Details of a Researcher

Sarcopenia, Ectopic Fat Infiltration into the Lumbar Paravertebral Muscles, and Lumbo-Pelvic Deformity in Older Adults Undergoing Lumbar Surgery.

Lee D, Kuroki T, Nagai T, Kawano K, Higa K, Kurogi S, Hamanaka H, Chosa E

Spine 47 ( 2 ) E46 - E57 2021.7

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

Study Design.A retrospective analysis of a prospective, non-randomized cohort dataset.Objective.To cross-sectionally examine the prevalence of sarcopenia and the association between spine-pelvic deformity and skeletal muscle volume loss and ectopic fat infiltration into lumbar paravertebral muscles (PVMs) in patients who underwent lumbar surgery.Summary of Background Data.Muscle quality deterioration has been considered the main pathology of sarcopenia, reducing muscle strength directly. The qualitative deterioration as well as volume loss in PVM, which contributes significantly to core body extension, might cause aging-related spine deformity.Methods.In total, 184 patients were included. Sarcopenia was diagnosed at baseline, and all patients underwent whole-body X-ray. The amount of fat in lumbar PVM was evaluated with the Goutallier classification in magnetic resonance imaging findings. The expression of adipogenesis- and atrophy-promoting factors in PVM was evaluated with quantitative polymerase chain reaction.Results.In total, 36.1% of adults aged ≥60 years were diagnosed with sarcopenia. The values of skeletal muscle indexes of the limb and trunk were inversely correlated with the sagittal vertical axis, pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL) values. The PT and PI-LL were greater, PVM area was smaller, and Goutallier grade was greater in sarcopenic adults than in non-sarcopenic older adults. Additionally, the PVM area correlated with the LL value, and Goutallier's grade correlated with the PT and PI-LL values. Moreover, the amount of ectopic fat in PVMs inversely correlated with skeletal muscle indexes. The expression levels of atrophy gene-1 and muscle ring-finger protein-1 did not differ between the groups and did not correlate with the PVM area. In contrast, the expression of Pparg and Cebpa was upregulated in sarcopenic older adults, where it correlated with Goutallier's grade.Conclusion.The volume loss of skeletal muscle, including lumbar PVM, and ectopic fat infiltration into the PVM, may cause the lumbo-pelvic deformity.Level of Evidence: 3.

DOI： 10.1097/BRS.0000000000004175

Total Knee Arthroplasty Improved Locomotive Syndrome in Knee Osteoarthritis Patients: A Prospective Cohort Study Focused on Total Clinical Decision Limits Stage 3

Miyazaki S., Yoshinaga S., Tsuruta K., Hombu A., Fujii Y., Arakawa H., Sakamoto T., Chosa E.

BioMed Research International 2021 3919989 2021.6

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

Purpose. The purpose of this study is to investigate the treatment efficacy of total knee arthroplasty (TKA) on locomotive syndrome (LS) focusing on total clinical decision limit (CDL) stage 3 leading to revealing the motor function indicators that can predict LS improvement in knee osteoarthritis patients who had received TKA. Methods. This prospective cohort study was conducted in 47 patients evaluated as total CDL stage 3 before TKA who received primary TKA on the operated side and were diagnosed with Kellgren-Lawrence grade 2, 3, or 4 knee osteoarthritis on the nonoperated side. LS was evaluated using stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. In addition, the motor function indicators which could predict the LS improvement were examined. All assessments were conducted before TKA and three months after TKA. Results. Of the 47 subjects who were evaluated to be in total CDL stage 3 before TKA, 13 patients (27.7%) were determined to show improvements in total CDL. From the result of the decision tree analysis, when the CDL of the two-step test before TKA was 1 or less, the improvement rate was 83.3%. Even if the CDL of the two-step test before TKA was higher than 1 and if the 3 m-Timed Up and Go test (3m-TUG) before TKA was 9.6 or less, the improvement rate was 50%. Conclusions. As of three months after surgery, TKA can improve LS in about 30% of knee osteoarthritis patients. A two-step test before TKA and 3m-TUG before TKA can be used as motor function indicators to predict LS improvement. This study provides useful information for setting the goal for rehabilitation prior to surgery.

