Details of a Researcher - Iwamoto, Takuji

Papers - Iwamoto, Takuji

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Myoelectric prosthesis application following radial nerve reconstruction for a case of duplicated amputation of the upper limb

Hara Y., Kimura H., Toga A., Suzuki T., Matsumura N., Iwamoto T., Nakamura M., Matsumoto M.

Journal of Orthopaedic Science 28 ( 6 ) 1478 - 1481 2023.11

ISSN 09492658

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COVID-19ワクチン接種が契機となり発症したと考えられた胸郭出口症候群の検討

増本奈々, 鈴木拓, 古旗了伍, 松村昇, 佐藤和毅, 岩本卓士

日本手外科学会雑誌 ((一社)日本手外科学会) 40 ( 2 ) 79 - 81 2023.11

ISSN 2185-4092

COVID-19ワクチン接種後に胸郭出口症候群の症状を呈した4例5肢を経験した.上肢挙上時や下垂時に悪化する上肢のだるさ・痛み・しびれ・色調不良を認め,手術加療を施行した3肢に関しては術前より症状は軽快し,経過観察中の2肢においては症状は持続している.COVID-19のワクチンの普及とともに,ワクチンの接種を契機に胸郭出口症候群の症状を呈することがあるため,同副反応も念頭におき,注意深い経過観察が必要である.(著者抄録)

野球選手に発生した有鉤骨鉤および体部二重骨折の1例

増本奈々, 佐藤和毅, 木村洋朗, 鈴木拓, 松村昇, 岩本卓士, 松本守雄, 中村雅也

関東整形災害外科学会雑誌 (関東整形災害外科学会) 54 ( 5 ) 113 - 117 2023.10

ISSN 0389-7087

有鉤骨骨折は比較的発生頻度が低い骨折で,野球選手やゴルファーなどに多いとされる.鉤骨折と体部骨折に分類されるが,体部骨折は比較的稀である.今回,有鉤骨鉤骨折と体部骨折を合併した二重骨折の1例を経験し,手術治療により早期の競技復帰を果たしたので報告する.症例:18歳男性.プロ野球選手(捕手,右投左打).内角速球をよけながら振ったバットのグリップエンドにボールがぶつかり,右手尺側部痛が出現した.右手尺側はびまん性に腫脹し,有鉤骨鉤部と手背尺側に疼痛を訴え,圧痛を有した.単純X線で明らかな骨傷は認めなかったが,CT像では有鉤骨鉤ならびに体部の骨折を認めた.右有鉤骨鉤および体部の二重骨折と診断し,受傷17日目に手術を施行した.有鉤骨鉤は摘出し,体部骨折はヘッドレススクリューで接合した.術後3週より手術痕部にパッドをあてスイングやキャッチボールを開始し,術後9週間で試合復帰した.考察:本例はスイング中のバットのグリップエンドにボールがぶつかり,有鉤骨鉤ならびに体部に非常に強い直達外力が加わり受傷したものと推察した.鉤摘出ならびに体部を強固に内固定することにより早期復帰を果たした.(著者抄録)

【整形外科領域の患者立脚型評価(PROMs)】手・肘領域におけるPROMsの活用

清田康弘, 鈴木拓, 岩本卓士

整形・災害外科 (金原出版(株)) 66 ( 11 ) 1291 - 1299 2023.10

ISSN 0387-4095

＜文献概要＞筋骨格系障害を有する患者を評価する際に医療者主導での評価が,以前より行われてきた。近年は,患者自身の主観的な評価も重要視されるようになり,患者立脚型評価(PROMs)は日常臨床や臨床研究での治療効果判定に必要不可欠なものとなっている。PROMsは,妥当性(validity),信頼性(reliability),反応性(responsiveness)といった基本的な尺度特性を有している必要がある。開発されたPROMsはこれらの尺度についての検証が行われた後に,使用が可能となる。また,海外で作成されたPROMsは日本語版のcross-cultural validationを経て,使用可能となる。手・肘領域のPROMsも多く,部位別,疾患別の評価法や,包括的評価法などがあり,目的に応じて使い分ける必要がある。近年,Patient-Reported Outcomes Measurement Information System(PROMIS)が開発され,コンピュータ適応型テスト(CAT)で評価を行うことで,短時間に広範囲の評価を行うことができるようになった。この評価法については,今後,検証が重ねられることで,標準的評価法となる可能性がある。

