佐粧 孝久

BACKGROUND: Radiographs of the feet are the reference standard for measuring the hallux valgus angle. However, the availability and use of radiographs are constrained due to cost and radiation exposure. Less invasive, nonradiographic assessments have been proposed, although measurement using self-photography has not been reported. OBJECTIVES: To determine (1) reliability of photographic hallux valgus angle (pHVA) measurement using the same photographs of the feet, (2) reliability of repeated self-photography trials, and (3) measurement error when the radiographic hallux valgus angle (rHVA) is estimated using the pHVA. METHODS: In this reliability study, participants took photographs of their own feet using a digital camera. The intrarater and interrater reliability of pHVA measurements were then assessed using the intraclass correlation coefficient (ICC) and 95% minimum detectable change (MDC). The participants took photographs twice, and the reliability of repeated self-photography trials was examined. Participants also received radiographs of their feet, from which the rHVA was measured. The measurement error was assessed using the mean difference and 95% limits of agreement. RESULTS: The intrarater and interrater ICC of pHVA measurement was 0.99, with MDCs less than 2°. The ICC of pHVA measurement for repeated self-photography was 0.96, and the MDC was 6.9°. The pHVA was systematically lower than the rHVA, by 5.3°. CONCLUSION: Measurement of the pHVA using self-photography was reproducible, although pHVA measurement underestimated the rHVA. The pHVA can be a useful nonradiographic method to quantify hallux valgus deformity. J Orthop Sports Phys Ther 2019;49(2):80-86. Epub 12 Sep 2018. doi: 10.2519/jospt.2019.8280.

Background: In the progression of osteoarthritis (OA) of the knee, a correlation between meniscal posterior segment injuries and medial meniscal extrusion has been reported, but there have been few reports on the relationship with the meniscal shape. The purpose of this study was to clarify the features of the meniscal shape involved in the progression of knee OA. Methods: Data were obtained from the Osteoarthritis Initiative (OAI) database. We defined two sets of subjects. One set included 455 knees of subjects whose OA grade on the Kellgren Lawrence (KL) scale progressed in 24 months from baseline and the other set consisted of 455 knees with no progression. The OA progressed subjects were divided to three groups: the "OA change group", KL0 and KL1 knees that progressed to KL2 and KL3 the "mild change group", KL2 knees that progressed to KL3 and the "severe change group", KL2 and KL3 knees that progressed to KL4. The no progression set was divided into three groups whose OA grade remained unchanged. We used magnetic resonance imaging data and manually measured seven items (longitudinal diameter [LD], anterior wedge thickness, anterior wedge width, posterior wedge width, posterior wedge thickness, anterior wedge angle, posterior wedge angle) from the sagittal slice and the extrusion from the coronal slice. These measurements were compared between knees with and without OA progression. Results: In the "OA change group" and "mild change group", the anterior and posterior wedge widths and the extrusion were significantly larger, but the anterior and the posterior wedge angles were significantly smaller. In the "severe change group," the LD and the extrusion were significantly larger. In each group, there was no uniform tendency for the correlation coefficient of the parameters evaluated. Conclusions: Our findings suggested (1) a larger meniscal LD at the baseline predicted progression of knee OA after 24 months and (2) a larger meniscal width and smaller meniscal angle predicted progression of knee OA after 24 months.

