Details of a Researcher - Iwamoto, Takuji

Papers - Iwamoto, Takuji

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上腕骨解剖頸骨折を伴った肩関節後方脱臼骨折に対して骨接合術を行った1例

岡村駿, 松村昇, 木村洋朗, 鈴木拓, 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) 53 ( 6 ) 179 - 184 2022.12

ISSN 0389-7087

69歳女性。前方に転倒した際に左肘を強打して受傷し、左肩関節痛を主訴に来院となった。単純X線およびCT所見を踏まえて、上腕骨解剖頸骨折を伴った左肩関節後方脱臼骨折と診断されたが、非観血的整復が困難であった。そのため観血的に脱臼を整復後、ロッキングプレートによる骨接合術が施行された。術後は3ヵ月で骨癒合し、術後3年7ヵ月経過現在、左肩関節痛はなく、肩関節可動域は屈曲が150°、外旋が40°で、JOAスコアは96点と良好である。

【四肢骨折プレート固定術の創意工夫】小児骨折に対するプレート固定の適応と実際

佐藤和毅, 木村豪志, 木之田章, 岩本卓士, 鈴木拓, 木村洋朗, 太田憲和, 高木岳彦

Orthopaedics ((株)全日本病院出版会) 35 ( 10 ) 280 - 288 2022.10

ISSN 0914-8124

小児の骨折治療では基本的には外固定による保存的治療が優先される.不安定例に対する手術においても内固定は髄内固定術,ピンニングなどが推奨され,プレート固定の必要性は低い.一方で,プレート固定の最大の長所は,解剖学的整復が可能であることと強固な固定力である.(1)高度な不安定性を呈する骨折,(2)十分な骨長を保てない粉砕骨折,(3)変形治癒骨折に対する矯正骨切り術,(4)偽関節手術などに対してプレート固定は適応となる.しかし,その場合も骨格が成熟しつつある小児(10～12歳の学童期以降)に対して行うのが望ましい.(著者抄録)

Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff Repair

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

Orthopaedic Journal of Sports Medicine 10 ( 9 ) 23259671221126095 2022.09

ISSN 2325-9671

Background: Radiographic changes in the glenohumeral joint often occur after rotator cuff repair; however, the details of the progression and underlying causes remain unknown. Purpose: To retrospectively evaluate the timing and frequency of radiographic changes after arthroscopic rotator cuff repair and to clarify the predictive factors that affect the onset of such changes using multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively reviewed 100 patients with 5 years of follow-up after arthroscopic rotator cuff repair and evaluated the postoperative shift in radiographic findings on plain radiographs every year during follow-up. Factors related to osteoarthritis, acromial spur re-formation, and greater tuberosity resorption at 5 years after surgery were evaluated using logistic regression analyses. Explanatory variables included preoperative factors, intraoperative factors, and postoperative retear. Baseline variables significant in the univariate analyses were included in the multivariate models. Results: Of the 100 patients, 12 developed osteoarthritis, 26 developed acromial spur formation, and 16 developed greater tuberosity resorption at 5 years after surgery. The incidence and grade of osteoarthritis and acromial spur gradually increased over time postoperatively. On the other hand, greater tuberosity resorption developed within 2 years after surgery but did not progress later. Multivariate analysis showed that a larger anteroposterior tear size (odds ratio [OR], 1.09; 95% CI, 1.01-1.17; P =.037) was a risk factor for postoperative osteoarthritis. Early retear (OR, 10.26; 95% CI, 1.03-102.40; P =.047) was a risk factor for acromial spur re-formation. Roughness of the greater tuberosity (OR, 9.07; 95% CI, 1.13-72.82; P =.038) and larger number of suture anchors (OR, 3.34; 95% CI, 1.66-6.74; P =.001) were risk factors for greater tuberosity resorption. Conclusion: Our study showed that radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. While the osteoarthritic changes and acromial spur re-formation gradually progressed postoperatively, the greater tuberosity resorption stopped within 2 years after surgery. Tear size, morphology of the greater tuberosity, and the number of suture anchors can affect radiographic changes. Furthermore, this study suggested that acromial spur re-formation may be an indicator of early retears.

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A Rare Intra-articular Abnormality in the Posterior Radiocapitellar Joint: A Case Report.

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

Journal of orthopaedic case reports 12 ( 8 ) 53 - 56 2022.08

ISSN 2250-0685

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Visualization of the morphological changes in the median nerve after carpal tunnel release using three-dimensional magnetic resonance imaging

Funahasi T., Suzuki T., Hayakawa K., Nakane T., Maeda A., Kuroiwa T., Kawano Y., Iwamoto T., Fujita N.

