共查询到20条相似文献，搜索用时 15 毫秒
1.
2.
Shogo Tanaka Yoshikuni Kawaguchi Shoji Kubo Akishige Kanazawa Yutaka Takeda Fumitoshi Hirokawa Hiroyuki Nitta Takayoshi Nakajima Takashi Kaizu Masaki Kaibori Toru Kojima Yuichiro Otsuka David Fuks Kiyoshi Hasegawa Norihiro Kokudo Hironori Kaneko Brice Gayet Go Wakabayashi 《Surgery》2019,165(4):731-740
3.
Eiji Oki Mototsugu Shimokawa Koji Ando Akihiko Murata Takao Takahashi Kiyoshi Maeda Tetsuya Kusumoto Yoshinori Munemoto Ryota Nakanishi Yuichiro Nakashima Hiroshi Saeki Yoshihiko Maehara 《Surgery》2019,165(3):586-592
Background
Lateral lymph node dissection has been 1 of the standard treatments for mid and ow rectal cancer in Japan. The aim of this ad-hoc analysis was to evaluate the impact of lateral lymph node dissection on outcomes in the randomized clinical trial, referred to as the Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial.Methods
The Adjuvant Chemotherapy for Stage II/III Rectal Cancer trial was a randomized, phase III trial of adjuvant chemotherapy of 2 different oral fluoropyrimidines; 445 patients with lower rectal cancer were studied in this ad-hoc analysis out of 959 patients in total, 215 of whom underwent lateral lymph node dissection and 230 did not.Results
There were no significant differences in background characteristics of the patients in the group, except for in age and number of dissected lymph nodes, between the lateral lymph node dissection and without lateral lymph node dissection groups. The age of the younger patients was often used to select candidates for lateral lymph node dissection (lateral lymph node dissection versus non–lateral lymph node dissection; 63.5 ± 8.9 vs 60.7 ± 9.4 [P?=?.0017]). Lateral lymph node dissection had no impact on relapse-free survival (hazard ratio?=?0.941, 95% confidence interval: 0.696–1.271) or overall survival (hazard ratio?=?0.858, 95% confidence interval: 0.601–1.224) in all patients with mid and low rectal cancer. In subset analysis, lateral lymph node dissection improved relapse-free survival in female patients and in patients with stage B/C or N3/4 disease. For cumulative recurrence across all patients, the proportion of patients with distant recurrence was slightly greater in the lateral lymph node dissection group but there was no difference in local recurrence.Conclusion
This exploratory analysis did not show that lateral lymph node dissection improves relapse-free survival and overall survival in patients with mid and low rectal cancer. Lateral lymph node dissection may, however, have a prognostic impact on patients with highly invasive rectal cancer. 相似文献4.
5.
Terufumi Kokabu Masahiko Takahata Nobuhisa Ishiguro Norimasa Iwasaki 《Journal of orthopaedic science》2017,22(5):822-827
Background
Hematogenous vertebral osteomyelitis (HVO) has a generally favorable prognosis if appropriate treatment is initiated in its early phase; however, some intractable cases with HVO can develop neurological impairment as well as spinal deformity during the course of treatment and these sequelae may lead to impaired quality of life (QOL). In this study, we aimed to evaluate the long-term relapse rate, mortality, and QOL of patients with HVO.Methods
In this retrospective case series study, medical records of 60 patients with HVO with a mean follow-up period of 8 years (5–23 years) were reviewed to assess demographic data, details of infection, and clinical course. Mortality rate was assessed using a Kaplan–Meier plot. QOL was measured using the EuroQol 5 Dimension (EQ-5D) questionnaire and residual pain using a numeric rating scale (NRS).Results
HVO relapsed in 4 of 60 patients (7%). Overall 5-year survival rate in 60 patients with HVO was 85%. The factors associated with increased mortality were malignant tumor, diabetes mellitus, chronic use of glucocorticoids, and drug-resistant strains of staphylococcus. Female-to-male ratio, NRS, prevalence of neurological impairment were significantly higher in patients with low EQ-5D score (poor health) compared to those with high EQ-5D score (good health).Conclusions
Patients with HVO have shorter life expectancy if they have malignancy, diabetes mellitus, chronic use of glucocorticoids, and a history of drug-resistant strains of staphylococcus infection. Female gender, residual neurological defects and persistent back pain are associated with impaired QOL in patients with HVO. 相似文献6.
