Papers - Iwamoto, Takuji

Enhanced nerve regeneration after transplantation of NCAM-positive neural crest-like cells derived from human iPSC

Amemiya T., Ouchi T., Kimura H., Okuyama K., Phan T.Q., Iwamoto T., Nakagawa T., Matsumoto M., Nakamura M., Okano H., Nagoshi N., Shibata S.

Inflammation and Regeneration 46 ( 1 )  2026.12

ISSN  18809693

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Background: Peripheral nerve injuries often cause persistent sensory and motor deficits, and autologous nerve grafting, the current standard, is limited by donor site morbidity and tissue availability. Human induced pluripotent stem cells (hiPSCs)-derived neural crest-like cells (NCLCs) have shown potential for nerve regeneration, but achieving high purity and safety remains a challenge. Methods: Using a mouse model of large sciatic nerve defects, we evaluated the efficacy of transplanting NCLCs triple-positive for low-affinity nerve growth factor receptor (LNGFR), thymocyte antigen 1 (THY-1), and neural cell adhesion molecule (NCAM). Purified triple-positive cells induced from hiPSC-derived neural crest lineage were seeded in the conduit with collagen gel in the transplantation group and compared the regeneration with the autograft group and the negative control group without cells. Results: NCAM-positive NCLCs promoted robust angiogenesis and recruited host Schwann cells, thereby establishing a supportive regenerative microenvironment. This facilitated axonal regrowth, thick myelination, and organized nerve architecture comparable to that of autografts. Functional recovery, assessed by electrophysiological conduction and motor performance, eventually matched autografts, with earlier improvement observed in the transplantation group. No tumor formation was detected, and the proliferative activity of transplanted cells declined over time. Selective marker-based purification likely contributed to the favorable safety profile. Conclusion: NCAM-positive NCLCs derived from hiPSCs enhance peripheral nerve regeneration through vascularization and Schwann cell-mediated remyelination, resulting in structural and functional recovery equivalent to autografts. This strategy offers a safe, scalable alternative to donor nerve harvest, and integration with bioengineered conduits could further expand clinical applicability in peripheral nerve reconstruction.

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Anatomical Reconstruction of the Terminal Tendon and Lateral Band for Severe Chronic Tendon Mallet Injury

Suzuki T., Kiyota Y., Matsumura N., Sato K., Nakamura M., Iwamoto T.

Journal of Hand Surgery 51 ( 1 ) 92 - 92.e7 2026.01

ISSN  03635023

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Purpose This study aimed to evaluate the clinical outcomes of surgical treatment for chronic mallet injury with severe extension lag using an anatomic reconstruction of the terminal tendon and lateral band with a palmaris longus (PL) tendon graft. Methods Eleven patients with a mean age of 52 years (range, 24–82 years) who underwent surgical reconstruction for chronic tendon mallet injuries using the PL tendon were included. The harvested PL tendon was either folded longitudinally or divided into two slips. The graft was secured to the distal phalanx using a bone anchor and sutured to the soft tissues and remnants of the original terminal tendon distal to the distal interphalangeal (DIP) joint. Each half-slip tendon was passed under the transverse retinacular ligament and sutured side-to-side to the lateral band at approximately the midpoint of the proximal phalanx. The active range of motion of the affected finger was evaluated before and after surgery, and any complications were recorded. Results Before surgery, the extension of the DIP joint averaged −49.5° (range, −40° to −60°). The postoperative mean lag of the DIP joint improved to −7.8° (range, −20° to +20°). According to the Miller classification, four patients had excellent results, four had good results, and three had fair results. Two patients who underwent folded-PL tendon grafting developed superficial dorsal skin infections on the little finger that resolved with oral antibiotics or removal of the sutures. Conclusions Anatomical reconstruction of the terminal tendon and lateral bands using a PL tendon graft yielded satisfactory outcomes in chronic tendon mallet injuries. Dividing the PL tendon into two slips is recommended to reduce the risk of postoperative infection. Type of study/level of evidence Therapeutic IV.

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Platelet-like cells differentiated from adipose-derived mesenchymal stem cells inhibit acute inflammation of tendinopathy in rats

Torii A., Yamada Y., Ono-Uruga Y., Sato Y., Kaneko Y., Nakamura S., Iwamoto T., Matsubara Y., Matsumoto M., Nakamura M., Sato K., Miyamoto T.

Journal of Bone and Mineral Metabolism 44 ( 1 ) 18 - 27 2026.01

ISSN  09148779

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Introduction: Tendinopathy, a disease that causes inflammation and pain and limits patients’ activities of daily living, is considered particularly important to treat during the acute inflammatory phase to prevent the transition to chronic degeneration. Recently, platelet-rich plasma (PRP) has been used to treat tendinopathy; however, it is not clear whether platelets themselves, which are the active component of PRP, could be effective in treating tendinopathy. Materials and Methods: We made rat Achilles tendinopathy models by incision of the calcaneal attachment and administrated platelet-like cells derived from adipose-derived mesenchymal stem cells (ASCL-PLCs) to the injury site and investigated the anti-inflammatory effect. Results: ASCL-PLCs significantly inhibits the inflammatory cytokine expression and inflammatory cell infiltration in acute tendonitis in a rat Achilles tendon injury model in vivo. Interestingly, we observed no xeno-reaction when human-derived ASCL-PLCs were administered to wild-type rats in vivo. Moreover, IL-6 expression and phosphorylation seen in NIH3T3 fibroblasts treated with IL-6 plus soluble IL-6 receptor were both significantly suppressed by ASCL-PLCs in vitro. Conclusion: ASCL-PLC has advantages over existing PRP therapies, including the ability to be cryopreserved after quality checks, and homogeneous populations of ASCL-PLCs can be prepared in large quantity. We conclude that in the future ASCL-PLCs may serve as an allogeneic transplant effective to treat tendinopathy.

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Delayed diagnosis of psoriatic arthritis presenting with infection-like finger inflammation: A case report

Takahashi S., Kiyota Y., Iwamoto T., Torii A., Oki S., Suzuki T., Matsumura N., Nakamura M.

Modern Rheumatology Case Reports 10 ( 1 )  2026

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Psoriatic arthritis is a chronic inflammatory disease associated with psoriasis, and its diagnosis can be challenging owing to nonspecific symptoms, absence of reliable biomarkers, and occasional delay in skin manifestations. Herein, we report a case of psoriatic arthritis that initially presented as an acute finger inflammation mimicking infection. A 46-year-old woman developed sudden swelling and pain in the left ring finger during chemotherapy for cervical cancer. Based on the results of the physical examination, laboratory tests, and magnetic resonance imaging, pyogenic flexor tenosynovitis was suspected, and synovectomy was performed; however, bacterial and mycobacterial cultures yielded negative results. Despite the administration of antibiotics, the inflammation persisted, and she was referred to the Rheumatology Department, where she was diagnosed with reactive arthritis secondary to Chlamydia infection. Although the inflammation improved after antimicrobial therapy, the finger swelling persisted. Follow-up magnetic resonance imaging and serological testing were performed, and the patient was diagnosed with seronegative rheumatoid arthritis. Four years after onset, erythematous skin lesions appeared, and dermatological evaluation confirmed plaque psoriasis; thus, a definitive diagnosis of psoriatic arthritis was established. Disease-modifying antirheumatic drug adjustments improved symptoms, but residual ‘pencil-in-cup’ deformity and limited finger motion remained. This case highlights the difficulty in diagnosing psoriatic arthritis when arthritis precedes skin lesions. Clinicians should consider psoriatic arthritis in persistent or refractory arthritis and carefully monitor skin and nail changes to achieve an earlier diagnosis and prevent irreversible joint damage.

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Accuracy of Implant Placement Using Augmented Reality–assisted Technique in Total Wrist Arthroplasty

Watanabe S., Iwamoto T., Tanji A., Kiyota Y., Suzuki T., Nagura T., Nakamura M.

Journal of Hand Surgery 51 ( 4 ) 371 - 381 2026

ISSN  03635023

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Purpose The study aimed to evaluate the accuracy of augmented reality–assisted total wrist arthroplasty (AR-TWA) in a cadaveric model using a three-point registration method. The hypothesis is that AR-assisted surgery can enable surgeons to achieve accurate implant placement comparable with surgeries performed under specialist guidance. Methods Fourteen fresh-frozen upper extremities from seven cadavers were used for TWA. Computed tomography data were imported into three-dimensional image analysis software for surgical planning. On one side, AR-TWA was performed by a board-certified orthpaedic surgeon with no clinical experience in TWA, and on the contralateral side, non–AR-TWA was performed by the same surgeon under the guidance of an experienced hand surgeon. The accuracy of implant placement was assessed by comparing preoperative and postoperative computed tomography scans and measuring deviations and angular errors between the planned and actual component positions. Results For both the radial and carpal components, four of six parameters demonstrated smaller errors in the AR-TWA. Although certain parameters favored the non–AR-TWA, overall variability was lower with AR. When classified as acceptable or outlier, all seven radial cases in the AR-TWA were acceptable for deviation, and six were acceptable for angular error, indicating better consistency than the non–AR-TWA. On the carpal side, AR-TWA demonstrated higher accuracy than non–AR-TWA, but more outliers were observed, suggesting relatively greater variability in this region. Conclusions Augmented reality–assisted TWA using a three-point registration method improved the accuracy of implant placement, even when performed by a less experienced surgeon. Clinical relevance Augmented reality technology may assist less experienced surgeons in performing technically demanding procedures, such as TWA, with improved accuracy.

