Details of a Researcher - Iwamoto, Takuji

Papers - Iwamoto, Takuji

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A Novel Alaska Pollock Gelatin Sealant Shows Higher Bonding Strength and Nerve Regeneration Comparable to That of Fibrin Sealant in a Cadaveric Model and a Rat Model

Masuda S., Suzuki T., Shibata S., Moritoki N., Abe Y., Chen X., Mizuno Y., Nishiguchi A., Kimura H., Matsumura N., Iwamoto T., Taguchi T., Matsumoto M., Nakamura M.

Plastic and Reconstructive Surgery 148 ( 5 ) 742 - 752 2021.11

ISSN 00321052

Background: A novel biocompatible sealant composed of Alaska pollock- derived gelatin (ApGltn) has recently shown good burst strength and biocompatibility in a porcine aorta. The purpose of this study was to investigate the bonding strength and biocompatibility of the ApGltn sealant in transected digital nerves of fresh frozen cadavers and in the sciatic nerves of a rat model. Methods: Eighty human digital nerves of fresh frozen cadavers were transected for biomechanical traction testing. They were treated with four surgical interventions: (1) suture plus ApGltn sealant; (2) suture; (3) ApGltn sealant; and (4) fibrin sealant. Forty-three sciatic nerves of male Wistar rats were used for functional and histopathologic evaluation. They were treated with six surgical interventions: (1) suture plus ApGltn sealant; (2) suture; (3) ApGltn sealant; (4) fibrin sealant; (5) resection with a 5-mm gap (10 rats per group); and (6) sham operation (three rats). Macroscopic confirmation, muscle weight measurement, and histopathologic findings including G-ratio were examined 8 weeks after the procedure. Results: The maximum failure load of the ApGltn sealant was significantly higher than that of a fibrin sealant (0.22 ± 0.05 N versus 0.06 ± 0.04 N). The maximum failure load of the ApGltn sealant was significantly lower that of suture plus ApGltn sealant (1.37 N) and suture (1.27 N). Functional evaluation and histologic examination showed that sciatic nerves repaired with ApGltn sealant showed similar nerve recovery compared to repair with the suture and fibrin sealant. Conclusion: The ApGltn sealant showed higher bonding strength and equal effect of nerve regeneration when compared with the fibrin sealant.

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関節リウマチに対する人工手関節置換術の効果の検討

三輪一馬, 阿部薫, 岩本卓士

日本ハンドセラピィ学会誌 ((一社)日本ハンドセラピィ学会) 14 ( 1 ) 32 - 36 2021.11

ISSN 1880-7380

DARTS人工手関節は,本邦で臨床使用が可能となった人工手関節である.今回,高度な手関節破壊を呈するRA2例3手に対しDARTS人工手関節を用いた人工手関節置換術(TWA)が施行され,術後セラピィを実施した.セラピィは,3週でキャスト除去後,Dart throw motion(投げ矢運動)に準じた自動運動を開始し,8週で他動運動許可,日常使用は段階的に進め,12週で積極的な使用を許可した.手関節可動域は,術前掌屈平均22.6°背屈平均-5°から術後掌屈平均21.3°背屈平均21.3°となり,掌屈域を維持したまま背屈優位の可動域を獲得した.Wrist scoring systemの術前総合計は平均41.3点から術後平均84.6点となり,特にPain reliefは,術後全手で50点となり疼痛は消失した.DARTS人工手関節を用いたTWAは,除痛に加えた可動域の拡大によりADL改善の可能性が示唆された.(著者抄録)

上腕骨内側上顆炎に対する直視下手術の臨床成績

鈴木拓, 早川克彦, 中根高志, 武谷博明, 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) 28 ( 2 ) 148 - 149 2021.11

ISSN 1349-7324

目的:上腕骨内側上顆炎に対する直視下手術の成績について報告する.対象と方法:保存加療に抵抗性の上腕骨内側上顆炎に対して直視下手術を施行した7例(男性5例,女性2例,平均年齢54歳)を対象とした.術前に尺骨神経の症状を呈していた症例は5例であった.手術は,全例,屈筋共同腱のデブリドマン,尺骨神経剥離,内側上顆部分切除,内側上顆のドリリングを施行した.評価は,術前,術後1年における疼痛(VAS),握力健側比に関して調査した.結果:平均VASは術前81(55-100)であったのに対して,術後1年では15(0-40)と有意に低下した.平均握力健側比も術前で64(26-71)%であったのに対して,最終観察時には95(84-100)%と有意に改善した.考察:上腕骨内側上顆炎に対する直視下手術は,有用であった.(著者抄録)