European Radiology 32 ( 5 ) 3016 - 3023 2022.05

ISSN 09387994

Objectives: This study aimed to compare the pre- and postoperative morphology of the median nerve using three-dimensional (3-D) MRI in patients with carpal tunnel syndrome (CTS). Methods: We assessed 31 patients with CTS who underwent open carpal tunnel release and T2*-weighted MRI of the wrist preoperatively and at 6 months postoperatively. The median nerve morphology was evaluated on the basis of the cross-sectional areas (CSAs) and cross-sectional volumes (CSVs). The association between these MRI findings and nerve conduction studies was also evaluated. Results: The mean preoperative CSA and CSV values at the proximal carpal tunnel level significantly decreased from 22.2 mm2 and 24.4 mm3 to 16.5 mm2 and 18.1 mm3, respectively, postoperatively. Median nerve swelling at the proximal carpal tunnel level was observed in 29 (94%) and 23 (74%) patients before and after surgery, respectively. The mean preoperative CSA and CSV values at the hamate level significantly increased from 9.9 to 12.3 mm2 and from 10.9 to 13.5 mm3 after surgery, respectively. Nerve narrowing at the hamate bone level was preoperatively observed in 28 (90%) patients and postoperatively in 21 (68%) patients. Preoperative CSA and CSV values at the proximal carpal tunnel were significantly associated with preoperative distal motor and sensory latency. Conclusions: Visual confirmation of the median nerve morphology using 3-D MRI is useful when considering postoperative recovery and explaining the nerve condition to the patients. Key Points: • The 3-D morphology of the median nerve after carpal tunnel release can be delineated using 3-D MRI. • Preoperative swelling of the median nerve in the 2-D and 3-D planes reflects the severity of carpal tunnel syndrome. • Visual confirmation of the median nerve morphology is useful when considering median nerve recovery after carpal tunnel release and for explaining the condition of the nerve to patients.

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Arthroscopic Distal Clavicle Resection for an Acromioclavicular Ganglion Cyst with Cuff Tear Arthropathy: A Case Report

Fujii Y., Matsumura N., Furuhata R., Kimura H., Suzuki T., Iwamoto T., Matsumoto M., Nakamura M.

Jbjs Case Connector 12 ( 2 ) 2022.04

ISSN 21603251

Case:A 77-year-old man with an acromioclavicular joint ganglion cyst with cuff tear arthropathy had a large mass in the left shoulder. Arthroscopic distal clavicle resection successfully relieved his symptoms without loss of shoulder function by enlargement of the bypass between the cyst and subacromial space through the acromioclavicular joint.Conclusion:Arthroscopic distal clavicle resection can remove a 1-way check valve in a minimally invasive manner. This case indicated that arthroscopic distal clavicle resection could be a useful treatment option for patients with acromioclavicular joint ganglion cysts with functional but irreparable rotator cuff tears.

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【女性によくみる手疾患】手根管症候群の診断と治療

岩本卓士

Orthopaedics ((株)全日本病院出版会) 35 ( 4 ) 21 - 27 2022.04

ISSN 0914-8124

手根管症候群は最多の絞扼性神経障害であり、日常診療で遭遇する機会も多い。約80%は特発性であり両側性に生じることが多く、特に女性の発病率は男性の3.8倍であり、更年期である50歳代に発症のピークがあることから女性ホルモンの関与が考えられる。病初期は夜間痛を主訴とし、その後しびれや感覚障害が常時出現し、進行期は母指対立運動障害が認められる。手根管症候群の診断法については確定診断となる診断方法はないが、Phalen testやTinel様徴候をはじめとする臨床症状からスコアリングするCTS-6が有用であり、電気生理学的検査、超音波画像が補助診断として用いられる。局所の安静や手根管内へのステロイド注射による保存療法が奏功しない症例や重症例では外科的治療として手根管開放術が推奨される。また進行例で母指対立運動に障害をきたしている場合には、腱移行による母指対立再建術を検討する必要がある。(著者抄録)

Bone Block Grafting for Posterior Instability after Anatomical Total Shoulder Arthroplasty: A Case Report

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

Jbjs Case Connector 12 ( 1 ) 2022.03

ISSN 21603251

Case:A 60-year-old woman with avascular necrosis of the right humeral head underwent anatomical total shoulder arthroplasty (TSA); however, recurrent posterior dislocation occurred 13 months postoperatively. We performed bone block grafting of an autologous iliac crest to the posterior glenoid and posterior capsular plication, after which satisfactory postoperative shoulder function without residual joint instability was achieved.Conclusion:The presented case had recurrent posterior dislocation after TSA without any abnormal findings in the prosthetic components. Posterior bone block grafting with capsular plication should be considered a viable option for posterior instability after anatomical TSA.