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Peripheral nerve regeneration using a bioresorbable silk fibroin-based artificial nerve conduit fabricated via a novel freeze–thaw process

Matsuo T., Kimura H., Nishijima T., Kiyota Y., Suzuki T., Nagoshi N., Shibata S., Shindo T., Moritoki N., Sasaki M., Noguchi S., Tamada Y., Nakamura M., Iwamoto T.

Scientific Reports 15 ( 1 ) 3797 2025.12

ISSN  2045-2322

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While silk fibroin (SF) obtained from silkworm cocoons is expected to become a next-generation natural polymer, a fabrication method for SF-based artificial nerve conduits (SFCs) has not yet been established. Here, we report a bioresorbable SFC, fabricated using a novel freeze–thaw process, which ensures biosafety by avoiding any harmful chemical additives. The SFC demonstrated favorable biocompatibility (high hydrophilicity and porosity with a water content of > 90%), structural stability (stiffness, toughness, and elasticity), and biodegradability, making it an ideal candidate for nerve regeneration. We evaluated the nerve-regenerative effects of the SFC in a rat sciatic-nerve-defect model, including its motor and sensory function recovery as well as histological regeneration. We found that SFC transplantation significantly promoted functional recovery and nerve regeneration compared to silicone tubes and was almost equally effective as autologous nerve transplantation. Histological analyses indicated that vascularization and M2 macrophage recruitment were pronounced inside the SFC. These results suggest that the unique properties of the SFC further enhanced the peripheral nerve regeneration mechanism. As no SFC has been applied in clinical practice, the SFC reported herein may be a promising candidate for repairing extensive peripheral nerve defects.

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Mid-term clinical outcomes of the unlinked type K-NOW total elbow arthroplasty

Matsuo T., Iwamoto T., Kiyota Y., Suzuki T., Matsumura N., Sato K., Ikegami H.

Bone and Joint Journal 107 B ( 11 ) 1203 - 1211 2025.11

ISSN  20494394

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Aims This study aimed to evaluate the mid-term clinical outcomes, complications, and survival rates of the unlinked K-NOW (Teijin Nakashima Medical, Japan) total elbow arthroplasty (TEA), focusing on the use of cementless fixation. Methods This retrospective study included 41 elbows in 37 patients who underwent primary TEA using unlinked K-NOW between April 2012 and March 2021, with a minimum follow-up of two years. Surgical approaches included the lateral paraolecranon (LPO) and triceps-off approaches. Clinical evaluations included range of motion (ROM) and Mayo Elbow Performance Score (MEPS). Complications were recorded, and Kaplan-Meier survival analysis was performed, with aseptic loosening and revision surgery as endpoints. Results The mean patient age was 68.4 years (SD 11.6), and the mean follow-up period was 4.7 years (2.1 to 10.1). The LPO approach was used in 35 elbows (85.4%), and cementless fixation was applied to 41 humeral components (100%) and 35 ulnar components (85.4%). Among patients with ≥ five years of follow-up (n = 16), significant improvements were observed in ROM (extension, from -38° to -19°; flexion, from 107° to 130°; pronation, from 55° to 72°; supination, from 62° to 73°; p < 0.001), and MEPS (from 48 to 93 points; p < 0.001) at five years postoperatively. Complications occurred in six elbows (14.6%): three elbows (7.3%) with aseptic loosening and three elbows (7.3%) with periprosthetic fractures; no postoperative dislocation was observed. Revision surgeries were required in two elbows (4.9%). Kaplan-Meier survival rates were 92.7% (95% CI 84.7 to 100) at five years for loosening, and 97.1% (95% CI 91.4 to 100) at five years for revision. All aseptic loosening occurred within three months postoperatively. Conclusion The unlinked K-NOW with cementless fixation, mostly using the LPO approach, demonstrated favourable outcomes with improved ROM and MEPS, a low complication rate, and promising survival. In cases with severe osteoporosis or bone-implant instability, cemented fixation or a triceps-off approach may help reduce the risk of early complications.

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Three-Dimensional Magnetic Resonance Imaging of Median Nerve Volume for Assessing Carpal Tunnel Syndrome Severity

Hayakawa K., Suzuki T., Hayakawa K., Kawano Y., Iwamoto T., Fujita N.

Muscle and Nerve 72 ( 5 ) 1117 - 1121 2025.11

ISSN  0148639X

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Introduction/Aims: 3D magnetic resonance imaging (MRI) is a tool for visualizing and quantifying the volume of the median nerve; however, the diagnostic value of the volume of the median nerve for assessing CTS severity is unclear. This study aimed to evaluate the utility of 3T MRI combined with three-dimensional (3D) imaging to assess the cross-sectional volume (CSV) of the median nerve for diagnosing carpal tunnel syndrome (CTS) and determining its severity. Methods: We used MRI to measure the CSV of the median nerve in 95 patients with CTS and 26 healthy controls. CTS severity was graded according to the Padua classification, and differences in CSV according to severity were analyzed. Results: The mean CSVs for the severity groups were as follows: control, 22.4 mm³; minimal, 28.8 mm³; moderate, 34.4 mm³; severe, 53.6 mm³; and extreme, 48.3 mm³. CSV increased with CTS severity, with significantly higher values in the severe and extreme groups compared with the moderate, minimal, and control groups. Discussion: This study showed that the CSV of the median nerve increased with disease severity, both visually and in three dimensions. This helps to visually understand the severity of CTS, and the association between morphology and disease severity may contribute to a better understanding of the pathophysiology of CTS.

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Optimizing surgical instrument and implant utilization in orthopedic procedures: A lean methodology approach to cost reduction and efficiency improvement

Watanabe K., Iwamoto T., Nakayama R., Kobayashi S., Oya A., Matsumoto M., Nakamura M.

Journal of Orthopaedic Science 30 ( 6 ) 1199 - 1205 2025.11

ISSN  09492658

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Background: Operating rooms (ORs) are among the most resource-intensive areas in hospitals, and optimizing surgical efficiency is crucial for cost reduction. A key contributor to inefficiency is the overstocking of surgical instrument trays and implants, leading to increased sterilization costs, longer processing times, and workflow inefficiencies. Despite its impact, instrument tray optimization has received limited attention in orthopedic surgery. Methods: This single-center prospective observational study analyzed the utilization rates of surgical instruments and implants in total knee arthroplasty (TKA), total hip arthroplasty (THA), anterior cruciate ligament (ACL) reconstruction, and posterior spinal fusion (PSF) surgeries. Using Lean methodology, unnecessary instruments and implants were identified and removed from standard trays. The effectiveness of this optimization was assessed through comparisons of instrument utilization rates, sterilization costs, and OR preparation times before and after implementation. Results: A total of 162 procedures were analyzed. Prior to optimization, mean instrument tray utilization rates were low across all procedures (58–65 %), and implant utilization was particularly poor (5–11 %). Post-optimization, significant reductions were observed in the mean number of instrument trays and implants brought into the OR, leading to improved utilization rates (PSF: 67 %, THA: 75 %, ACL: 67 %) and cost savings of up to 1374 JPY per case. The mean intraoperative times unchanged after optimization, while in THA, a notable decrease in intraoperative time was observed (p = 0.022). Conclusion: Lean-based surgical instrument tray optimization effectively reduces unnecessary material use, lowers sterilization costs up to 1374 JPY per case, without compromising intraoperative times. The estimated annual cost savings for the hospital amounted to 729,575 JPY. Further research on long-term impact is warranted to maximize cost savings and enhance standardization in orthopedic surgeries.

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シリコンインプラントを用いたMP関節形成術後に重度の骨融解を生じた1例

菊地 啓士朗, 岩本 卓士, 清田 康弘, 鈴木 拓, 松村 昇, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 246 - 246 2025.09

ISSN  2185-4092

Steindler変法による肘屈曲再建と腕橈骨筋re-routingによる前腕回外再建を行った前腕回外再建を行った腕神経叢損傷の1例

沖 智碩, 清田 康弘, 木村 洋朗, 鈴木 拓, 松村 昇, 岩本 卓士, 佐藤 和毅, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 240 - 240 2025.09

ISSN  2185-4092

鎖骨下動脈盗血症候群を合併した胸郭出口症候群の1例

影山 瑛大, 鈴木 拓, 清田 康弘, 松村 昇, 岩本 卓士, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 138 - 138 2025.09

ISSN  2185-4092

伸筋腱断裂を伴うKienbock病に対して人工月状骨置換術を施行した1例

早川 賀津野, 鈴木 拓, 古旗 了伍, 木村 洋朗, 松村 昇, 岩本 卓士, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 61 - 61 2025.09

ISSN  2185-4092

新型コロナウイルス感染症(COVID-19)のワクチン接種後に胸郭出口症候群をきたした1例

古旗 了伍, 鈴木 拓, 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)  42 ( 2 ) 170 - 170 2025.09

ISSN  2185-4092

尺骨神経の解剖学的変異により生じた手関節尺側部痛の1例

名久井 龍成, 岩本 卓士, 木村 洋朗, 鈴木 拓, 松村 昇, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 148 - 148 2025.09

ISSN  2185-4092

尺側側索の過形成が原因で中指MP関節に弾発症状をきたした1例

中西 杏奈, 鈴木 拓, 木村 洋朗, 松村 昇, 岩本 卓士, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 162 - 162 2025.09

ISSN  2185-4092

外科的治療により胸部症状が改善した胸郭出口症候群の1例

牧田 修太朗, 鈴木 拓, 清田 康弘, 松村 昇, 岩本 卓士, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 235 - 235 2025.09

ISSN  2185-4092

副甲状腺癌に伴う原発性副甲状腺機能亢進症により橈骨骨折をきたした1例

早川 賀津野, 鈴木 拓, 清田 康弘, 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)  42 ( 2 ) 135 - 135 2025.09

ISSN  2185-4092

内視鏡補助下鎖骨下アプローチを用いて第1肋骨奇形を切除した胸郭出口症候群の1例

麓 政人, 鈴木 拓, 清田 康弘, 松村 昇, 岩本 卓士, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  42 ( 2 ) 74 - 74 2025.09

ISSN  2185-4092

【手指の変形性PIP関節症(ブシャール結節)に対する保存治療と外科治療:Knowledge Update】クリニカルクエスチョン　変形性PIP関節症に対する人工関節置換術の効果と合併症は?

