山口 智志

OBJECTIVE: To compare the effects of 3 implant designs, with and without hydroxyapatite reinforcement, on push/pull-out strength and rotational torque. METHODS: Three implant designs (Gamma 3, INTERTAN, and PFNA-II) were selected for comparison. A hydroxyapatite cylinder (NEOBRACE) was used to reinforce the interface between the femoral head and the lag screw. Maximum push-out strength, maximum pull-out strength, and peak rotational torque were measured in cellular blocks mimicking osteoporotic cancellous bone, with and without NEOBRACE. RESULTS: In the push-out test, INTERTAN produced a significantly higher push-out strength in osteoporotic bone density cellular blocks than the other lag screws and blades (P < .05). With the addition of NEOBRACE, push-out strength was significantly higher for INTERTAN and PFNA-II (P < .05) than for the non-NEOBRACE group. In the pull-out test, INTERTAN produced a significantly higher pull-out strength in the osteoporotic bone density cellular blocks than did the other lag screws and blades (P < .05). With the addition of NEOBRACE, the pull-out strengths of INTERTAN and Gamma 3 versus those of the non-NEOBRACE group significantly increased (P < .05). In the rotational torque test, INTERTAN produced significantly greater rotational torque in the osteoporotic cellular blocks than the other lag screws and blades (P < .05). The addition of NEOBRACE resulted in a significant increase in rotational torque only for INTERTAN (P < .05). CONCLUSION: The use of NEOBRACE supported an increase in push/pull-out strength and rotational torque, especially in systems with a relatively increased bone or implant interface area.Level of Evidence: Level V.

Abstract Background Mobility decrease leading to disability can gradually develop during early life, however, its related factors are not well clarified. Therefore, we investigate the related factors of mobility decrease at various levels, using nationwide data in Japan. Methods In total, 8681 independent community dwellers aged 20-89 years were analysed (average age, 51.6 years; 58.5% women). Three stages of mobility decrease were based on the locomotive syndrome risk test: Stage 1, emerging; Stage 2, progressing; Stage 3, progressed to restrict social engagement. Age was analysed using a simple quadratic function model. Results The prevalence of Stages 1-3 was 31.6% (n = 2746), 5.8% (n = 504), and 3.2% (n = 278), respectively. On the multivariable logistic regression, increased age in participants aged ≥40 years (stage 1: odds ratio[OR] 1.05-1.20, stage 2: OR 1.04-1.22, stage 3: OR 1.05-1.22), female (stage 1: OR 2.28, 95% confidence interval [CI] 1.99-2.61, stage 2: OR 2.40, 95% CI 1.77-3.25, stage 3: OR 1.80, 95% CI 1.19-2.72), overweight status (stage 1: OR 1.56, 95% CI 1.34-1.82, stage 2: OR 3.19, 95% CI 2.38-4.27, stage 3: OR 2.87, 95% CI 1.90-4.32), hypertension (stage 1: OR 1.20, 95% CI 1.01-1.41, stage 2: OR 1.99, 95% CI 1.49-2.64, stage 3: OR 2.10, 95% CI 1.44-3.05), and diabetes mellitus (stage 1: OR 1.62, 95% CI 1.17-2.24, stage 2: OR 1.57, 95% CI 0.93-2.66, stage 3: OR 2.10, 95% CI 1.13-3.90) were positively associated. The frequency of physical activity/sports, even a few per month, was inversely associated with all stages (stage 1: OR 0.59-0.72, stage 2: OR 0.50-0.67, stage 3: 0.36-0.53). A one-year increase in age had a stronger impact on mobility decrease in older adults than in younger ones. Increased age in participants aged &lt; 40 years and smoking were associated with Stage 1, while intake of various foods was inversely associated with Stages 1 and 2. Conclusion Increased age (&lt; 40 years) was associated with emerging mobility decrease, while that (≥ 40 years) was associated with any levels of mobility decrease. Female, lifestyle habits, including physical activities and overweight status, were associated with mobility decrease at every level.

