記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】環軸椎後方固定術(Magerl法)では片側固定にBrooks法などの後方ワイヤリングを併用することで固定性は十分とされているが,片側固定の手術成績ついての報告は限られており十分な検討は行われていない.【対象と方法】当院でMagerl法を施行し1年以上経過観察可能であった26例(片側固定11例,両側固定15例)について調査を行った.片側固定と両側固定の偽関節率について調査した.偽関節例については患者背景(年齢,既往,環軸椎不安定性),スクリュー設置位置を癒合例と比較し,その要因を検討した.【結果】偽関節率は片側固定27%(3/11),両側固定0%(0/15)で片側固定が高かった(p=0.03).偽関節は片側固定でのみ生じており,偽関節例は癒合例と比較しスクリュー設置位置が不良であった.【結論】Magerl法は骨癒合の面からは両側固定が望ましく,片側固定では良好なスクリュー設置が重要と考えられた.(著者抄録)

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】アルカプトン尿症は稀な先天性代謝異常症であり,色素沈着をきたした関節軟骨の変性により大関節に関節症性変化,脊椎に強直性変化が見られる.脊椎強直は特に胸腰椎に多く認め,頸椎ではまれであるが,今回我々は下位頸椎の強直により環軸椎の不安定性をきたし,脊髄症を発症したアルカプトン尿症の1例を経験したので報告する.【症例】65歳男性.歩行障害,四肢のしびれ,巧緻運動障害が出現し当科紹介.初診時の単純X線にて下位頸椎の強直及び環軸椎亜脱臼を認め,MRIではC1レベルでの脊髄の萎縮を認め,同レベルでの脊髄症と診断した.棘突起間スペーサーを用いた環軸椎関節の整復とMagerl+Brooks法による後方固定を施行し,脊髄症による症状は改善した.【結語】アルカプトン尿症において頸椎の強直性変化を認める症例は,環軸椎の不安定性をきたしやすく,脊髄症をきたす可能性を念頭に置くことが重要と思われた.(著者抄録)

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】アルカプトン尿症は稀な先天性代謝異常症であり,色素沈着をきたした関節軟骨の変性により大関節に関節症性変化,脊椎に強直性変化が見られる.脊椎強直は特に胸腰椎に多く認め,頸椎ではまれであるが,今回我々は下位頸椎の強直により環軸椎の不安定性をきたし,脊髄症を発症したアルカプトン尿症の1例を経験したので報告する.【症例】65歳男性.歩行障害,四肢のしびれ,巧緻運動障害が出現し当科紹介.初診時の単純X線にて下位頸椎の強直及び環軸椎亜脱臼を認め,MRIではC1レベルでの脊髄の萎縮を認め,同レベルでの脊髄症と診断した.棘突起間スペーサーを用いた環軸椎関節の整復とMagerl+Brooks法による後方固定を施行し,脊髄症による症状は改善した.【結語】アルカプトン尿症において頸椎の強直性変化を認める症例は,環軸椎の不安定性をきたしやすく,脊髄症をきたす可能性を念頭に置くことが重要と思われた.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00766&link_issn=&doc_id=20240515240031&doc_link_id=%2Fdl8ortra%2F2024%2F007302%2F031%2F0302-0306%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdl8ortra%2F2024%2F007302%2F031%2F0302-0306%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本関節病学会  

目的:Adverse pelvic mobility(APM),Flatback deformity(FB),Stiff spinopelvic mobility(SPM)における三次元動態の特徴を解析することで,人工股関節置換術におけるCup設置の目標値を示すこと。方法:脊椎固定患者40人(腰椎単椎間,腰椎多椎間,腰仙椎単椎間,腰仙椎多椎間の各10人)を対象とした。座位起立動作の連続X線撮影を行い,イメージマッチング法を用いた三次元動態解析により骨盤前後傾と股関節屈伸角を算出し,CTより臥位の角度も測定した。APM(臥位-立位Δ骨盤傾斜>13°),FB(PI-LL mismatch≧10°),Stiff SPM(立位-座位Δ骨盤傾斜<10°)の有無で,座位起立動作中の骨盤・股関節動態を比較した。結果:APM有群(15人,38%)は無群と比べ,臥位-立位の骨盤後傾量は9°,股関節伸展量は5°大きく,立位の骨盤後傾は6°増加していたが,臥位と座位起立動作中の股関節動態に有意差はなかった。FB有群(24人,60%)は無群と比べ,臥位-立位の骨盤後傾量と股関節伸展量に有意差はなく,臥位と座位起立動作中の骨盤後傾は7～9°,股関節伸展角は6～9°増加していた。Stiff SPM有群(24人,65%)は無群と比べ,臥位-立位の骨盤後傾量と股関節伸展量,および臥位と立位の骨盤前後傾と股関節屈伸展角に有意差はないが,座位(座位起立動作の初期姿勢)と深座位(股関節最大屈曲角となる姿勢)の骨盤後傾は7～10°,股関節伸展は7～10°低下していた。考察:APMは骨盤後傾増加に応じたCup減捻を行うと後方脱臼リスク増加の可能性がある。FBは臥位FPPに対したCup前捻設置が必要であり,Stiff SPMは前傾増加に応じたCup約6°の増捻が目安となる。(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Heliyon  

Background: Spinal metastases can impair mobility, worsening the Karnofsky Performance Status (KPS). Surgery for spinal metastases has the potential to improve KPS and extend prognosis, but it is crucial to recognize the elevated risk of perioperative complications. Therefore, the development of a new scoring system to accurately predict perioperative complications in spinal metastatic surgery is essential. Methods: We conducted a retrospective observational study with 86 patients who underwent surgical intervention for spinal metastases. Patients were divided into two groups based on the presence or absence of perioperative complications within 14 days after surgery. Various factors related to perioperative complications were assessed through univariate and multivariate analyses. We established a clinical prognostic scoring system called the Perioperative Complications following Metastatic Spinal Surgery (PERCOM) score and evaluated its precision using receiver operating characteristic (ROC) analysis. Results: Five variables (age, KPS, primary prostate cancer, Albumin, and Hemoglobin) identified in the univariate analysis were assigned binary values of 0 or 1. The PERCOM score was then calculated for each patient by summing the individual points, ranging from 0 to 5. The optimal threshold determined by ROC curve analysis for the PERCOM score was 2 points, with a sensitivity of 86 % and a specificity of 56 %. Conclusions: The composite PERCOM score effectively predicted perioperative complications in spinal metastasis surgery. To further validate its precision, a prospective multicenter study is needed.

DOI： 10.1016/j.heliyon.2024.e25180

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記述言語：英語   出版者・発行元：American Journal of Case Reports  

BACKGROUND: Postoperative acute liver failure, a complication following spine surgery, can cause delayed emergence from total intravenous anesthesia. Here, we report a case of acute severe postoperative liver failure following posterior spinal correction and fusion in a patient with congenital scoliosis. CASE REPORT: A girl’s congenital scoliosis worsened, and posterior spinal correction and fusion was scheduled. General anesthesia was induced with sevoflurane, fentanyl, target-controlled-infusion with propofol, and rocuronium. General anesthesia was maintained using target-controlled-infusion with propofol and remifentanil. The operation was completed with no remarkable complications. The operative time was 516 min and the anesthesia time was 641 min in the prone position. Emergence from anesthesia was poor, and it took 68 min to remove the tracheal tube after discontinuation of the anesthetic agents. The patient was drowsy and was transferred to her room in a general ward without reporting any pain, nausea, or dyspnea. On postoperative day 1, the results of laboratory investigations were suggestive of acute liver failure; contrast-enhanced computed tomography revealed a poorly enhanced area in the umbilical portion of the left liver lobe portal vein, indicating ischemic liver damage. Although no additional treatment was administered for acute liver failure, the patient recovered over time, and laboratory values normalized. No other postoperative complications were observed, and the patient was discharged on postoperative day 21. CONCLUSIONS: Delayed emergence from general anesthesia may be due to acute liver failure following posterior spinal correction and fusion. There are several possible causes of postoperative liver failure, including anesthetics, prone position, and spinal surgery.