Yasuhiko Takegami Taisuke Seki Yoshitoshi Higuchi Daigo Komatsu Yoshihiro Nishida Naoki Ishiguro 《Journal of orthopaedic science》2017,22(6):1096-1101
Introduction
This study clarified individual associations of joint space narrowing (JSN) and radiographic features (RF) of hip osteoarthritis (HOA), i.e., cyst and osteophyte formation and subchondral sclerosis, with quality of life (QOL) in Japanese HOA patients.Methods
This cross-sectional study comprised 117 Japanese HOA patients (98 women, 17 men; mean age, 61.2 years). We recorded locations and the size of each RF and measured JSN on the acetabular side (Ace) or femoral head (FH). We evaluated pain with the Visual Analog Scale (VAS) and assessed QOL with the physical component summary (PCS) and mental component summary (MCS) of the Medical Outcomes Study Short Form-36. We compared QOL with/without the RF on the Ace, FH or both and analyzed relationships between each RF and VAS, PCS and MCS with linear regression analysis. We assessed independent associations of each RF with PCS and MCS with multiple regression analysis using various independent variables.Results
VAS values with the cyst on the Ace only were significantly lower than those with the cyst at both locations. PCS values with the cyst on the Ace only were significantly higher than those for both locations. Independent associations existed for maximum cyst length on the Ace and FH with VAS and for JSN with PCS, but none existed for MCS.Conclusions
Our study suggested that the location and the size of the cyst formation were associated with both VAS and QOL in Japanese HOA patients. The JSN was independently associated with the PCS. 相似文献7.
Mohammad Suhrab Rahmani Shinji Takahashi Masatoshi Hoshino Kazushi Takayama Ryuichi Sasaoka Tadao Tsujio Hiroyuki Yasuda Fumiaki Kanematsu Hiroshi Kono Hiromitsu Toyoda Hiroaki Nakamura 《Journal of orthopaedic science》2018,23(4):627-634
Background
With the increasing aging population in developed countries, there has been an associated increased prevalence of osteoporotic vertebral fracture (OVF). Many previous reports have attempted to predict the risk of delayed union associated with OVF. However, the role of endplate failure and the degeneration of adjacent intervertebral discs, and their association with delayed union has received little attention. The aim of this study was to evaluate the endplate fracture and disc degeneration rank as risk factors for delayed union.Materials and methods
Two hundred and eighteen consecutive patients with fresh OVF were enrolled in the study. MRI and X–ray were performed at the time of enrollment and at the 6 months follow-up. The MR images were used to assess the degeneration grade of adjacent intervertebral discs (using the modified Pfirrmann grading system), and endplate failure. Supine and weight-bearing radiographs were used to define angular motion and compression ratio of the anterior vertebral body wall.Results
A total of 139 patients (112 female, 27 male) completed the 6 month follow-up (a 65.1% follow-up rate). The study revealed 27 cases of delayed union (19.4%). A healthier adjacent caudal disc with low grade degeneration was found to be associated with an increased risk of delayed union (P = 0.008). Bi-endplate injury and significant compression of the anterior vertebral body wall were significantly associated with delayed union (P = 0.019, and P = 0.001 respectively). Rapid progression of the adjacent cranial disc degeneration was observed at the end of the 6 month follow-up period (P = 0.001).Conclusion
Modified Pfirrmann grading system revealed that a healthier adjacent intervertebral disc at the caudal level and bi-endplate fracture were significantly associated with an increased risk of delayed union. These findings may influence the management strategy for patients with OVF. 相似文献8.