BACKGROUND: Nationwide epidemiologic studies in Scandinavian countries have shown that the incidence of Achilles tendon ruptures (ATRs) has increased, and the rate of surgical treatment has declined markedly in the past decade. However, there is a lack of national-level data on the trend of ATRs and surgical procedures in other regions. PURPOSE: To clarify the trend in the incidence of ATRs and the proportion of surgery using the nationwide health care database in Japan. STUDY DESIGN: Descriptive epidemiology study. METHODS: Age- and sex-stratified data on the annual number of ATRs and surgical procedures between 2010 and 2017 were obtained from the Japanese national health care database, which includes almost all inpatient and outpatient medical claims nationwide. The Japanese population data were also obtained from the population census. The change in the annual incidence of ATRs per 100,000 people was assessed using a Poisson regression analysis. The trend in the annual proportion of surgeries relative to the occurrence of tendon ruptures was determined using a linear regression analysis. RESULTS: A total of 112,601 ATRs, with men accounting for 67%, were identified over 8 years. Patients aged ≥60 years accounted for 27,106 (24%), while those aged 20 to 39 years and 40 to 59 years accounted for 36,164 (32%) and 49,331 (44%), respectively. The annual incidence of ATR ranged from 12.8/100,000 to 13.9/100,000 (women, 8.2-8.9/100,000; men, 17.2-19.5/100,000), which did not change over the study period (P = .82). Moreover, the annual incidences did not change across sexes and age categories. The annual proportion of surgery increased significantly, from 67% in 2010 to 72% in 2017 (P = .003). The annual proportions increased across sexes and age categories except for women aged 40 to 59 years. CONCLUSION: The incidence of ATR did not change between 2010 and 2017, according to the Japanese nationwide health care database. Furthermore, the proportion of surgical treatment increased during the study period. Overall, 70% of patients underwent surgical treatment. This study suggested that the trend in ATR and surgery differed across regions.

OBJECTIVE: Cartilage lesions in the knee joint can lead to joint mechanics changes and cause knee pain. Bone marrow stimulation (BMS) promotes cartilage regeneration by perforating the subchondral bone just below the injury and inducing bone marrow cells. This study aimed to investigate whether systemic administration of granulocyte colony-stimulating factor (G-CSF) with BMS improves repair of chronic partial-thickness cartilage defects (PTCDs). DESIGN: Eighteen 6-month-old New Zealand white rabbits were divided into 3 groups: control (C, n = 6), BMS alone (n = 6), and BMS + G-CSF (n = 6). Partial cartilage defects with 5 mm diameter were created in the trochlear region of both knees; after 4 weeks, the BMS alone and BMS + G-CSF groups underwent BMS; G-CSF (50 µg/kg) or saline was administered subcutaneously for 5 days starting from 3 days before BMS. At 8 and 16 weeks after cartilage defect creation, the area of cartilage defects was macroscopically and histologically evaluated. RESULTS: International Cartilage Repair Society (ICRS) grades for macroscopic assessment were 0, 0.7, and 0.7 at 8 weeks and 0, 1.2, and 1.3 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. Wakitani scores for histological assessment were 9.8, 8.7, and 8.2 at 8 weeks and 9.5, 9, and 8.2 at 16 weeks in the C, BMS, and BMS + G-CSF groups, respectively. The BMS + G-CSF group showed significantly more repair than the C group, but there was no difference from the BMS group. CONCLUSIONS: The effect of BMS and G-CSF on chronic PTCDs in mature rabbit knees was limited.