DOI： 10.1155/2021/3919989

Symptomatic discoid lateral meniscus shows a relationship between types and tear patterns, and between causes of clinical symptom onset and the age distribution

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

Knee Surgery, Sports Traumatology, Arthroscopy 30 ( 4 ) 1436 - 1442 2021.6

Language：English Publishing type：Research paper (scientific journal) Publisher：Knee Surgery, Sports Traumatology, Arthroscopy

Purpose: Discoid meniscus is a congenital abnormality of the lateral meniscus and is seen more frequently in East Asia. The purpose of this study was to retrospectively assess the relationship between discoid lateral meniscus (DLM) types and tear patterns and causes of age-specific clinical symptom onset. Methods: Of 1650 arthroscopic surgeries over a 20-year period, 138 (105 patients) were performed for DLM and were evaluated in this study. The mean age at surgery was 21.5 ± 15.8 years. The DLM type was classified by Watanabe’s classification, and tear patterns were classified by the modified Bin’s classification as simple horizontal, complicated horizontal, longitudinal, radial, complex, and no tear. Additionally, patients were divided by age group (< 10, 10–19, 20–39, 40–59, and ≥ 60 years) and classified according to the causes of clinical symptom onset as follows: sports activities, minor trauma in daily living, and no traumatic episode. Results: The DLM was complete in 78 (56.5%) knees and incomplete in 60 (43.5%); no Wrisberg type DLM was observed. Simple horizontal and complicated horizontal tears were significantly more frequent in complete DLM, whereas radial tears and no tears were significantly more frequent in incomplete DLM (p < 0.0001). When classified by age group, 74 (53.6%) knees with DLMs were found in teenagers. Sports activities caused symptom onset significantly more often in teenagers, no traumatic episode caused symptom onset in patients aged < 10 years, and minor trauma in daily living caused symptom onset in patients aged 40–59 years and ≥ 60 years (p < 0.0001). No relationship was found between the age distribution and tear patterns; however, the absence of tears tended to be more common in teenaged patients, and complicated horizontal tears were more common in patients over 20 years of age. Conclusion: Symptomatic DLM occurred most often in teenagers. A relationship was identified between the DLM types and tear patterns, which could be helpful in preoperative planning. Causes of clinical symptom onset in patients with DLM were characterised by age group, which might help clinicians to suspect the presence of DLM. Level of evidence: Level IV.

DOI： 10.1007/s00167-021-06635-3

Non-anatomical placement adversely affects the functional performance of the meniscal implant: a finite element study

Shriram D., Yamako G., Kumar G.P., Chosa E., Cui F., Subburaj K.

Biomechanics and Modeling in Mechanobiology 20 ( 3 ) 1167 - 1185 2021.6

Language：English Publishing type：Research paper (scientific journal) Publisher：Biomechanics and Modeling in Mechanobiology

Non-anatomical placement may occur during the surgical implantation of the meniscal implant, and its influence on the resulting biomechanics of the knee joint has not been systematically studied. The purpose of this study was to evaluate the biomechanical effects of non-anatomical placement of the meniscal implant on the knee joint during a complete walking cycle. Three-dimensional finite element (FE) analyses of the knee joint were performed, based on the model developed from magnetic resonance images and the loading conditions derived from the gait pattern of a healthy male subject, for the following physiological conditions: (i) knee joint with intact native meniscus, (ii) medial meniscectomized knee joint, (iii) knee joint with anatomically placed meniscal implant, and (iv) knee joint with the meniscal implant placed in four different in vitro determined non-anatomical locations. While the native menisci were modeled using the nonlinear hyperelastic Holzapfel–Gasser–Ogden (HGO) constitutive model, the meniscal implant was modeled using the isotropic hyperelastic neo-Hookean model. Placement of the meniscal implant in the non-anatomical lateral-posterior and lateral-anterior locations significantly increased the peak contact pressure in the medial compartment. Placement of the meniscal implant in non-anatomical locations significantly altered the tibial rotational kinematics and increased the total force acting at the meniscal horns. Results suggest that placement of the meniscal implant in non-anatomical locations may restrain its ability to be chondroprotective and may initiate or accelerate cartilage degeneration. In conclusion, clinicians should endeavor to place the implant as closest as possible to the anatomical location to restore the normal knee biomechanics.