9.
Kenichi Komaya Tomoki Ebata Yukihiro Yokoyama Tsuyoshi Igami Gen Sugawara Takashi Mizuno Junpei Yamaguchi Masato Nagino 《Surgery》2018,163(4):732-738
Background
Although several studies have been conducted on the patterns of recurrence in resected perihilar cholangiocarcinoma, they have many limitations. The aim of this study was to investigate recurrence after resection and to evaluate prognostic factors on the time to recurrence and recurrence-free survival.Methods
Consecutive patients who underwent curative-intent resection of perihilar cholangiocarcinoma between 2001 and 2012 were reviewed retrospectively. The Cox proportional hazards model was used for multivariable analysis.Results
In the study period, 402 patients underwent resection of perihilar cholangiocarcinoma (R0, n?=?340; R1, n?=?62). Radial margin positivity (n?=?43, 69%) was the most common reason for R1 resection. The median follow-up of survivors was 7.4 years. The cumulative recurrence probability was higher in R1 than in R0 resection (86% vs 57% at 5 years, P?<?.001). Seventeen R0 patients had a recurrence over 5 years after resection. There was no difference in median survival time after recurrence between R0 and R1 resection (10 vs 7 months). The proportion of isolated locoregional recurrence was higher in R1 than in R0 resection (37% vs 16%, P?<?.001), whereas the proportion of distant recurrence was similar. In R0 resection, the independent prognostic factors for time to recurrence and recurrence-free survival were microscopic venous invasion and lymph node metastasis.Conclusion
More than half of patients with perihilar cholangiocarcinoma experience recurrence after R0 resection. These recurrences occur frequently within 5 years but occasionally after 5 years, which emphasizes the need for close and long-term surveillance. Adjuvant strategies should be considered, especially for patients with nodal metastasis or venous invasion even after R0 resection. 相似文献10.
11.
Yuichi Kuroda Koji Takayama Kazunari Ishida Shinya Hayashi Shingo Hashimoto Kyohei Nishida Takehiko Matsushita Takahiro Niikura Ryosuke Kuroda Tomoyuki Matsumoto 《Journal of orthopaedic science》2019,24(4):668-673
BackgroundThe relationship between postoperative limb alignment and clinical outcomes in primary total knee arthroplasty (TKA) is well reported, but the instruments used to evaluate clinical outcomes of TKA are mainly scoring systems from the physician's viewpoint, not patient-reported outcomes. The purpose of this study was to investigate retrospectively the relationship between postoperative limb alignment and patient-reported clinical outcomes using the 2011 Knee Society Knee Scoring System (2011 KSS).MethodsThe present study included 155 knees of patients (median age, 74 years) who underwent primary TKA for varus osteoarthritis, with a mean follow-up period of 46 months. The subjects were divided into three groups based on postoperative limb alignment and femoral and tibial component positioning angle (varus, neutral, and valgus). The 2011 KSS scores were compared among the groups.ResultsFor limb alignment, the postoperative objective knee indicator score was significantly lower in the valgus group than in the varus and neutral groups, whereas no significant differences were observed in any subjective categories of the 2011 KSS. However, for the femoral component angle, functional activity scores were significantly lower in the valgus group than in the varus and neutral groups.ConclusionsThe subjective patient-reported score was not affected by the postoperative limb alignment. However, the valgus femoral component angle resulted in lower subjective functional scores. For clinical relevance, postoperative valgus positioning of femoral component should be avoided from patient-reported functional aspects during TKA. 相似文献
12.