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上腕骨解剖頸骨折を伴った肩関節後方脱臼骨折に対して骨接合を行った1例

岡村駿, 松村昇, 木村洋朗, 鈴木拓, 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) 53 ( 臨増号外 ) 155 - 155 2022.03

ISSN 0389-7087

Blocking screw augmentation in intramedullary nailing for displaced surgical neck fractures of the proximal humerus

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

Jses Reviews Reports and Techniques 2 ( 1 ) 46 - 51 2022.02

A displaced surgical neck fracture can be a good indication for antegrade intramedullary nailing. However, nail insertion may result in malreduction and translational displacement of the humeral head fragment because of muscle traction and size discrepancies between the diameters of the medullary canal and the intramedullary nail. We used blocking screw augmentation in 20 fractures with residual medial displacement of the distal fragment after nail insertion to anatomically reduce displacement of the fracture and to maintain the reduced position before bone union. A blocking screw was placed percutaneously at the lateral side of the canal. Next, a straight intramedullary nail was reinserted medial to the blocking screw. Finally, the nail was locked both proximally and distally. All cases showed bone union without fixation failure at the time of the final follow-up. Blocking screw augmentation with intramedullary nailing is feasible for the treatment of humeral surgical neck fractures and is thought to be helpful for fracture reduction during surgery and stable fixation after surgery.

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上腕骨外側上顆炎に合併した稀な形態を呈した滑膜ひだの1例

内野まり恵, 鈴木拓, 木村洋朗, 松村昇, 岩本卓士, 中村雅也, 松本守雄

日本肘関節学会雑誌 (日本肘関節学会) 29 ( 1 ) S82 - S82 2022.02

ISSN 1349-7324

尺骨鉤状突起低形成を伴う後外側不安定性に対して腸骨移植による鉤状突起再建を行なった1例

武谷博明, 鈴木拓, 木村洋朗, 佐藤和毅, 岩本卓士

日本肘関節学会雑誌 (日本肘関節学会) 29 ( 1 ) S74 - S74 2022.02

ISSN 1349-7324

人工肘関節置換術後早期にゆるみを生じた神経病性関節症の1例

中村鴻志, 岩本卓士, 木村洋朗, 鈴木拓, 松村昇, 中村雅也, 松本守雄

日本肘関節学会雑誌 (日本肘関節学会) 29 ( 1 ) S92 - S92 2022.02

ISSN 1349-7324

Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears

Furuhata R., Matsumura N., Oki S., Kimura H., Suzuki T., Iwamoto T., Matsumoto M., Nakamura M.

Orthopaedic Journal of Sports Medicine 10 ( 1 ) 23259671211071077 2022.01

ISSN 2325-9671

Background: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. Purpose: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. Results: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P =.001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P <.001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P =.001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P =.011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P <.001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P =.044) were significantly associated with loss of ER. Conclusion: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.

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Change of wrist motion before and after fixation of the distal radioulnar joint and resection of the distal ulna in a cadaveric model

Suzuki T., Terasaka Y., Tomoyuki K., Hagiwara T., Masuda S., Kimura H., Matsumura N., Iwamoto T.

Modern Rheumatology 32 ( 1 ) 136 - 140 2022.01

ISSN 14397595

Objective: Recent study suggests the distal radioulnar joint (DRUJ) plays a role in flexion and extension of the wrist. We examined the range of motion (ROM) of the wrist before and after DRUJ fixation and distal ulnar resection in a cadaveric model. Methods: Twenty fresh cadaveric human wrists were transected and treated with two sequential interventions: (a) DRUJ fixation, and (b) distal ulnar resection. The angle of maximum flexion and extension of the wrist was measured before and after the procedures. Maximum force to the wrist was determined before the procedures using a digital pressure monitor. Results: The mean maximum wrist flexion ROM was 84.2° before the procedures. The ROM decreased to 82.5° after DRUJ fixation, and significantly increased to 88.2° after subsequent resection of the distal ulna. The mean maximum wrist extension ROM before the procedures was 73.5°. The ROM decreased to 71.6° after DRUJ fixation, and significantly increased to 77.1° after subsequent resection of the distal ulna. Conclusions: Motion of the wrist is affected by DRUJ. This study suggests that the DRUJ might contribute to the ROM in flexion and extension of the wrist.

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Total elbow arthroplasty using an augmented reality–assisted surgical technique

Tanji A., Nagura T., Iwamoto T., Matsumura N., Nakamura M., Matsumoto M., Sato K.