BACKGROUND: Evaluation over time is important in assessing the reduction of the syndesmosis after suture-button fixation for ankle malleolar fractures. The purposes of this study were to evaluate time-dependent change in the syndesmotic reduction immediately after suture-button fixation for ankle malleolus fractures and 1 year after surgery using computed tomography, and to investigate the reliability of the measurement values to evaluate the reduction of syndesmosis. METHODS: We assessed 28 patients who underwent suture-button fixation for ankle fractures. Syndesmotic reduction was assessed within 2 weeks of the fracture surgery and 1 year after surgery using axial computer tomographic images. Side-to-side differences in the anterior, central, and posterior tibiofibular distances, anteroposterior fibular translation, fibular rotation, and syndesmosis area were measured. RESULTS: The mean anterior tibiofibular distance and anteroposterior fibular translation were 1.8 mm and 1.5 mm, respectively, after syndesmotic fixation. They decreased to 1.2 mm and 0.6 mm, respectively, at 1 year after surgery (P = .03 and P = .01, respectively). The other measurement values did not change over time. The minimum detectable change in the distance of measurements was 1 mm or less. CONCLUSION: The anterior tibiofibular distance and anteroposterior fibular translation had decreased 1 year after fixation in ankle malleolar fractures with syndesmotic suture button. Even if the fibula is posteriorly malreduced by the time computed tomography is performed immediately after surgery, the fibula may return to a good position 1 year after surgery. LEVEL OF EVIDENCE: Level IV, case series.

日本国民における性・年代別のロコモ度テスト参照値を明らかにするために、ロコモ度テスト10,000人調査を行った。地域在住の、独立した20歳代から80歳代の生活者10,444名にロコモ度テストを行い、8,681名(女性5,074名、男性3,607名)を解析対象とした。2ステップテスト、立ち上がりテストは、30歳代から40歳代より低下が始まっていた。一方、ロコモ25は70歳代後半より急激にスコアが増加した。本調査の結果は、今後のロコモに関連する研究のみならず、普及・啓発活動にも活用できる。(著者抄録)

COVID-19のパンデミックにより、少なくとも数年に及ぶ生活様式の変更の必要が予想される。自粛による身体活動の低下は、幅広い世代に負の影響を与え、慢性疾患の悪化やロコモティブシンドローム、フレイルの増悪等が危惧される。新しい生活様式のなかでも、われわれは国民に身体活動を確保して移動機能を保持していただき、ひいては健康寿命の延伸に寄与する柔軟な方法やシステムを模索する必要がある。本座談会では「コロナ時代のロコモ対策をめざす方向とは」をテーマにコロナ時代における高齢者、勤労世代、若年者でのロコモ対策についてエキスパートの先生方よりお話を伺った。(著者抄録)

COVID-19のパンデミックにより、少なくとも数年に及ぶ生活様式の変更の必要が予想される。自粛による身体活動の低下は、幅広い世代に負の影響を与え、慢性疾患の悪化やロコモティブシンドローム、フレイルの増悪等が危惧される。新しい生活様式のなかでも、われわれは国民に身体活動を確保して移動機能を保持していただき、ひいては健康寿命の延伸に寄与する柔軟な方法やシステムを模索する必要がある。本座談会では「コロナ時代のロコモ対策をめざす方向とは」をテーマにコロナ時代における高齢者、勤労世代、若年者でのロコモ対策についてエキスパートの先生方よりお話を伺った。(著者抄録)

＜文献概要＞アキレス腱症は非付着部症と付着部症に分類され,病態が若干異なる。病態に応じたさまざまな治療法が提唱されているが,非付着部症,付着部症ともに運動療法を中心とした保存療法が主体となる。