Kazuki Oishi Eiji Sasaki Takuya Naraoka Yuka Kimura Eiichi Tsuda Hiroshi Shimoda Yasuyuki Ishibashi 《Journal of orthopaedic science》2019,24(3):494-500
PurposeThe influence of tunnel extension outside the anatomical anterior cruciate ligament (ACL) insertion in single-bundle (SB) or double-bundle (DB) ACL reconstruction is unclear. This study aimed to investigate the anatomical relationship between ACL insertion and tunnel extension in SB and DB ACL reconstruction, and the impact of tibial tunnel extension to the insertion of anterior horn of lateral meniscus in terms of injury.MethodsForty-six paired cadaver knees (mean age, 82.7 ± 10.7 years) were used. Right and left knees were used for SB (10 mm) and DB tunnel reaming (6 mm for the anteromedial and posterolateral bundles). Tibial and femoral tunnels were created to aim at the center of the ACL insertion by arthroscopic visualization. The relationship between tunnel extension and ACL insertion was evaluated macroscopically, and there ratio in two groups were compared by chi-square test. Further, the relative risk for meniscus injury based on tunnel placement was estimated. Coronal section of tibia and parallel section to Blumensaat line in femur were prepared to evaluate the relationship among tunnel position, ACL insertion, and anterior horn of the meniscus histologically.ResultsTibial tunnel extension out of the ACL insertion was observed macroscopically in 9 (39.1%) knees of the SB group, and 3 (13.0%) of the DB group (p = 0.045). In femoral tunnels, extension out of the ACL insertion was seen in 8 (34.8%) knees of the SB group and 1 (4.3%) of the DB group (p = 0.011). Partial injuries of the lateral meniscus anterior horn (LMAH) were observed in 5 (21.7%) knees of the SB group and 1 (4.3%) knee of the DB group (p = 0.091). The relative risk for LMAH injury was calculated as 5.0 (odds ratio, 6.1). Microscopically, SB tunnels appeared to expand out of ACL insertion, both in the femur and tibia.ConclusionsThe incidence of tunnel extension out of the ACL insertion in femur and tibia were higher with SB than with DB reconstruction. Furthermore, injury rate of the LMAH in the DB group was lower. 相似文献
13.
Ryota Yamauchi Ryo Inoue Daisuke Chiba Yuji Yamamoto Yoshifumi Harada Ippei Takahashi Shigeyuki Nakaji Yasuyuki Ishibashi 《Journal of orthopaedic science》2017,22(1):94-98
Background
The relationships between the clinical and radiographic signs of femoroacetabular impingement (FAI) are unknown. The purpose of this study was to assess the relationship between hip pain, a positive anterior impingement sign (AIS), and radiographic signs of FAI in a general Japanese population.Methods
A total of 616 individuals participated in this study. Hip pain was assessed using the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) pain category score and the AIS was used as a provocation test. Participants were divided into a positive AIS group (at least one positive hip) and a negative AIS group. Radiographs were assessed for the cross-over sign (COS), ischial spine sign (ISS), posterior wall sign (PWS), and pistol grip deformity (PGD). Then, the relationships between the clinical and radiographic signs of FAI were evaluated.Results
JHEQ pain scores did not differ between men and women. Seven men (3.4%) and 29 women (7.1%) had a least one hip with a positive AIS. The mean JHEQ pain scores were 22.9 ± 7.2 for the positive and 27.3 ± 2.2 for the negative AIS group (P < 0.01). The prevalences of COS, ISS, PWS, and PGD were 8.9%, 17.2%, 21.8%, and 1.9%, respectively. There were no significant associations between degree of hip pain, AIS, and each radiographic finding.Conclusions
Radiographic signs of FAI were not associated with the degree of hip pain or a positive AIS, which suggests that radiographic findings may not be important in the clinical diagnosis of FAI. 相似文献14.
