山崎健: 腰部脊柱管狭窄症の疫学調査とQOL調査 地方都市における一般住民の有病率と健康関連QOL調査. Orthopaedics 2010; 23(10): 11-18.
Hachiro Ohnishi, Yasunori Sawayama, Norihiro Furusyo, Shinji Maeda, Shoji Tokunaga, Jun Hayashi
Risk factors for and the prevalence of peripheral arterial disease and its relationship to carotid atherosclerosis: the Kyushu and Okinawa Population Study (KOPS).
J Atheroscler Thromb. 2010 Jul 30;17(7):751-8. Epub 2010 Jun 2.
Abstract/Text
AIM: Peripheral arterial disease (PAD) is associated with cerebrovascular disease, ischemic heart disease, and other cardiovascular disease. We investigated the prevalence of and factors related to PAD to clarify the relationship between PAD and carotid atherosclerosis in a cross-sectional population-based study.
METHODS: The study included 2,402 (900 males and 1,502 females; mean+/-SD=64.9+/-10.9 years) of 3,862 residents of two Japanese rural areas who reported for a free health examination in 2005 or 2006. An ankle brachial index value < or =0.9 was considered to be PAD. The carotid artery intima-media thickness (CA-IMT) was measured by carotid ultrasound.
RESULTS: The prevalence of PAD was 1.71% (n=41) of all participants. The risk factors independently associated with a significantly higher risk of PAD, identified by multivariate analysis, are as follows: For males, age, dyslipidemia, and CA-IMT, and for females, age, waist circumference, and dyslipidemia.
CONCLUSION: The prevalence of PAD in Japan was confirmed to be lower than that of similar studies performed in other countries. PAD was strongly correlated with age and dyslipidemia in both sexes, carotid atherosclerosis in males, and abdominal fat in females.
N Yoshimura, L Campbell, T Hashimoto, H Kinoshita, T Okayasu, C Wilman, D Coggon, P Croft, C Cooper
Acetabular dysplasia and hip osteoarthritis in Britain and Japan.
Br J Rheumatol. 1998 Nov;37(11):1193-7.
Abstract/Text
OBJECTIVE: Geographic differences in the prevalence of hip osteoarthritis (OA) have been ascribed to differences in the frequency of acetabular dysplasia among different ethnic groups. However, there are few data on the shape of the acetabulum in various populations around the world. We examined this issue in samples of pelvic radiographs from Britain and Japan.
METHODS: Measurements were made on the pelvic radiographs of 1303 men and 195 women, aged 60-75 yr, who attended for i.v. urography in two British centres. These were compared with 99 men and 99 women aged 60-79 yr who were included in a population-based study in a rural community in Japan, and who agreed to undergo standardized pelvic radiography. Acetabular dysplasia was assessed by morphometric measurement of the centre-edge (CE) angle and acetabular depth.
RESULTS: The mean CE angle among men was 36 degrees (95% CI 35-37 degrees ) in Britain and 31 degrees (95% CI 29-32 degrees ) in Japan; that in women was 37 degrees (95%, CI 36-38 degrees ) in Britain and 31 degrees (95% CI 29 33 degrees ) in Japan. The mean values of acetabular depth were also significantly (P < 0.001) lower in Japan than in Britain. However, the prevalence of hip OA was lower in Japan (0% in men, 2% in women) than in Britain ( 11% in men, 4.8 / in women). In a random effects model, there were negative relationships between measures of acetabular dysplasia and minimum joint space among individuals.
CONCLUSIONS: We conclude that there are marked differences in pelvic morphometry between Britain and Japan. The acetabular dimensions of Japanese subjects are considerably shallower than those of their British counterparts of similar age and sex. Nevertheless, hip OA is more frequent in Britain than in Japan. Further studies are required on the risk factors for hip OA in Oriental populations, in order that the aetiology of this disorder can be better understood.
De Q H Tran, Silvia Duong, Roderick J Finlayson
Lumbar spinal stenosis: a brief review of the nonsurgical management.
Can J Anaesth. 2010 Jul;57(7):694-703. doi: 10.1007/s12630-010-9315-3. Epub 2010 Apr 29.
Abstract/Text
PURPOSE: The purpose of this brief narrative review is to summarize the evidence derived from randomized controlled trials pertaining to the nonsurgical treatment of lumbar spinal stenosis (LSS).
SOURCE: The MEDLINE (January 1950 to the fourth week of January 2010) and EMBASE (January 1980 to 2009, week 53) databases, the MESH term "spinal stenosis", and the key words, "vertebral canal stenosis" and "neurogenic claudication", were searched. Results were limited to randomized controlled trials (RCTs) conducted on human subjects, written in English, and published in peer-reviewed journals. Only RCTs pertaining to nonsurgical treatment were considered. Studies comparing conservative and surgical management or different surgical techniques were not included in the review.