【整形外科外来Red Flags 2023】外傷を契機としない肘関節痛患者をみるときのRed Flags

岩本卓士

Orthopaedics ((株)全日本病院出版会) 36 ( 10 ) 236 - 241 2023.10

ISSN 0914-8124

外傷を契機としない肘関節痛の診察では原因が神経障害によるものか,骨関節に起因するものかを判断する.急性に発症し強い炎症を伴う場合には小児例も含め化膿性肘関節炎を疑う必要がある.慢性の肘関節炎で関節腫脹を伴う場合には関節リウマチを第一に考えるが,結核性関節炎も稀ではあるが鑑別に挙がる.関節腫脹が軽度の場合には変形性肘関節症を考える.神経障害で最も頻度が高いものは尺骨神経障害(肘部管症候群)である.加齢に伴う肘部管の狭小化以外にも,過去の外傷や尺骨神経の脱臼,上腕三頭筋の肥大も発症の原因となる.また特徴的な神経麻痺として前骨間神経麻痺・後骨間神経麻痺がある.明らかな原因なく生じる特発性のものが多く,前駆症状として上肢の痛みを伴う場合が多いことから何らかの炎症が関与していると考えられている.頸椎疾患との鑑別を要する場合もあり,MRIや筋電図等で総合的に判断する必要がある.(著者抄録)

【バイオ時代におけるリウマチ性疾患の診療】手術的治療　上肢　人工手関節置換術の術前計画と短期成績

松尾知樹, 岩本卓士, 木村洋朗, 鈴木拓, 松村昇

別冊整形外科 ((株)南江堂) ( 84 ) 85 - 90 2023.10

ISSN 0287-1645

＜文献概要＞はじめに　人工手関節置換術(TWA)は,近年インプラントの改良に伴い,関節固定術と同等～それ以上の良好な成績を示してる.本邦では2017年よりDARTS人工手関節(帝人ナカシマメディカル社)が使用可能となった.重大な合併症や再置換例はなく,良好な臨床成績を示している一方,弛みやスクリュー破損の報告もあり,長期成績は不明である.また一般的にTWA再置換例の成績は不良とされており,初回手術でいかに今後の合併症を減らす工夫を行えるかが重要である.当科におけるTWA合併症を低減するための取り組み(術前計画,手術手技)とインプラント設置の正確性,最後にその短期臨床成績について述べる.

TNFα-dependent mTOR activity is required for tenotomy-induced ectopic ossification in mice

Kushima Y., Sato Y., Kobayashi T., Fukuma Y., Matsumoto M., Nakamura M., Iwamoto T., Miyamoto T.

Journal of Bone and Mineral Metabolism 41 ( 5 ) 583 - 591 2023.09

ISSN 09148779

Introduction: Ectopic ossifications often occur in skeletal muscles or tendons following local trauma or internal hemorrhage, and occasionally cause severe pain that limits activities of daily living. However, mechanisms underlying their development remain unknown. Materials and methods: The right Achilles tendon in 8-week-old female or male mice was dissected. Some mice were injected intraperitoneally either with phosphate-buffered saline, dimethyl sulfoxide, cimetidine, rapamycin, celecoxib or loxoprofen for 10 weeks. One week after surgery, immunohistochemical analysis was performed for mTOR, TNFα or F4/80. Ten weeks after surgery, ectopic ossification at the tenotomy site was detected by 3D micro-CT. Results: Ectopic ossification was seen at dissection sites in all wild-type mice by dissection of the Achilles tendon. mTOR activation was detected at dissection sites, and development of ectopic ossification was significantly inhibited by administration of rapamycin, an mTOR inhibitor, to wild-type mice. Moreover, administration of the histamine 2 blocker cimetidine, which reportedly inhibits ectopic ossification in tendons, was not effective in inhibiting ectopic ossification in our models. TNFα-expressing F4/80-positive macrophages accumulate at dissection sites and that ectopic ossification of the Achilles tendon dissection was significantly inhibited in TNFα-deficient mice in vivo. Ectopic ossification is significantly inhibited by administration of either celecoxib or loxoprofen, both anti-inflammatory agents, in wild-type mice. mTOR activation by Achilles tendon tenotomy is inhibited in TNFα-deficient mice. Conclusion: The TNFα-mTOR axis could be targeted therapeutically to prevent trauma-induced ectopic ossification in tendons.