はじめに:近年、性同一性障害に対する認識が高まっているが、スポーツ現場で活動する整形外科医は、性同一性障害のアスリートに対する認知度やサポートのための知識、日常診療やスポーツ現場で性同一性障害のサポート経験が少ない可能性がある。目的:本研究の目的は、アスリートの診療に関わる整形外科医を対象に1)性同一性障害に対する認知度や知識、2)性同一性障害アスリートのサポート経験の有無を明らかにすることである。方法:千葉大学整形外科および関連病院に勤務し、アスリートの診療に関わる整形外科医を対象に質問票による調査を行った。1)研究協力者背景:性別、スポーツドクター資格の有無、研究協力者が診療しているアスリートの競技種目、2)性同一性障害、IOC Consensus Meeting 2015の認知率、3)性同一性障害アスリートへのサポート経験の有無等を調査した。結果:研究協力者は男性65名、女性5名だった。研究協力者が診療しているアスリートの競技種目は、サッカー、ラグビー、野球など多岐に渡った。性同一性障害、IOC Consensus Meeting 2015の認知度は、各86%、6%だった。11%が性同一性障害アスリートの存在を認識したことがあり、1名は実際にサポート経験があった。まとめ:性同一性障害の認知率は2010年代の他の報告と同等だった。少数ではあるが性同一性障害アスリートを認識またはサポート経験がある医師も存在した。整形外科医に対する教育体制や、各競技団体、またはスポーツ界全体でのサポート体制の構築が望まれる。(著者抄録)

Background: Osteochondritis dissecans (OCD) rarely occurs in multiple joints. Furthermore, the existence of left-right asymmetric OCDs in different joints of the contralateral side of the body and lesions occurring with a temporal difference is rare. Here, we report a rare case with multiple OCDs sequentially detected in various joints. Case Presentation. The 15-year-old male patient was referred to our hospital for an OCD in the medial femoral condyle of the left knee. He had a history of an OCD in his right elbow, and his father had a history of surgically treated OCDs in both knees. One year and five months after, surgery was performed to the lesion in his left medial femoral condyle, a new OCD lesion occurred in the femoral trochlea of the same knee, which was again treated surgically. Five months after the second surgery, the patient returned with pain in the right knee, and an OCD on the right femoral trochlea was detected by an MRI scan. This lesion remained stable without any further restriction in physical activities for 17 months until detachment occurred and was again treated surgically. Conclusion: In cases with history and a family history of multiple OCDs, in particular, with a short stature, an MRI scan should be performed for the symptomatic joint to detect and treat the lesion before progression.

60歳女性。58歳時に当院で変形性膝関節症に伴う両膝痛に対し左人工膝関節全置換術(TKA)を施行後、半年経過で右TKAを他院で受けたが、術後に右膝関節の可動域制限を伴う疼痛、歩行時の違和感が持続したため当院へ再受診となった。単純X線とCT所見より右脛骨コンポーネントの回旋設置位置不良に伴う疼痛および可動域制限と診断され、再置換術が行われた。CTによる術前評価に基づく脛骨コンポーネントの回旋位を修正した結果、術後には右膝関節可動域は改善し、右膝痛、歩行時の違和感も消失した。

A displaced avulsion fracture at the tibial attachment of the posterior cruciate ligament is considered an indication for surgical reduction and internal fixation because nonunion and remaining posterior instability of the knee are common consequences of conservative treatment. The problems with standard open surgical techniques are that they are relatively invasive despite the limited operative field and it is impossible to explore intra-articular lesions by the posterior approach. An arthroscopic procedure has the advantage of being minimally invasive and allowing the surgeon to detect and treat associated intra-articular injuries. We present an arthroscopic reduction-internal fixation technique using an adjustable-length loop device. A trans-septal portal is created to visualize the fracture fragment directly, and the fragment is reduced and penetrated with a cannulated drill under fluoroscopic guidance. An adjustable-length loop device is relayed from the posteromedial portal and pulled out through the fragment in an anterograde fashion, placing a button on top of the fragment. By tightening the loop, downward compression can be applied to the fragment. Overall, this technique provides good reduction and bone union, and excellent clinical outcomes, including posterior knee stability, can be achieved.

BACKGROUND: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.

BACKGROUND: The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head on foot radiographs. METHODS: A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head's lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations. RESULTS: The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (77%, 27%, and 29% for rounded, intermediate, and angular, respectively, P < .001), and the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. These associations were also significant in the multiple regression analysis. CONCLUSION: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.

