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[ABSTRACT] Low back pain is a globally debilitating health condition, but the mechanism of pain induction and perception in the context of low back pain remains unclear. Advanced glycation end-products (AGEs) have been reported as a possible biomarker of aging and we hypothesized that AGE accumulation is associated with chronic low back pain. The aim of this study was to determine whether AGEs measured by skin autofluorescence (SAF) can serve as a biomarker for chronic low back pain. 111 patients who visited the outpatient clinic were included in this prospective cohort study. They were divided into a chronic low back pain group (C group: 48 patients, mean age 52.2) and a group without low back pain (N group: 63 healthy volunteers, mean age 40.8). SAF was measured as a parameter of AGEs using an autofluorescence reader. Measurements of low back pain visual analog scale (VAS), presence of diabetes mellitus, and SAF were recorded, and correlations between VAS or diabetes mellitus and SAF were investigated. The C group had significantly higher SAF (2.20 vs 1.97, P＝0.033) than the N group, whereas the SAF for diabetes mellitus patients was significantly higher (2.42 vs 1.97, P＝0.003) than subjects without diabetes mellitus. SAF had no correlation with VAS (P＝0.190). From multiple logistic regression analysis, SAF (OR＝1.177, P＝0.04) was identified as risk factors for chronic low back pain. SAF may serve as a biomarker for chronic low back pain.

研究科: 千葉大学大学院医学薬学府（先端医学薬学専攻）, 学位記番号: 千大院医薬博甲第医1930号

[SUMMARY] An acetabular component of total hip arthroplasty that protrudes into the pelvis carries a risk of injury to the iliac blood vessels during removal of the implant. We report three cases of intrapelvic migration of an acetabular component in contact with the iliac vessels. Preoperative computed tomography angiography in all cases revealed that the external /or internal iliac vessels were displaced superiomedially due to compression by the migrated cup. The implants were removed safely using a conventional hip approach in combination with release of vessels via a retroperitoneal approach in two cases, and via temporal intra-aortic balloon occlusion in one case. One of the two patients treated with a retroperitoneal approach underwent acetabular reconstruction in a consecutive surgery in a supine position through a direct anterior approach, and the other underwent reconstruction through a direct lateral approach after a postural change. For the patient who underwent intra-aortic balloon occlusion, we performed resection arthroplasty to allow a less invasive treatment. No marked intraoperative bleeding caused by injury to iliac vessels occurred in any patient, although one case required blood transfusion for oozing. These cases show that dissection of the iliac vessels via a retroperitoneal approach is safe with minimum morbidity during handling of the migrated acetabular components. A direct anterior approach can be used for acetabular revision of the protruded components without patient repositioning by combining this procedure with a retroperitoneal approach. Intra-aortic balloon occlusion is an alternative for protruded components in a case with a risk of vessel injury during dissection.