Yusuke Osawa Yukiharu Hasegawa Taisuke Seki Yasuhiko Takegami Takafumi Amano Naoki Ishiguro 《Journal of orthopaedic science》2018,23(2):346-349
Background
There has been constant discussion about whether the clinical outcome of THA after periacetabular osteotomy (PAO) is equivalent to that after primary total hip arthroplasty (THA). However, there have been few reports about patient-reported outcomes (PRO) for those who undergo THA after PAO. We compared the pre- and postoperative PRO of patients who underwent THA after PAO and those who underwent primary THA alone.Methods
We performed a case–control study. Twenty-seven patients (29 hips) underwent THA after PAO (osteotomy group); their mean age at surgery was 57.2 years, and they underwent postoperative follow-up for a mean period of 3.0 years. For the control group, after matching age, sex, and Crowe classification, we included 54 patients (58 joints) who underwent primary THA for hip dysplasia. Assessment performed preoperatively and at the last follow-up included the Harris hip score, the Short Form 36 (SF-36) for the Physical Component Summary (PCS), Mental Component Summary (MCS), and Role/Social Component Summary (RCS) domains, Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for pain, movement, and mental health, and the visual analog scale (VAS) score of hip pain and satisfaction.Results
The two groups demonstrated no significant difference in the preoperative Harris hip score, each domain of the SF-36, JHEQ, and the VAS score of hip pain and satisfaction. The osteotomy group demonstrated significantly poor Harris hip scores for gait and activity, and JHEQ for movement at the last follow-up. There was no significant difference in each domain of the SF-36 and the VAS score of hip pain and satisfaction at the last follow-up.Conclusion
Previous PAO affects the quality of physical function in patients who undergo subsequent THA. 相似文献15.
16.
17.
Yohei Shibata Takehiko Matsushita Daisuke Araki Akihiro Kida Kohei Takiguchi Yuya Ueda Kumiko Ono Tomoyuki Matsumoto Takahiro Niikura Yoshitada Sakai Ryosuke Kuroda 《Journal of orthopaedic science》2019,24(2):301-305
Background
The wide variations in patient demographics and concomitant injuries make the prediction of which patients will regain strength quickly following anterior cruciate ligament (ACL) reconstruction challenging. This study aimed to identify the dominant factor affecting quadriceps strength recovery after ACL reconstruction with a hamstring tendon autograft and to construct a predictive model for quadriceps strength recovery using decision tree analysis.Methods
Three hundred and eighty-six patients who underwent ACL reconstruction with a hamstring tendon autograft were included in this study. The isokinetic quadriceps strength at 60°/s was measured preoperatively and at 6 months after surgery. The quadriceps strength index (QSI) was calculated by normalising the peak torque of the involved leg with the uninvolved leg and multiplying it by 100. A stepwise multiple linear regression and a decision tree analysis were performed to assess whether or not the following parameters affect quadriceps strength recovery at 6 months: socio-demographic data and maximum isokinetic quadriceps strength.Results
The preoperative QSI, age, and pre-injury Tegner activity scale were independently correlated with quadriceps strength recovery at 6 month after surgery. The decision tree analysis demonstrated that patients were expected to have a QSI ≥85% at 6 months after surgery if they met one of the following conditions: (1) age <23 years with a preoperative QSI ≥78.8%, (2) age ≥29 years with a preoperative QSI ≥98.0%, or (3) age <16 years with a preoperative QSI <58.5% and pre-injury Tegner activity scale ≥9. By contrast, patients ≥29 years with a preoperative QSI <98.0% were likely to achieve a quadriceps strength index <70% at 6 months after surgery.Conclusions
Based on the results of the decision tree analysis, younger patients could achieve good quadriceps recovery even if they have a lower preoperative QSI, whereas patients ≥29 years need a higher preoperative QSI to obtain good muscle recovery. 相似文献18.
