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| 1.
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Hayashi, Katsuhiro ; Niu, Xiaohui ; Tang, Xiaodong ; Singh, Vivek Ajit ; Asavamongkolkul, Apichat ; Kawai, Akira ; Yamamoto, Norio ; Shirai, Toshiharu ; Takeuchi, Akihiko ; Kimura, Hiroaki ; Miwa, Shinji ; Tsuchiya, Hiroyuki ; 林, 克洋 ; 山本, 憲男 ; 白井, 寿治 ; 武内, 章彦 ; 木村, 浩彰 ; 三輪, 真嗣 ; 土屋, 弘行
概要:
Total scapulectomy and reconstruction has been performed for scapular tumor, however, most of the reconstruction methods
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have resulted in poor functional outcomes and there is still room for improvement. Most of the reports of reconstruction after scapulectomy are from a single institution. In the present study, we investigated functional outcomes after total scapulectomy in a multicenter study in The Eastern Asian Musculoskeletal Oncology Group (EAMOG). Thirty-three patients who underwent total scapulectomy were registered at EAMOG affiliated hospitals. The patients were separated into no reconstruction group (n=8), humeral suspension group (n=15) and prosthesis group (n=10). Functional outcome was assessed by the Enneking score. One-way ANOVA was used to compare parameters between the patient groups. Complications included five local recurrences, one superficial infection, one dislocation and one clavicle protrusion. The average follow-up period was 43.5. months. The average active flexion range was 45.8° (0-120°), and 37.1° in abduction (0-120°). The mean total functional score was 22.9 out of 30 (15-29), which is a satisfactory score following resection of the shoulder girdle. There were significant differences in reconstruction methods for active range of motion. Bony reconstruction provided better range of motion in this study. There was a variety of reconstruction methods after scapulectomy in the eastern Asian countries. Although better functional score was obtained using scapular prosthesis or recycled bone and prosthesis composite grafting, postoperative function is still lower than preoperative function. Modified designed prosthesis with or without combination of recycle bone or allograft would restore the lost shoulder function in the future. © 2016 The Authors.<br />Embargo Period 12 months
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| 2.
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Miwa, Shinji ; Shirai, Toshiharu ; Yamamoto, Norio ; Hayashi, Katsuhiro ; Takeuchi, Akihiko ; Tada, Kaoru ; Kajino, Yoshitomo ; Inatani, Hiroyuki ; Higuchi, Takashi ; Abe, Kensaku ; Taniguchi, Yuta ; Tsuchiya, Hiroyuki ; 三輪, 真嗣 ; 白井, 寿治 ; 山本, 憲男 ; 林, 克洋 ; 武内, 章彦 ; 多田, 薫 ; 樋口, 貴史 ; 阿部, 健作 ; 土屋, 弘行
概要:
金沢大学医薬保健研究域医学系<br />Background: Postoperative deep infection after bone tumor surgery remains a serious complication. Al
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though there are numerous reports about risk factors for postoperative deep infection in general surgery, there is only a small number of reports about those for bone tumor surgery. This retrospective study aimed to identify risk factors for postoperative deep infection after bone tumor resection. Methods: We reviewed data of 681 patients (844 bone tumors) who underwent surgery. Associations between variables, including age, recurrent tumor, pathological fracture, surgical site (pelvis/other), chemotherapy, biological reconstruction, augmentation of artificial bone or bone cement, the use of an implant, intraoperative blood loss, operative time, additional surgery for complications, and postoperative deep infection were evaluated. Results: The rate of postoperative deep infection was 3.2% (27/844 tumors). A pelvic tumor (odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.0–11.3) and use of an implant (OR: 9.3, 95% CI: 1.9–45.5) were associated with an increased risk of deep infection. Conclusions: This retrospective study showed that pelvic tumor and use of an implant were independent risk factors for deep infection. This information will help surgeons prepare an adequate surgical plan for patients with bone tumors. © 2017 Miwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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| 3.