DOI： 10.12659/AJCR.941563

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Journal of Clinical Medicine  

Background: In patients with cervical spinal cord injury (SCI), we need to make accurate prognostic predictions in the acute phase for more effective rehabilitation. We hypothesized that a multivariate prognosis would be useful for patients with cervical SCI. Methods: We made two predictive models using Multiple Linear Regression (MLR) and Artificial Neural Networks (ANNs). We adopted MLR as a conventional predictive model. Both models were created using the same 20 clinical parameters of the acute phase data at the time of admission. The prediction results were classified by the ASIA Impairment Scale. The training data consisted of 60 cases, and prognosis prediction was performed for 20 future cases (test cohort). All patients were treated in the Spinal Injuries Center (SIC) in Fukuoka, Japan. Results: A total of 16 out of 20 cases were predictable. The correct answer rate of MLR was 31.3%, while the rate of ANNs was 75.0% (number of correct answers: 12). Conclusion: We were able to predict the prognosis of patients with cervical SCI from acute clinical data using ANNs. Performing effective rehabilitation based on this prediction will improve the patient’s quality of life after discharge. Although there is room for improvement, ANNs are useful as a prognostic tool for patients with cervical SCI.

DOI： 10.3390/jcm13010253

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記述言語：英語   出版者・発行元：Spine  

Study design: Retrospective study of prospectively collected data. Objective: To investigate the influence of cartilaginous endplates (CEs) in herniated discs on clinical symptoms and postoperative outcomes in patients with lumbar disc herniation (LDH) in different age groups. Summary of Background Data: LDH involving CEs, which are hard and less resorptive, is frequently observed with increasing age and appears to affect the natural course and clinical outcomes following discectomy. Methods: Overall, 239 patients who underwent microscopic discectomy were included. Main outcomes were evaluated using motor strength, visual analog scale (VAS) for back and leg pain, and Rolland-Morris Disability Questionnaire. The effects of CEs on clinical variables and postoperative outcomes were compared between two groups (<50 years and >50 years). Furthermore, we investigated the characteristics of CE avulsions in each group and examined the association between CE occupancy rate and clinical symptoms. Results: CEs were predominantly observed with increasing age and were more frequently detected in patients with Modic changes in both groups (p < 0.001). A higher proportion of LDH with a >20% occupancy rate was found in patients aged <50 years (p = 0.009) and was associated with a decrease in motor strength preoperatively (p = 0.007). Postoperative VAS score for low back pain (LBP) was higher in patients with CEs than in those without CEs in the >50-year-old group (p < 0.001). In multiple regression analysis, the presence of CEs was independently associated with residual LBP at 1 year postoperatively in older patients (β = 0.46, p < 0.001). Conclusion: Avulsion-type herniations in patients aged <50 years had a higher CE occupancy rate, which is a potential cause of preoperative motor weakness. Clinical outcomes following discectomy improved regardless of the presence of CEs, however, cartilaginous herniation in patients aged >50 years may affect residual LBP at 1 year.

DOI： 10.1097/BRS.0000000000005178

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記述言語：日本語   出版者・発行元：日本関節病学会  

<p><b>目的：</b>Adverse pelvic mobility（APM），Flatback deformity（FB），Stiff spinopelvic mobility（SPM）における三次元動態の特徴を解析することで，人工股関節置換術におけるCup設置の目標値を示すこと。</p><p><b>方法：</b>脊椎固定患者40人（腰椎単椎間，腰椎多椎間，腰仙椎単椎間，腰仙椎多椎間の各10人）を対象とした。座位起立動作の連続X線撮影を行い，イメージマッチング法を用いた三次元動態解析により骨盤前後傾と股関節屈伸角を算出し，CTより臥位の角度も測定した。APM（臥位−立位Δ骨盤傾斜＞13°），FB（PI-LL mismatch≧10°），Stiff SPM（立位−座位Δ骨盤傾斜＜10°）の有無で，座位起立動作中の骨盤・股関節動態を比較した。</p><p><b>結果：</b>APM有群（15人，38%）は無群と比べ，臥位−立位の骨盤後傾量は9°，股関節伸展量は5°大きく，立位の骨盤後傾は6°増加していたが，臥位と座位起立動作中の股関節動態に有意差はなかった。FB有群（24人，60%）は無群と比べ，臥位−立位の骨盤後傾量と股関節伸展量に有意差はなく，臥位と座位起立動作中の骨盤後傾は7～9°，股関節伸展角は6～9°増加していた。Stiff SPM有群（24人，65%）は無群と比べ，臥位−立位の骨盤後傾量と股関節伸展量，および臥位と立位の骨盤前後傾と股関節屈伸展角に有意差はないが，座位（座位起立動作の初期姿勢）と深座位（股関節最大屈曲角となる姿勢）の骨盤後傾は7～10°，股関節伸展は7～10°低下していた。</p><p><b>考察：</b>APMは骨盤後傾増加に応じたCup減捻を行うと後方脱臼リスク増加の可能性がある。FBは臥位FPPに対したCup前捻設置が必要であり，Stiff SPMは前傾増加に応じたCup約6°の増捻が目安となる。</p>

DOI： 10.11551/jsjd.43.16

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Global Spine Journal  

Study Design: Retrospective study. Objective: To investigate the characteristics of newly developing Modic changes following discectomy and their impact on residual low back pain (LBP) in the early postoperative stage of lumbar disc herniation. Methods: We included 96 patients who underwent microscopic discectomy. Through MRI, we assessed new developments of Modic changes and the progression of disc degeneration at the surgical level. The presence of cartilaginous endplates was evaluated using resected specimens, and the main outcome was assessed using the visual analog scale (VAS). Further, the prevalence and time course of Modic changes, and their effects on clinical outcomes in the early postoperative period were examined. Results: A new development of Modic changes was detected in 28% of cartilaginous herniations at 6 months. Modic changes were observed more frequently in patients with cartilaginous herniation than in those without cartilaginous herniation postoperatively (P <.001). The VAS scores for LBP up to 6 months were greater in patients with Modic changes (P <.001) than those without; however, no significant differences were identified in the presence or absence of Modic changes over the year follow-up. The development of Modic changes was closely associated with residual LBP at 6 months (β:0.511, P <.001). Conclusions: Modic changes develop predominantly in patients with avulsion-type herniation than in those with annular rupture at an earlier phase after discectomy. Furthermore, disc herniation with cartilaginous endplates may be associated with a slower decrease in LBP for up to 6 months, supporting the notion that newly developing endplate changes may cause residual LBP.