PRINCIPAL FINDINGS: The search criteria yielded 13 RCTs. The average enrolment was 54 subjects per study. Blinded assessment and sample size justification were provided in 85% and 39% of RCTs, respectively. The available evidence suggests that parenteral calcitonin, but not intranasal calcitonin, can transiently decrease pain in patients with LSS. In the setting of epidural blocks, local anesthetics can improve pain and function, but the benefits seem short-lived. The available evidence does not support the addition of steroids to local anesthetic agents. Based on the limited evidence, passive physical therapy seems to provide minimal benefits in LSS. The optimal regimen for active physiotherapy remains unknown. Although benefits have been reported with gabapentin, limaprost, methylcobalamin, and epidural adhesiolysis, further trials are required to validate these findings.
CONCLUSIONS: Because of their variable quality, published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS. In this narrative review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. This aspect may represent a limitation as it may serve to overemphasize evidence derived from "weaker" trials. Further well-designed RCTs are warranted.
Roberto A Mangiafico, Carmelo E Fiore
Current management of intermittent claudication: the role of pharmacological and nonpharmacological symptom-directed therapies.
Curr Vasc Pharmacol. 2009 Jul;7(3):394-413.
Abstract/Text
Lower extremity peripheral arterial disease (PAD) is a manifestation of atherosclerosis, with a prevalence ranging from 4% to 12% in the adult population and increasing up to 20% in older individuals. Intermittent claudication (IC) may markedly impair walking ability, overall functional status and quality of life. PAD is a marker of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality. However, leg disease usually runs a rather benign course in claudicant patients, with only about 1% to 3% of them ever requiring a major amputation over a 5-year period. The goals of treatment for claudication are to relieve exertional symptoms, and improve walking capacity and quality of life. Therapeutic strategies aimed at reducing systemic cardiovascular risk burden and prolonging survival, including intensive risk factor modification and antiplatelet therapy, should be implemented in all patients with PAD. Supervised exercise training has proven the most effective conservative treatment for symptomatic relief of IC. Current evidence for drug therapy of IC supports the use of cilostazol as a first-line drug. Other drugs with more limited evidence of benefit for claudication include pentoxifylline and naftidrofuryl. Endovascular or surgical revascularization is indicated for selected patients with vocation- or lifestyle-limiting claudication who are unresponsive to exercise and pharmacotherapy. New drug candidates for managing claudication symptoms include propionyl-L-carnitine and statins. Preliminary studies suggest that therapeutic angiogenesis holds promise for future treatment of IC.
Inge H F Reininga, Martin Stevens, Robert Wagenmakers, Sjoerd K Bulstra, Johan W Groothoff, Wiebren Zijlstra
Subjects with hip osteoarthritis show distinctive patterns of trunk movements during gait-a body-fixed-sensor based analysis.
J Neuroeng Rehabil. 2012 Jan 20;9:3. doi: 10.1186/1743-0003-9-3. Epub 2012 Jan 20.
Abstract/Text
BACKGROUND: Compensatory trunk movements during gait, such as a Duchenne limp, are observed frequently in subjects with osteoarthritis of the hip, yet angular trunk movements are seldom included in clinical gait assessments. Hence, the objective of this study was to quantify compensatory trunk movements during gait in subjects with hip osteoarthritis, outside a gait laboratory, using a body-fixed-sensor based gait analysis. Frontal plane angular movements of the pelvis and thorax and spatiotemporal parameters of persons who showed a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp.
METHODS: A Body-fixed-sensor based gait analysis approach was used. Two body-fixed sensors were positioned at the dorsal side of the pelvis and on the upper thorax. Peak-to-peak frontal plane range of motion (ROM) and spatiotemporal parameters (walking speed, step length and cadence) of persons with a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp. Participants were instructed to walk at a self-selected low, preferred and high speed along a hospital corridor. Generalized estimating equations (GEE) analyses were used to assess group differences between persons with a Duchenne limp, without a Duchenne limp and healthy subjects.
RESULTS: Persons with a Duchenne limp showed a significantly larger thoracic ROM during walking compared to healthy subjects and to persons without a Duchenne limp. In both groups of persons with hip osteoarthritis, pelvic ROM was lower than in healthy subjects. This difference however only reached significance in persons without a Duchenne limp. The ratio of thoracic ROM relative to pelvic ROM revealed distinct differences in trunk movement patterns. Persons with hip osteoarthritis walked at a significantly lower speed compared to healthy subjects. No differences in step length and cadence were found between patients and healthy subjects, after correction for differences in walking speed.
CONCLUSIONS: Distinctive patterns of frontal plane angular trunk movements during gait could be objectively quantified in healthy subjects and in persons with hip osteoarthritis using a body-fixed-sensor based gait analysis approach. Therefore, frontal plane angular trunk movements should be included in clinical gait assessments of persons with hip osteoarthritis.