岩本 卓士

Loco Cure ((株)先端医学社)  11 ( 3 ) 240 - 242 2025.08

ISSN  2189-4221

【肘関節疾患治療の最近の進歩】人工肘関節全置換術の合併症を防ぐための工夫

岩本 卓士, 松尾 知樹, 渡邉 慎平, 清田 康弘, 鈴木 拓, 松村 昇

整形・災害外科 (金原出版(株))  68 ( 9 ) 1027 - 1031 2025.08

ISSN  0387-4095

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＜文献概要＞人工肘関節全置換術(TEA)は有用な治療法であるが,他の人工関節置換術と比較して合併症発生率が高く,術後合併症予防が重要である。主な合併症はインプラントのゆるみ,脱臼,不安定性などであり,初回手術での対策が求められる。当科では,合併症低減を目指し,複数の戦略を実施している。具体的には,セメントレスunlinked型インプラントの選択,三次元術前計画による正確な設置,上腕三頭筋腱の連続性を温存する低侵襲アプローチを導入し,合併症低減に努めている。さらに,術中支援技術として拡張現実(AR)を活用したナビゲーションシステムの開発にも取り組み,TEAの安全性向上と良好な臨床成績の実現を目指している。

PIP関節強直に対するシリコンインプラントを用いた人工指関節置換術の短期成績

杉浦 祐太郎, 鈴木 拓, 早川 克彦, 清田 康弘, 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)  41 ( 6 ) 644 - 647 2025.04

ISSN  2185-4092

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PIP関節強直に対するシリコンインプラントを用いた人工指関節置換術の短期成績について報告する.平均PIP関節自動屈伸可動域は,術前が屈曲,伸展ともに0°であったが,最終観察時(平均35ヵ月)は屈曲63°,伸展-4°であり,インプラントの破損や緩みは認めなかった.PIP関節強直に対する人工関節置換術は,術前と比較してPIP関節自動屈伸可動域を改善し,短期的な成績は良好であったが,インプラントの破損も含めた長期的な経過観察が必要である.(著者抄録)

Webplasty using an external fixator for complex syndactyly caused by Apert syndrome

Kinoda A., Sato K., Iwamoto T., Matsumura N., Suzuki T., Kiyota Y., Kimura T., Nakamura T.

Journal of Orthopaedic Science 30 ( 2 ) 302 - 306 2025.03

ISSN  09492658

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Background: Webplasty can be conducted for complex syndactyly caused by Apert syndrome (also referred to as Apert hand) by extending the soft tissue in the lateral direction using an external fixator. This study aimed to verify the usefulness of webplasty without skin grafting. Methods: Webplasty with lateral extension was conducted at a single institution from 2015 to 2023. The patients were four children with Apert hand aged 1–3 years. A custom-made small external fixator was used for all of the soft tissue extension. Results: Webplasty without skin grafting was completed by the time all five patients were 5–6 years of age. Conclusion: Webplasty without skin grafting was possible with lateral extension of the soft tissue using a simple external fixator.

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【手・手指の関節変形　基本の対処法】リウマチ母指変形の分類と治療選択

清田 康弘, 岩本 卓士

Orthopaedics ((株)全日本病院出版会)  38 ( 3 ) 39 - 47 2025.03

ISSN  0914-8124

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母指は手全体の機能の約40%を担っており,母指の疾患は生活の質に深刻な影響を与える.特に関節リウマチ患者においては,母指の変形や機能障害が顕著で,日常生活動作に支障をきたすことになる.リウマチ母指変形はNalebuffにより6つのTypeに分類され,そのうち,Type Iボタン穴変形とType IIIスワンネック変形が多くみられる変形である.ボタン穴変形は主にMP関節の滑膜炎が原因で発生し,MP関節が屈曲し,IP関節が過伸展する.スワンネック変形は主にCM関節の滑膜炎が原因で発生し,CM関節が橈背側亜脱臼し,MP関節が過伸展,IP関節が屈曲する.リウマチ母指の治療には薬物,理学,手術療法があるが,治療の際には,それぞれの変形が生じるメカニズムを十分に理解することが必要である.そのうえで,IP,MP,CMの各関節の変性や拘縮の程度に応じて,治療法を選択する必要がある.(著者抄録)

Breast cancer statistics for Japan in 2022: annual report of the national clinical database-breast cancer registry-clinical implications including chemosensitivity of breast cancer with low estrogen receptor expression

Nagahashi, M; Kumamaru, H; Kinukawa, N; Iwamoto, T; Kawashima, M; Kinoshita, T; Konishi, T; Sagara, Y; Sasada, S; Saji, S; Sanuki, N; Tanakura, K; Niikura, N; Miyashita, M; Yoshida, M; Ishida, T; Taira, N

BREAST CANCER 32 ( 2 ) 217 - 226 2025.03

ISSN  1340-6868

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上腕骨近位部骨折続発症に対してPSIガイドを用いて人工肩関節置換を行った1例

岩間 耕太, 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)  56 ( 1 ) 26 - 26 2025.02

ISSN  0389-7087

Modified Intravascular Stent for Microvascular Suture in a Rat Superficial Femoral Artery

Maeda K., Suzuki T., Masugi Y., Tsuji O., Iwamoto T., Nakamura M.

Annals of Plastic Surgery 94 ( 1 ) 107 - 113 2025.01

ISSN  01487043

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Background Intravascular stent (IVaS) is sometimes used for suturing small vessels, but removing the stent after suturing is difficult. To overcome this problem, we developed an IVaS that integrates a stent and a manipulating string. This study aimed to investigate the usefulness of the modified IVaS (M-IVaS) by comparing it with conventional sutures (CS) and conventional IVaS (C-IVaS). Methods Forty-five superficial femoral arteries from rats were resected and sutured. The rats were randomly divided into the following 3 groups: CS, M-IVaS, and C-IVaS, with 15 rats per group. Patency rate, operating time, and ultrasonographic blood flow dynamics were examined immediately after suturing. Patency tests, ultrasonographic evaluations, and histological investigations were performed 1 week (n = 5), 2 weeks (n = 5), and 6 weeks (n = 5) after surgery. Results The 3 groups showed vessel patency in all cases immediately after suturing and at 1 week, 2 weeks, and 6 weeks after surgery. The mean operative time was 22.6 minutes for the CS group, 21.5 minutes for the M-IVaS group, and 25.9 minutes for the C-IVaS group. There were no significant differences in peak flow velocity and stenosis rate among the 3 groups as evaluated by ultrasonography. Histopathological evaluation revealed a similar recovery process of endothelial cells and no damage to the vascular wall. Conclusion The surgical time using M-IVaS was significantly shorter compared to that using C-IVaS. The M-IVaS reduced the inconvenience of C-IVaS removal. M-IVaS showed the same effectiveness as did the CS in terms of patency rate, operating time, ultrasonographic blood flow dynamics, and histological evaluation. M-IVaS can be used in the field of microsurgery.

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Effect of Alaska pollock-gelatin sheet on repair strength and regeneration of nerve

Tsujisaka R., Suzuki T., Shibata S., Iwamoto T., Taguchi T., Nakamura M.

Journal of Hand Surgery European Volume 50 ( 1 ) 76 - 84 2025.01

ISSN  17531934

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The aim of the study was to investigate the repair strength and the biocompatibility of Alaska pollock-derived gelatin (ApGltn) sheet for nerve repair. Cadaveric digital nerves were repaired with double suture, single suture + ApGltn sheet, single suture + fibrin glue, single suture, ApGltn sheet and fibrin. Maximum failure loads were measured (20 nerves each). Rat sciatic nerves were repaired with double suture, single suture + ApGltn sheet, single suture, ApGltn sheet, fibrin glue and resection (10 nerves each). Macroscopic appearance, muscle weight and histopathological findings were examined 8 weeks postoperatively. The mean failure load of ApGltn sheet (0.39 N) was significantly higher than that of a fibrin (0.05 N), and that of single suture + ApGltn sheet (1.32 N) was significantly higher than that of a single suture alone (0.97 N). Functional and histological assessments showed similar nerve recovery among the suture, ApGltn and fibrin groups. ApGltn sheet has potential for clinical application as an alternative to fibrin.