四次元CTを用いた健常手関節運動の動態解析

松村昇, 大木聡, 稲葉尚人, 木村洋朗, 鈴木拓, 岩本卓士

日本手外科学会雑誌 ((一社)日本手外科学会) 38 ( 2 ) 188 - 192 2021.11

ISSN 2185-4092

手関節運動時には橈骨手根関節と手根中央関節が連動して働くことが知られているが,その詳細な関節動態は未だ明らかでない.著者らは四次元CTを用いて手関節自動運動中の動態解析を行い,健常手関節の機能を評価した.健常ボランティア10名を対象とし,右手関節の自動掌背屈運動を連続的にCT撮影した.得られた画像データより橈骨・月状骨・第3中手骨の表面画像をそれぞれ再構成し,手関節自動運動中の各手関節角度における橈骨手根関節の角度を計測した.健常手関節の自動運動中は,中間位から掌屈位に比べ,中間位から背屈位にある際に橈骨手根関節が大きく動作することが明らかとなった.また自動背屈運動と自動掌屈運動の間には明らかな橈骨手根関節運動の差は認められなかった.本研究結果より,手関節中間位を境界として背屈位と掌屈位では橈骨手根関節と手根中央関節の働きが変化することが示唆された.(著者抄録)

上腕骨外側上顆炎に対するステロイド局所注射が原因と考えられる外側側副靱帯損傷

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) 28 ( 2 ) 69 - 71 2021.11

ISSN 1349-7324

目的:上腕骨外側上顆炎へのステロイド局所注射が原因であると考えられる外側側副靱帯損傷の症例に対して長掌筋腱を用いた靱帯再建術を行い,良好な結果を得たために報告する.方法:上腕骨外側上顆炎に対してステロイド局所注射後に,外側側副靱帯損傷を生じた3症例(平均年齢52歳,男性3例)を対象とした.評価は,術前注射回数,術後疼痛,不安定性の有無,肘関節自動運動可動域について調査した.結果:術前注射回数は平均5.3(3～5)回であった.全例で術前に認めていた肘関節外側部痛や不安定性は術後に消失し,可動域制限も認めなかった.考察:上腕骨外側上顆炎へのステロイド局所注射による外側側副靱帯損傷は注射回数が3回以上を損傷リスクとする報告もある.上腕骨外側上顆炎に対しての多数回のステロイド局所注射は,外側側副靱帯断裂の原因となる可能性があることに留意が必要である.(著者抄録)

A Case of Coronal Intra-articular and Epiphyseal Fractures of the Metacarpal Head in Early Adolescence

Kato T., Iwamoto T., Suzuki T., Matsumura N., Nakamura M., Matsumoto M., Sato K.

Journal of Hand and Microsurgery 13 ( 4 ) 247 - 251 2021.10

ISSN 09743227

Intra-articular metacarpal head fracture is relatively rare. We report a case of coronal intra-articular and epiphyseal fractures of Salter-Harris type IV injury in the metacarpal head of the index finger. Surgery was performed by a dorsal approach. The volar fragment that was displaced proximally was gently reduced while bending the metacarpophalangeal (MP) joint, and it was fixed with cortical screws inserted proximal to the articular cartilage facilitating early rehabilitation. We consider the mechanism of injury to be a force applied from the distal phalanx that was transmitted unevenly to the volar side when the MP joint was slightly flexed. A three-dimensional computed tomography scan was useful in making the precise diagnosis, confirming the fracture pattern and planning fixation of the fracture.

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動脈再建を行った胸郭出口症候群の2例

山口諒, 松原健太郎, 北英典, 鳥崎友紀子, 鈴木拓, 岩本卓士, 尾原秀明, 北川雄光

脈管学 ((一社)日本脈管学会) 61 ( Suppl. ) S259 - S259 2021.10

ISSN 0387-1126

Evaluation of Dynamic Carpal Arch Stability following Carpal Tunnel Release Using Four-Dimensional Computed Tomography

Kimura H., Sato K., Matsumura N., Suzuki T., Iwamoto T., Ohori K., Yamada Y., Matsumoto M., Nakamura M., Jinzaki M., Nagura T.