BACKGROUND: Medial meniscal extrusion (ME) is a biomarker to predict later development of knee osteoarthritis (KOA). On the other hand, we have reported osteophyte formation at the posterior condylar notch of the femur served as a biomarker for the same purpose. The purpose of this study is to compare capacity of the two biomarkers in predicting KOA development. METHODS: Two cohort of knees were established utilizing publicly available data from the Osteoarthritis Initiative (OAI). No OA group (NOA) consisted of knees that were grade 0 or 1 on Kellgren and Lawrence grade (K/L) both at baseline and 48 months later, and pre-radiographic-OA group (PROA) consisted of knees that were grade 0 or 1 at baseline but grade ≥2 48 months later. Baseline MR images were evaluated in terms of ME and osteophyte formation at the posterior condylar notch. ME was evaluated both by meniscus subluxation index (MSI) indicating the ratio of the extruded width of the medial meniscus to the width of medial meniscal body and by the medial radial displacement (MRD) indicating actual extruded width. The size of the osteophyte was assessed using a semi-quantitative whole-organ magnetic resonance imaging score (WORMS). The predictive accuracy of KOA was assessed by the area under the receiver operating characteristic curve (AUC) and optimal cutoff was determined for each parameter. RESULTS: The AUC for MSI was 0.654 (0.561-0.748: 95% CI) and the cutoff value was determined as 17%. That for MRD was 0.677 (0.584-0.770) and the cutoff value was 2.2 mm. The AUC for the WORMS score at the posterior condylar notch was 0.667 (0.579-0.756) and the cutoff value was 2. CONCLUSIONS: Similar predicting capacity of KOA development was found both in ME and osteophyte formation at the posterior condylar notch. Using these simple parameter, mas-screening for KOA development would be possible.

症例は17歳の男性である。運動時の外傷を契機に右膝内側の痛みが出現した。内側関節裂隙の圧痛と荷重時痛を認めたが、画像上は明らかな異常所見はなかった。保存治療に抵抗性であり、MCSを疑い関節鏡手術を施行した。関節鏡視にてMCSが確認され、半月の縫合にて症状は軽快した。MCSは画像所見に乏しく診断に難渋することが多い。本症例でも術前検査では確定診断に至らず、関節鏡にて診断・治療がなされ良好な結果を得た。(著者抄録)

BACKGROUND: Rotator cuff tears are the most common shoulder injury, and little is known about the underlying etiology of fatty infiltration after rotator cuff tear. Previous studies speculated that rotator cuff tears lead to neural injury due to tethering of the suprascapular nerve at the notch. This study aimed to evaluate fatty infiltration after suprascapular nerve injury and rotator cuff tears. METHODS: Ninety adult male Sprague-Dawley rats were used and were divided into four groups: sham, tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation. The suprascapular nerve injury models were created by tying the suprascapular nerve. At 2, 4, and 8 weeks postoperatively, histological analysis and biomechanical testing were performed to evaluate fatty infiltration and elastic change in the supraspinatus muscles. RESULTS: The amount of fatty infiltration in the supraspinatus muscle was significantly higher in both the suprascapular nerve ligation and tendon transection plus suprascapular nerve ligation groups than in the tendon transection only group at 2, 4, and 8 weeks. The ultimate failure load and tensile strength were significantly different among the tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation groups at 8 weeks postoperatively. Furthermore, the mean Young's modulus of the muscle was significantly greater in the tendon transection plus suprascapular nerve ligation group than in both the tendon transection only and suprascapular nerve ligation groups at 8 weeks postoperatively. CONCLUSIONS: In this study, based on the results of histological and biomechanical examinations in our rat models, the etiology of fatty infiltration after massive rotator cuff tear might be different from the suprascapular nerve injury.

Cartilage degeneration is believed to be the primary event in the development of osteoarthritis (OA). On the other hand, meniscal degeneration is observed with high prevalence, and some researchers have pointed out that pathological changes in menisci precede that of cartilage. The purpose of the present study is to investigate comprehensive gene expression pattern of cartilage and menisci in the initial phase of surgically induced OA and to compare them. Secondary OA was surgically induced in 10-week-old male Wistar rats by anterior cruciate ligament transection (ACLT). Articular cartilage and menisci were separately dissected from six ACLT- and six sham-operated rats. Each specimen was analyzed by microarray, histological, and immunohistochemical analysis 3 weeks after surgery. Of the 36,685 transcripts detectable by microarray, the number of upregulated transcripts in ACLT menisci was >2.5-fold compared with that in ACLT menisci in any given threshold. Cluster analysis using the Database for Annotation Visualization and Integrated Discovery (DAVID) showed genes related to OA, such as response to stimulus, angiogenesis, and apoptosis, which were predominantly found in menisci in ACLT rats. Representative proteases including Adamts2, 4, Mmp2, 12, 13, 14, 16, extracellular matrix genes including versican (Vcan), lumican (Lum), syndecan1 (Sdc1), and Prostaglandin endoperoxide synthase2 (Ptgs2) were up-regulated in menisci, but were not up-regulated in cartilage. Our results indicated that the molecular changes that occurred in menisci preceded those occurred in cartilage in the very early phase of surgically induced OA models.