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Tanzawa, Yoshikazu ; Tsuchiya, Hiroyuki ; Shirai, Toshiharu ; Hayashi, Katsuhiro ; Zen, Yoh ; Tomita, Katsuro
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金沢大学医薬保健研究域医学系<br />Background: Several oncological sterilization methods involving autoclaving, irradiation, or pasteur
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ization have been developed for limb reconstruction of large bone defects following tumor excision. Studies involving histological examinations of these autografts have all found that osteogenesis occurs slowly. We have used frozen autografts treated by liquid nitrogen for limb reconstruction and have achieved excellent results for bone union. To determine if frozen autografts exhibit early bone remodeling, we investigated the repair processes of the frozen bones. Methods: We analyzed frozen autografts treated by liquid nitrogen, retrieved at a mean of 19.1 months (2-75 months) after implantation because of complications or local tumor recurrence. The specimens were obtained from six patients with a mean age of 36.2 years (8-68 years). The six grafts comprised three osteoarticular grafts, two intercalary grafts, and one joint graft. We histologically reviewed the autograft-containing sections for tumor cell necrosis, evidence of cortical repair, the cortical junction, and joint cartilage. Results: Tumor cells were completely eradicated from the frozen bone in all cases. In a specimen retrieved 5 months after implantation, a small area of the bone showed active osteocytes and osteoblasts. In three cases retrieved more than 1 year after implantation, osteocytes and osteoblasts were observed in broad portions of the frozen bones, indicating the onset of osteogenesis in the frozen bone at an early stage. The cortical host-graft junction showed incorporation along with continuity of bone trabeculae. In addition, we were able to fi nd normal chondrocytes on the articular surface. Conclusions: The frozen bone specimens in this study thus showed evidence of newly formed bone and earlier osteogenesis than has been previously reported. Our results suggest that frozen autografts may be considered one of the most useful recycled materials for biological reconstruction. © 2009 The Japanese Orthopaedic Association.
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| 4.
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Shirai, Toshiharu ; Shimizu, Takaki ; Ohtani, Kaori ; Zen, Yoh ; Takaya, M. ; Tsuchiya, Hiroyuki
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金沢大学医薬保健研究域医学系<br />Deep infection remains a serious complication in orthopedic implant surgery. In order to reduce the
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incidence of implant-associated infections, several biomaterial surface treatments have been proposed. This study focused on evaluating the antibacterial activity of iodine-supported titanium (Ti-I 2) and its impact on post-implant infection, as well as determining the potential suitability of Ti-I2 as a biomaterial. External fixation pins were used in this experiment as trial implants because of the ease of making the septic models. The antibacterial activity of the metal was measured using a modification of the Japanese Industrial Standards method. Activity was evaluated by exposing the implants to Staphylococcus aureus or Escherichia coli and comparing reaction of pathogens to Ti-I2 vs. stainless steel and titanium controls. Ti-I2 clearly inhibited bacterial colonization more than the control metals. In addition, cytocompatibility was assessed by counting the number of colonies that formed on the metals. The three metals showed the same amount of fibroblast colony formation. Japanese white rabbits were used as an in vivo model. Three pins were inserted into both femora of six rabbits for histological analysis. Pin sites were inspected and graded for infection and inflammation. Fewer signs of infection and inflammatory changes were observed in conjunction with the Ti-I2 pins. Furthermore, osteoconductivity of the implant was evaluated with osteoid formation surface of the pin. Consecutive bone formation was observed around the Ti-I2 and titanium pins, while little osteoid formation was found around the stainless steel pins. These findings suggest that Ti-I2 has antimicrobial activity and exhibits cytocompatibility. Therefore, Ti-I2 substantially reduces the incidence of implant infection and shows particular promise as a biomaterial. © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