DOI： 10.1007/s10237-021-01440-w

特集ロコモティブシンドロームの現況 Ⅵ.疾患とロコモ 8.人工股関節術後リハビリテーション

中村嘉宏, 帖佐悦男

整形外科 72 ( 6 ) 686 - 689 2021.5

Publishing type：Research paper (scientific journal) Publisher：南江堂

DOI： 10.15106/j_seikei72_686

特集ロコモティブシンドロームの現況 Ⅴ.ロコモ広報と地域活動･検診の実践 2.ロコモザワールド宮崎構想

帖佐悦男

整形外科 72 ( 6 ) 654 - 658 2021.5

Publishing type：Research paper (scientific journal) Publisher：南江堂

DOI： 10.15106/j_seikei72_654

連載創刊40周年記念特別企画オンライン座談会｢整形外科学×『関節外科』40年の歩み｣　後編

帖佐悦男, 筒井廣明, 吉矢晋一

関節外科　基礎と臨床 40 ( 5 ) 577 - 579 2021.5

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

DOI： 10.18885/jjs.0000000643

A hand-worn inertial measurement unit for detection of bat–ball impact during baseball hitting

Punchihewa N.G., Arakawa H., Chosa E., Yamako G.

Sensors 21 ( 9 ) 2021.5

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

Swinging a baseball bat at a pitched ball takes less than half of a second. A hitter uses his lower extremities to generate power, and coordination of the swing motion gradually transfers power through the trunk to the upper extremities during bat–ball impact. The most important instant of the baseball swing is at the bat–ball impact, after which the direction, speed, height, and distance of the hit ball determines whether runs can be scored. Thus, analyzing the biomechanical parameters at the bat–ball impact is useful for evaluating player performance. Different motion-capture systems use different methods to identify bat–ball impact. However, the level of accuracy to detect bat–ball impact is not well documented. The study aim was to examine the required accuracy to detect bat–ball impact timing. The results revealed that ±2 ms accuracy is required to report trunk and hand kinematics, especially for higher-order time-derivatives. Here, we propose a new method using a hand-worn inertial measurement unit to accurately detect bat–ball impact timing. The results of this study will be beneficial for analyzing the kinematics of baseball hitting under real-game conditions.

DOI： 10.3390/s21093002

Association between long-term hospitalization for mental illness and locomotive syndrome.

治療に難渋した浅大腿動脈損傷を伴う大腿骨転子下骨折の1例 Reviewed

福嶋研人, 塩月康弘, 今里浩之, 日吉優, 中村嘉宏, 帖佐悦男

骨折 43 ( 3 ) 702 - 704 2021.5

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：日本骨折治療学会

手関節疼痛のある関節リウマチ患者における脱着式保温素材を用いたリストサポーター装着時の即時効果に関する検討

前田翔吾, 濱田浩朗, 黒木友希, 横山茉未, 帖佐悦男, 鳥取部光司

日本ハンドセラピィ学会誌 13 ( 2 ) 107 - 110 2021.5

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：日本ハンドセラピィ学会

Yusuke Ishibashi, Hideki Arakawa, Sae Uezono, Sosuke Kitakaze, Munetsugu Kota, Shinichi Daikuya, Junichi Hirakawa, Takeshi Nakamura, Etsuo Chosa

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 27 ( 2 ) 473 - 477 2021.4

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

BACKGROUND: Patients in psychiatric care wards face serious problems in terms of declining physical function due to aging and long-term hospitalization. This study aimed to determine the current status of locomotive syndrome (LS) in long-term inpatients in psychiatric care wards and to clarify the factors associated with LS risk severity. METHODS: The study included 84 patients admitted to psychiatric care wards who underwent the LS stage test. We investigated the participants' age, length of stay, antipsychotic drug use, body mass index, and activities of daily living were assessed and analyzed the correlations between the LS stage test and each assessment item. RESULTS: The participants' mean age was 60.0 ± 13.6 years, with those aged ≥60 years comprising nearly 60% of the sample. The participants' mean length of stay was 10.5 ± 12.0 years, and over half of the patients stayed >5 years: 17.9% stayed between 5 and 10 years, while 36.9% stayed ≥10 years. Nearly 90% of participants stayed for >1 year. The LS stage test showed that 60.7% of the participants were stage 3, 21.4% were stage 2, 14.3% were stage 1, and 3.6% had no risk. The results of the LS stage indicated significant correlations with age, length of stay, and the Barthel Index scores. CONCLUSIONS: Patients who stay in a psychiatric care unit for a long period experience declining physical function, which is associated with aging and long-term hospitalization and might affect their activities of daily living.