DOI： 10.1177/21925682231220893

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記述言語：英語   出版者・発行元：Cell Death Discovery  

In osteoclastogenesis, the metabolism of metal ions plays an essential role in controlling reactive oxygen species (ROS) production, mitochondrial biogenesis, and survival, and differentiation. However, the mechanism regulating metal ions during osteoclast differentiation remains unclear. The metal-binding protein metallothionein (MT) detoxifies heavy metals, maintains metal ion homeostasis, especially zinc, and manages cellular redox levels. We carried out tests using murine osteoclast precursors to examine the function of MT in osteoclastogenesis and evaluated their potential as targets for future osteoporosis treatments. MT genes were significantly upregulated upon differentiation from osteoclast precursors to mature osteoclasts in response to receptor activators of nuclear factor-κB (NF-κB) ligand (RANKL) stimulation, and MT3 expression was particularly pronounced in mature osteoclasts among MT genes. The knockdown of MT3 in osteoclast precursors demonstrated a remarkable inhibition of differentiation into mature osteoclasts. In preosteoclasts, MT3 knockdown suppressed the activity of mitogen-activated protein kinase (MAPK) and NF-κB signaling pathways upon RANKL stimulation, leading to affect cell survival through elevated cleaved Caspase 3 and poly (ADP-ribose) polymerase (PARP) levels. Additionally, ROS levels were decreased, and nuclear factor erythroid 2-related factor 2 (NRF2) (a suppressor of ROS) and the downstream antioxidant proteins, such as catalase (CAT) and heme oxygenase 1 (HO-1), were more highly expressed in the MT3 preosteoclast knockdowns. mitochondrial ROS, which is involved in mitochondrial biogenesis and the production of reactive oxygen species, were similarly decreased because cAMP response element-binding (CREB) and peroxisome proliferator-activated receptor γ coactivator 1β (PGC-1β) were less activated due to MT3 depletion. Thus, by modulating ROS through the NRF2 pathway, MT3 plays a crucial role in regulating osteoclast differentiation and survival, acting as a metabolic modulator of intracellular zinc ions. [Figure not available: see fulltext.]

DOI： 10.1038/s41420-023-01729-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers in Immunology  

Background: Spinal cord injury (SCI) is a devastating disease that results in permanent paralysis. Currently, there is no effective treatment for SCI, and it is important to identify factors that can provide therapeutic intervention during the course of the disease. Zinc, an essential trace element, has attracted attention as a regulator of inflammatory responses. In this study, we investigated the effect of zinc status on the SCI pathology and whether or not zinc could be a potential therapeutic target. Methods: We created experimental mouse models with three different serum zinc concentration by changing the zinc content of the diet. After inducing contusion injury to the spinal cord of three mouse models, we assessed inflammation, apoptosis, demyelination, axonal regeneration, and the number of nuclear translocations of NF-κB in macrophages by using qPCR and immunostaining. In addition, macrophages in the injured spinal cord of these mouse models were isolated by flow cytometry, and their intracellular zinc concentration level and gene expression were examined. Functional recovery was assessed using the open field motor score, a foot print analysis, and a grid walk test. Statistical analysis was performed using Wilcoxon rank-sum test and ANOVA with the Tukey-Kramer test. Results: In macrophages after SCI, zinc deficiency promoted nuclear translocation of NF-κB, polarization to pro-inflammatory like phenotype and expression of pro-inflammatory cytokines. The inflammatory response exacerbated by zinc deficiency led to worsening motor function by inducing more apoptosis of oligodendrocytes and demyelination and inhibiting axonal regeneration in the lesion site compared to the normal zinc condition. Furthermore, zinc supplementation after SCI attenuated these zinc-deficiency-induced series of responses and improved motor function. Conclusion: We demonstrated that zinc affected axonal regeneration and motor functional recovery after SCI by negatively regulating NF-κB activity and the subsequent inflammatory response in macrophages. Our findings suggest that zinc supplementation after SCI may be a novel therapeutic strategy for SCI.

DOI： 10.3389/fimmu.2023.1290100

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：iScience  

We proposed a bimodal artificial intelligence that integrates patient information with images to diagnose spinal cord tumors. Our model combines TabNet, a state-of-the-art deep learning model for tabular data for patient information, and a convolutional neural network for images. As training data, we collected 259 spinal tumor patients (158 for schwannoma and 101 for meningioma). We compared the performance of the image-only unimodal model, table-only unimodal model, bimodal model using a gradient-boosting decision tree, and bimodal model using TabNet. Our proposed bimodal model using TabNet performed best (area under the receiver-operating characteristic curve [AUROC]: 0.91) in the training data and significantly outperformed the physicians' performance. In the external validation using 62 cases from the other two facilities, our bimodal model showed an AUROC of 0.92, proving the robustness of the model. The bimodal analysis using TabNet was effective for differentiating spinal tumors.

DOI： 10.1016/j.isci.2023.107900

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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 Neuroscience  

BACKGROUND: Meningiomas, although benign, often require complete resection due to their tendency for recurrence. However, dural reconstruction poses significant challenges, especially in the case of ventral meningiomas. While some reports have highlighted the usefulness of dural reconstruction using an artificial dura mater, no studies have yet confirmed dural canal enlargement through MRI post-surgically. This study aimed to assess the effectiveness of the Fenestrated Durotomy with Oversized Graft (FDOG) technique in cases of meningiomas and other intradural extramedullary tumors and evaluated dural canal dilation through MRI after using an artificial dura mater. METHODS: This retrospective case series included 8 patients who underwent combined resection of intradural extramedullary tumors and dural repair using the FDOG technique. An artificial dura mater larger than that resected was inserted into the dural defect resulting from complete tumor resection on the ventral or lateral side of the spinal cord. The new dura mater was secured with a single dorsal suture. The dural incision was closed using watertight sutures following standard procedure. Measurement of the extent of dural canal enlargement was achieved via pre- and postoperative MRI scans. RESULTS: None of the patients required additional treatments or lumbar drainage. All achieved independent ambulation without complications, and imaging tests indicated satisfactory dural expansion without signs of cerebrospinal fluid leakage. CONCLUSIONS: The proposed method for dural repair in cases involving large dural defects on the ventral or lateral side of the spinal cord was shown to be a straightforward and effective approach with minimal postoperative complications.

DOI： 10.1016/j.jocn.2023.09.003

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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: Progression of kyphosis after laminoplasty sometimes results in the recurrence of myelopathy with lamina closure. However, only a few case reports have been published on the reoperation of double-door laminoplasty using the suture method. This study investigated the incidence and clinical features of reoperation cases caused by the recurrence of myelopathy with lamina closure after double-door laminoplasty using a modified Kirita-Miyazaki suture method. METHODS: A total of 169 patients who underwent double-door laminoplasty were included in this study, with a mean follow-up duration of 6.6 years (range: 2-16). All surgeries were double-door laminoplasties in which the open lamina was sutured to the paravertebral muscle. The reoperation rate for myelopathy recurrence due to lamina closure and the associated risk factors were investigated. The risk factors included age, history, cervical alignment, C2-7 lordosis, the cervical sagittal vertical axis, and C7 slope. RESULTS: The reoperation rate for recurrence of myelopathy by lamina closure was 3.0% (5/169). All patients showed kyphosis progression after surgery; the spinal cord was more compressed by closed lamina than before the initial surgery. The reoperation group had more patients with neuromuscular or psychiatric disorders (60% [3/5] vs. 2% [4/164]; p < 0.001), kyphotic alignments (60% [3/5] vs. 10% [16/164]; p < 0.001), and cases with less than -10° of C2-7 lordosis (60% [3/5] vs. 7% [11/164]; p < 0.001). CONCLUSIONS: Double-door laminoplasty with the suture method may not be suitable for patients with a neuromuscular or psychiatric disease or those with preoperative C2-7 lordosis less than -10°.