BACKGROUND: The purpose of this study was to clarify 1) the measurement error of the pronation angle using the first metatarsal axial radiograph with the pronation angle along the longitudinal axis of the first metatarsal as the reference standard, 2) the influence of variability in the foot position on the measurement error, and 3) the intra- and interrater reliability of pronation angle measurement using digitally reconstructed radiographs. METHODS: Digitally reconstructed radiographs of the first metatarsal were generated from the computed tomography images of 10 feet without hallux valgus (non-HV group) and 10 feet with hallux valgus (HV group). In total, 135 images were created at different degrees of supination, plantarflexion, and adduction from each foot to simulate the first metatarsal axial view. Then, the pronation angle of the first metatarsal was measured. The measurement error was determined using the mean error and 95% limits of agreement. Simple linear regression analysis was used to test the correlations of the measurement error with pronation, plantarflexion and adduction angles. The intra- and interrater reliability of measurement was assessed using the intraclass correlation coefficient and minimum detectable change values. RESULTS: The mean measurement errors were 0.1° for both the non-HV and HV groups. There was no significant correlation of the measurement error with pronation, plantarflexion or adduction angles for both groups. Additionally, the intraclass correlation coefficients for the intra- and interrater reliability were more than 0.9 in both the non-HV and HV groups with the minimum detectable change values ranging from 0.7° to 1.4°. CONCLUSION: The measurement error of first metatarsal pronation using the axial view was clinically acceptable. The measurements were not influenced by the variability in foot position while obtaining the radiograph. The first metatarsal axial view could be used to quantify the first metatarsal coronal rotation.

BACKGROUND: Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan. OBJECTIVE: The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university. METHODS: A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses. RESULTS: The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001). CONCLUSIONS: The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines.

近年のLGBTQ(Lesbian、Gay、Bisexual、Transgender、QueerもしくはQuestioningの頭文字をとったもの)といった言葉になぞられえられるように、ジェンダーの多様化が目望ましい。他方、生まれ持った生物学的な性別が性分化疾患等により従来の男女による性別で区別するのが困難な場合もある。スポーツは現在、男女の区別のある競技が大多数であり、性別二元制を基本とするが、既存の性別二元制の枠に当てはまらないジェンダーやセクシャリティを持つアスリートも存在する。例えばトランスジェンダーアスリートは生まれ持った性別とは異なる性別を選択し、新たな性別の枠で競技生活を送る場合もある。性分化疾患を抱える一部の女性アスリートは血中濃度が一般女性を大きく上回る高アンドロゲン血症を抱えている。これらにより女性競技での公平性が問われるといった事態につながりかねないため、スポーツの公平性を保つ目的でIOCはIOC Statement of the Stockholm Consensus on Sex Reassignment in SportsやIOC Consensus Meeting on Sex Reassignment and Hyperandrogenism November 2015を時代の変遷に合わせ制定している。(著者抄録)

BACKGROUND: The purpose of this study was to determine the diagnostic accuracy of ultrasonography for the diagnosis of avulsion fractures of the distal fibula for lateral ankle sprain in children and compare it to that of radiography. METHODS: Children who sustained lateral ankle sprain were prospectively surveyed. They underwent both ultrasonography and radiography at the first clinic visit to diagnose any concomitant avulsion fractures of the distal fibula. The patients underwent follow-up radiography 4 weeks later to obtain the reference standard diagnosis. The measures of diagnostic accuracy (i.e., sensitivity, specificity, positive predictive value, and negative predictive value) of the initial ultrasonography and radiography were calculated; they were then compared using the McNemar test. Totally, 52 patients (with a median age of 9 years) were analyzed. RESULTS: On the reference standard (follow-up) radiographs, 32 patients (62%) were found to have avulsion fractures of the distal fibula. The sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 94, 85, 91, and 89% respectively; and 81, 100, 100, and 77% respectively for radiography at the first visit. There were no significant differences in sensitivity and specificity between the two diagnostic methods (P = 0.22, 0.25). CONCLUSIONS: Ultrasonography has a high diagnostic accuracy, which is comparable to that of radiography, for the diagnosis of avulsion fracture of the distal fibula. Ultrasonography may be used as an option of imaging modality for lateral ankle sprain in children.