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Influence of Electrodiagnostic Studies on Surgery for Carpal Tunnel Syndrome: A Retrospective Analysis of Data from a Single Urban Institution

Kimura H., Matsuo T., Suzuki T., Matsumura N., Sato K., Iwamoto T.

Journal of Hand Surgery Asian Pacific Volume 28 ( 4 ) 453 - 460 2023.08

ISSN 24248355

Background: This study aimed to clarify the influence of preoperative electrodiagnostic (EDX) utilisation and its severity on surgically treated patients with carpal tunnel syndrome (CTS). Methods: This retrospective study analysed the data of patients who underwent CTS surgery at our facility from 2012 to 2022. Data regarding age, sex, affected side, diabetes mellitus, rheumatoid arthritis, haemodialysis and insurance type were collected, along with the following clinical information: utilisation of EDX, steroid injection, number of items of preoperative physical examination and history taking, intervals between symptom onset and the initial visit and between the initial visit and surgery, type of surgical procedure and surgery categorisation (primary or revision). EDX data (EDX severity, interval between EDX and surgery and concomitant nerve lesions) were also investigated. Univariate and multivariate analyses were conducted to assess the influence of EDX utilisation and severity on clinical parameters. Results: Of the 343 hands enrolled in our study, 304 (89%) underwent preoperative EDX assessment. EDX severity was classified as normal, mild, moderate or severe in 6 (2%), 18 (6%), 102 (34%) and 178 hands (58%), respectively. After the univariate and multivariable analyses, more items of preoperative physical examination and history taking were associated with non-EDX utilisation, whereas younger age, female sex and steroid injection were associated with milder EDX. Conclusions: Increased number of items of preoperative physical examination and history taking or steroid injection were independently associated with non-EDX utilisation or milder EDX, respectively, suggesting that when thorough clinical evaluation is conducted, hand surgeons may be less likely to request for EDX before surgery. Moreover, their treatment recommendation may be influenced by EDX severity. Level of Evidence: Level III (Diagnostic)

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Persistent Ulnar Nerve Palsy with Cubitus Valgus Deformity Following a Surgically Treated Flexion-type Supracondylar Humeral Fracture - A Case Report.

Ito Y, Kimura H, Suzuki T, Matsumura N, Iwamoto T, Nakamura M

Journal of orthopaedic case reports 13 ( 8 ) 117 - 120 2023.08

ISSN 2250-0685

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Press-Fit Hemihamate Arthroplasty for the Proximal Interphalangeal Joint

Takeya, H; Iwamoto, T; Kimura, H; Suzuki, T; Matsumura, N; Hosozawa, T; Iwabu, S

JOURNAL OF WRIST SURGERY 12 ( 04 ) 371 - 376 2023.08

ISSN 2163-3916

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肩甲上腕関節内に結節状線維組織が形成された1例

喜多大樹, 松村昇, 清田康弘, 鈴木拓, 岩本卓士, 中村雅也

関東整形災害外科学会雑誌 (関東整形災害外科学会) 54 ( 4 ) 106 - 106 2023.08

ISSN 0389-7087

A case of neuropathic arthropathy of the elbow with early loosening after total elbow arthroplasty

Nakamura H., Iwamoto T., Kimura H., Suzuki T., Matsumura N., Matsumoto M., Nakamura M.

Modern Rheumatology Case Reports 7 ( 2 ) 480 - 482 2023.07

We reported the case of a 65-year-old woman who presented with neuropathic arthropathy of the elbow and had undergone cervical spinal cord tumour resection at 32 years of age. Open synovectomy with free-body resection was performed; however, the instability of the elbow joint rapidly progressed. Therefore, we performed total elbow arthroplasty (TEA) using a linked-type prosthesis. However, the humeral stem became severely loosened 1 year after arthroplasty. Furthermore, a periprosthetic humeral fracture developed due to a minor trauma. A revision TEA using a long-stem prosthesis was performed 4 years after the primary TEA. Radiographs taken 2 years after the revision surgery showed no evidence of implant loosening. In this case, early postoperative loosening occurred despite the use of a linked-type prosthesis and an appropriate cementing technique, suggesting that normal implants may not provide sufficient fixation for neuropathic arthropathy of the elbow. Since surgery for neuropathic arthropathy generally has a poor prognosis, surgical interventions including TEA should be carefully considered.