DOI： 10.1016/j.jor.2023.07.024

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記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

<p>【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること．【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした．平均手術時年齢は66.8歳，術後平均7.5ヶ月で評価した．ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした．【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた．通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw（PPS）群ではゆるみに有意差はなかったが，術前後アライメント変化はPPS群で有意に大きかった．PPS群の中で，ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった．【考察】Open群ではアライメントにあわせたロッドを連結するのに対し，PPSではロッドをスクリューに押し込むよう連結するため，インプラントに負荷がかかり，ゆるみが生じやすいことが示唆された．</p>

DOI： 10.5035/nishiseisai.72.579

CiNii Research

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

<p>【はじめに】腰椎手術でのトラネキサム酸（TXA）投与の周術期出血量における影響を検討した．【対象と方法】腰椎手術を行った116例を対象とした．TXAは術直前に1000 mg投与した．年齢，身長，体重，術式（固定，非固定），手術椎間数，手術時間，術中出血量，術後1日目の出血量を検討項目とし，TXA投与群と非投与群で比較検討行った．【結果】投与群は57例，非投与群は59例であった．年齢，身長，体重で有意差はなかった．術式は投与群で固定術25例，非固定32例，非投与群で固定術30例，非固定29例であった．手術椎間数，手術時間に有意差はなかった．術中出血量（ml）は投与群134±165，非投与群で165±152であり，両群間に有意差はなかった．術後1日目の出血量（ml）は投与群187±135，非投与群308±210であり，TXA投与で有意に減少していた（p＜0.05）．【考察】トラネキサム酸投与は，腰椎手術において，術後出血量の抑制に有効であると考えられた．</p>

DOI： 10.5035/nishiseisai.72.825

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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 Neurotrauma  

Neonatal spinal cord injury (SCI) shows better functional outcomes than adult SCI. Although the regenerative capability in the neonatal spinal cord may have cues in the treatment of adult SCI, the mechanism underlying neonatal spinal cord regeneration after SCI is unclear. We previously reported age-dependent variation in the pathogenesis of inflammation after SCI. Therefore, we explored differences in the pathogenesis of inflammation after SCI between neonatal and adult mice and their effect on axon regeneration and functional outcome. We established two-day-old spinal cord crush mice as a model of neonatal SCI. Immunohistochemistry of the spinal cord revealed that the nuclear translocation of NF-κB, which promotes the expression of chemokines, was significantly lower in the astrocytes of neonates than in those of adults. Flow cytometry revealed that neonatal astrocytes secrete low levels of chemokines to recruit circulating neutrophils (e.g., Cxcl1 and Cxcl2) after SCI in comparison with adults. We also found that the expression of a chemokine receptor (CXCR2) and an adhesion molecule (β2 integrin) quantified by flow cytometry was lower in neonatal circulating neutrophils than in adult neutrophils. Strikingly, these neonate-specific cellular properties seemed to be associated with no neutrophil infiltration into the injured spinal cord, followed by significantly lower expression of inflammatory cytokines (Il-1β, Il-6 and TNF-α) after SCI in the spinal cords of neonates than in those of adults. At the same time, significantly fewer apoptotic neurons and greater axonal regeneration were observed in neonates in comparison with adults, which led to a marked recovery of locomotor function. This neonate-specific mechanism of inflammation regulation may have potential therapeutic applications in controlling inflammation after adult SCI.

DOI： 10.1089/neu.2023.0044

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記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】腰椎手術でのトラネキサム酸(TXA)投与の周術期出血量における影響を検討した.【対象と方法】腰椎手術を行った116例を対象とした.TXAは術直前に1000mg投与した.年齢,身長,体重,術式(固定,非固定),手術椎間数,手術時間,術中出血量,術後1日目の出血量を検討項目とし,TXA投与群と非投与群で比較検討行った.【結果】投与群は57例,非投与群は59例であった.年齢,身長,体重で有意差はなかった.術式は投与群で固定術25例,非固定32例,非投与群で固定術30例,非固定29例であった.手術椎間数,手術時間に有意差はなかった.術中出血量(ml)は投与群134±165,非投与群で165±152であり,両群間に有意差はなかった.術後1日目の出血量(ml)は投与群187±135,非投与群308±210であり,TXA投与で有意に減少していた(p<0.05).【考察】トラネキサム酸投与は,腰椎手術において,術後出血量の抑制に有効であると考えられた.(著者抄録)

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【目的】脊椎転移に対する後方固定術後のスクリューのゆるみに影響しうる因子について検討すること.【対象と方法】2017年1月～2020年2月に脊椎転移に対し後方固定術を行なった33例を対象とした.平均手術時年齢は66.8歳,術後平均7.5ヵ月で評価した.ゆるみは画像上スクリュー周囲に1mm以上のradiolucent zoneを認めるものとした.【結果】固定範囲における術前後の矢状面アライメント変化が大きいほどゆるみを生じていた.通常の展開で固定したOpen群と経皮的スクリューを用いたpercutaneous pedicle screw(PPS)群ではゆるみに有意差はなかったが,術前後アライメント変化はPPS群で有意に大きかった.PPS群の中で,ゆるみを生じた群では生じていない群に比較しアライメント変化が大きい傾向にあった.【考察】Open群ではアライメントにあわせたロッドを連結するのに対し,PPSではロッドをスクリューに押し込むよう連結するため,インプラントに負荷がかかり,ゆるみが生じやすいことが示唆された.(著者抄録)

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

After spinal cord injury (SCI), inflammatory cells such as macrophages infiltrate the injured area, and astrocytes migrate, forming a glial scar around macrophages. The glial scar inhibits axonal regeneration, resulting in significant permanent disability. However, the mechanism through which glial scar-forming astrocytes migrate to the injury site has not been clarified. Here we show that migrating macrophages attract reactive astrocytes toward the center of the lesion after SCI. Chimeric mice with bone marrow lacking IRF8, which controls macrophage centripetal migration after SCI, showed widely scattered macrophages in the injured spinal cord with the formation of a huge glial scar around the macrophages. To determine whether astrocytes or macrophages play a leading role in determining the directions of migration, we generated chimeric mice with reactive astrocyte-specific Socs3-/- mice, which showed enhanced astrocyte migration, and bone marrow from IRF8-/- mice. In this mouse model, macrophages were widely scattered, and a huge glial scar was formed around the macrophages as in wild-type mice that were transplanted with IRF8-/- bone marrow. In addition, we revealed that macrophage-secreted ATP-derived ADP attracts astrocytes via the P2Y1 receptor. Our findings revealed a mechanism through which migrating macrophages attract astrocytes and affect the pathophysiology and outcome after SCI.

