the Dutch orthopaedic society. The questions in this study were focused on the diagnosis, conservative treatment, rehabilitation, and the criteria for return to sports (RTS). Results: The survey response rate was 82.7% (129/156). Among the respondents, 95.3% did not consider the Ottawa Ankle Rules in the decision to perform plain radiography for patients. Rehabilitation following LAS was performed in 58.9% of patients. Eighty-five (65.9%) of the surgeons used only one factor as the criterion for RTS. The absence of pain was the most frequently used criterion (45.7%). No objective criteria were used for the RTS decision in athletes with LAS. Conclusions: The present study suggested that most general orthopaedic surgeons do not provide the care for patients with LAS recommended by the current CPGs. No objective criteria for the RTS decision are used for athletes with LAS.

DOI： 10.1186/s12891-021-04527-8

Shadow pitching deviates ball release position: kinematic analysis in high school baseball pitchers. International journal

Shigeaki Miyazaki, Go Yamako, Koji Totoribe, Tomohisa Sekimoto, Yuko Kadowaki, Kurumi Tsuruta, Etsuo Chosa

BMC sports science, medicine & rehabilitation 13 ( 1 ) 26 - 26 2021.12

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

BACKGROUND: Although shadow pitching, commonly called "towel drill," is recommended to improve the throwing motion for the rehabilitation of pitching disorders before the initiation of a throwing program aimed at returning to throwing using a ball, the motion differs from that of normal throwing. Learning improper motion during ball release (BR) may increase shoulder joint forces. Abnormal throwing biomechanics leads to injures. However, there has been no study of shadow pitching focusing on the BR position. The purpose of the present study was to evaluate the BR position and kinematic differences between shadow pitching and normal throwing. In addition, the effect of setting a target guide for BR position on throwing motion was examined in shadow pitching. METHODS: The participants included in this study were 20 healthy male students who were overhand right-handed pitchers with no pain induced by a throwing motion. Participants performed normal throwing (task 1), shadow pitching using a hand towel (task 2), and shadow pitching by setting a target of the BR position (task 3). A motion capture system was used to evaluate kinematic differences in throwing motions, respectively. Examination items comprised joint angles and the differences in BR position. RESULTS: BR position of task 2 shifted significantly toward the anterior, leftward, and downward directions compared with task 1. The distance of BR position between tasks 1 and 2 was 24 ± 10%. However, task 3 had decreased BR deviation compared with task 2 (the distance between 3 and 1 was 14 ± 7%). Kinematic differences were observed among groups at BR. For shoulder joint, task 2 showed the highest value in abduction and horizontal adduction among groups. In spine flexion, left rotation and thorax flexion, task 2 was significantly higher than task 1. Task 3 showed small differences compared with task 1. CONCLUSIONS: The BR position of shadow pitching deviated significantly in the anterior, leftward, and downward directions compared with normal throwing. Furthermore, we demonstrated that the setting of BR target reduces this deviation. Thus, the target of BR position should be set accurately during shadow pitching exercises in the process of rehabilitation.

DOI： 10.1186/s13102-021-00255-7

Biomechanical effect of intertrochanteric curved varus osteotomy on stress reduction in femoral head osteonecrosis: a finite element analysis

Wang Y., Yamako G., Okada T., Arakawa H., Nakamura Y., Chosa E.

Journal of Orthopaedic Surgery and Research 16 ( 1 ) 465 2021.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Orthopaedic Surgery and Research

Background: Intertrochanteric curved varus osteotomy (CVO) has been widely used to remove the necrotic bone away from the weight-bearing portion in the treatment of osteonecrosis of the femoral head (ONFH). However, whether all types of necrosis will benefit from CVO, in terms of the stress level, the effect of different center-edge (CE) angles of acetabulum on stress distribution of necrosis after CVO, and the relationship between the intact ratio and the stress of necrosis, has never been addressed. The purpose of the study was to evaluate the influence of CVO on the stress reduction in necrotic bone using a finite element analysis (FEA) with different CE angles. Methods: CVO finite element models of the hip joint were simulated with a lesion of 60°. The osteotomy angles were divided into four configurations (15°, 20°, 25°, and 30°), and three types (A, B, and C1) of lesions were established based on the Japanese Investigation Committee (JIC) classification. In addition, two CE angles (18° and 33°) of acetabulum were considered. The maximum and mean von Mises stress were analyzed in terms of the necrotic bone by a physiological loading condition. Moreover, the correlation of the intact ratio measured in 3D and the stress distribution after CVO was analyzed. Results: Stress reduction was obtained after CVO. For type B, the CVO angle was 20° (0.61 MPa), and for type C1, the CVO angle was 30° (0.77 MPa), if the mean stress level was close to type A (0.61 MPa), as a standard. The maximum and mean von Mises stress were higher in the CE angle of 18°models, respectively. The intact ratio measured in 3D had a good negative correlation with stress after CVO and had more influence on stress distribution in comparison to other geometric parameters. Conclusions: For making decisions about the biomechanics of CVO, a CVO angle of > 20° was recommended for type B and > 30° was safe for type C1. The risk of progressive collapse was increased in the insufficient situation of the weight-bearing portion after CVO. The intact ratio could provide information about clinical outcomes and stress distribution after CVO.