Hiroji Shinkawa Hideo Yasunaga Kiyoshi Hasegawa Hiroki Matsui Kiyohide Fushimi Nobuaki Michihata Norihiro Kokudo 《Surgery》2018,163(6):1234-1237
Background
Whether patients undergoing hemodialysis have greater risks of mortality and morbidity after hepatic resection remains unclear.Methods
We used the Diagnosis Procedure Combination database, a national inpatient database in Japan, to identify patients who underwent hepatic resection from July 2010 to March 2014. Propensity scorematching analysis was performed to compare morbidity and mortality between patients with and without hemodialysis.Results
Of 53,651 eligible patients, 498 (0.93%) underwent hemodialysis. Propensity score-matching analysis indicated greater in-hospital mortality in patients with than without hemodialysis (8.6% vs 2.0%; P < .001). Patients undergoing hemodialysis had more postoperative major complications than did patients not undergoing hemodialysis (18.1% vs 7.4%; P < .001). In the subgroup analyses for in-hospital mortality, the odds ratio of hemodialysis was 2.36 (95% confidence interval, 0.78–6.59; P = .067) in limited resection, 4.61 (95% confidence interval, 1.90–11.2; P < .001) in segmentectomy or sectoriectomy, and 5.58 (95% confidence interval, 3.40–14.9; P < .001) in bisectoriectomy or trisectoriectomy. In the age subgroup analyses, the odds ratio of hemodialysis was 4.38 (95% confidence interval, 2.66–7.21; P < .001) in patients aged <80 years and 7.20 (95% confidence interval, 1.55–36.7; P = .0011) in those aged ≥80 years.Conclusion
Patients undergoing hemodialysis had a substantially increased risk of mortality and morbidity after hepatic resection. Surgical indications for major hepatectomy in patients undergoing hemodialysis who are ≥80 years of age may be limited and require careful scrutiny. 相似文献19.
Takashi Kaito Keitaro Matsukawa Yuichiro Abe Meinrad Fiechter Xia Zhu Alfonso Fantigrossi 《Journal of orthopaedic science》2018,23(6):865-869
Background
Cortical pedicle screw placement is an attractive technique in terms of both fixation strength and less invasiveness. However, to insert the screw with penetrating cortical bone on the ideal trajectory is technically demanding. The use of three-dimensional (3D) patient-matched guides may facilitate the use of this technique.Purpose
To examine the accuracy of cortical screw placement using a patient-matched targeting guide with a cadaveric study assessing the accuracy.Methods
The 3D planning of the pedicle screw placement, including the location at which the screw would pass through the center of the pedicle, sagittal/transverse trajectory (angle), length, and diameter, was developed using 3D CAD design software. Three-dimensional guides based on the preoperative planning were created for three cadaveric specimens (L1 to S1, 36 pedicles). Screws (n = 18) and pins (n = 18) were placed using K-wire or drill-based guides, without X-ray exposure. Actual positioning was compared to the preoperative plan by superimposing the inserted screws/pins based on postoperative CT. The placement accuracy was graded based on the degree of perforation of the pedicle by the pedicle screw or pin using an acceptance criterion (no perforation; Grade A, 0–2 mm; Grade B, 2–4 mm; and Grade C, >4 mm). The mean deviation between the planned and inserted screw positions on the coronal plane at the midpoint of the pedicle was compared to the accuracy of screw guide for traditional pedicle screw trajectory (0.70 mm).Results
Of 35 evaluated screws and pins, 32 (91.4%) were inserted completely inside the pedicle. All pedicle perforation was within 2 mm. The mean deviation from the plan at the midpoint of pedicle was 0.66 mm; thus, the accuracy was within the predefined criteria.Conclusions
Cortical pedicle screw placement using 3D-patient matched guides is accurate. Further clinical studies are required to confirm the radiographic and clinical effects. 相似文献20.
Yuichi Kasai Mitsuru Fukui Kazuhisa Takahashi Seiji Ohtori Daisaku Takeuchi Hiroshi Hashizume Masahiko Kanamori Noboru Hosono Tsukasa Kanchiku Eiji Wada Miho Sekiguchi Shinichi Konno Mamoru Kawakami 《Journal of orthopaedic science》2017,22(4):665-669