Journal of Hand and Microsurgery 13 ( 3 ) 138 - 142 2021.09

ISSN 09743227

Introduction This study aimed to assess the carpal arch dynamics during active finger and wrist motion following carpal tunnel release using four-dimensional computed tomography (4D-CT). Materials and Methods Four patients who diagnosed with bilateral carpal tunnel syndrome and underwent unilateral carpal tunnel release were prospectively included. 4D-CT of the bilateral wrists during active finger and wrist motion was performed for 10 seconds at five frames per second. The distances between the tip of tuberosity of the scaphoid and the volar ridge of the pisiform (S-P distance) and volar ridge of trapezium and the tip of hook of hamate (T-H distance) were measured at each position and the values of S-P and T-H distances were compared between the postoperative and contralateral wrists. Results During finger motion, the S-P and T-H distances were not different at any position between the postoperative side and contralateral side. Conversely, S-P and T-H distances gradually increased in the postoperative wrists. The differences between the sides of S-P distance were significant, with >0 degrees of wrist extension, and differences of T-H distance were significant with >15 degrees of wrist extension. Conclusion This study demonstrated the carpal arch dynamics using 4D-CT and revealed that the carpal arch was widened with the wrist in extension after carpal tunnel release. This study suggests that the transverse carpal ligament plays an important role in maintaining carpal arch stability.

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胸郭出口症候群に対して2-window approachを用いて第1肋骨切除を施行した1例

河姫暎, 鈴木拓, 木村洋朗, 松村昇, 岩本卓士, 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 ( 4 ) 153 - 156 2021.08

ISSN 0389-7087

60歳男性。左上肢しびれ、冷感を主訴に、前医にて保存加療を受けるも改善せず、当院へ紹介となった。初診時、徒手テストではMorlyテストは陰性であったが、RoosテストおよびWrightテストは陽性であった。また、頸椎単純X線とMRIでは異常所見はみられなかったが、造影3D-CTでは鎖骨下動脈の挙上位では高度な狭窄が認められた。以上、これらの所見を踏まえて、本症例は圧迫型の動脈性胸郭出口症候群と診断され、鎖骨上と鎖骨下の2-window approachを用いて第1肋骨切除術が行われた。その結果、術翌日より症状は改善し、術後1ヵ月時の造影CTでは鎖骨下動脈の圧迫所見の消失も確認された。

Normal values and ranges of the lateral capitello-humeral angle in healthy children

Kiyota Y., Suzuki T., Inaba N., Nishiwaki M., Kimura H., Matsumura N., Sato K., Nakamura M., Matsumoto M., Iwamoto T.

Journal of Pediatric Orthopaedics Part B 30 ( 4 ) 381 - 384 2021.07

ISSN 1060152X

The lateral capitello-humeral angle (LCHA), which is an index of sagittal alignment of the elbow, has gradually been adopted for the postoperative assessment of radiographic results. However, the normal values and ranges of the LCHA remain unclear. A retrospective cohort study was performed to evaluate the normal values and ranges of the LCHA in a sample of healthy children with even distributions of age, sex and laterality. A total of 168 radiographs of the elbows of healthy children (age range, 0–11 years) with even distributions of age, sex and laterality were reviewed. The primary aim was to analyze the normal values and ranges of the LCHA categorized by age, sex and laterality. The secondary aim was to assess the association of the LCHA with increasing age. The LCHA between sex or laterality in each age category was also compared. The mean LCHA of the 168 patients was 47.1º(range, 27º–63º). There was a weak association between the LCHA and increasing age (r = 0.41). The mean LCHA in females (49.1º) was significantly larger than that in males (45.1º). Significant sex-related differences were observed in age categories between 2 and 7 years. Results of this study will be useful in the postoperative radiographic assessment of sagittal alignment of the elbow in children.

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Motion of the distal radioulnar joint in extension and flexion of the wrist using axial CT imaging of healthy volunteers

Suzuki T., Hayakawa K., Nakane T., Inaba N., Matsumura N., Sato K., Iwamoto T.