The objective of this research is to mechanically and histologically evaluate the capacity of different PRP concentrations to promote tendon healing. 60 New Zealand white rabbits were used. In 20 rabbits（L-PRP group）, 1.0 mL of low-concentration PRP was applied to the Achilles tendon tear transection site on both hindlimbs of each animal. The other 20 rabbits（H-PRP group）, 1.0 mL of high-concentration PRP and in the remaining 20 rabbits（S group）, 1.0 mL of saline were applied. Ten rabbits from each group were slaughtered at 4 and 8 weeks following the transection surgery, with subsequent histological evaluation of the right legs, and mechanical evaluation of the left legs. Platelet counts were 3.8 times higher for L-PRP and 12.8 times higher for H-PRP than for whole blood. The semi-quantitative Bonar scale（0 is normal）decreased significantly from the S to L-PRP to H-PRP groups（P＝0.03）. The values for ultimate load, ultimate stress, elastic modulus, and stiffness increased from the S to L-PRP to H-PRP groups. A significant difference was observed between the groups for stiffness（P＝0.03）. Our results showed that PRP preparations with a high concentration of platelets were superior in the promotion of histological and mechanical healing of the Achilles tendon.

OBJECTIVE: We investigated the effect of administration of intra-articular mesenchymal stem cells (MSCs) on cartilage repair at different timings, and the distribution of MSCs in the knee. DESIGN: A partial thickness cartilage defect (PTCD) was created on the medial femoral condyle in 14-week-old Sprague-Dawley rats. Intra-articular injection of 1 × 106 MSCs was performed at 3 time points, namely at the time of surgery (0w group), at 1 week after surgery (1w group), and at 2 weeks after surgery (2w group). For the control, 50 μL phosphate-buffered saline was injected at the time of surgery. The femoral condyles were collected at 6 weeks after creation of PTCD and assessed histologically. To investigate the distribution of MSCs, fluorescent-labeled MSCs were injected into the knee joint. RESULTS: In the control group, the cartilage lesion was distinguishable from surrounding cartilage. In the 0w group, hypocellularity and a slight decrease in safranin O stainability were observed around the injured area, but cartilage was restored to a nearly normal condition. In contrast, in the 1w and 2w groups, the cartilage surface was irregular and safranin O stainability in the injured and surrounding areas was poor. Histological score in the 0w group was significantly better than in the control, 1w, and 2w groups. At 1 day postinjection, fluorescent-labeled MSCs were mostly distributed in synovium. However, no migration into the PTCD was observed. CONCLUSIONS: Early intra-articular injection of MSCs was effective in enhancing cartilage healing in a rat PTCD model. Injected MSCs were distributed in synovium, not in cartilage surrounding the PTCD.

内側型の変形性膝関節症あるいは膝関節特発性骨壊死に対して人工膝関節単顆置換術を行った13例14膝(U群)と、内側開大型高位脛骨骨切り術を行った7例9膝(H群)の術後成績をForgotten Join Score 12(FJS)を用いて比較し、FJSに影響を及ぼす患者因子について検討した。平均観察期間はU群21.9ヵ月、H群20.9ヵ月で、いずれも良好な可動域(ROM)とKOOSが得られ、平均FJSはU群65.3±22.8点、H群71.1±15.8点であった。患者背景、客観的評価、患者立脚型評価を比較した結果、年齢はU群が有意に高く、Body Mass Index(BMI)とKOOSのADL項目はH群が高い傾向にあったが、性別、術前大腿脛骨角、術後ROM、KOOS、FJSに有意差はなかった。また、年齢、BMIを含めたいずれの項目もFJSとの有意な相関を認めなかった。