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Surgical Approaches for Thoracic Outlet Syndrome: A Review of the Literature

Suzuki T., Kimura H., Matsumura N., Iwamoto T.

Journal of Hand Surgery Global Online 5 ( 4 ) 577 - 584 2023.07

Thoracic outlet syndrome (TOS) is caused by entrapment of the neurovascular bundle in the interscalene, costoclavicular, or subpectoral minor space. Compression in the interscalene or costoclavicular space with the first rib and scalene muscle leads to vascular and neurogenic TOS, whereas compression in the subpectoral minor space leads to pectoralis minor syndrome. Various surgical approaches exist for the treatment of TOS. The introduction and development of surgical approaches have minimized surgical invasiveness and complications. The reported approaches include transaxillary, supraclavicular, infraclavicular, posterior, combined transaxillary and supraclavicular, combined supraclavicular and infraclavicular (paraclavicular), endoscopic-assisted transaxillary, and video-assisted thoracoscopic approaches. In this review, we summarize the reported surgical approaches for TOS treatment, in terms of the history of the approach, surgical procedure, advantages and disadvantages, clinical outcomes, and complications. An adequate excision of compression structures, including the first rib and scalene muscles, provides satisfactory outcomes regardless of the approach selected, whereas an inadequate release of compression structures leads to failed or recurrent outcomes. Reducing the risk of complications is the most important aspect of TOS management. Surgery should be performed safely, with sufficient resection of compression structures. Additionally, the approach should be selected based on the surgeon's skill, surgeon's preferences, surgical invasiveness, cosmetic appearance, and the presence of special equipment, as well as other advantages and disadvantages of each approach.

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Artificial Lunate Arthroplasty for Kienböck Disease with Multiple Extensor Tendon Ruptures: A Case Report

Hayakawa K., Suzuki T., Furuhata R., Kimura H., Matsumura N., Iwamoto T., Nakamura M.

Jbjs Case Connector 13 ( 2 ) e23.00147 2023.06

ISSN 21603251

Case:A 73-year-old woman presented with wrist pain and loss of extension in the middle and ring fingers. Radiography revealed a dorsally displaced lunate fragment, resulting in a diagnosis of Kienböck disease with extensor tendon rupture. Artificial lunate replacement and tendon transfer were performed as treatment. Two years postoperatively, the pain was relieved, and the extension lag was 0°. The wrist motion and carpal height had also improved.Conclusion:Lunate excision, partial wrist arthrodesis, or proximal row carpectomy are known treatments for Kienböck disease with extensor tendon rupture. Lunate arthroplasty is a novel, useful treatment option for this condition.

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Factors Associated with Change in Diagnosis of Carpal Tunnel Syndrome after Electrodiagnostic Studies

Matsuo T., Kimura H., Furuhata R., Suzuki T., Matsumura N., Iwamoto T.

Journal of Hand Surgery Asian Pacific Volume 28 ( 3 ) 336 - 341 2023.06

ISSN 24248355

Background: Hand surgeons sometimes place more weight on clinical findings and may not always consider the results of electrodiagnostic studies (EDX) in the diagnosis of carpal tunnel syndrome (CTS). The aim of this study is to determine factors associated with a change in diagnosis of CTS after EDX. Methods: This is a retrospective study of all patients with an initial clinical diagnosis of CTS who underwent EDX at our hospital. We identified patients whose diagnosis changed from CTS to non-CTS after EDX and used univariate and multivariate analysis to determine if age, sex, hand dominance, unilateral symptoms, history of diabetes mellitus, rheumatoid arthritis, haemodialysis, cerebral lesion, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items in CTS-6 and a CTS-negative EDX result were associated with a change in diagnosis after EDX. Results: A total of 479 hands with a clinical diagnosis of CTS underwent EDX. The diagnosis was changed to non-CTS in 61 hands (13%) after EDX. Univariate analysis demonstrated that unilateral symptoms, cervical lesion, mental disorder, initial diagnosis by a non-hand surgeon, the number of examined items and a CTS-negative EDX result were significantly associated with a change in diagnosis. In the multivariate analysis, only the number of examined items was significantly associated with a change in diagnosis. Conclusions: EDX results were particularly valued in hands where the initial diagnosis was uncertain for CTS. In hands with an initial diagnosis of CTS, the performance of sufficient history-taking and physical examination was more valued at the final diagnosis than EDX results or other aspects of the patient’s background. The process of confirming a clear initial clinical diagnosis of CTS using EDX may be of little value for decision-making at the final diagnosis. Level of Evidence: Level III (Therapeutic).