Journal of Shoulder and Elbow Surgery 31 ( 1 ) 175 - 184 2022.01

ISSN 10582746

Background: Precision placement of implants in total elbow arthroplasty (TEA) using conventional surgical techniques can be difficult and riddled with errors. Modern technologies such as augmented reality (AR) and 3-dimensional (3D) printing have already found useful applications in many fields of medicine. We proposed a cutting-edge surgical technique, augmented reality total elbow arthroplasty (ARTEA), that uses AR and 3D printing to provide 3D information for intuitive preoperative planning. The purpose of this study was to evaluate the accuracy of humeral and ulnar component placement using ARTEA. Methods: Twelve upper extremities from human frozen cadavers were used for experiments performed in this study. We scanned the extremities via computed tomography prior to performing TEA to plan placement sites using computer simulations. The ARTEA technique was used to perform TEA surgery on 6 of the extremities, whereas conventional (non-ARTEA) techniques were used on the other 6 extremities. Computed tomography scanning was repeated after TEA completion, and the error between the planned and actual placements of humeral and ulnar components was calculated and compared. Results: For humeral component placement, the mean positional error ± standard deviation of ARTEA vs. non-ARTEA was 1.4° ± 0.6° vs. 4.4° ± 0.9° in total rotation (P = .002) and 1.5 ± 0.6 mm vs. 8.6 ± 1.3 mm in total translation (P = .002). For ulnar component placement, the mean positional error ± standard deviation of ARTEA vs. non-ARTEA was 5.5° ± 3.1° vs. 19.5° ± 9.8° in total rotation (P = .004) and 1.5 ± 0.4 mm vs. 6.9 ± 1.6 mm in total translation (P = .002). Both rotational accuracy and translational accuracy were greater for joint components replaced using the ARTEA technique compared with the non-ARTEA technique (P < .05). Conclusion: Compared with conventional surgical techniques, ARTEA had greater accuracy in prosthetic implant placement when used to perform TEA.

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肘関節鏡視下手術により生じた医原性尺骨神経断裂の1例

渥美龍太, 木村洋朗, 岩本卓士, 鈴木拓, 松村昇, 中村雅也, 松本守雄

臨床整形外科 ((株)医学書院) 57 ( 1 ) 103 - 107 2022.01

ISSN 0557-0433

＜文献概要＞13歳男性.前医での肘関節鏡視下手術施行直後より尺骨神経麻痺が生じ,症状改善を認めないため術後1年3ヵ月の時点で当科を受診した.鏡視下手術に伴う尺骨神経麻痺の診断で手術を施行した.尺骨神経は肘関節高位で完全断裂しており,神経断端を新鮮化した後に筋層下に前方移動し端々縫合を行った.神経縫合術後3年時点で手内筋の麻痺は残存するが鷲手変形および感覚障害の改善を認めた.肘関節鏡視下手術では尺骨神経損傷が多いことが知られており,内側のポータル作製や鏡視下操作には十分な注意が必要である.

Matsumura N., Kaneda K., Oki S., Kimura H., Suzuki T., Iwamoto T., Matsumoto M., Nakamura M., Nagura T.

Journal of Orthopaedic Surgery and Research 16 ( 1 ) 255 2021.12

ISSN 1749-799X

Background: Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods: A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results: Larger humeral head defects (P <.001) and a higher number of total instability episodes (P =.032) were found to be factors related to large glenoid defects. On the other hand, male sex (P =.014), larger glenoid defects (P =.015), and larger number of self-irreducible dislocations (P =.027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P =.001) and larger glenoid defects (P =.002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P =.007). Conclusions: Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

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17歳の投手に発症した手指循環障害の1例

米澤嘉朗, 佐藤和毅, 岩本卓士, 松村昇, 鈴木拓, 中村雅也, 松本守雄

関東整形災害外科学会雑誌 (関東整形災害外科学会) 52 ( 6 ) 241 - 244 2021.12

ISSN 0389-7087

17歳男性。野球強豪校の投手で、投球により増悪する右示・中指の冷感、投球時痛を主訴とした。近医の整形外科を受診し、局所安静と内服治療により症状は改善したが、投球再開直後に再燃した。保存的加療では効果なく、症状が増悪したため、発症から約7ヵ月で当院へ紹介となった。初診時、右示・中指指尖に小潰瘍が認められ、血管造影検査を行ったところ、虫様筋管症候群による手指循環障害と診断された。治療として虫様筋管開放術を行った結果、術後は症状が著明に改善し、術後3週より投球を再開し、術後3ヵ月で完全復帰することができた。

胸郭出口症候群における頸肋切除術の臨床成績

鈴木拓, 武谷博明, 木村洋朗, 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) 38 ( 3 ) 297 - 300 2021.12

ISSN 2185-4092

頸肋による胸郭出口症候群に対して手術を施行した13例(男性2例,女性11例)の臨床成績を報告する.全例,鎖骨上アプローチにて頸肋切除を行った.術後,しびれや脱力感は全例で改善し,Derkash's Classificationでは優10例,良3例であった.術前筋萎縮を呈していた8症例においては,筋萎縮は残存した.2例に術前,鎖骨下動脈瘤を伴う血栓を認め,血行再建を行った.頸肋による胸郭出口症候群は,若年の女性に多く発症し,頸肋切除による術後成績は良好であった.筋萎縮や血栓を生じる前に手術を行うことが望ましい.(著者抄録)

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