DOI： 10.1186/s13018-021-02614-z

Hanging radiograph in idiopathic scoliosis patients: significance as a preoperative stress X-ray

Kuroki H., Nagai T., Chosa E., Tajima N.

Journal of Spine Surgery 7 ( 4 ) 495 - 501 2021.12

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Spine Surgery

Background: Before corrective surgery for idiopathic scoliosis, the stress X-rays are indispensable to collect information regarding the reducibility of deformity, deciding fusion levels, and categorizing curve types and so on. The hanging radiograph has not been conducted preoperatively so far as known. The objective of this study was to investigate retrospectively the significance of the hanging radiograph for prediction of the curve correction with surgical procedure by comparing with the side-bending and the traction radiographs. Methods: The subjects enrolled in current study were 22 cases of idiopathic scoliosis who performed posterior instrumentation and fusion by ISOLA method between 2008 and 2014. They included 2 males and 20 females, with a mean age of 16 years and 8 months. The type of curves by Lenke classification were type 1 in 20 cases, type 2 in 1 case, and type 3 in 1 case. We investigated the correction rates of main thoracic curves in side-bending, traction, and hanging positions and compared them with that after surgery. In addition, correction indices were also calculated and compared among these stress X-rays. Results: The correction rate after surgery was 65.9% that was statistically higher than those in side-bending (44.2%), traction (46.6%), and hanging (22.1%) positions. There were statistical correlations between the correction rates after surgery and in side-bending position (R=0.73) and those after surgery and in traction position (R=0.57). However, there was no statistical correlation between the correction rates after surgery and in hanging position (R=-0.01). With regard to the correction indices, that in hanging position (3.67) was statistically higher than those in side-bending (1.51) and traction (1.45) positions. Conclusions: The correction rates in side-bending and traction positions seem to be useful to estimate the amount of curve correction before surgery. Whereas, that in hanging position did not have any significance as preoperative evaluation.

DOI： 10.21037/jss-21-74

特集大腿骨近位部骨折治療のエキスパートを目指そう頚部骨折大腿骨頚部骨折の分類

日吉優, 帖佐悦男

関節外科　基礎と臨床 40 ( 11 ) 1129 - 1136 2021.11

Publishing type：Research paper (scientific journal) Publisher：メジカルビュー社

DOI： 10.18885/jjs.0000000803

特集大腿骨近位部骨折治療のエキスパートを目指そう introduction

帖佐悦男

関節外科　基礎と臨床 40 ( 11 ) 1111 - 1111 2021.11

Publishing type：Research paper (scientific journal) Publisher：メジカルビュー社

DOI： 10.18885/jjs.0000000800

特集整形外科領域におけるリアルワールドデータを用いた研究四肢長管骨開放骨折レジストリー

石井桂輔, 黒住健人, 鈴木卓, 渡部欣忍, 井口浩一, 帖佐悦男

整形･災害外科 64 ( 12 ) 1513 - 1521 2021.11

Publishing type：Research paper (scientific journal) Publisher：金原出版

DOI： 10.18888/se.0000001939

A case of nail-patella syndrome with osteochondral lesion of the lateral femoral condyle accompanied with anomalies of anterior horns of the menisci and lateral femoral condyle

28 ( 6 ) 1543 - 1547 2021.10

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

DOI： 10.1016/j.jos.2021.09.004

特集運動器エコーのエキスパートを目指そう introduction

帖佐悦男

関節外科　基礎と臨床 40 ( 14 ) 7 - 7 2021.10

Publishing type：Research paper (scientific journal) Publisher：メジカルビュー社

DOI： 10.18885/jjs.0000000770

Exploring whole-body kinematics when eating real foods with the dominant hand in healthy adults

Nakatake J., Totoribe K., Arakawa H., Chosa E.