DOI： 10.1038/s41598-023-38301-8

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記述言語：日本語   出版者・発行元：日本脊髄障害医学会  

初代培養アストロサイトを用いてIII型コラーゲンの細胞遊走への影響を調査した。次にマウスの損傷脊髄内にIII型コラーゲン/G蛋白質共役受容体56(GPR56)/PBSを投与した。さらにGpr56遺伝子を細胞特異的にノックダウンしたマウスに脊髄損傷を作成し、各群で損傷後42日までの運動機能をBasso Mouse Scaleにて評価し、免疫染色による瘢痕組織の評価を行った。損傷部に沈着したIII型コラーゲンは、アストロサイトのGpr56を介してRhoAを活性化させ、アストロサイトの細胞遊走を低下させることで線維性瘢痕周囲にアストロサイトの集簇を起こしていることが明らかとなり、GPR56拮抗薬による新規治療法の実現可能性が示唆された。

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

Joint contracture causes distressing permanent mobility disorder due to trauma, arthritis, and aging, with no effective treatment available. A principal and irreversible cause of joint contracture has been regarded as the development of joint capsule fibrosis. However, the molecular mechanisms underlying contracture remain unclear. We established a mouse model of knee joint contracture, revealing that fibrosis in joint capsules causes irreversible contracture. RNA-sequencing of contracture capsules demonstrated a marked enrichment of the genes involved in the extracellular region, particularly periostin (Postn). Three-dimensional magnetic resonance imaging and immunohistological analysis of contracture patients revealed posterior joint capsule thickening with abundant type I collagen (Col1a2) and POSTN in humans. Col1a2-GFPTG ; Postn-/- mice and chimeric mice with Col1a2-GFPTG ; tdTomatoTG bone marrow showed fibrosis in joint capsules caused by bone marrow-derived fibroblasts, and POSTN promoted the migration of bone marrow-derived fibroblasts, contributing to fibrosis and contracture. Conversely, POSTN-neutralizing antibody attenuated contracture exacerbation. Our findings identified POSTN as a key inducer of fibroblast migration that exacerbates capsule fibrosis, providing a potential therapeutic strategy for joint contracture.

DOI： 10.1096/fj.202201598R

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記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

<p>総合せき損センターにおける腰椎椎間板ヘルニアに対するコンドリアーゼ（ヘルニコア®）椎間板内投与の治療効果について検討した．同院でコンドリアーゼ椎間板内投与を行い，投与後3ヶ月間フォローし得た7症例について，腰痛・殿部下肢痛・殿部下肢の痺れを調査した．いずれの項目でもVASは有意に低下し，JOAに関しても疼痛関連障害・社会生活障害の項目で有意な改善を認めた．さらに，投与翌日の症状改善効果についても検討を行った．対象はヘルニコア椎間板内投与後翌日に評価し得た7症例であり，腰痛のVASは統計学的に有意な改善を認め，下肢痛は改善の傾向が見られた．今回の症例からは，疼痛が高度であっても投与後早期から治療効果が得られる症例もあり，適応の症例は一般的に考えられているより広い可能性があることが示唆された．</p>

DOI： 10.5035/nishiseisai.72.295

CiNii Research

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

総合せき損センターにおける腰椎椎間板ヘルニアに対するコンドリアーゼ(ヘルニコア)椎間板内投与の治療効果について検討した.同院でコンドリアーゼ椎間板内投与を行い,投与後3ヶ月間フォローし得た7症例について,腰痛・臀部下肢痛・臀部下肢の痺れを調査した.いずれの項目でもVASは有意に低下し,JOAに関しても疼痛関連障害・社会生活障害の項目で有意な改善を認めた.さらに,投与翌日の症状改善効果についても検討を行った.対象はヘルニコア椎間板内投与後翌日に評価し得た7症例であり,腰痛のVASは統計学的に有意な改善を認め,下肢痛は改善の傾向が見られた.今回の症例からは,疼痛が高度であっても投与後早期から治療効果が得られる症例もあり,適応の症例は一般的に考えられているより広い可能性があることが示唆された.(著者抄録)

記述言語：日本語   出版者・発行元：一般社団法人 日本脊椎脊髄病学会  

<p><b>はじめに：</b>Spinal Instability Neoplastic Score（SINS）は転移性脊椎腫瘍の不安定性評価法であるが，骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている．転移性脊椎腫瘍による脊髄症状発症例から，脊髄症状発症前のSINSを測定することにより，SINSによるリスク患者検出の有効性について検証した．</p><p><b>対象と方法：</b>2004年から2019年，頚胸椎部の転移性脊椎腫瘍に対する手術例81例から，脊髄症状発症前の画像評価が可能であった29例について調査した．脊髄症状発症半年以内に撮影されたCTからSINSを測定し，SINS7以上をリスク患者とした．</p><p><b>結果：</b>CT撮影時期は脊髄症状発症の平均72日前であった．SINSは転移なし2例，7未満（stability）4例，7以上～13未満（indeterminate instability）15例，13以上（instability）8例であり，21%（6/29）はリスク患者とならなかった．</p><p><b>結語：</b>脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された．</p>

DOI： 10.34371/jspineres.2022-0021

CiNii Research

記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J05510&link_issn=&doc_id=20230227380004&doc_link_id=%2Ffg7spine%2F2023%2F001402%2F005%2F0082-0087%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffg7spine%2F2023%2F001402%2F005%2F0082-0087%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本脊椎脊髄病学会  

はじめに:Spinal Instability Neoplastic Score(SINS)は転移性脊椎腫瘍の不安定性評価法であるが,骨有害事象リスク患者を検出する際のスクリーニング手段としても使用が報告されている.転移性脊椎腫瘍による脊髄症状発症例から,脊髄症状発症前のSINSを測定することにより,SINSによるリスク患者検出の有効性について検証した.対象と方法:2004年から2019年,頸胸椎部の転移性脊椎腫瘍に対する手術例81例から,脊髄症状発症前の画像評価が可能であった29例について調査した.脊髄症状発症半年以内に撮影されたCTからSINSを測定し,SINS7以上をリスク患者とした.結果:CT撮影時期は脊髄症状発症の平均72日前であった.SINSは転移なし2例,7未満(stability)4例,7以上～13未満(indeterminate instability)15例,13以上(instability)8例であり,21%(6/29)はリスク患者とならなかった.結語:脊髄症状発症前のSINSによる評価では約20%で脊髄症状発症の危険性を検出できない可能性が示唆された.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J05510&link_issn=&doc_id=20230227380004&doc_link_id=10.34371%2Fjspineres.2022-0021&url=https%3A%2F%2Fdoi.org%2F10.34371%2Fjspineres.2022-0021&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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 Case Reports  

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a spectrum of heterogeneous diseases commonly recognised by skin and osteoarticular lesions. There have been reports of some surgical cases of the progressive, destructive spondylitis associated with SAPHO syndrome, wherein the destructive spondylitis was considered to have developed due to the progression of spondylitis with SAPHO syndrome as the pathogenic bacteria were not isolated. We herein report a surgical case of destructive cervical spondylitis associated with SAPHO syndrome. A 54-year-old woman with a history of palmoplantar pustulosis suffered severe neck pain for 6 months. Radiography and computeed tomography showed sclerosed and collapsed cervical vertebrae, and the patient was referred to our hospital for further evaluation and management upon suspicion of infection or spondylitis with SAPHO syndrome. For the severe neck pain and progressive destruction of cervical vertebrae, we performed posterior fusion surgery with subsequent anterior fusion. Cutibacterium acnes (C. acnes) was isolated by enrichment culture with thioglycolate broth from both the anterior and the posterior tissue samples. We diagnosed pyogenic spondylitis secondary to C. acnes infection and administered doxycycline for 6 weeks after the first surgery. The neck pain was resolved and cervical fusion was achieved one year postoperatively. C. acnes infection could elicit destructive spondylitis. An enrichment culture should be performed to isolate the pathogenic bacteria in cases of destructive spondylitis with SAPHO syndrome.

