Objectives: Previous studies have suggested that the effects of vitamin D in preventing osteoporotic fractures result in part from its influence on fall prevention. However, the effects of vitamin D on dynamic balance as a contributor to fall prevention have not been fully evaluated. Moreover, few studies have compared the effects of native and active forms of vitamin D. The objective of this preliminary randomized prospective study was to compare the effects of native vitamin D and eldecalcitol on muscular strength and dynamic balance in postmenopausal patients undergoing denosumab treatment for osteoporosis. Methods: A total of 30 women with postmenopausal osteoporosis were randomly assigned to a native D group (administered denosumab and native vitamin D with calcium) or an ELD group (administered denosumab and eldecalcitol) and were followed up for 6 months. The following parameters were compared: the strengths of the back extensor and lower extremity muscles; static balance evaluated using the one-leg standing test; and dynamic balance evaluated using the 10-m walk test, the functional reach test, the timed up and go test, and the total length of the trajectory of the center of gravity (LNG) measured using a dynamic sitting balance measurement device. Results: Compared to baseline measurements, back extensor and knee extensor strengths had significantly increased after 6 months of treatment in the native D group (P<0.05) but not in the ELD group. In contrast, LNG significantly improved in both groups after 6 months (P<0.05). No significant differences between the two groups were seen in any of these measured parameters after treatment. Conclusions: Both native vitamin D + denosumab and eldecalcitol + denosumab were effective for improving dynamic sitting balance in postmenopausal women with osteoporosis.

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Key words：座位バランス／体幹バランス／バランス／姿勢制御／転倒 要 旨 安全にバランス機能を測定するため，動的座位によるバランス計測装置を開発した．本装置 は、座面反力(重心動揺)を検出する計測装置と，モータの回転により座面を側方傾斜させ 一定の周期で座面を振動させる外乱刺激装置で構成される．3 軸力学センサを用い，座面の 圧力と圧力中心点を算出することが可能である．座位で計測を行うことで安全であり，下肢 の影響を受けないため体幹バランス能力の評価にも使用できると考えている．現在までに 行った基礎実験やフィールドワークでの活動，および本装置を用いた介入試験の結果と有用 性，今後の活動について概説する． ＊1 秋田大学医学部附属病院リハビリテーション科 (〒010-8543 秋田県秋田市広面字蓮沼 44-2) E-mail：kimio@doc.med.akita-u.ac.jp ＊2 秋田大学大学院医学系研究科 医学専攻機能展開医学系整形外科学講座 ＊3 秋田大学理工学部システムデザイン工学科 機械工学コース はじめに リハビリテーションにおけるバランス機能の評価 は非常に重要である．特に加齢変化に伴うバラン ス能力の低下は，転倒を引き起こす重要な因子と 考えられており，高齢者に対するバランス評価は転 倒予防の観点からも必須である．バランス機能の 評価方法としては，立位重心動揺検査 ø) ，Balance Evaluation Systems Test ù) ，Berg Balance Scale ú) ，外乱刺激装置を用いた動的平衡検査 û) な どがあり，歩行の能力や易転倒性に関するさまざ まな客観的な知見が示されている．しかし，立位 でのバランス評価には，めまいや膝折れなどによる 転倒の危険性も含まれるため，転倒リスクを抱えた 高齢者には評価自体が危険な場合があり，バラン ス機能を安全かつ簡便に評価する手法の開発が望 まれている．われわれは，安全にバランス機能を測 定するため，動的座位によるバランス計測装置を 開発した ü) ． システム 座位バランス測定装置の概略を図 ø に示す．本 装置は座面反力(重心動揺)を検出する計測装置 と，座面の側方傾斜角を制御する外乱刺激装置で 構成される．座面反力の計測には，座面下 ú カ所 に配置した ú 軸力学センサを用い，各点のセンサ 特集 先端機器とリハビリテーション Jpn J Rehabil Med 2017；54：31-35

An association between spinal kyphosis and gastroesophageal reflux disease (GERD) was reported in recent years. However, it remains unclear whether spinal kyphosis affects gastric motility. We evaluated the changes in myoelectrical activity measured by electrogastrography (EGG) in elderly osteoporosis patients. A total of 18 patients scheduled for the treatment of osteoporosis were included in this study. They were analyzed by recording EGG to assess myoelectrical activity and heart rate variability (HRV) to evaluate the autonomic nervous system function before and after meals. Dominant power (DP) representing the strength of gastric electrical activity and dominant frequency (DF) representing its frequency were analyzed in blocks with a 5-minute duration. We divided the patients into 2 groups, thoracolumbar kyphosis (TLK) and non-TLK groups, and compared them. There were no significant differences between the 2 groups in background data. In the non-TLK group, DPs post 0-5 min were significantly higher than those during pre 5-0 min in channels 1 and 3 (P < 0.05 and P < 0.01). DF deviation in the TLK group was significantly higher than that in the non-TLK group at 10 to 15 postprandial minutes (P < 0.05). Low frequency/high frequency activity measured by HRV, reflecting the activity of the sympathetic nervous system, in the TLK group was significantly lower than that in the non-TLK group while eating (P < 0.01). The EGG of patients with spinal kyphotic deformity showed a similar change to that of patients with GERD; the spinal kyphotic deformity itself may affect gastric electrical activity.

The shortage of doctors is a societal problem, especially in rural areas such as Akita Prefecture, Japan. Therefore, it is not unusual in Akita for orthopedic surgeons to perform upper and lower limb surgeries under ultrasound-guided peripheral nerve blocks managed by the operators themselves. Multicenter studies of ultrasound-guided peripheral nerve blocks performed by orthopedic surgeons have not been reported. The purpose of this study was to clarify the safety and reliability of ultrasound-guided peripheral nerve blocks performed by orthopedic surgeons in Akita. A total of 1,674 upper extremity surgery cases operated under ultrasound-guided peripheral nerve blocks at 8 hospitals in Akita prefecture from April 2016 to April 2018 were investigated retrospectively. These blocks were performed by a total of 37 orthopedic surgeons, including senior surgeons and residents. In 321 of the 1,674 cases (19%), local anesthetics were added to the surgical field. Two cases with special factors were converted to general anesthesia. There were 2 cases of complications associated with the nerve block, but they were all transient and recovered promptly. The block site and the hospital where the block was performed showed a significant relationship with the addition of local anesthetics to the surgical site ( P < 0.001 ). Surgery time, age at surgery, and surgical site showed no significant relationships with the addition of local anesthetics. The volume of the anesthetic used for the nerve block showed a significant inverse relationship with the addition of local anesthetics ( P = 0.040 ). Many orthopedic surgeons in Akita prefecture began to perform ultrasound-guided peripheral nerve blocks, which had a reliable anesthesia effect with no noticeable complications, whether performed by residents or senior orthopedic surgeons, and this is a useful anesthetic technique for orthopedic surgeons.