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Shirai, Toshiharu ; Tsuchiya, Hiroyuki ; Shimizu, Tohru ; Ohtani, Kaori ; Zen, Yoh ; Tomita, Katsuro
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金沢大学医薬保健研究域医学系<br />The most frequent complication in external fixation is pin tract infection. To reduce the incidence
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of implant-associated infection, many published reports have looked at preventing bacterial adhesion by treating the pin surface. This study aimed to evaluate the antibacterial activity of a Titanium-Copper (Ti-Cu) alloy on implant infection, and to determine the potential use of the Ti-Cu alloy as a biomaterial. Two forms of Ti-Cu alloys were synthesized: one with 1% Cu and the other with 5% Cu. For analyzing infectious behavior, the implants were exposed to Staphylococcus aureus and Escherichia coli. The reaction of pathogens to the Ti-Cu alloys was compared with their reaction to stainless steel and pure titanium as controls. Both Ti-Cu alloys evidently inhibited colonization by both bacteria. Conversely, cytocompatibility studies were performed using fibroblasts and colony formation on the metals was assessed by counting the number of colonies. Ti-1% Cu alloy showed no difference in the number of colonies compared with the control. External fixator pins made of Ti-Cu alloys were evaluated in a rabbit model. The tissue-implant interactions were analyzed for the presence of infection, inflammatory changes and osteoid-formation. Ti-1% Cu alloy significantly inhibited inflammation and infection, and had excellent osteoid-formation. Copper blood levels were measured before surgery and at 14 days postoperatively. Preoperative and postoperative blood copper values were not statistically different. Overall, it was concluded that Ti-Cu alloys have antimicrobial activity and substantially reduce the incidence of pin tract infection. Ti-1% Cu alloy shows particular promise as a biomaterial. © 2009 Wiley Periodicals, Inc.
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| 6.
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Tsuchiya, Hiroyuki ; Takeuchi, Akihiko ; Yamamoto, Norio ; Shirai, Toshiharu ; Hayashi, Katsuhiro ; Nishida, Hideji ; Tomita, Katsuro
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金沢大学医薬保健研究域医学系
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| 7.
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Tsuchiya, Hiroyuki ; Takeuchi, Akihiko ; Yamamoto, Norio ; Shirai, Toshiharu ; Hayashi, Katsuhiro ; Nishida, Hideji ; Tomita, Katsuro
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| 8.
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Watanabe, Koji ; Tsuchiya, Hiroyuki ; Yamamoto, Norio ; Shirai, Toshiharu ; Nishida, Hideji ; Hayashi, Katsuhiro ; Takeuchi, Akihiko ; Matsubara, Hidenori ; Nomura, Issei
概要:
Background: The aim of this study was to investigate the long-term functional capabilities of patients who underwent bon
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e distraction for the treatment of bone defects caused by bone tumor excision. Methods: Bone distraction was indicated for patients with stage IIB malignant bone tumors when chemotherapy was judged to be effective and an epiphysis could be preserved or for patients with low-grade or aggressive benign bone tumors. Twenty-two patients who underwent reconstruction with bone distraction and were followed up for at least 10 years were retrospectively investigated. Patients included 8 males and 14 females, with a mean age of 25.3 years. Tumor types included seven osteosarcomas, two osteofibrous dysplasias, one Ewing's sarcoma, five low-grade osteosarcomas, two adamantinomas, and five giant cell tumors. Chemotherapy was performed during bone distraction in 8 cases. Bone transport was used in 17 cases, while shortening distraction was used in 5 cases. Results: The mean distraction length was 8.1 cm, and the mean external fixation period was 301 days. The average Musculoskeletal Tumor Society score (used to measure functional outcome) was 91.5 % at mean follow-up of 202 months. Fourteen patients were able to play sports without any difficulty. Conclusions: Epiphyseal preservation and reconstruction by bone distraction require both time and effort, but can provide excellent long-term outcomes, resulting in a stable reconstruction that functionally restores the natural limb. © 2012 The Japanese Orthopaedic Association.
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| 9.