PLoS ONE 16 ( 10 October ) e0259184 2021.10

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：PLoS ONE

Despite the importance of eating movements to the rehabilitation of neurological patients, information regarding the normal kinematics of eating in a realistic setting is limited. We aimed to quantify whole-body three-dimensional kinematics among healthy individuals by assessing movement patterns in defined phases while eating real food with the dominant hand in a seated position. Our cross-sectional study included 45 healthy, right-hand dominant individuals with a mean age of 27.3 ± 5.1 years. Whole-body kinematics (joint angles of the upper limb, hip, neck, and trunk) were captured using an inertial sensor motion system. The eating motion was divided into four phases for analysis: reaching, spooning, transport, and mouth. The mean joint angles were compared among the phases with Friedman’s analysis of variance. The maximum angles through all eating phases were 129.0° of elbow flexion, 32.4° of wrist extension, 50.4° of hip flexion, 6.8° of hip abduction, and 0.2° of hip rotation. The mean shoulder, elbow, and hip joint flexion angles were largest in the mouth phase, with the smallest being the neck flexion angle. By contrast, in the spooning phase, the shoulder, elbow, and hip flexion were the smallest, with the largest being the neck flexion angle. These angles were significantly different between the mouth and spooning phases (p < 0.008, Bonferroni post hoc correction). Our results revealed that characteristic whole-body movements correspond to each phase of realistic eating in healthy individuals. This study provides useful kinematic data regarding normal eating movements, which may inform whole-body positioning and movement, improve the assessment of eating abilities in clinical settings, and provide a basis for future studies.

DOI： 10.1371/journal.pone.0259184

高校空手選手における貧血調査

木戸義隆, 田島卓也, 山口奈美, 長澤誠, 大田智美, 森田雄大, 横江琢示, 川越秀一, 帖佐悦男

整形外科と災害外科 70 ( 4 ) 703 - 706 2021.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：西日本整形・災害外科学会

【目的】高校空手選手の貧血について調査したので報告する．【対象・方法】2012-2019年の宮崎県某高校空手部1年生68名（男子39名，女子29名）を対象とし，2015-2019年の国民体育大会宮崎県代表候補選手のうち高校1年生160名（男子114名，女子46名）と比較した．【結果】男子はHb＜13 g/dL，女子はHb＜12 g/dLを貧血とした．【結果】空手選手では30.8％（男子28.2％，女子34.5％）に貧血を認め，全例正球性貧血だった．他競技の貧血例は陸上女子選手1例だった．空手選手の貧血群と非貧血群で血清鉄，網赤血球，フェリチン，不飽和鉄結合能に有意差はなく，貧血と鉄欠乏に関連はなかった．【考察】空手部の貧血が全例正球性貧血であったことから，空手の突き動作に伴い頻回に足を踏み込む動作で足底血管にて溶血をきたしたと考えた．空手選手のメディカルサポートの際には，貧血を考慮する必要があると考えられた．

DOI： 10.5035/nishiseisai.70.703

上下肢3か所に多発した腱鞘巨細胞腫の治療経験

當瀬雅大, 大田智美, 坂本武郎, 田島卓也, 山口奈美, 長澤誠, 森田雄大, 横江琢示, 川越秀一, 帖佐悦男, 川野啓介

整形外科と災害外科 70 ( 4 ) 749 - 753 2021.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：西日本整形・災害外科学会

〔はじめに〕腱鞘巨細胞腫は手指に多く発生することが知られているが，多発例の報告は稀である．上下肢3か所に多発した稀な腱鞘巨細胞腫の症例を経験したので報告する．〔症例〕45歳男性で，約4年前に左示指に釣り針が刺さった同時期より左示指，左肘，左膝の腫瘤を自覚した．MRIで3か所とも関節外にT1強調画像で等から軽度高信号，T2強調画像で低信号，造影で不均一に造影される境界明瞭な腫瘤を認めた．左膝腫瘤の切除生検を施行した結果，腱鞘巨細胞腫の診断に至った．生検と画像所見より，多発腱鞘巨細胞腫と判断し，3か所同時に腫瘍摘出術を施行し，最終診断もすべて腱鞘巨細胞腫であった．〔考察〕我々が渉猟しえた限りでは多発例は32報告で，上下肢に及ぶ2か所発生例，3病変の発生例はそれぞれ1例のみであった．本症例は上下肢に及ぶ3病変の多発例であり，稀な症例であると思われた．〔結語〕本症例は再発リスク因子が多く，今後の慎重な経過観察が必要と考える．

DOI： 10.5035/nishiseisai.70.749

点状軟骨異形成症に伴う環軸椎亜脱臼に対して手術した1例

帖佐直紀, 濱中秀昭, 黒木修司, 比嘉聖, 永井琢哉, 李徳哲, 黒木智文, 帖佐悦男

整形外科と災害外科 70 ( 3 ) 374 - 377 2021.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：西日本整形・災害外科学会