DOI： 10.1093/mrcr/rxac035

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記述言語：英語  

After spinal cord injury (SCI), inflammatory cells such as macrophages infiltrate the injured area, and astrocytes migrate, forming a glial scar around macrophages. The glial scar inhibits axonal regeneration, resulting in significant permanent disability. However, the mechanism by which glial scar-forming astrocytes migrate to the injury site has not been clarified. Here we show that migrating macrophages attract reactive astrocytes toward the center of the lesion after SCI. Chimeric mice with bone marrow lacking IRF8, which controls macrophage centripetal migration after SCI, showed widely scattered macrophages in injured spinal cord with the formation of a huge glial scar around the macrophages. To determine whether astrocytes or macrophages play a leading role in determining the directions of migration, we generated chimeric mice with reactive astrocyte-specific Socs3 -/- mice, which showed enhanced astrocyte migration, and bone marrow from IRF8 -/- mice. In this mouse model, macrophages were widely scattered, and a huge glial scar was formed around the macrophages as in wild-type mice that were transplanted with IRF8 -/ bone marrow. In addition, we revealed that macrophage-secreted ATP-derived ADP attracts astrocytes via the P2Y1 receptor. Our findings revealed a mechanism in which migrating macrophages attracted astrocytes and affected the pathophysiology and outcome after SCI.

DOI： 10.21203/rs.3.rs-2427082/v1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Experimental Neurology  

Spinal cord injury (SCI) causes reactive astrogliosis, the sequential phenotypic change of astrocytes in which naïve astrocytes (NAs) transform into reactive astrocytes (RAs) and subsequently become scar-forming astrocytes (SAs), resulting in glial scar formation around the lesion site and thereby limiting axonal regeneration and motor/sensory functional recovery. Inhibiting the transformation of RAs into SAs in the acute phase attenuates the reactive astrogliosis and promotes regeneration. However, whether or not SAs once formed can revert to RAs or SAs is unclear. We performed selective isolation of astrocytes from glial scars at different time points for a gene expression analysis and found that the expression of Sox9, an important transcriptional factor for glial cell differentiation, was significantly increased in chronic phase astrocytes (CAs) compared to SAs in the sub-acute phase. Furthermore, CAs showed a significantly lower expression of chondroitin sulfate proteoglycan (CSPG)-related genes than SAs. These results indicated that SAs changed their phenotypes according to the surrounding environment of the injured spinal cord over time. Even though the integrin-N-cadherin pathway is critical for glial scar formation, collagen-I-grown scar-forming astrocytes (Col-I-SAs) did not change their phenotype after depleting the effect of integrin or N-cadherin. In addition, we found that Col-I-SAs transplanted into a naïve spinal cord formed glial scar again by maintaining a high expression of genes involved in the integrin-N-cadherin pathway and a low expression of CSPG-related genes. Interestingly, the transplanted Col-I-SAs changed NAs into SAs, and anti-β1-integrin antibody blocked the recruitment of SAs while reducing the volume of glial scar in the chronic phase. Our findings indicate that while the characteristics of glial scars change over time after SCI, SAs have a cell-autonomous function to form and maintain a glial scar, highlighting the basic mechanism underlying the persistence of glial scars after central nervous system injury until the chronic phase, which may be a therapeutic target.

DOI： 10.1016/j.expneurol.2022.114264

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記述言語：英語   出版者・発行元：Oxford University Press  

症例は54歳男性で、5年前に掌蹠膿疱症と診断され、紫外線療法にて寛解が得られていたが、6ヵ月前より頸部痛と左肩甲骨痛をきたした。このため、頸部カラーを用いた保存療法を受けていたが改善なく、画像診断で頸椎の硬化症と挫滅がみられたため、SAPHO症候群を伴う脊椎炎などが疑われ精査加療目的に当院に紹介された。徒手筋力テストでは筋力低下はみられなかったが左前腕に感覚鈍麻が検出され、臨床検査では白血球数8670/mm3、CRP 0.62mg/L、赤血球沈降速度63mm/hを示し、リウマチ因子、抗環状シトルリン化ペプチド抗体、HLA B-27は陰性、血液培養結果は陰性であった。CT所見でC5-6接合部椎体にびらんと挫滅がみられ、ガドリニウム造影MRIにて前後エレメントに高信号が検出された。重度の頸部痛と進行性頸椎破壊に対して手術を行う方針とし、後方固定後に前方固定術を施行した。C4/5とC6/7の間の椎間板を切除し、腸骨とプレートを用いて再建を施した。術後の菌培養ではアクネ菌が同定されたことから、アクネ菌による二次性化膿性脊椎炎と診断し、ドキシサイクリン200mg/日を6週間投与した。術後に頸部痛の改善が認められ、白血球数とCRPは減少、1年後の画像所見で骨癒合が確認された。

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

<p>【はじめに】特発性側弯症患者の呼吸機能に影響する因子を検討した．【対象と方法】後方矯正固定術を行なった特発性側弯症患者62例を対象とした．Lenke分類1-4を対象とし，男性12名，女性50名，平均年齢17歳（11歳～29歳）であった．年齢，身長，体重，胸椎Cobb角，頂椎高位，CTでの頂椎の回旋度を検討項目とし，呼吸機能検査における％VC，FEV1.0に対しての影響を検討した．【結果】Cobb角，頂椎の回旋度は，％VCとの有意な相関を認めた．年齢，身長，体重，頂椎高位には相関は認めなかった．FEV1はどの検討項目でも有意な相関を認めなかった．ROCカーブにおける検討では，Cobb角55度以上，頂椎回旋14度以上では，％VC≦80％となり，呼吸機能に異常を認める結果となった．【考察】Cobb角，頂椎回旋度は％VCに影響し，術前に呼吸機能に異常を認める可能性が高いことが示唆された．</p>

DOI： 10.5035/nishiseisai.71.545

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Global Spine Journal  

STUDY DESIGN: Retrospective diagnostic analysis. OBJECTIVES: To establish a new predictor of surgical outcome after surgery for intradural extramedullary spinal tumor (IDEMT) in the thoracic spine, we introduced shape factor (SF), a mathematical description of the morphology of the spinal cord. SF was calculated by dividing object area by the square of perimeter. MATERIALS AND METHODS: Forty-three consecutive patients with IDEMT, detected by magnetic resonance imaging at the thoracic level with myelopathic signs, were included. Preoperative transverse cross-sectional area (CSA) and perimeter of the spinal cord (perimeter) at the level of maximal compression were measured. SF was calculated as 4π × CSA/(perimeter)2. The association between clinicoradiological factors and surgical outcome of IDEMT was statistically analyzed. RESULTS: Mean CSA, perimeter, and SF were 27.8 ± 15.8 mm2, 28.8 ± 6.1 mm, and 0.385 ± 0.14, respectively. A histogram distribution revealed that perimeter and SF, but not CSA, fit the normal distribution. The patients were subdivided into 2 groups according to postoperative modified Japanese Orthopedic Association Score (mJOA). [group F (favorable): n = 32, mJOA ≥ 9; group UF (unfavorable): n = 11, mJOA < 9). Group UF had significantly lower mean CSA and SF. In univariate analysis of possible predictive factors for IDEMT surgery, greater age, lower preoperative mJOA, and lower SF were significantly associated with unfavorable outcome. In multivariate analysis, lower SF was the only significant predictor of postoperative outcome (odds ratio = 2.66, 95% CI 1.10-6.39, p = 0.0115). CONCLUSION: Measurements of CSA and perimeter, followed by calculation of SF, may provide valuable quantitative information for the outcome of surgery for IDEMT.