Journal of Orthopaedic Science 26 ( 4 ) 610 - 615 2021.07

ISSN 09492658

Background: The midcarpal joint and the radiocarpal joint contribute to the extension and flexion of the wrist. Little is known about the contribution of the distal radioulnar joint (DRUJ) to the extension and flexion of the wrist. This study evaluated the ulnar motion in extension and flexion of the wrist using computed tomography (CT) imaging. Methods: A total of 30 wrists of healthy volunteers were enrolled. CT images of the axial sections of the DRUJ were obtained with 3 different positions of the wrist: 0° of extension (straight position), maximum active extension, and maximum active flexion. Each wrist motion was performed with 3 different forearm positions: neutral, pronation, and supination. Ulnar position at the DRUJ level was measured and ulnar position with the wrist in straight position was defined as baseline. The ulnar position was recorded as positive value when the position of the ulnar head was volar side and negative value when the position of the ulnar head was dorsal side. The difference from baseline in a position of maximum extension and flexion was evaluated. Results: In forearm neutral position and pronation, a value of ulnar position in maximum wrist flexion is significantly negative compared to that in the wrist straight position: the ulnar head moved dorsally from the wrist straight position to wrist flexion. In forearm supination, a value of ulnar position in maximum wrist extension is significantly positive compared to that in the wrist straight position: the ulnar head moved to the volar side from the wrist straight position to wrist extension. Conclusions: The ulnar head moves during extension and flexion of the wrist. The direction of the ulnar motion was different according to the wrist and forearm position.

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【肩・肘・手指・股・膝・足　いまいちばん新しくてくわしい人工関節置換術とケア】人工肘関節置換術

岩本卓士

整形外科看護 ((株)メディカ出版) 26 ( 7 ) 655 - 661 2021.07

ISSN 1342-4718

Range of Motion after the Sauvé-Kapandji and Darrach Procedures without Extensor Tendon Rupture.

Kato T, Suzuki T, Kameyama M, Okazaki M, Morisawa Y, Nishiwaki M, Nakamura T, Sato K, Iwamoto T

Journal of wrist surgery 10 ( 3 ) 190 - 195 2021.06

ISSN 2163-3916

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橈骨遠位端骨折に対する掌側ロッキングプレート固定術後の抜釘の現況

西脇正夫, 岡崎真人, 岩本卓士, 鈴木拓, 川崎恵吉, 市原理司

骨折 ((一社)日本整形外傷学会) 43 ( 3 ) 494 - 497 2021.05

ISSN 0287-2285

橈骨遠位端骨折に対する掌側ロッキングプレート固定術後の抜釘に関するアンケート調査を日本手外科学会会員54名に行った.調査項目は,掌側ロッキングプレート抜釘率,患者年齢別抜釘率,プレート設置高位別抜釘率,整形外科経験年数,手外科専門医有無,手外科手術と掌側ロッキングプレート固定術の年間件数,抜釘時の入院の有無と麻酔の種類とした.調査の結果,掌側ロッキングプレート抜釘率は,術者間で10～100%と大きな差があり,その平均は55%と諸外国や本邦からの英語論文で報告されている抜釘率よりはるかに高かった.抜釘率は,70歳以上の患者ではほかの年齢層より低く,プレート近位設置例は遠位設置例より低かった.整形外科経験年数,手外科専門医有無,手外科手術や掌側ロッキングプレート固定術の件数,抜釘時の麻酔の種類によって抜釘率に差はなかったが,抜釘術を入院で行う医師は日帰りで行う医師より抜釘率が高かった.(著者抄録)

Causes of Procedural Failures of Closed Reductions using an Extension-Block Pin for Bony Mallet Finger

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

Journal of Hand and Microsurgery 13 ( 2 ) 69 - 74 2021.04

ISSN 09743227

This retrospective study evaluated procedural failures of closed reductions using an extension-block Kirschner wire (K-wire) for bony mallet finger. A total of 132 patients who underwent a closed reduction for bony mallet finger in a procedure using an extension-block K-wire were radiographically assessed. Radiographs were used to evaluate (1) postoperative displacement of the reduction before or after K-wire removal and (2) inaccurate reduction of the fragment immediately after surgery. The causes of procedural failure and bone union were evaluated using radiographs and medical records of the intraoperative findings. Out of 132 patients, 17 with procedural failure were enrolled. Displacement of the reduction before and after K-wire removal occurred in seven and six cases, respectively. Inaccurate reduction immediately after surgery occurred in four cases. The most common cause of procedural failure was inaccurate insertion of the K-wire to fix the distal interphalangeal joint (eight cases) followed by inaccurate insertion of the extension-block pin (five cases). All patients had bone union regardless of the displacement of the reduction or inaccurate reduction of the fragment. Caution should be exercised during the reduction and fixation when an extension-block K-wire is used in a closed reduction procedure.

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Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report.