DOI： 10.1016/j.jos.2021.01.015

連載創刊40周年記念特別企画オンライン座談会｢整形外科学×『関節外科』40年の歩み｣

帖佐悦男, 筒井廣明, 吉矢晋一

関節外科　基礎と臨床 40 ( 4 ) 467 - 470 2021.4

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

DOI： 10.18885/jjs.0000000593

特集骨粗鬆症-指導に役立つエビデンス骨粗鬆症のインパクト

帖佐悦男

総合リハビリテーション 49 ( 4 ) 333 - 337 2021.4

Publishing type：Research paper (scientific journal) Publisher：株式会社医学書院

DOI： 10.11477/mf.1552202193

Predictors of Spondylolysis on Magnetic Resonance Imaging in Adolescent Athletes With Low Back Pain

Takuji Yokoe, Takuya Tajima, Hiroshi Sugimura, Shinichirou Kubo, Shotarou Nozaki, Nami Yamaguchi, Yudai Morita, Etsuo Chosa

Orthopaedic Journal of Sports Medicine 9 ( 4 ) 2021.4

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

DOI： 10.1177/2325967121995466

特集整形外科疾患の運動療法-最近の進歩ロコモティブシンドロームに対する運動療法

帖佐悦男

整形･災害外科 64 ( 4 ) 443 - 449 2021.4

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

DOI： 10.18888/se.0000001683

The impact of helicopter emergency medical services and craniocervical traction on the early reduction of cervical spine dislocation in a rural area of Japan

Lee D., Kawano K., Ishida S., Yamaguchi Y., Kuroki T., Nagai T., Higa K., Kurogi S., Hamanaka H., Ochiai H., Chosa E.

Journal of Orthopaedic Science 27 ( 3 ) 606 - 613 2021.3

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Orthopaedic Science

Background: Several studies have shown an association between achieving decompression of the spinal cord within a few hours and neurological recovery, even in patients with complete paralysis due to cervical spine dislocation. This study aimed to clarify the impact of helicopter emergency medical services (HEMSs) and craniocervical traction on the rapid reduction of lower cervical spine dislocation in rural Japan. Methods: The success rate of and factors inhibiting closed reduction, the time from injury to reduction and the functional prognosis of lower cervical spine dislocations treated between July 2012 and February 2020 were retrospectively analysed. Results: Fourteen patients were transported by HEMS (group H), seven by ambulance (group A) and two by themselves. Although the average traveled distance and injury severity score were significantly higher in group H (64.5 km, 28.0) than in group A (24.7 km, 18.6), there was no significant difference in the average time to admission or the time to initiation of craniocervical traction after admission between groups H (159.4 min, 52.2 min) and A (163.6 min, 53.2 min). The success rate of closed reduction was 95%, and neurological deterioration was not observed in any cases. The average traction time and weight for reduction were 30.3 min and 16.3 kg, respectively. Body size and fracture-dislocation type did not significantly affect the traction time or weight. The rate of reduction within 4 h after injury was higher in group H (79%) than in group A (33%). Inner fixations were treated an average of 5.7 days after admission. After treatment, three of nine AIS A patients recovered the ability to walk, and all three patients underwent successful closed reduction within 4 h after injury. Conclusion: HEMS and highly successful closed reduction contributed to the early reduction of cervical spine dislocation and can potentially improve complete paralysis.

DOI： 10.1016/j.jos.2021.03.008

Brown-Sequard型麻痺を呈した脊髄ヘルニアの一例

松本尊行, 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 ( 2 ) 195 - 198 2021.3

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

脊髄ヘルニアは稀な疾患であり，Brown-Sequard型麻痺を呈し手術加療で軽快した1例を経験したため文献的考察を加え報告する．【症例】59歳，女性【現病歴】来院19年前から左下肢の疼痛と痺れを自覚，徐々に症状増悪したため近医を受診した．MRIにてTh2/3に脊髄ヘルニアを疑う所見を認め手術加療目的で当科紹介となった．【身体所見】下肢MMTは3/5と右下肢で低下，痛覚は左Th7以下で5/10でありBrown-Sequard型麻痺を認めた．【MRI】Th2/3レベルで脊髄の腹側への偏位と右前方への脱出がみられた．【経過】脊髄ヘルニアの診断で，麻痺が進行するため手術加療の方針とした．手術は脊椎後方アプローチにて，硬膜を切開し腹側ヘルニア孔を確認，歯状靭帯を牽引しながらヘルニアを解除した．その後脱出孔を拡大し再度陥頓しないことを確認した．術後下肢筋力は改善，痛覚は左Th7以下で9/10と筋力，感覚ともに改善，MRIでもヘルニアの再発も認められなかった．

DOI： 10.5035/nishiseisai.70.195