DOI： 10.1177/2192568220982571

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

In crush syndrome, massive muscle breakdown resulting from ischemia-reperfusion muscle injury can be a life-threatening condition that requires urgent treatment. Blood reperfusion into the ischemic muscle triggers an immediate inflammatory response, and neutrophils are the first to infiltrate and exacerbate the muscle damage. Since free zinc ion play a critical role in the immune system and the function of neutrophils is impaired by zinc depletion, we hypothesized that the administration of a zinc chelator would be effective for suppressing the inflammatory reaction at the site of ischemia-reperfusion injury and for improving of the pathology of crush syndrome. A crush syndrome model was created by using a rubber tourniquet to compress the bilateral hind limbs of mice at 8 weeks. A zinc chelator N,N,N',N'-tetrakis-(2-pyridylmethyl)-ethylenediamine (TPEN) was administered immediately after reperfusion in order to assess the anti-inflammatory effect of the chelator for neutrophils. Histopathological evaluation showed significantly less muscle breakdown and fewer neutrophil infiltration in TPEN administration group compared with control group. In addition, the expression levels of inflammatory cytokine and chemokine such as IL-6, TNFα, CXCL1, CXCL2, CXCR2, CCL2 in ischemia-reperfusion injured muscle were significantly suppressed with TPEN treatment. Less dilatation of renal tubules in histological evaluation in renal tissue and significantly better survival rate were demonstrated in TPEN treatment for ischemia-reperfusion injury in crush syndrome. The findings of our study suggest that zinc chelators contributed to the resolution of exacerbation of the inflammatory response and attenuation of muscle breakdown in the acute phase after crush syndrome. In addition, our strategy of attenuation of the acute inflammatory reaction by zinc chelators may provide a promising therapeutic strategy not only for crush syndrome, but also for other diseases driven by inflammatory reactions.

DOI： 10.1038/s41598-022-19903-0

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記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】特発性側彎症患者の呼吸機能に影響する因子を検討した.【対象と方法】後方矯正固定術を行なった特発性側彎症患者62例を対象とした.Lenke分類1-4を対象とし,男性12名,女性50名,平均年齢17歳(11歳～29歳)であった.年齢,身長,体重,胸椎Cobb角,頂椎高位,CTでの頂椎の回旋度を検討項目とし,呼吸機能検査における%VC,FEV1.0に対しての影響を検討した.【結果】Cobb角,頂椎の回旋度は,%VCとの有意な相関を認めた.年齢,身長,体重,頂椎高位には相関は認めなかった.FEV1はどの検討項目でも有意な相関を認めなかった.ROCカーブにおける検討では,Cobb角55度以上,頂椎回旋14度以上では,%VC≦80%となり,呼吸機能に異常を認める結果となった.【考察】Cobb角,頂椎回旋度は%VCに影響し,術前に呼吸機能に異常を認める可能性が高いことが示唆された.(著者抄録)

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: Malignant tumors occurring around both the spinal column and posterior chest wall are uncommon. Surgical resection of chest wall tumors adjacent to the spinal column is still challenging due to the surrounding anatomical structures. The purpose of the present study was to evaluate the long-term outcomes of surgical management in malignant tumors involving the spinal column and posterior chest wall. METHODS: Between 1999 and 2007, 10 consecutive patients underwent en bloc resection combined with the posterior chest wall in the treatment of malignant tumors around the spinal column. There were 6 males and 4 females with a mean age at the surgery of 40.9 years old (range, 14-62 years old). The mean postoperative follow-up period was 159.7 months (range, 84-245 months). The clinical history, physical examination, laboratory data, radiological findings, and operative findings for each patient were retrospectively reviewed. RESULTS: All surgeries were performed via a combined anterior and posterior approach. The mean numbers of partially resected vertebrae and ribs were 3.1 and 4.1, respectively. Lower or upper lobectomy was performed in four patients, and the diaphragm was partially resected in two patients. The surgical margin was wide in seven patients and marginal in two patients. Although five patients had postoperative respiratory problem, all patients improved immediately without life-threatening complications. There were no patients with respiratory insufficiency after surgery. One patient with osteosarcoma died of lung metastases 99 months after surgery. At the final follow-up, only one patient had local recurrence, five had been continuously disease-free, and three were alive with no evidence of disease. CONCLUSIONS: En bloc resection and reconstruction in selected patients with malignant tumors involving both the spinal column and posterior chest wall demonstrated good long-term results for local control and the respiratory function.

DOI： 10.1016/j.jos.2021.03.017

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記述言語：英語   出版者・発行元：(公社)日本整形外科学会  

脊柱および後部胸壁に浸潤する悪性腫瘍に対する外科治療の長期成績を評価した。1999～2007年に脊柱周囲の悪性腫瘍に対して後部胸壁を含めた一括切除を施行した10例(男性6例、女性4例、平均年齢40.9歳)を対象とした。術後の経過観察期間は平均159.7ヵ月であった。全例、前方+後方アプローチにて手術を施行し、切除椎骨数は平均3.1、切除肋骨数は平均4.1、肺下葉または上葉切除術を4例、横隔膜部分切除術を2例に行った。術後、5例に呼吸器合併症を認めたが迅速に改善し、呼吸不全をきたした症例はなかった。骨肉腫の1例は肺転移をきたして術後99ヵ月に死亡した。最終経過観察時、局所再発が1例、無病生存が5例、生存が3例であった。脊柱と後部胸壁に生じた悪性腫瘍の患者に対する一括切除および再建術は良好な長期成績を示した。

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1408202373

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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: Basic science study. OBJECTIVE: The aim of this study was to examine whether epidural fat tissue (EFT) transplantation can prevent epidural adhesion after laminectomy more efficiently than subcutaneous fat tissue (SFT) transplantation. SUMMARY OF BACKGROUND DATA: Epidural adhesion is almost inevitable after laminectomy. Although many materials have been used to prevent adhesion, none has been widely accepted. As EFT is an ectopic fat tissue located on the dura mater and there is no adhesion between EFT and the dura mater, we focused on the efficacy of EFT for adhesion prevention. METHODS: We examined the differences in histology and gene expression between EFT and SFT of mice. We performed laminectomy at the 10th thoracic level and immediately transplanted EFT or SFT to the dura mater in mice. At 6 weeks after transplantation, we performed histological and gene expression analyses and evaluated the adhesion tenacity. In addition, we examined the characteristic differences between human EFT and SFT. RESULTS: The adipocytes of EFT were significantly smaller than those of SFT in mice and humans. The gene expression of inflammatory cytokine and fibrosis-related factors was significantly higher in SFT than in EFT. At 6 weeks after transplantation, the percentage of the remaining fat area over the dura mater was significantly greater in the EFT group than in SFT group, and the adhesion tenacity score was significantly lower in the EFT group than that in the SFT group. An RNA sequencing analysis revealed 1921 differentially expressed genes (DEGs) between human EFT and SFT, and a Gene Ontology term associated with the inflammatory response was most highly enriched in SFT. CONCLUSION: EFT has different molecular and histological profiles from SFT and EFT grafting is more effective for epidural adhesion prevention than conventional SFT transplantation after laminectomy in a mouse model.Level of Evidence: N/A.