Kimura H, Toga A, Suzuki T, Iwamoto T

Journal of wrist surgery 10 ( 2 ) 164 - 168 2021.04

ISSN 2163-3916

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Risk Factors Contributing to Early Implant Fracture in Silicone Metacarpophalangeal Joint Arthroplasty for Patients With Rheumatoid Arthritis

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

Journal of Hand Surgery 46 ( 3 ) 243 - 243.e7 2021.03

ISSN 03635023

Purpose: To identify the risk factors associated with early implant fracture of silicone metacarpophalangeal (MCP) joint arthroplasty using the volar hinge silicone implant for patients with rheumatoid arthritis. Methods: We retrospectively reviewed 113 fingers of 31 hands that underwent MCP joint arthroplasty between 2008 and 2014, with a minimum follow-up of 3 years,. An implant fracture within 3 years after surgery was regarded as an early implant fracture. Patient records were reviewed for potential risk factors of age, affected fingers, ulnar drift angle, and range of motion of the MCP joint before surgery and 1 year after surgery. Candidate risk factors were compared at the level of the digit and at the patient level. Results: With fracture of the implants as the end point, Kaplan–Meier estimated survival rate was 74.3% at 3 years and 67.9% at 5 years. Early implant fracture was detected in 29 fingers. Bivariate analyses showed significant associations between early implant fracture and MCP joint arc of motion before surgery, MCP joint flexion range 1 year after surgery, and MCP joint arc of motion 1 year after surgery. Multiple logistic regression analysis showed that increased MCP joint flexion range 1 year after surgery was an independent risk factor for early implant fracture. Conclusions: Increasing MCP joint flexion range was associated with increased fractures of the implants. We propose that the MCP joint flexion range should be restricted to less than 60° in postoperative rehabilitation; it is necessary to educate the patient to permanently avoid excessive flexion of the MCP joint. Type of study/level of evidence: Therapeutic IV.

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青年期に発生した胸鎖関節後方脱臼および脱臼骨折に対する鋼線を用いた胸鎖関節制動術

松村昇, 宇田川和彦, 笠原知樹, 平賀聡, 鈴木拓, 岩本卓士

骨折 ((一社)日本整形外傷学会) 43 ( 2 ) 228 - 231 2021.03

ISSN 0287-2285

胸鎖関節後方脱臼や鎖骨近位骨端離開は主に青年期に発生する比較的稀な外傷であるが,その治療法は確立されていない.我々は徒手整復不能であった胸鎖関節後方損傷5例に対して観血的整復と鋼線を用いた胸鎖関節制動術を施行した.全例男性であり,平均年齢は15.3±1.4歳,4例は鎖骨近位骨端離開であったのに対し,1例は胸鎖関節後方脱臼の形態を呈していた.手術は鎖骨の後方不安定性を確実に防ぐことを目的とし,鎖骨近位端から挿入したKirschner鋼線を胸骨柄の前面に位置させることにより,胸鎖関節固定せずに鎖骨の後方転位を防止する胸鎖関節制動術を施行した.術後は慎重に経過観察を行い,平均3.3±0.3ヵ月で鋼線を抜去した.全例で合併症や再転位なく日常生活およびスポーツ復帰しており,良好な治療成績が得られている.本法は青年期に発生した胸鎖関節後方損傷に対して,安全かつ比較的低侵襲な手技と考えられた.(著者抄録)

鏡視下鎖骨遠位端切除により消失した肩鎖関節ガングリオン嚢腫の1例

藤井雄斗, 松村昇, 木村洋朗, 鈴木拓, 岩本卓士, 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 ( 臨増号外 ) 140 - 140 2021.03

ISSN 0389-7087

上腕骨外側上顆炎に対する鏡視下手術とPRP療法の臨床成績

鈴木拓, 早川克彦, 中根高志, 木村洋朗, 清田康弘, 林健太郎, 佐藤和毅, 岩本卓士

日本肘関節学会雑誌 (日本肘関節学会) 27 ( 2 ) 301 - 302 2021.03

ISSN 1349-7324

【目的】上腕骨外側上顆炎に対する鏡視下手術とPRP療法の臨床成績について報告する.【対象と方法】上腕骨外側上顆炎に対して鏡視下手術を施行した20例,PRP療法を施行した25例を対象とした.手術加療前にPRP療法を施行した患者は認めなかった.手術およびPRP療法施行前,施行後1,3,6,12ヵ月時のVAS,握力健側比に関して調査し,両群の成績を比較検討した.【結果】治療前,治療後1,3,6,12ヵ月における平均VASは手術群が71→36→30→18→11,PRP療法群は76→41→24→11→8と低下し,両群ともに治療前と比べて有意に改善した.全ての観察時における両群のVASに有意差は認めなかった.またPRP療法を施行した群で手術加療に移行した症例は認めなかった.【考察】上腕骨外側上顆炎に対するPRP療法は,手術加療と同等の成績であった.(著者抄録)

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