2019年1月に千葉大学医学部附属病院にスポーツメディクスセンター(SMC)が設置された。SMCは地域に根差しスポーツと医療の連携にある課題を吸い上げる。病院内・自治体・三師会・スポーツ協会・各スポーツ団体・アカデミアなどと連携し、組織横断的に課題を解決に導き、スポーツと医療の連携の深化、スポーツを起点とした健康増進など地域への貢献を目的とする。当面はスポーツ現場の課題である安全救護の充実に取り組み、スポーツイベントや団体の緊急時行動計画立案、医療者・関係者への救護医療の技術支援などを行い安全なスポーツ環境を創出する。2020年以降は、アスリートのみならず地域住民も対象に、公衆衛生学的観点も含めたスポーツと医療に関する研究と実践を行う。これらから得られた知見や実践の知恵を地域社会へ還元し貢献する。本報告では『地域密着の医療・スポーツ連携で未来を拓く』を掲げるSMCの理念と取組・今後の展望について解説した。(著者抄録)

2015年1月〜2017年7月に国内8施設において末期変形性足関節症(OA)に対して足関節固定術(AF)もしくは人工足関節全置換術(TAA)の手術を行い1年以上経過した75歳以上の35例(男10例、女25例、平均年齢78.3±2.6歳)を対象として、術後の状態をThe Japanese Society for Surgery of the Foot(JSSF) scale、the Self-Administered Foot Evaluation Questionnaire(SAFE-Q)を用いて評価した。全35例中、stageはIVが最も多く、necrosisを背景としたOAも3例認めた。平均経過観察期間は18.5±7.7ヵ月であった。臨床評価では、JSSF scaleは52.6→89.6と有意に改善し、SAFE-Qの下位尺度である痛み・痛み関連、身体機能・日常生活の状態、社会生活機能、靴関連、全体的健康感の全てにおいて有意に改善した。術中骨折は3例発生し、術後合併症として感染1例、弛み4例、癒合不全1例、再手術2例が発生した。

PURPOSE: The purpose of this study was to clarify radiographic and clinical outcomes, as well as their association, of ankle sprain in children. METHODS: Patients who sustained a first-time ankle sprain were prospectively surveyed. Patients underwent radiography of the ankle in the mortise, lateral, anterior talofibular ligament (ATFL), and calcaneofibular ligament views at the first clinic visit to assess avulsion fractures of the distal fibula. Patients with avulsion fractures underwent radiography after 8 weeks to assess bone union. The treatment method was not standardized and was determined by the patient, their parents, and the treating physician. Recurrent sprain and quality of life were evaluated by using the Self-Administered Foot Evaluation Questionnaire and reviewing the medical records of patients. The association between avulsion fracture and recurrent sprain was assessed using univariate and multivariate analyses. RESULTS: A total of 143 patients with a median age of 9 (range 6-12) years were analyzed. Avulsion fractures were present in 89 (62%) patients. The sensitivity of the ATFL view for the diagnosis of avulsion fractures was 0.94, whereas that for the anteroposterior and lateral views was significantly lower at 0.46 (P < 0.001). Only 17% of fractures united at 8 weeks. Of 114 (follow-up rate, 80%) patients who were followed up for a median period of 24 months, recurrent sprain occurred in 41 (36%) patients. The incidence rate was significantly higher in patients with avulsion fractures than in patients without the fractures (44 vs. 23%, P = 0.027). In multivariate logistic regression analysis, avulsion fracture was independently associated with recurrent sprain (P = 0.027). CONCLUSION: More than one-third of patients experienced recurrent sprain. The presence of avulsion fracture was associated with an increased risk of recurrent sprain. Patients with avulsion fracture and their parents should be informed about the risk of recurrent sprain and subsequent ankle instability, and careful follow-up is needed for these patients. LEVEL OF EVIDENCE: III.