平成28年4月から学校保健で運動器検診が義務化され、小児の運動器疾患に対する社会的な注目が高まっている。近年では小児期の運動習慣が二極化しているといわれ、体を動かす機会がほとんどなくなった者が増えた一方で、特定の運動を過剰に繰り返し運動器障害が発症する小児も多い。スポーツ障害は、柔軟性や運動量、身体の成長時期など多くの要因が関与するため、予防はかならずしも容易ではないが、運動の内容および量を適切にコントロールすることが重要と考えられる。小児期から生じる運動器の問題は、先天性の素因などにより予防が困難なものもあるが、適切な管理によって発症リスクを減じる、あるいは早期発見によって重症化を防ぐことが可能なものも多く、発症要因の同定および予防法の開発、早期発見を目指した検診制度の確立のためにさらなる知見の蓄積が求められる。(著者抄録)

Objectives: To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament (ACL) reconstruction animal model. Methods: Anterior cruciate ligament reconstruction using the plantaris tendon as graft material was performed on both knees of 24 rabbits (48 knees) to mimic ACL reconstruction by two different suspensory fixation devices for graft fixation. For the adjustable fixation device model (Socket group; group S), a 5 mm deep socket was created in the lateral femoral condyle (LFC) of the right knee. For the fixed-loop model (Tunnel group; group T), a femoral tunnel penetrating the LFC was created in the left knee. Animals were sacrificed at four and eight weeks after surgery for histological evaluation and biomechanical testing. Results: Histologically, both groups showed a mixture of direct and indirect healing patterns at four weeks, whereas only indirect healing patterns were observed in both groups at eight weeks. No significant histological differences were seen between the two groups at four and eight weeks in the roof zone (four weeks, S: mean 4.8 sd 1.7, T: mean 4.5 sd 0.5, p = 0.14; eight weeks, S: mean 5.8 sd 0.8, T: mean 4.8 sd 1.8, p = 0.88, Mann-Whitney U test) or side zone (four weeks, S: mean 5.0 sd 1.2, T: mean 4.8 sd 0.4, p = 0.43; eight weeks, S: mean 5.3 sd 0.8,T: mean 5.5 sd 0.8, p = 0.61, Mann-Whitney U test) . Similarly, no significant difference was seen in the maximum failure load between group S and group T at four (15.6 sd 9.0N and 13.1 sd 5.6N) or eight weeks (12.6 sd 3.6N and 17.1 sd 6.4N, respectively). Conclusion: Regardless of bone tunnel configuration, tendon-bone healing after ACL reconstruction primarily occurred through indirect healing. No significant histological or mechanical differences were observed between adjustable and fixed-loop femoral cortical suspension methods.Cite this article: Y. Sato, R. Akagi, Y. Akatsu, Y. Matsuura, S. Takahashi, S. Yamaguchi, T. Enomoto, R. Nakagawa, H. Hoshi, T. Sasaki, S. Kimura, Y. Ogawa, A. Sadamasu, S. Ohtori, T. Sasho. The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction: An animal study. Bone Joint Res 2018;7:327-335. DOI: 10.1302/2046-3758.75.BJR-2017-0238.R2.

