稲毛 一秀

PURPOSES: To evaluate whether a relationship exists between patient-based scoring systems and the activity level of patients with low back pain (LBP) by using wearable activity trackers, and to determine whether activity level was affected by patient factors. METHODS: The subjects were 66 patients with LBP. The physical activity of participants was objectively evaluated using the Micro-Motion logger (Actigraph). The activity level was analyzed with the mean active count of the proportional-integrating mode (PMAC) and zero-crossing mode. Clinical symptoms were evaluated using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Roland-Morris Disability Questionnaire, the Oswestry Disability Index, and visual analog scale (VAS). The relationships between each item of the patient-based questionnaire and activity level, and the influence of individual factors (age, sex, body mass index [BMI], low back pain, and muscle mass) on the activity level were evaluated. RESULTS: In each domain of the JOABPEQ, lumbar spine dysfunction and social life dysfunction were correlated with PMAC (r = 0.327 and 0.321, respectively). The low back pain VAS scores were correlated with PMAC (r = - 0.246). Multiple regression analysis shows that individual factors affecting the activity level of patients with LBP were sex, BMI, low back pain, and muscle mass in PMAC (p < 0.01). CONCLUSIONS: Some domains of the questionnaires were correlated with activity level, but others were not. Additionally, the activity level of patients with LBP was affected by sex, BMI, LBP, and skeletal muscle mass index. These slides can be retrieved under Electronic Supplementary Material.

近年では超高齢社会を背景に、骨粗鬆症に起因する脆弱性骨折に対する手術が多く実施されるようになってきている。そこで本稿では、脆弱性骨折手術後の骨粗鬆症薬物療法について、1)骨癒合促進、2)二次骨折予防の2つの観点から概説する。(著者抄録)

＜文献概要＞目的:腰背部痛を呈した中高年女性における身体的特性を明らかにする.対象:腰背部痛群67例(平均年齢71.3±9.5歳),腰背部痛がない群37例(平均年齢70.0±9.1歳)方法:%young adult mean(%YAM値),体組成値,身体機能,visual analogue scale(VAS値)の関係,骨粗鬆症とサルコペニアの有病率を調べた.結果:腰背部痛群の%YAM値と年齢と下肢筋量は有意に相関しており,VAS値との相関は認めなかった.骨粗鬆症を呈した腰背部痛群は筋量が低下しており,対照群と比較して体脂肪率と脂肪量が高値であった.結論:腰背部痛患者の%YAM値は下肢筋量と相関していた.

新鮮脆弱性椎体骨折に対しweekly PTH製剤(テリボン56.5μg、週1回皮下注射)を投与した50例を対象に、投与前から投与後10週に日本整形外科学会腰痛評価質問票(JOABPEQ)を患者本人が毎週回答を記載した。得られたデータを集計し、疼痛改善の指標として疼痛関連障害スコア、ADL改善の指標として社会生活障害スコアの変化を調査した。その結果、疼痛関連障害スコアは投与前と比較して経時的に増加し、投与後6週以降に投与前と比較し20ポイント以上の上昇を認めた。また、社会生活障害スコアも投与前と比較して経時的に増加し、投与後8週以降に20ポイント以上の上昇を認めた。新鮮脆弱性椎体骨折はweekly PTH製剤投与により疼痛は6週、ADLは8週で改善すると考えられた。

Objective: The aim was to compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves in patients with unilateral osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ONFH) using diffusion tensor imaging (DTI) and to investigate the mechanism of hip pain. Methods: Forty-four patients (22 OA and 22 ONFH) underwent DTI of the sciatic and femoral nerves at the level of the hip joint and the S1 roots to visualize the tractography and quantify the FA and ADC values. Results: The tractography of the femoral and the sciatic nerves on the affected side with OA and ONFH were similar to those on the normal side. The mean FA values of the sciatic and femoral nerves, and the S1 roots were 0.542, 0.551, and 0.316 with OA, 0.568, 0.560, and 0.318 with ONFH on the affected side, and 0.559, 0.560, and 0.315 on the normal side, respectively, and did not show significant differences. The FA values of the sciatic nerve on the affected side with OA decreased with longer pain duration. Conclusion: The FA and ADC values of the sciatic and femoral nerves in patients with unilateral OA and ONFH showed no significant differences between the affected and normal sides.

PURPOSE: We investigated the involvement of sarcopenia in middle-aged and elderly women with degenerative lumbar scoliosis (DLS). METHODS: A total of 971 women (mean age 70.4 years) were included in our study. These included 87 cases of DLS (mean 73.8 years) and 884 controls (69.8). Lumbar and femur BMD was measured for all participants using dual-energy X-ray absorptiometry. We used a bioelectrical impedance analyzer to analyze body composition, including appendicular skeletal muscle mass index (SMI; appendicular lean mass (kg)/(height (m))2. We determined bone density and skeletal muscle mass in both groups and determined the prevalence of sarcopenia. We examined the correlation between bone density and appendicular muscle mass in both groups. We also examined factors related to scoliosis using logistic regression analysis. RESULTS: The DLS group showed significantly higher lumbar BMD, lower femur BMD, lower lean mass arm, and lower lean mass leg, and lower lean mass trunk (p < 0.05). Sarcopenia prevalence (SMI < 5.75) was 59.8% in DLS subjects and 42.8% in controls, revealing a high prevalence in DLS (p < 0.05). In both groups, lumbar and femur BMD were positively correlated with appendicular muscle mass. By logistic regression analysis, trunk muscle mass was detected as a risk factor for DLS independent of age (p < 0.05). CONCLUSIONS: In middle-aged and elderly women, prevalence of sarcopenia was 59.8% in DLS cases and 42.8% in controls, which revealed a high prevalence in DLS. A decrease in trunk muscle was a significant risk factor for DLS that was independent of age. These slides can be retrieved under Electronic Supplementary Material.

プレガバリンは電位依存性カルシウムチャネルのα2δサブユニットと結合し、興奮性神経伝達物質の遊離を抑制して鎮痛効果をもたらす。本邦では末梢性・中枢性神経障害性疼痛や線維筋痛症に伴う疼痛、帯状疱疹後神経痛、糖尿病性神経障害に伴う痛みやしびれ、脊髄損傷後疼痛などに対して有意な鎮痛効果が示されている。一方でめまいや鎮静、傾眠などの副作用が知られており、最小用量から開始し漸増するなどの処方の工夫によりその発生が抑制されうる。腎機能低下症例、透析症例では慎重投与を心がけることが重要である。神経障害性疼痛に加え侵害受容性疼痛や心理社会的要因など多因子由来の病態である慢性の腰下肢痛に対しては必ずしも全例で効果を示すわけではないが、この場合NSAIDsなどの併用処方が有用である。本剤処方において最も重要なのは入念な診察に基づく確実な神経障害性疼痛の診断であり、臀部痛・下肢痛症例における神経障害性疼痛の関与の報告はその根拠のひとつとなる。(著者抄録)