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Arata Sakai,Atsuhiro Masuda,Takaaki Eguchi,Keisuke Furumatsu,Takao Iemoto,Shiei Yoshida,Yoshihiro Okabe,Kodai Yamanaka,Ikuya Miki,Saori Kakuyama,Yosuke Yagi,Daisuke Shirasaka,Shinya Kohashi,Takashi Ko 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.3
Background/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO. Methods: This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events. Results: A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration. Conclusions: The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration.
Accurate and Easy Measurement of Sliding Distance of Intramedullary Nail in Trochanteric Fracture
Nobuaki Chinzei,Takafumi Hiranaka,Takahiro Niikura,Takaaki Fujishiro,Shinya Hayashi,Noriyuki Kanzaki,Shingo Hashimoto,Yoshitada Sakai,Ryosuke Kuroda,Masahiro Kurosaka 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2
In daily clinical practice, it is essential to properly evaluate the postoperative sliding distance of various femoral head fixation devices (HFD) for trochanteric fractures. Although it is necessary to develop an accurate and reproducible method that is unaffected by inconsistent postoperative limb position on radiography, few studies have examined which method is optimal. Therefore, the purpose of this study is to prospectively compare the accuracy and reproducibility of our four original methods in the measurement of sliding distance of the HFD. Methods: Radiographs of plastic simulated bone implanted with Japanese proximal femoral nail antirotation were taken in five limb postures: neutral, flexion, minute internal rotation, greater external rotation, and flexion with external rotation. Orthopedic surgeons performed five measurements of the sliding distance of the HFD in each of the flowing four methods: nail axis reference (NAR), modified NAR, inner edge reference, and nail tip reference. We also assessed two clinical cases by using these methods and evaluated the intraclass correlation coefficients. Results: The measured values were consistent in the NAR method regardless of limb posture, with an even smaller error when using the modified NAR method. The standard deviation (SD) was high in the nail tip reference method and extremely low in the modified NAR method. In the two clinical cases, the SD was the lowest in the modified NAR method, similar to the results using plastic simulated bone. The intraclass correlation coefficients showed the highest value in the modified NAR method. Conclusions: We conclude that the modified NAR method should be the most recommended based on its accuracy, reproducibility, and usefulness.
Yoshikawa Ryo,Hiranaka Takafumi,Okamoto Koji,Fujishiro Takaaki,Hida Yuichi,Kamenaga Tomoyuki,Sakai Yoshitada 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.2
Background: Tibial fracture after cementless Oxford unicompartmental knee arthroplasty (OUKA) is a rare but serious complication. It is reported more frequently in Asian countries. The aim of this retrospective study was to assess the morphological characteristics of the tibia by using a simple novel measurement method in patients with tibial fractures after OUKA. Methods: Six knees (all women) with tibial fractures after cementless OUKA (fracture group) and 150 knees without an obvious complication after cementless OUKA (control group) were examined retrospectively at our institution between January 2016 and April 2017. We drew a medial eminence line (ME line) defined as a line extending from the tip of the medial intercondylar eminence parallel to the tibial axis. The ME line was classified into two types (intramedullary type [type I] and extramedullary type [type E]), and the proportion of each type was compared between fracture patients and controls. Results: In the fracture group, there were four (66.7%) type E cases and two (33.3%) type I cases; in the control group, there were 18 (12%) type E cases and 132 (88%) type I cases. Fisher exact tests showed that the proportion of type E was higher in the fracture group than in the control group (p < 0.01). Conclusions: Measurement of the ME line can be recommended as a useful method to assess the risk of postoperative fracture after cementless OUKA.