平成28年5月に運動器検診を受けた小学3年生〜中学3年生の児童生徒885名を対象として、下肢柔軟性と膝・踵の痛みの発生頻度との関連について検討した。運動器検診の下肢機能に関連する項目で、しゃがみ込みができない割合や立位体前屈で指先が床に届かない割合は小学6年生から中学1年生を境に増加しており、検診時に膝に圧痛があった者は49名(5.6%)、踵に圧痛があった者は6名(0.7%)で、いずれも男児に多くみられた。膝痛のある割合は中学1年生から増加、踵痛は全体として頻度は少ないものの、比較的低学年で多く発症する傾向にあり、下肢柔軟性が低下する時期と膝や踵の疼痛が発症する時期が一致することが示された。また、膝痛がある群では立位体前屈で指先が床に届かない者の割合が多く、ハムストリングと大腿四頭筋の柔軟性が低かった。

運動器検診の際に下肢柔軟性を測定した小学3年生〜中学3年生のうち、検診時に膝の圧痛がなかった836名と踵の圧痛がなかった879名を対象として、健診から9ヵ月間に膝・踵の圧痛を新規発症した者の割合(新規発症率)と月ごとの膝・踵の圧痛を有する者の割合(有訴者率)を算出した。その結果、膝の圧痛の新規発症率は22%で、小学4年生以上で高い傾向にあり、有訴者率は概ね13%以下で推移していた。踵の圧痛の新規発症率は15%で、中学生に比べて小学生に多い傾向にあり、有訴者率は概ね8%以下で推移していた。また、膝・踵の圧痛の発症と下肢柔軟性との関連について検討した結果、膝痛の新規発症例278膝ではheel buttock distanceが有意に大きく、膝痛の発症に大腿四頭筋のタイトネスが関与している可能性が示唆されたが、踵痛の発症と下肢柔軟性との関連は認めなかった。

INTRODUCTION: This study assesses the effect of radial extracorporeal shock wave (rESW) exposure on neuromuscular transmission and neuromuscular junction (NMJ) morphology. METHODS: We applied 2,000 rESWs at 0.18 mJ/mm2 and a frequency of 15 Hz to the right calf of male rats, measured the compound muscle action potential (CMAP), and examined NMJ morphology using electron microscopy. Left calf muscles were used as controls. RESULTS: rESW exposure significantly reduced CMAP amplitude without delayed latency in exposed muscles compared with controls. All rESW-exposed muscles exhibited NMJs with irregular end plates. Mean interjunctional fold interval was significantly increased compared with controls. However, axon terminals and muscle fibers surrounding NMJs with irregular end plates were unchanged. DISCUSSION: This localized destruction of end plates may be caused by differences in acoustic impedance induced by the density of acetylcholine receptors. These results provide a possible mechanism for the effectiveness of rESW treatment for spasticity and dystonia. Muscle Nerve 57: 466-472, 2018.

The purpose of this study was to clarify the association of locomotive syndrome with present and past physical activities, as well as gait speed. Subjects were recruited from the participants of the specific health checkups in Oamishirasato City. The presence of locomotive syndrome was assessed using the stand-up test, two-step test, and 25-question geriatric locomotive function scale. Present physical activity was measured using the International Physical Activity Questionnaire. Questionnaires were also used to assess past physical activity and usual gait speed. The association of each locomotive syndrome risk test with the physical activities and gait speed was examined using univariate analysis and multiple logistic regression analysis. A total of 172 subjects with a mean age of 67.5 years were enrolled. Sixty-nine（40%）and 13（8%）subjects were classified as having stage 1 and 2 locomotive syndrome, respectively. Among the four groups classified by physical activity level, the proportions of subjects with positive stand-up test were higher in the groups of lowest and highest physical activity（P＝0.048）. Faster gait speed was a significant predictor of the negative two-step test（P＝0.08）, negative 25-question geriatric locomotive function scale（P＜0.001）, and absence of locomotive syndrome（P＝0.002）. The associations remained significant in the multiple regression analysis, after adjusting for age, sex, and body mass index. In conclusion, present physical activity was associated with the stand-up test, whereas self-reported usual gait speed was associated with the two-step test and 25-question geriatric locomotive function scale.