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Shirai, Toshiharu ; Tsuchiya, Hiroyuki ; Terauchi, Ryu ; Tsuchida, Shinji ; Mizoshiri, Naoki ; Igarashi, Kentaro ; Miwa, Shinji ; Takeuchi, Akihiko ; Kimura, Hiroaki ; Hayashi, Katsuhiro ; Yamamoto, Norio ; Kubo, Toshikazu
概要:
Objective: We perform reconstruction using frozen tumor bone treated by liquid nitrogen after excision of malignant bone
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tumors. To prevent post-operative infection, we use iodine-coated implants that we developed. The purpose of this study is to compare the outcome of reconstruction using frozen autograft with non-coated implants (group N) and iodine-coated implants (group I).Methods: Sixty-two patients were included in group N. The mean age was 31.9 ± 2.3 years. A total of 20 patients died and two were lost to follow-up, averaging 20.0 ± 2.9 months post-operatively, leaving 40 patients available for an assessment at a mean of 79.1 ± 5.8 months post-operatively. There were 38 patients in group I. The mean age was 29.8 ± 3.9 years. The mean follow-up period was 32.1 ± 3.0 months. All patients were alive at the latest follow-up. Survival of frozen bone was determined by Kaplan-Meier analysis.Results: In group N, survival of frozen bone was 80.7 ± 6.0% and 57.4 ± 10.2% at 5 and 10 years, respectively. Complications were encountered in 31 of 62 patients (50.0%), including deep infection in 10 (16.1%), fracture in 11 (17.7%), local soft-tissue recurrence in 6 (9.7%) and bone absorption in 4 (6.5%). In group I, survival of frozen bone was 86.7 ± 6.3% at 5 years. Complications were encountered in 8 of 38 patients (21.1%), including deep infection in one (2.6%), fracture in four (10.5%), local soft-tissue recurrence in two (5.3%) and bone absorption in one (2.6%). There was a significantly lower infection rate in group I (P = 0.032).Conclusion: Reconstruction using frozen autograft combined with iodine-coated implants for patients with malignant bone tumor is very useful method in which good limb function can be gained with minimized risk of infection. © The Author 2016. Published by Oxford University Press. All rights reserved.<br />Article number hyw065 / Embargo Period 6 months
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| 10.
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Tsuchiya, Hiroyuki ; Shirai, Toshiharu ; Nishida, Hideji ; Murakami, Hideki ; Kabata, Tamon ; Yamamoto, Norio ; Watanabe, Koji ; Nakase, Junsuke
概要:
Background: Postoperative infection associated with implants remains a serious complication in orthopedic surgery. Several biomaterial surface treatments have been proposed as a means of reducing the incidence of implantassociated
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infections. In this study, a clinical trial was performed using an iodine-supported titanium that suppresses the microbial activities. Methods: A total of 222 patients with postoperative infection or compromised status were treated using iodinesupported titanium implants. The mean age of the patients was 49.4 years (range 5-85 years). One hundred twentyseven patients were male and 95 were female. In 158 patients, iodine-supported implants were used to prevent infection, such as compromised hosts and conditions, and in 64 patients to treat active infection. White blood cell (WBCs) and C-reactive protein (CRP) levels were measured pre- and postoperatively in all patients. To confirm whether iodine from the implant affected physiological functions, thyroid hormone levels in the blood were examined. Both examinations were conducted sequentially for a year. Radiological evaluations were performed regularly after the operation. The chronological changes of the iodine amount were evaluated using half pins removed after completion of external fixation. Results: The mean follow-up period was 18.4 months (range 3-44 months). Acute infection developed in three tumor cases among the 158 patients on preventive therapy. All three recovered without removal of the implants. Infection was cured in all 64 patients with infection. Median WBC levels were in the normal range, and median CRP levels returned to <0.5 within 4 weeks after surgery. Abnormalities of thyroid gland function were not detected. None of the patients experienced loosening of the implants. There were two patients with mechanical implant failure, which was treated by re-implantation. Excellent bone ingrowth and ongrowth were found around all hip and tumor prostheses. One year later, the amount of iodine on external fixation pins remained about 20-30 %. Conclusions: Iodine-supported titanium implants can be very effective for preventing and treating infections after orthopedic surgery. Cytotoxicity and adverse effects were not detected.
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