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Point of care ultrasound combined with CTS-6 to diagnose idiopathic carpal tunnel syndrome

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

Journal of Orthopaedic Science 30 ( 1 ) 85 - 90 2025.01

ISSN  09492658

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Background: This study aimed to demonstrate the effectiveness of our new diagnostic chart using point of care ultrasound combined with CTS-6 for diagnosing idiopathic carpal tunnel syndrome. Methods: We conducted a retrospective analysis of the data of patients who visited our department and received point of care ultrasound combined with CTS-6 from 2020 to 2023. Data regarding age, sex, initial and final diagnosis, cross-sectional area of the median nerve, CTS-6 score, and electrodiagnostic severity were obtained and statistically analyzed. Results: Of the 177 wrists included in our study, 138 (78 %) were diagnosed with carpal tunnel syndrome, while 39 (22 %) were not (non-carpal tunnel syndrome). With our diagnostic method, 127 wrists (72 %) were diagnosed initially with carpal tunnel syndrome, 23 wrists (13 %) with non-carpal tunnel syndrome, and the rest 27 wrists (15 %) as borderline. Our initial diagnoses of carpal tunnel syndrome and non-carpal tunnel syndrome were maintained in all cases except for two. Cross-sectional area, CTS-6 score, and electrodiagnostic severity showed a positive correlation. A post hoc analysis showed that the new scoring system (CTS-6 score + 2 × cross-sectional area) with a cutoff value of 31.25 points showed a sensitivity as high as 95 % and a specificity of 100 %. Conclusions: Our findings suggest that most suspected idiopathic carpal tunnel syndrome cases can be diagnosed correctly using the diagnostic chart. Although additional tools, including electrodiagnostic studies, may be needed for borderline cases, the use of point of care ultrasound combined with CTS-6 may be a recommendable first-line confirmatory test because point of care ultrasound and CTS-6 could be complementary tools, and this chart may be especially beneficial for atypical or outlier cases. Level of evidence: Diagnostic III.

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【生活習慣病と整形外科疾患】生活習慣病と手外科疾患

松尾 知樹, 岩本 卓士

臨床整形外科 ((株)医学書院)  60 ( 1 ) 41 - 45 2025.01

ISSN  0557-0433

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＜文献概要＞手指拘縮,手根管症候群,狭窄性腱鞘炎,手指変形性関節症などは,しばしば遭遇する主要な手外科疾患である.その発症の危険因子にはさまざまなものが考えられているが,生活習慣病,特に糖尿病や肥満との関連が明らかになっている.特に高血糖状態は終末糖化産物であるadvanced glycation endproduct(AGE)を産生し,AGEがコラーゲンを架橋することで組織硬化をもたらし,手指拘縮,手根管症候群,狭窄性腱鞘炎の原因となり得る.また肥満については,脂肪組織から産生されるサイトカインにより手指変形性関節症を引き起こす可能性も示唆されている.本稿では糖尿病や肥満を中心に,各手外科疾患との関連を疫学や治療成績の観点から述べる.

手根管症候群における腱鞘滑膜へのアミロイド沈着と心アミロイドーシスの関連

御子柴 直紀, 岩本 卓士, 清田 康弘, 鈴木 拓, 松村 昇, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  41 ( 4 ) 317 - 320 2025.01

ISSN  2185-4092

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手根管症候群は全身性アミロイドーシスの初発症状の一つであり,近年,手根管症候群に対する術中腱鞘滑膜生検のスクリーニングとしての意義が注目されている.2019年1月～2023年7月に当院で手根管症候群に対して手術を行い,術中に腱鞘滑膜生検を施行した40症例を対象に,アミロイド沈着と心アミロイドーシスの関連を検討した.循環器内科からの依頼により施行した症例は14例,スクリーニングとして施行した症例は26例であった.循環器内科からの依頼症例は14例中14例(100%)がアミロイド陽性であった.スクリーニング症例では26例中10例(38%)がアミロイド陽性で,特に男性は5例中5例(100%)が陽性であり,アミロイド陽性は,高齢,男性に有意に多かった.スクリーニング症例で心アミロイドーシスの診断に至った症例は1例(4%)であったが,心疾患の診断に至らなかった症例も今後,心アミロイドーシスを発症する可能性があり,術中腱鞘滑膜生検のスクリーニングとしての有用性の評価にはさらなる縦断的研究が必要である.(著者抄録)

Severe osteolysis following metacarpophalangeal arthroplasty with silicone implants: A case report

Kikuchi K., Iwamoto T., Kiyota Y., Torii A., Suzuki T., Matsumura N., Ueno A., Okita H., Nakamura M.

Modern Rheumatology Case Reports 9 ( 2 )  2025

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We report a rare case of severe osteolysis following metacarpophalangeal (MP) joint arthroplasty using silicone implants in a patient with rheumatoid arthritis. A 72-year-old woman presented with painless masses on the dorsum of the left hand 6 years after MP joint arthroplasty using Sutter-type silicone implants. Radiographic evaluation revealed implant-associated osteolysis and cortical perforation of the second to fifth metacarpals. Revision arthroplasty was performed using grommet-equipped Swanson-type silicone implants combined with synovectomy and iliac bone grafting for severe palmar bone loss. One year later, similar osteolysis occurred in the right hand, and revision arthroplasty was again performed using Swanson-type implants without the need for bone grafting. The postoperative course was uneventful, and no recurrence of osteolysis or implant-related complications was observed over a 7-year follow-up period. Silicone synovitis is a recognised complication of silicone implant arthroplasty, caused by wear debris triggering chronic inflammation and bone resorption. This case highlights the importance of early detection and intervention for implant-related osteolysis. In cases where bone defects remain manageable, revision with grommet-equipped silicone implants can be a viable and durable treatment option. Surgeons should be aware of this potentially severe complication, as delayed intervention may preclude the use of silicone implants altogether due to extensive bone loss.

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テニス選手の上腕骨滑車内側に生じた離断性骨軟骨炎に対して骨釘移植を行った一例

木之田 章, 佐藤 和毅, 山田 唯一, 岩本 卓士, 松村 昇, 鈴木 拓, 清田 康弘, 吉田 雅人

日本肘関節学会雑誌 (日本肘関節学会)  32 ( 1 ) S99 - S99 2025

ISSN  1349-7324

病変の再発と骨折により治療に難渋した肘関節滑膜軟骨腫症の1例

御子柴 直紀, 岩本 卓士, 清田 康弘, 鈴木 拓, 佐藤 和毅

日本肘関節学会雑誌 (日本肘関節学会)  32 ( 2 ) 276 - 278 2025

ISSN  1349-7324

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症例は40歳男性.4年前より誘因なく左肘関節の疼痛および可動域制限が出現し当院を紹介受診した.関節拘縮の状態であり,単純X線およびCTから関節内遊離体を伴う変形性肘関節症と判断し観血的関節授動術および遊離体摘出術を行った.術中に軟骨成分を多く含む多数の遊離体が摘出され,病理所見から滑膜軟骨腫症と診断した.一時的に肘関節可動域は改善したが術後経過とともに関節可動域は減少し,転倒により左上腕骨通顆骨折を受傷した.滑膜軟骨腫症の再発も認め,外固定での骨癒合後に2度目の観血的関節授動術と遊離体摘出術を行った.現在まで明らかな遊離体の再発を認めないが,肘関節には関節症性変化が生じており,強い可動域制限が残存した.画像所見で遊離体を認めた場合には,稀ではあるが本疾患を念頭に置いて治療を進める必要がある.(著者抄録)

Endoscopic-Assisted Infraclavicular Approach for Hypoplastic First Rib Resection in Thoracic Outlet Syndrome: A Case Report

Fumoto M., Suzuki T., Kiyota Y., Matsumura N., Iwamoto T., Nakamura M.

Jbjs Case Connector 14 ( 4 )  2024.12

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Case:A 25-year-old man presented with neck and upper-limb pain. He underwent surgery for the resection of a left hypoplastic first rib, which was causing thoracic outlet syndrome. The subclavian vein was retracted through an infraclavicular incision, and an endoscope was inserted dorsally to the vein. With the assistance of endoscopy, the first rib was partially resected, and scalene muscles were released from the rib. The preoperative symptoms improved after surgery without any complications.Conclusion:The endoscopic-assisted infraclavicular approach enabled sufficient resection of the hypoplastic first rib, leading to satisfactory outcomes. This method can be considered as an option for resecting a hypoplastic first rib.

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A case of concomitant subclavian steal syndrome and thoracic outlet syndrome

Kageyama A., Suzuki T., Kiyota Y., Matsumura N., Iwamoto T., Nakamura M.

Journal of Vascular Surgery Cases Innovations and Techniques 10 ( 6 ) 101613 2024.12

ISSN  2468-4287

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A 59-year-old woman presented with dizziness and numbness of her left upper limb. Computed tomography (CT) angiography revealed an occlusion of the subclavian artery at its origin, leading to a diagnosis of subclavian steal syndrome. She was treated with percutaneous angioplasty and stenting; however, her symptoms did not improve. CT angiography of the arm in the elevated position revealed subclavian artery stenosis at the costoclavicular space, and the diagnosis was neurogenic thoracic outlet syndrome (TOS). First-rib resection was performed, and the symptoms disappeared immediately after surgery. TOS should be considered when symptoms persist despite subclavian steal syndrome treatment. Physical examination and CT imaging with the arm elevated aid in diagnosing TOS.