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Distal Radioulnar Joint Locking with Bipolar Injury

Ichikawa, T; Suzuki, T; Kimura, H; Matsumura, N; Iwamoto, T; Nakamura, M; Matsumoto, M

JOURNAL OF WRIST SURGERY 12 ( 03 ) 269 - 272 2023.06

ISSN 2163-3916

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Endoscopic-assisted Infraclavicular Approach for First-Rib Resection in Neurologic Thoracic Outlet Syndrome: A Report of Two Cases

Suzuki T., Kimura H., Matsumura N., Iwamoto T.

Journal of Hand Surgery Asian Pacific Volume 28 ( 2 ) 287 - 291 2023.04

ISSN 24248355

Various reported surgical approaches for the treatment of thoracic outlet syndrome (TOS) exist and no firm evidence exists for any approach. A 16-year-old and a 29-year-old male presented with numbness in the upper limb. Neurologic TOS was diagnosed, and surgery was planned for the resection of the first rib and scalene muscles. Through an infraclavicular incision, open resection of the anterior scalene muscle and the anterior aspect of the first rib was performed. With the assistance of endoscopy, the middle scalene muscles and the posterior aspect of the first rib were resected. Preoperative symptoms improved after surgery without any complications. The endoscopic-assisted infraclavicular approach enabled resection of the first rib and scalene muscles, leading to satisfactory outcomes.

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Hybrid Tension Band Wiring for Olecranon Fractures

Kimura H., Morisawa Y., Suzuki T., Iwamoto T.

Journal of Hand Surgery Asian Pacific Volume 28 ( 2 ) 301 - 305 2023.04

ISSN 24248355

Tension band wiring (TBW) is a standard surgical technique for treating olecranon fractures (OFs). We devised a hybrid TBW (HTBW) combining TBW using wires with eyelets and cerclage wiring. Twenty-six patients with isolated OFs with Colton classification groups 1-2C were subjected to HTBW, and the data was compared with those treated with conventional TBW (38 patients). The mean operation time and hardware removal rate were 51 versus 67 minutes (p < 0.001) and 42% versus 74% (p < 0.012), respectively. The HTBW group had one patient (4%) with surgical wire breakage. The conventional TBW group had 14 patients (37%) with symptomatic backout of Kirschner wires, three patients (8%) with loss of reduction, two patients (5%) with surgical site infection and one patient (3%) with ulnar nerve palsy. The motion and functional score ranges of the elbow were not significantly different. Therefore, this procedure may be a feasible alternative.

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Comparative study on the effectiveness of bone grafting for arthrodesis of the thumb carpometacarpal arthritis

Matsuo T., Suzuki T., Hayakawa K., Kimura H., Matsumura N., Iwamoto T.

Journal of Hand Surgery European Volume 48 ( 4 ) 309 - 315 2023.04

ISSN 17531934

The aim of this retrospective study was to assess the effectiveness of autogenous bone grafting for arthrodesis of the thumb carpometacarpal joint by comparing the bone union rates with and without bone grafting. We included 36 patients who underwent arthrodesis of the thumb carpometacarpal joint for arthritis (20 patients with bone grafts and 16 without bone grafts). Implants used for internal fixation were K-wire, tension band wiring, headless compression screw and locking plate. The presence of bone union and the time from surgery to bone union were evaluated. The bone union rate was 20/20 (100%) in the bone grafting group and 12/16 (75%) in the non-bone grafting group (p = 0.03). There were no significant differences between the two groups in the time from surgery to bone union and patient characteristics. In conclusion, autogenous bone grafting may contribute to the bone union in the arthrodesis of thumb carpometacarpal arthritis. Level of evidence: III

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Thompson-Littler変法が有用であった陳旧性PIP関節脱臼の2例

松尾知樹, 鈴木拓, 木村洋朗, 松村昇, 岩本卓士, 佐藤和毅

日本手外科学会雑誌 ((一社)日本手外科学会) 39 ( 6 ) 1022 - 1022 2023.04

ISSN 2185-4092

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