【抄録】乳児の頸椎疾患に対しての手術は稀で本邦でも報告数は少ない．今回，点状軟骨異形成症の乳児に対して手術を施行した稀な症例を経験したので報告する．【症例】生後50日，女児．妊娠37週2日で出生．胎児期から鼻の低形成が疑われていた．出生時に第1啼泣なく陥没呼吸が強いため人工呼吸器にて管理された．画像所見にて点状石灰化や環軸椎亜脱臼による脊髄圧迫の所見の他，鼻根部低形成などの特徴的顔貌から点状軟骨異形成症が疑われた．手術目的に転院となり，環椎後弓切除術と大後頭孔減圧術を施行した．術後は四肢の麻痺や筋力低下なく経過し，術後の画像所見でも圧迫が解除されていた．【考察】点状軟骨異形成症の頸椎病変に対する治療の基準は確立されていない．本症例では生後50日と乳児のため環椎後弓切除術と大後頭孔減圧術のみとし，今後不安定性が残存する場合は固定も考慮される．児の年齢や罹患場所に応じた治療を選択する事が重要である．

DOI： 10.5035/nishiseisai.70.374

長時間の砕石位手術後に下腿のWell-leg compartment syndromeを来した一例

神谷俊樹, 日吉優, 坂本武郎, 舩元太郎, 中村嘉宏, 山口洋一朗, 平川雄介, 今里浩之, 帖佐悦男

整形外科と災害外科 70 ( 4 ) 595 - 598 2021.9

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：西日本整形・災害外科学会

【はじめに】コンパートメント症候群の中でも下肢の不適切な体位が原因となるWell-leg compartment syndrome（WLCS）の一例を経験したので報告する．【症例】38歳男性の直腸カルチノイドに対して砕石位で腹腔鏡補助下低位前方切除術・回腸人工肛門造設術を施行した．手術時間は6時間39分，麻酔時間は8時間5分であった．覚醒時より左下腿の疼痛を自覚し，下肢挙上台（レビテーター）に一致した圧迫痕と腫脹を認めた．血液検査にて経時的なクレアチンキナーゼ（CK）の上昇，コンパートメント内圧の上昇を認め，同日筋膜切開を行った．切開術直後より疼痛は改善し，後遺症を残すことなく経過良好であった．【考察】WLCSは砕石位で最も多いと言われる．砕石位は他科で汎用されるが，コンパートメント症候群は他科では馴染みの少ない病態であり，我々整形外科医が率先して手術室スタッフを含めた知識の共有を行うことで，予防，早期発見・治療が可能と思われる．

DOI： 10.5035/nishiseisai.70.595

Real-time action recognition system for elderly people using stereo depth camera

Zin T.T., Htet Y., Akagi Y., Tamura H., Kondo K., Araki S., Chosa E.

Sensors 21 ( 17 ) 2021.9

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

Smart technologies are necessary for ambient assisted living (AAL) to help family mem-bers, caregivers, and health-care professionals in providing care for elderly people independently. Among these technologies, the current work is proposed as a computer vision-based solution that can monitor the elderly by recognizing actions using a stereo depth camera. In this work, we intro-duce a system that fuses together feature extraction methods from previous works in a novel combination of action recognition. Using depth frame sequences provided by the depth camera, the system localizes people by extracting different regions of interest (ROI) from UV-disparity maps. As for feature vectors, the spatial-temporal features of two action representation maps (depth motion appearance (DMA) and depth motion history (DMH) with a histogram of oriented gradients (HOG) descriptor) are used in combination with the distance-based features, and fused together with the automatic rounding method for action recognition of continuous long frame sequences. The experimental results are tested using random frame sequences from a dataset that was collected at an elder care center, demonstrating that the proposed system can detect various actions in real-time with reasonable recognition rates, regardless of the length of the image sequences.

DOI： 10.3390/s21175895

Internal Fixation of a Lateral Inverted Osteochondral Fracture of the Talus (LIFT) Lesion Using an Innovative Surgical Approach: Inverting the Capsulo-Lateral Fibulotalocalcaneal Ligament (LFTCL)–Fibular Periosteum Complex

Yokoe T., Tajima T., Yamaguchi N., Ota T., Nagasawa M., Morita Y., Chosa E.

Journal of Foot and Ankle Surgery 60 ( 5 ) 1054 - 1059 2021.9

Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of Foot and Ankle Surgery

Osteotomy of the distal fibula or anterolateral corner of the tibia is usually required to fix a displaced osteochondral fracture of the talus that is located central to posterior area of the lateral talar dome. However, osteotomy is an invasive procedure and is associated with complications, including nonunion, persistent pain, and hardware-related problems. Lateral inverted osteochondral fracture of the talus (LIFT) lesion is an extremely rare type of displaced osteochondral lesion of the talus. We describe a case in which a LIFT lesion was fixed using an innovative surgical approach, inverting capsulo-lateral fibulotalocalcaneal ligament (LFTCL)–fibular periosteum complex, with a favorable short-term clinical outcome.

DOI： 10.1053/j.jfas.2021.03.005