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Novel artificial nerve transplantation of human iPSC-derived neurite bundles enhanced nerve regeneration after peripheral nerve injury

Nishijima T., Okuyama K., Shibata S., Kimura H., Shinozaki M., Ouchi T., Mabuchi Y., Ohno T., Nakayama J., Hayatsu M., Uchiyama K., Shindo T., Niiyama E., Toita S., Kawada J., Iwamoto T., Nakamura M., Okano H., Nagoshi N.

Inflammation and Regeneration 44 ( 1 ) 6 2024.12

ISSN  1880-9693

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Background: Severe peripheral nerve damage always requires surgical treatment. Autologous nerve transplantation is a standard treatment, but it is not sufficient due to length limitations and extended surgical time. Even with the available artificial nerves, there is still large room for improvement in their therapeutic effects. Novel treatments for peripheral nerve injury are greatly expected. Methods: Using a specialized microfluidic device, we generated artificial neurite bundles from human iPSC-derived motor and sensory nerve organoids. We developed a new technology to isolate cell-free neurite bundles from spheroids. Transplantation therapy was carried out for large nerve defects in rat sciatic nerve with novel artificial nerve conduit filled with lineally assembled sets of human neurite bundles. Quantitative comparisons were performed over time to search for the artificial nerve with the therapeutic effect, evaluating the recovery of motor and sensory functions and histological regeneration. In addition, a multidimensional unbiased gene expression profiling was carried out by using next-generation sequencing. Result: After transplantation, the neurite bundle-derived artificial nerves exerted significant therapeutic effects, both functionally and histologically. Remarkably, therapeutic efficacy was achieved without immunosuppression, even in xenotransplantation. Transplanted neurite bundles fully dissolved after several weeks, with no tumor formation or cell proliferation, confirming their biosafety. Posttransplant gene expression analysis highlighted the immune system’s role in recovery. Conclusion: The combination of newly developed microfluidic devices and iPSC technology enables the preparation of artificial nerves from organoid-derived neurite bundles in advance for future treatment of peripheral nerve injury patients. A promising, safe, and effective peripheral nerve treatment is now ready for clinical application.

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Prospective Study on Splinting for First Carpometacarpal Joint: A Comparison of Conventional and Three-Dimensional Printed Splint

Inaba N., Iwamoto T., Ishii K., Oki S., Suzuki T., Sato K., Nagura T., Nakamura M.

Journal of Clinical Medicine 13 ( 23 )  2024.12

ISSN  2077-0383

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Background: Patient compliance is a major concern of hand orthosis in first carpometacarpal osteoarthritis. To address this issue, we established a method for creating a custom-made three-dimensional printed splint based on computed tomography. This prospective study evaluates the usefulness of the three-dimensional printed splint compared with the conventional splint. Methods: A total of 12 hands in nine patients were included. The mean age of the patients was 69 years (range: 58–84). Conventional orthoses were made by prosthetists using molds. Three-dimensional printed orthoses (long and short types) were digitally designed from computed tomography data and created using Fused Deposition Modeling. Subjects were instructed to use three types of orthoses for 2 weeks each. They completed questionnaires that indicated pain, function, percentage of daytime spent using the orthosis, satisfaction score, and discomfort caused by wearing orthoses. Results: The pain on motion showed an improvement of approximately 20% for all orthoses. There was no significant difference in pain scale, function, percentages of daytime spent using each orthosis, and satisfaction score among the three types of orthoses. Discomfort caused by wearing orthosis was more frequent in conventional orthosis than in 3D-printed orthosis, and there was a significant difference between the conventional type and the long-type 3D-printed orthosis. Conclusions: This study suggests that 3D-printed splints provide comparable pain relief to conventional splints with reduced discomfort. However, limitations such as small sample size, short follow-up, and reliance on CT imaging highlight the need for further research.

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Accuracy of Implant Placement Based on Three-Dimensional Preoperative Planning in Total Elbow Arthroplasty

Matsuo T., Iwamoto T., Kiyota Y., Suzuki T., Matsumura N., Sato K.

Journal of Hand Surgery Asian Pacific Volume 29 ( 5 ) 397 - 407 2024.10

ISSN  24248355

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Background: Accurate implant placement in the optimal position is important to obtain favourable clinical outcomes and prevent complications in total joint arthroplasty. We aimed to assess the accuracy of implant placement based on three-dimensional (3D) preoperative planning for unlinked total elbow arthroplasty (TEA) and to clarify the effect of implant placement on clinical outcomes. Methods: This study included 20 patients (22 elbows, 17 with rheumatoid arthritis and 5 with osteoarthritis, with a mean follow-up period of 47 months) who underwent TEA with an unlinked-Type implant after computed tomography (CT)-based 3D preoperative planning. Implant placement was planned preoperatively and several parameters were set to reflect it intraoperatively. TEA was performed based on the plan, and postoperative CT was conducted to evaluate differences in implant placement by comparing the preoperative plan and postoperative implant placement. Furthermore, we evaluated the relationship between implant placement differences and postoperative clinical outcomes, including range of motion, Visual Analogue Scale, Mayo Elbow Performance Score 1 year after surgery and complications at the last follow-up. Results: The mean absolute translation was within 2 mm, the mean absolute tilt was within 4°, the mean absolute rotation of the humeral component was within 4° and the mean absolute rotation of the ulnar component was 10.2° ± 6.8°. In the ulnar components, 15/22 (68%) cases were externally rotated, and the mean external rotation was 7.1° ± 10.2°. We defined the absolute ulnar component's rotational difference of more than 10° as a 'malrotation' group (n = 8) and 10° or less as a 'control' group (n = 14). We compared the clinical outcomes between both groups, however, no significant differences were observed in clinical outcomes and complications. Conclusions: We observed notable malrotation in the postoperative positioning of the ulnar component. Intraoperative support devices may be necessary to accurately reproduce the preoperative plan in the surgical field. Level of Evidence: Level IV (Therapeutic)

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T2 magnetic resonance imaging mapping and morphology of the median nerve before and after surgery in carpal tunnel syndrome

Kondo H., Suzuki T., Hayakawa K., Maeda A., Funahashi T., Kuroiwa T., Kawano Y., Iwamoto T., Fujita N.

Muscle and Nerve 70 ( 3 ) 346 - 351 2024.09

ISSN  0148639X

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Introduction/Aims: T2 magnetic resonance imaging (MRI) mapping has been applied to carpal tunnel syndrome (CTS) for quantitative assessment of the median nerve. However, quantitative changes in the median nerve before and after surgery using T2 MRI mapping remain unclear. We aimed to investigate whether pathological changes could be identified by pre- and postoperative T2 MRI mapping of the median nerve in CTS patients after open carpal tunnel release. Methods: This was a prospective study that measured median nerve T2 and cross-sectional area (CSA) values at the distal carpal tunnel, hamate bone, proximal carpal tunnel, and forearm levels pre- and postoperatively. Associations between T2, CSA, and nerve conduction latency were also evaluated. Results: A total of 36 patients with CTS (mean age, 64.5 ± 11.7 years) who underwent surgery were studied. The mean preoperative T2 values significantly decreased from 56.3 to 46.9 ms at the proximal carpal tunnel levels (p =.001), and from 52.4 to 48.7 ms at the hamate levels postoperatively (p =.04). Although there was a moderate association between preoperative T2 values at the distal carpal tunnel levels and distal motor latency values (r = −.46), other T2 values at all four carpal tunnel levels were not significantly associated with CSA or nerve conduction latency pre- or postoperatively. Discussion: T2 MRI mapping of the carpal tunnel suggested a decrease in nerve edema after surgery. T2 MRI mapping provides quantitative information on the median nerve before and after surgery.

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Intra-Articular Corrective Osteotomy for Distal Radial Intra-Articular Malunion Using Patient-Matched Instruments: A Prospective, Multicenter, Open-Label, Single-Arm Trial

Oka K., Miyamura S., Shiode R., Tanaka H., Iwasaki N., Kawamura D., Sato K., Iwamoto T., Yamamoto M., Nishida K., Shimamura Y., Yamada T., Okada S., Murase T.

Jbjs Open Access 9 ( 3 )  2024.08

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Background:Corrective osteotomy for intra-articular malunion is a challenging procedure. However, recent advancements, including patient-matched instruments created on the basis of preoperative computer simulation, enable accurate intra-articular correction. We hypothesized that intra-articular corrective osteotomy using patient-matched instruments for the treatment of distal radial intra-articular malunion would reduce intra-articular deformity and restore wrist function at 12 months of follow-up.Methods:This prospective study included 12 patients with distal radial intra-articular malunion who underwent intra-articular corrective osteotomy external to the joint using patient-matched instruments. The primary end point was the maximum step-off on the articular surface of the distal radius, measured with use of computed tomography (CT), with an expected postoperative value of ≤1.5 mm. The secondary end points included the gap of the articular surface; range of motion; grip strength; pain evaluated using a visual analog scale (VAS); patient satisfaction; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Patient-Rated Wrist Evaluation (PRWE) score. A mean postoperative step-off of ≤1.5 mm for the primary end point was assessed with use of the 1-sample t test. The secondary end points were assessed with use of the Dunnett multiple comparison test.Results:The average step-off significantly improved from 3.75 ± 1.04 mm preoperatively to 0.51 ± 0.40 mm at the 52-week postoperative follow-up and was maintained within 1.5 mm. The average wrist and forearm range of motion, VAS score, grip strength, DASH score, and PRWE score significantly improved. Eleven patients were either very satisfied or satisfied with their outcomes.Conclusions:The use of patient-matched instruments could contribute to improving postoperative outcomes of intra-articular corrective osteotomy procedures involving the distal radius.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Humeral rotational osteotomy for malunion after intramedullary nailing in humeral shaft fracture: a case report

Tsujisaka R., Matsumura N., Kamata Y., Morioka H., Kiyota Y., Suzuki T., Iwamoto T.