DOI： 10.1097/BRS.0000000000004281

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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: Multiple spinal cord tumors in a single patient are very rare and most often seen in cases of neurofibromatosis and associated disorders. Schwannomatosis, which is characterized by the development of multiple schwannomas without vestibular schwannomas, has been newly defined as a distinct form of neurofibromatosis. The purpose of the present study was to describe and review the clinical and radiological features and the management of patients with multiple spinal schwannomas without vestibular schwannomas. METHODS: Between 1986 and 2016, 19 patients with multiple spinal schwannomas without vestibular schwannoma were diagnosed and treated. Of the 19 patients, 13 were males, and 6 were females. The mean age at the first surgery for spinal schwannoma was 45.2 years old. The mean follow-up period was 123.4 months. The clinical features and radiological findings of the patients with multiple spinal schwannomas were retrospectively reviewed. RESULTS: Among the 19 patients, there were more than 140 spinal schwannomas. The most common area of spinal schwannoma was the thoracolumbar-lumbar region. Initial symptoms and chief complaints caused by spinal schwannomas were primarily pain in the trunk or extremities in 17 (89.5%) of 19 patients. More than 60 spinal schwannomas were surgically resected. Multiple spinal surgeries were required in six patients. In all 19 patients, surgical treatment has provided successful relief of symptoms and neurological recovery. CONCLUSIONS: Surgical treatment was safe and effective in patients with multiple spinal schwannomas without vestibular schwannomas. After surgery, we recommend that all patients be followed with magnetic resonance imaging to monitor for asymptomatic tumors or detect new tumors early.

DOI： 10.1016/j.jos.2021.02.014

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記述言語：英語   出版者・発行元：(公社)日本整形外科学会  

前庭神経鞘腫を伴わない多発性脊椎神経鞘腫患者のX線学的所見と治療法について検討した。多発性脊椎神経鞘腫患者19例(男性13例、女性6例、平均45.2歳)を対象とした。神経線維腫症1(NF1)とNF2を除く孤発性脊椎神経鞘腫162例(男性84例、女性78例、平均50.8歳)との比較では、男女比は多発性神経鞘腫群の方が高く、年齢は低い傾向にあったが有意差はみられなかった。多発性脊椎神経鞘腫19例のうち7例(36.8%)は脊椎神経根や馬尾のほか末梢神経にも神経鞘腫の発症が認められ、術前のMRIまたはCT脊髄造影によって計140以上の脊髄腫瘍が検出された。罹患部位は頸椎が5例(26.3%)、胸椎が11例(57.9%)、胸腰椎が16例(84.2%)、仙骨が1例(5.3%)となっていた。初発症状としては体幹または四肢の疼痛が17例(89.5%)と最も多く、知覚障害や四肢の運動機能低下、膀胱機能障害といった神経症状を15例(78.9%)に認めた。19例に対して計28回の脊椎手術を施行し、単回手術が13例、複数回の手術が6例で、術後の病理所見に関して単回手術群と複数回手術群との間に明らかな差はみられなかった。全例手術によって症状の改善が得られ、最終経過観察時におけるJOAスコアの平均回復率は63.6±31.8%であった。前庭神経鞘腫を伴わない多発性脊椎神経鞘腫に対する手術療法は安全かつ有効な治療法であることが示された。

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

<p>【はじめに】成人脊柱変形手術はQOLの改善をもたらし保存療法より有効とされるが，高い合併症発生率は問題となっている．当院における成人脊柱変形手術の術後経過を調査し，問題点を検討した．【対象と方法】40歳以上，5椎間以上の固定術を行った成人脊柱変形手術30例を対象とした．インプラント関連合併症と周術期合併症について調査を行った．【結果】患者背景は平均年齢61.2歳，男性5例，女性25例，平均固定椎体8.7，二期的手術8例，骨切り併用7例であった．合併症はインプラント関連40％，周術期37％に認め，再手術率は40％であった．65歳以上の高齢者ではインプラント関連60％，周術期53％と若年者と比較し合併症発生率が高かった．【考察】高齢者ではインプラント関連，周術期ともに合併症は50％を超えており，手術適応を慎重に検討する必要があると思われた．</p>

DOI： 10.5035/nishiseisai.71.167

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記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

<p>【はじめに】透析患者における腰椎椎弓切除術後の経時的なレントゲン変化について検討した．【対象と方法】当院で腰椎椎弓切除術術施行された血液透析患者15例を対象とした．男性11名，女性4名，平均年齢69.0歳（52歳～82歳），平均透析歴10.3年（1年～33年）であった．術前，1年，2年時での腰椎単純X線画像（正面，側面，前後屈側面）を用いて，圓尾らのStage分類（Stage0：変化なし，Stage1：辺縁侵食期，Stage2：終板侵食期，椎間板狭小化，Stage3：椎体癒合），椎間板高，腰椎すべり度，手術椎間後弯角，手術椎間Cobb角について計測を行った．【結果】透析歴，手術前の手術椎間Stageは，術後のStage進行と有意に相関を認めた．また，透析歴10年以上の症例では10年以下の症例と比べ，手術椎間Stage，椎間板腔，手術椎間Cobb角において有意に増悪認めた．【考察】術前Stageの高い症例および10年以上の透析歴患者では，椎弓切除術後の脊椎症変化が早期に進行する可能性が示唆された．</p>

DOI： 10.5035/nishiseisai.71.162

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出版者・発行元：メジカルビュー社  

DOI： 10.18885/jjs.0000000921

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記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】透析患者における腰椎椎弓切除術後の経時的なレントゲン変化について検討した.【対象と方法】当院で腰椎椎弓切除術術施行された血液透析患者15例を対象とした.男性11名,女性4名,平均年齢69.0歳(52歳～82歳),平均透析歴10.3年(1年～33年)であった.術前,1年,2年時での腰椎単純X線画像(正面,側面,前後屈側面)を用いて,圓尾らのStage分類(Stage0:変化なし,Stage1:辺縁侵食期,Stage2:終板侵食期,椎間板狭小化,Stage3:椎体癒合),椎間板高,腰椎すべり度,手術椎間後彎角,手術椎間Cobb角について計測を行った.【結果】透析歴,手術前の手術椎間Stageは,術後のStage進行と有意に相関を認めた.また,透析歴10年以上の症例では10年以下の症例と比べ,手術椎間Stage,椎間板腔,手術椎間Cobb角において有意に増悪認めた.【考察】術前Stageの高い症例および10年以上の透析歴患者では,椎弓切除術後の脊椎症変化が早期に進行する可能性が示唆された.(著者抄録)

記述言語：日本語   出版者・発行元：西日本整形・災害外科学会  

【はじめに】成人脊柱変形手術はQOLの改善をもたらし保存療法より有効とされるが,高い合併症発生率は問題となっている.当院における成人脊柱変形手術の術後経過を調査し,問題点を検討した.【対象と方法】40歳以上,5椎間以上の固定術を行った成人脊柱変形手術30例を対象とした.インプラント関連合併症と周術期合併症について調査を行った.【結果】患者背景は平均年齢61.2歳,男性5例,女性25例,平均固定椎体8.7,二期的手術8例,骨切り併用7例であった.合併症はインプラント関連40%,周術期37%に認め,再手術率は40%であった.65歳以上の高齢者ではインプラント関連60%,周術期53%と若年者と比較し合併症発生率が高かった.【考察】高齢者ではインプラント関連,周術期ともに合併症は50%を超えており,手術適応を慎重に検討する必要があると思われた.(著者抄録)

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