© 2018 Background: The purpose of this study was to clarify the 2-year clinical and radiological outcomes of nonoperative treatment using foot orthosis for hallux valgus patients. Methods: Patients who underwent nonoperative treatment using foot orthosis were surveyed prospectively. Foot orthoses were made by one certified orthotist using the standardized method. Pain and quality of life were evaluated using subjective and objective assessment measures at 3, 6, 12, 18, and 24 months. Furthermore, radiological outcomes, patient satisfaction, and adherence to treatment were surveyed. Results: A total of 53 patients (50 women and 3 men; median age, 63 years) were included for analysis. The pain visual analogue scale score significantly decreased over time, with the lowest score observed at 12 months. The treatment effect was maintained over 24 months (median score, 52, 21, and 27 points at baseline, 12 months, and 24 months, respectively; P < .001). The Japanese Society for Surgery of the Foot hallux scale, American Academy of Orthopaedic Surgeons Foot and Ankle Scale, and 36-Item Short-Form Health Survey bodily pain subscale also improved, although the treatment effects were maximal

ハイテクニーII人工膝関節を用いて膝蓋骨非置換人工膝関節置換術を行った28例29膝(男性4膝、女性25膝、手術時平均年齢71.4歳)を対象に、術後PF(膝蓋大腿)関節へ中期的に生じるX線学的変化について解析した。術後平均観察期間8.0年の結果、外側傾斜や外側偏位については術前後で有意差はみられず、比較的良好に保たれていた。だが、関節症性変化については硬化像の進行を72.4%、骨棘形成の進行を62.1%、関節裂隙の狭小化の進行を82.8%で認め、全例において何らかの関節症性変化の進行が確認された。

Background: The purposes of this study were to clarify the incidence of anxiety and depression among patients with chronic foot and ankle diseases and to examine the independent association of anxiety and depression with pain and quality of life. Methods: Patients who visited the foot and ankle clinic from April 2015 to November 2016 were recruited. Anxiety and depression in patients were assessed using the Hospital Anxiety and Depression Scale. Pain and quality of life were evaluated using the visual analog scale (VAS) and Self-Administered Foot Evaluation Questionnaire (SAFE-Q), respectively. Furthermore, patient characteristics, including age, sex, body mass index, pain in other body areas, social support, employment, and household income, were surveyed. A multiple regression analysis was performed to examine the independent association of anxiety and depression with pain and quality of life. A total of 250 patients were included in the analysis. Results: The prevalence of anxiety and depression was 30% and 27%, respectively. The VAS and all SAFE-Q subscale scores were significantly worse in patients with anxiety or depression than in patients without the same (median VAS 63 vs 49 for anxiety, P = .005; 68 vs 47 for depression, P < .001). Furthermore, the multiple regression analyses showed that the presence of anxiety (P = .02) and depression (P < .001) was independently associated with increased pain, and it led to low scores on all SAFE-Q subscales (P < .001 for all subscales). Conclusion: About 30% of patients with chronic foot and ankle disease had anxiety or depression. The presence of these psychological symptoms was independently associated with worse pain and impaired quality of life after controlling for patient characteristics. Clinicians need to recognize the possibility of concurrent anxiety and depression to provide a more holistic treatment for chronic foot and ankle disease.

【目的】変形性膝関節症(膝OA)患者における運動療法によるメンタルヘルス改善効果の検討を目的とした。【方法】膝OA患者を(1)「薬物治療群」8例と、(2)薬物治療に加えて運動療法を行う「運動療法群」12例の2群に分け、自記式アンケート調査により3ヵ月間の治療前後の臨床症状(Knee Osteoarthritis Outcome Score;KOOS、Visual Analogue Scale;VAS、36-item Short-Form Health Survey;SF-36)及び睡眠の質(ISI)を検討した。同時に活動量も測定した。【結果】薬物治療群は臨床症状の全項目で治療前後に変化がなかったが、運動療法群ではKOOS(疼痛、activities of daily living;ADL、スポーツ、QOL)と臥位の疼痛VASで有意な改善を認めた。活動量は薬物治療群、運動療法群ともに全項目で治療前後に変化はなかった。【結論】運動療法を行うことで短期的にKOOSやVASの臨床症状を改善したが、メンタルヘルス、活動量は変化しなかった。(著者抄録)