Jses Reviews Reports and Techniques 4 ( 3 ) 520 - 525 2024.08

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Alaska Pollock-derived Gelatin Sealant has Higher Sealing Strength than, and Comparable Biocompatibility with, Fibrin Sealant in Porcine and Rat Dural Injury Models

Ono T., Suzuki T., Nagoshi N., Masugi Y., Maeda K., Hashimoto S., Watanabe S., Iwamoto T., Taguchi T., Nakamura M.

Spine 49 ( 13 ) E200 - E207 2024.07

ISSN  03622436

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Study Design. Burst strength study in porcine dural models and functional and histological study in rat dural models. Objective. This study aimed to investigate the sealing strength and biocompatibility of Alaska pollock-derived gelatin (ApGltn) and fibrin sealants in disrupted dural injuries. Summary of Background Data. Disruption of the dura mater occurs during spine surgery, leading to cerebrospinal fluid leakage. Fibrin sealant is usually applied to ruptured sites; however, it lacks sealing strength. A novel biocompatible sealant composed of ApGltn was recently demonstrated to have good burst strength and biocompatibility in the porcine aorta. Methods. Ten porcine dura maters with central holes were covered with ApGltn and fibrin sealants (five samples per group). The maximum burst strength of each sealant was measured, and histological examination was performed after burst testing. Twenty-seven dura maters of male Wistar rats were used for functional and histopathological evaluations. The rats were treated with three surgical interventions: defect + ApGltn sealant; defect + fibrin sealant; defect alone (nine rats per group). Macroscopic confirmation of the sealant, hindlimb motor function analysis, and histopathological examination were performed at two, four, and eight weeks after the procedure. Results. The maximum burst strength of the ApGltn sealant was 4.4 times higher than that of the fibrin sealant (68.1±12.1 vs. 15.6±8.7 mmHg; P<0.001). Histological examination confirmed that the ApGltn sealant showed tight adhesion to the dural surface, whereas a gap was observed between the fibrin sealant and the dura mater. In the rat model, the ApGltn sealant resulted in spinal function and dural histological findings similar to those of the fibrin sealant. Conclusion. The ApGltn sealant had a higher sealing strength than, and comparable effect on dura regeneration with, the fibrin sealant.

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Painful snapping of the middle finger caused by hyperplasia of the ulnar lateral band: A case report

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

Modern Rheumatology Case Reports 8 ( 2 ) 391 - 393 2024.07

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Snapping of fingers can be caused by pathologies such as stenosing flexor tenosynovitis. However, snapping symptoms in the metacarpophalangeal (MP) joint caused by hypertension and hyperplasia of the lateral band are rare. We present a 26-year-old female with symptoms of painful snapping of the middle finger. When the finger was actively flexed from the hyperextension of the MP joint, the ulnar lateral band was prominent, and a snapping phenomenon occurred. The cause of the snapping finger was considered to be tightness of the ulnar lateral band, and surgery was planned. Intraoperatively, the ulnar lateral band was tense and hyperplastic. The snapping phenomenon disappeared immediately after the resection of the lateral band. It is important to consider this condition as one of the differential diagnoses of snapping finger when the patient complains of an atypical snapping phenomenon.

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An upper arm ganglion cyst connected to the bicipital groove associated with glenohumeral osteoarthritis: a case report

Tsujisaka R., Matsumura N., Kamata Y., Morioka H., Kiyota Y., Suzuki T., Iwamoto T.

Jses Reviews Reports and Techniques 4 ( 2 ) 272 - 275 2024.05

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Quantitative evaluation of natural progression of fatty infiltration and muscle atrophy in chronic rotator cuff tears without tear extension using magnetic resonance imaging

Matsumura N., Kiyota Y., Suzuki T., Iwamoto T., Nozaki T., Jinzaki M., Nakamura M., Nagura T.

Jses International 8 ( 3 ) 630 - 637 2024.05

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Background: The pathology of and mechanisms underlying muscle degeneration remain unclear. We aimed to quantitatively evaluate the natural changes in fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears using 3-dimensional 2-point Dixon magnetic resonance imaging. Methods: Thirty patients with nonoperatively observed rotator cuff tears without tear extension were evaluated using multiple magnetic resonance imaging examinations with a minimum interval of 2 years. The fatty infiltration ratio (%fat) and muscle volume of the rotator cuff muscles were compared between the 2 examinations in those with supraspinatus (SSP) tear <2 cm (<2 cm SSP group), SSP tear ≥2 cm (≥2 cm SSP group), and massive tear (massive group). The SSP) infraspinatus, and teres minor (ISP + TM), and subscapularis muscles were evaluated. Results: The massive group showed a significantly greater %fat than the <2 and ≥2 cm SSP groups in the SSP (P = .002) and ISP + TM muscles (P < .001). The total muscle volume did not differ among the 3 groups for all rotator cuff muscle components. The %fat values did not change in any rotator cuff components during the follow-up period in all groups. The total muscle volume in the massive group significantly decreased in the SSP (P = .018) and ISP + TM muscles (P = .013). Conclusion: The present results indicate that fatty infiltration of the torn muscle occurs in the early phase after a rotator cuff tear, whereas muscle atrophy appears to progress gradually in chronic rotator cuff tears. Early intervention before muscle degeneration should be considered if the tear involves the infraspinatus tendon.

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Recent advances in unlinked total elbow arthroplasty in Japan

Iwamoto T., Ikegami H., Tanji A., Kiyota Y., Suzuki T., Matsumura N., Sato K.

Jses International 8 ( 3 ) 602 - 607 2024.05

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Background: Total elbow arthroplasty (TEA) is a valuable therapeutic approach for improving function and relieving pain in severely deformed elbow joints. However, TEA is associated with a high incidence of complications. In Japan, the use of unlinked TEA has a long history, with the development of the Kudo prosthesis marking a significant milestone. Subsequently, various unlinked implant designs have been developed. Although favorable long-term clinical results have been reported, complications remain a concern. To further improve the outcome of unlinked TEA, attempts have been made in recent years to develop various surgical approaches and intraoperative support devices. This review focuses on the clinical outcomes and recent advances in unlinked TEA in Japan. Methods: A comprehensive review of clinical results and advancements in unlinked TEA in Japan was conducted. The analysis included trends in the number of TEA, medium-term and long-term results for unlinked TEA, surgical approaches, or preoperative planning techniques. Results: Several implant designs have been developed in Japan. Clinical studies have reported satisfactory long-term outcomes with these implants, but complications, such as infection, fractures, and dislocation, have been observed. In order to enhance the outcomes of unlinked TEA, various triceps-on approaches have been developed as alternatives to the triceps-detaching approach, which compromises the continuity between the triceps tendon and ulna, leading to inevitable complications related to the triceps tendon. Preservation or repair of the surrounding soft tissues is considered critical for preventing postoperative instability due to the absence of a radial head in the current unlinked TEA design. Computed tomography-based 3-dimensional preoperative planning has been pioneered in Japan, demonstrating its effectiveness in predicting implant size and achieving appropriate implant placement. Additionally, augmented reality–assisted surgery is being explored to accurately translate preoperative planning into the surgical procedure. Conclusion: Unlinked TEA for inflammatory arthritis has exhibited promising long-term results in Japan, with ongoing efforts to improve surgical techniques and preoperative planning. Further advancements are anticipated to prevent complications such as dislocation and peri-implant fractures.

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Extra-Articular Stabilization for the Treatment of Recurrent Sternoclavicular Joint Instability: A Report of Two Cases

Kobayashi T., Matsumura N., Tasaki A., Kiyota Y., Suzuki T., Iwamoto T., Matsumoto M., Nakamura M.

Jbjs Case Connector 14 ( 2 )  2024.04

ISSN  21603251

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Case:A 22-year-old man and a 14-year-old adolescent boy, who exhibited moderate general joint laxity, experienced recurrent sternoclavicular joint instability without traumatic events. The patients were successfully treated with extra-articular stabilization using autologous tendon grafts without surgical exposure of the sternoclavicular joint.Conclusion:Atraumatic instability of the sternoclavicular joint is rare but often results in recurrent instability accompanied by discomfort, pain, and limitations in activities. Extra-articular stabilization, which reinforces the anterior capsule of the sternoclavicular joint and prevents anterior displacement of the proximal clavicle at the elevated arm position, could be a viable surgical option for this pathological condition.

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Volar Transfer of the Lateral Band With Transverse Retinacular Ligament for the Correction of Swan Neck Deformity

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

Hand 19 ( 2 ) 241 - 246 2024.03

ISSN  15589447

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Background: This retrospective study was designed to evaluate a surgical treatment for swan neck deformity of the fingers involving the volar transfer of the lateral band using the transverse retinacular ligament. Methods: Ten patients who underwent this surgical procedure for swan neck deformity treatment and were followed up for a mean of 26 months (range: 12-65 months) were included in the study. The dorsally located lateral bands were transferred toward the volar aspect of the finger, and their position was maintained using the transverse retinacular ligament. Improvement of the snapping and swan neck deformity was confirmed by intraoperative active motion of the finger. The active range of motion of the affected finger was evaluated pre- and postoperatively. Results: Extension of the proximal interphalangeal (PIP) joint averaged 30° (range: 20°-40°) preoperatively and improved to -2° (range: -5°-0°) postoperatively. Extension of the distal interphalangeal (DIP) joint averaged -30° (range: -15° to -70°) preoperatively and improved to -15° (range: 0° to -55°) postoperatively. The mean improvement in range of motion of the DIP joint was 15° (range: 10°-25°). The flexion of both the PIP and DIP joint did not significantly change in any of the patients postoperatively. Conclusions: Surgical transfer of the lateral band using the transverse retinacular ligament is effective in correcting mild swan neck deformity. Hyperextension of the PIP joint is corrected well, but the severe extension lag of the DIP joint remains uncorrected postoperatively.

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鎖骨遠位端長斜骨折に対して縫合糸による骨接合を行った1例

廣瀬 怜, 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)  55 ( 臨増号外 ) 141 - 141 2024.03

ISSN  0389-7087

【RAに対する整形外科的治療の動向と進歩2023】手肘における人工関節全置換術の最近の進歩

岩本 卓士

臨床リウマチ ((一社)日本臨床リウマチ学会)  36 ( 1 ) 25 - 31 2024.03

ISSN  0914-8760

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薬物療法の進歩に伴いRA関連手術は減少傾向が見られつつも適応が変化し,小関節手術の需要は高まっている.人工肘関節全置換術では日本においては歴史的に非連結型の開発と成績向上に向けての取り組みがなされており,良好な治療成績が得られている一方で,高率な合併症発生が課題である.これに対して近年はコンピュータ支援手術の導入や手術アプローチの改良が行われている.手関節では2017年より人工関節が臨床使用可能となり,新たな治療選択肢として加わった.複雑な形状を有する手根骨にインプラントを良好な位置に固定することが手技上の重要な点となるため,コンピューター支援手術は重要な役割を果たすと考える.手肘の人工関節は症例数が少ないためインプラントの開発,技術の進歩が進みにくい領域であるが,今後さらに合併症を低減し臨床成績を向上するためには,インプラント及び手術手技のさらなる進歩が期待される.(著者抄録)

上腕骨近位部骨折続発症に対する人工肩関節置換術の治療経験

辻阪 亮介, 松村 昇, 松尾 知樹, 清田 康弘, 鈴木 拓, 岩本 卓士

骨折 ((一社)日本整形外傷学会)  46 ( 2 ) 306 - 310 2024.03

ISSN  0287-2285

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【背景】上腕骨近位部骨折は高齢者に好発する骨折であり,保存的治療で良好な治療成績が期待できる.しかし,偽関節や変形癒合などの骨折続発症が生じた場合,疼痛や著しい機能低下により関節置換が必要となることがある.しかし,本邦での続発症症例に対する手術成績に関する報告は少なく,その有用性については明らかではない.【目的】上腕骨近位部骨折続発症に対する人工肩関節置換術の治療成績を明らかにすること.【研究デザイン】ケースシリーズ.【設定】大学附属病院1施設での後向き研究.【対象】2015～22年に初期治療で保存的治療が選択された上腕骨近位部骨折続発症に対し人工肩関節全置換術を施行し,術後1年以上経過観察が可能であった9例(女性6例,男性3例).平均手術時年齢は75±10歳,受傷から手術までの期間は平均50±104ヵ月,平均経過観察期間19±16ヵ月であった.【曝露】上腕骨近位部骨折続発症のBoileau分類において,type 1の2例に対しては解剖学的人工肩関節が,type 3の4例とtype 4の3例に対しては結節の骨切りを併用したリバース型人工肩関節置換術が選択された.【主要アウトカム】術後の合併症,術前と最終経過観察時での自動可動域,結節癒合率,臨床スコア,合併症を検討した.【結果】肩関節可動域は挙上が術前66±41°から術後115±28°へ,下垂位外旋は術前2±13°から術後22±10°へ改善した.結節の骨切りを行った6例全例で骨癒合が確認できた.最終経過観察時のASESスコアは73点であった.感染症や脱臼などの合併症や再手術となった症例はなかった.【結論】上腕骨近位部骨折続発症9例に対し人工関節置換術を施行し,比較的良好な治療成績が得られた.関節置換で除痛とある程度の機能回復が期待できるが,新鮮例に対する骨接合や関節置換より治療成績が劣るため,初期治療において適切な治療法を選択する必要があると考えられた.(著者抄録)

In-vivo kinematics of the trapeziometacarpal joint in dynamic pinch motion using four-dimensional computed tomography imaging

Inaba N., Oki S., Nagura T., Sato K., Jinzaki M., Iwamoto T., Nakamura M.

Skeletal Radiology 53 ( 1 ) 129 - 140 2024.01

ISSN  03642348

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Objective: CT imaging precisely and quantitatively analyzes the kinematics of the carpal bones to evaluate the etiology of related osteoarthritis. Previous studies have investigated the kinematics of the trapeziometacarpal joint using static CT scans of various postures including the pinch position. This study analyzed the in-vivo kinematics of the trapeziometacarpal joint during dynamic pinch motion in young healthy volunteers using four-dimensional CT. Materials and methods: Twelve healthy young volunteers participated in this study. Each participant held the pinch meter between their thumb and index finger and pinched it with maximum force for a period of 6 s. This series of movement was recorded using a four-dimensional CT. The surface data of the trapezium and first metacarpal of all frames were reconstructed, and bone movement at the trapeziometacarpal joint was calculated using sequential three-dimensional registration. The instantaneous pinch force of each frame was measured using a pointer on a pinch meter that was reconstructed from the CT data. Results: The first metacarpal was abducted (15.9 ± 8.3°) and flexed (12.2 ± 7.1°) relative to the trapezium, and significantly translated to the volar　(0.8 ± 0.6 mm) and ulnar directions (0.9 ± 0.8 mm) with maximum pinch force. This movement consistently increased with the pinch force. Conclusion: This study successfully employed 4D-CT to precisely demonstrate changes in rotation and translation at the trapeziometacarpal joint during pinch motion for various instantaneous forces.

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Three-dimensional Visualization of the Brachial Plexus

Suzuki T., Hayakawa K., Iwamoto T.

Internal Medicine 63 ( 19 ) 2715 2024

ISSN  09182918

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Comprehensive Segmental Revision Systemを用いて再建した人工肘関節再々置換術の1例

肥沼 直子, 岩本 卓士, 望月 猛, 矢野 紘一郎, 猪狩 勝則

関節の外科 (日本リウマチの外科学会)  51 ( 2 ) 91 - 91 2024

ISSN  0285-6255

Augmented reality補助下での人工肘関節置換術により再建した上腕骨遠位部転移性骨腫瘍の1例

佐藤 みのり, 岩本 卓士, 森 智章, 清田 康弘, 鈴木 拓, 松村 昇, 中村 雅也, 丹治 敦

日本肘関節学会雑誌 (日本肘関節学会)  31 ( 1 ) S102 - S102 2024

ISSN  1349-7324

病変の再発と骨折により治療に難渋した肘関節滑膜軟骨腫症の1例

御子柴 直紀, 岩本 卓士, 清田 康弘, 鈴木 拓, 佐藤 和毅

日本肘関節学会雑誌 (日本肘関節学会)  31 ( 1 ) S107 - S107 2024

ISSN  1349-7324

Schwann cell-encapsulated chitosan-collagen hydrogel nerve conduit promotes peripheral nerve regeneration in rodent sciatic nerve defect models

Takeya H., Itai S., Kimura H., Kurashina Y., Amemiya T., Nagoshi N., Iwamoto T., Sato K., Shibata S., Matsumoto M., Onoe H., Nakamura M.

Scientific Reports 13 ( 1 ) 11932 2023.12

ISSN  2045-2322

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Chitosan has various tissue regeneration effects. This study was designed to investigate the nerve regeneration effect of Schwann cell (SC)-encapsulated chitosan-collagen hydrogel nerve conduit (CCN) transplanted into a rat model of sciatic nerve defect. We prepared a CCN consisting of an outer layer of chitosan hydrogel and an inner layer of collagen hydrogel to encapsulate the intended cells. Rats with a 10-mm sciatic nerve defect were treated with SCs encapsulated in CCN (CCN+), CCN without SCs (CCN−), SC-encapsulated silicone tube (silicone+), and autologous nerve transplanting (auto). Behavioral and histological analyses indicated that motor functional recovery, axonal regrowth, and myelination of the CCN+ group were superior to those of the CCN− and silicone+ groups. Meanwhile, the CCN− and silicone+ groups showed no significant differences in the recovery of motor function and nerve histological restoration. In conclusion, SC-encapsulated CCN has a synergistic effect on peripheral nerve regeneration, especially axonal regrowth and remyelination of host SCs. In the early phase after transplantation, SC-encapsulated CCNs have a positive effect on recovery. Therefore, using SC-encapsulated CCNs may be a promising approach for massive peripheral nerve defects.

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Rupture of the Flexor Pollicis Longus Tendon Involved between the Radial Shaft and the Volar Locking Plate

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

JOURNAL OF WRIST SURGERY 12 ( 06 ) 540 - 542 2023.12

ISSN  2163-3916

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Long-standing Ulnar Wrist Pain Caused by an Anatomic Variant of the Ulnar Nerve: A Case Report

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

Jbjs Case Connector 13 ( 4 )  2023.11

ISSN  21603251

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Case:We present a 28-year-old woman with long-standing left ulnar wrist pain. Physical examination revealed severe tenderness over the pisiform; imaging findings were normal. Surgical exploration revealed compression of an aberrant branch, likely Kaplan's accessory branch, around the pisiform. Complete symptom relief was achieved after nerve decompression.Conclusion:Clinical symptoms associated with Kaplan's accessory branch are rare, indicating that many branches may be asymptomatic or overlooked despite the presence of symptoms. Kaplan's accessory branch should be considered as a potential differential diagnosis for refractory ulnar wrist pain.

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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

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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

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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

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＜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

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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

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＜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

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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

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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

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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

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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

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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

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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

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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

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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

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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

上肢二重切断における切断肢再接合術後,橈骨神経断裂に対する神経移植術を施行した1例

原 康, 木村 洋朗, 鈴木 拓, 松村 昇, 岩本 卓士, 中村 雅也, 松本 守雄

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 6 ) 1007 - 1007 2023.04

ISSN  2185-4092

診断に難渋したTFCC損傷によるDRUJロッキングの1例

市川 武, 鈴木 拓, 木村 洋朗, 松村 昇, 岩本 卓士, 中村 雅也, 松本 守雄, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 6 ) 1012 - 1012 2023.04

ISSN  2185-4092

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, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 6 ) 972 - 972 2023.04

ISSN  2185-4092

肘関節鏡視下手術後に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

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 6 ) 1005 - 1005 2023.04

ISSN  2185-4092

肋骨の形態異常が原因の鎖骨下動脈瘤に対して血行再建を行った胸郭出口症候群の2例

鈴木 拓, 武谷 博明, 松尾 知樹, 木村 洋朗, 松村 昇, 岩本 卓士, 佐藤 和毅, 尾原 秀明, 松原 健太郎

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 6 ) 1027 - 1027 2023.04

ISSN  2185-4092

掌側ロッキングプレートに挟まれ橈骨遠位端骨折術後1ヵ月で長母指屈筋腱断裂をきたした一例

平石 優理, 木村 洋朗, 鈴木 拓, 松村 昇, 岩本 卓士, 松本 守雄, 中村 雅也

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 6 ) 1032 - 1032 2023.04

ISSN  2185-4092

Modified Thompson-Littler Method for Chronic Instability of the Proximal Interphalangeal Joint: A Report of Two Cases

Matsuo T., Suzuki T., Kimura H., Iwamoto T.

Journal of Hand Surgery Asian Pacific Volume 28 ( 1 ) 125 - 128 2023.02

ISSN  24248355

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A 40-year-old patient and a 45-year-old patient presented with chronic dorsal and lateral subluxation of the proximal interphalangeal (PIP) joint of the little finger and underwent surgeries. Through a dorsal approach, the ulnar lateral band was transected and transferred to the radial side through the volar side of the PIP joint. The transferred lateral band and the remnant of the radial collateral ligament were secured with an anchor on the radial side of the proximal phalanx. Satisfactory results were obtained without the loss of flexion and recurrence of subluxation of the finger. This method enabled the correction of both dorsal and lateral instability of the PIP joint through a dorsal incision. The modified Thompson-Littler technique was useful for chronic instability of the PIP joint.

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【関節リウマチ手・肘に対する人工関節手術】人工指関節置換術の合併症とその対策

石井 和典, 岩本 卓士

Orthopaedics ((株)全日本病院出版会)  36 ( 2 ) 75 - 82 2023.02

ISSN  0914-8124

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関節リウマチ患者の手指MP関節の尺側偏位に対して関節置換術を施行する際,シリコンインプラントを使用する機会は多い.シリコンインプラントは明らかな関節構造を持たない関節スペーサーとして挿入されるが,手指の疼痛,機能,外観の改善をもたらし,再置換が容易であることから,現時点では最も頻用されているインプラントである.一方でシリコンインプラントは高率に折損が生じることも知られており,代表的な合併症である.折損しても臨床的に問題にならないこともあるが,疼痛や変形の再発があれば再置換術が必要となる.シリコンインプラントの折損率や対策については様々な報告があり一定の見解を得ていないが,当科では折損予防のため術後リハビリテーションにおいて過度のMP関節屈曲を制限することが必要と考えている.加えて,術後の尺側偏位の再発予防のため軟部組織再建も重要である.(著者抄録)

【関節リウマチ手・肘に対する人工関節手術】人工肘関節置換術・人工手関節置換術の合併症と対策

松尾 知樹, 岩本 卓士

Orthopaedics ((株)全日本病院出版会)  36 ( 2 ) 41 - 48 2023.02

ISSN  0914-8124

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人工肘関節置換術・人工手関節置換術は他の人工関節と比べ,合併症率は依然として高く,長期成績についても明らかになっていない点が多い.また近年はインプラントデザインの進化により,その適応は拡大してきており,それに伴い術後の合併症例や再置換術を要する例も増加してきている.安定した良好な長期成績を得るためには,初回手術で適切な関節置換術を行うことが重要である.当科では,適切なインプラント選択,3次元術前計画による正確なインプラント設置,手術手技やアプローチにおける工夫を行ってきており,これらの取り組みが長期的な合併症の低減に寄与すると考えている.本稿では,人工肘関節置換術,人工手関節置換術における主な合併症とそれを予防するための対策について述べる.(著者抄録)

小児上腕骨顆上骨折術後の外反肘により尺骨神経麻痺が遷延したと考えられた1例

伊藤 ゆりか, 木村 洋朗, 鈴木 拓, 松村 昇, 岩本 卓士, 中村 雅也

日本肘関節学会雑誌 (日本肘関節学会)  30 ( 1 ) S146 - S146 2023.02

ISSN  1349-7324

腱鞘滑膜におけるアミロイド沈着の検討

武谷 博明, 岩本 卓士, 木村 洋朗, 鈴木 拓, 松村 昇, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  39 ( 5 ) 663 - 667 2023.02

ISSN  2185-4092

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手根管症候群(carpal tunnel syndrome:CTS)は心アミロイドーシスのearly red-flagと言われている.当院で循環器内科と連携し術中に腱鞘滑膜組織を切除し,病理組織学的検討を行った症例を報告する.2019年1月から2021年7月の間に当院で術中に腱鞘滑膜組織を切除し,病理組織学的検討を行った22例(循環器内科依頼10例,術中に腱鞘滑膜増生を認めスクリーニングとして組織検査を施行した症例12例)を対象とした.平均年齢は68(45-91)歳,性別は男性12例,女性10例,手術はCTS12例,手指腱鞘炎6例,CTSと手指腱鞘炎同時手術4例であった.循環器内科依頼症例は10例全例がアミロイド陽性であった.スクリーニング症例は12例中4例がアミロイド陽性で,1例が早期心アミロイドーシスであった.手外科疾患手術時の滑膜組織のスクリーニング検査はアミロイドーシス早期診断に有用である.(著者抄録)

特発性前骨間神経麻痺に対する神経束間剥離術の治療成績および予後因子の検討

松尾 知樹, 木村 洋朗, 鈴木 拓, 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)  39 ( 5 ) 639 - 642 2023.02

ISSN  2185-4092

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特発性前骨間神経麻痺(sAINP)の保存治療抵抗例に対して,神経束間剥離術(IN)が広く行われているが,その有効性や予後について不明な点が多い.sAINPに対するINの治療成績およびその予後因子を明らかにすることを目的として調査を行った.当院で,臨床所見と電気生理学検査により最終的にsAINPと診断され,INを施行した症例16例を後ろ向きに調査した.最終観察時において全MMT3以上の改善を認めた改善群は14例(88%)であった.非改善群は2例存在し,共にくびれの狭窄率が0.75以上であり,改善群と比較し高度な狭窄を認めた.また改善群において,発症後回復期間は平均14.5ヵ月であり,喫煙歴ありの症例で有意に長く(p=0.006),また術前待機期間との正の相関を認めた(相関係数r=0.83,p<0.001).sAINPに対するINの成績は良好であり,喫煙歴,術前待機期間,くびれの狭窄率は予後因子になる可能性が示唆された.(著者抄録)

Excision of the hook of hamate in athletes using the carpal tunnel approach

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

Journal of Orthopaedic Science 28 ( 1 ) 143 - 146 2023.01

ISSN  09492658

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Background: Hook of the hamate fractures can be managed conservatively or fixed using a screw, but excision is recommended for prompt return to activities. Although various approaches have been described, there is no gold standard. Herein, the authors have described their clinical experiences in excising the hook of the hamate using the carpal tunnel approach, in athletes. Methods: A total of 36 athletes underwent excision of the hamate hook using the carpal tunnel approach. The mean age of the patients was 23 years, and most of them were baseball players (n = 31). Results: The mean operation time was 33 min. None of the patients presented with any complications aside from transient pillar pain in five cases. All of them returned to their sports activities within an average of 27 days. Conclusions: In our study, excision of the hook of the hamate was performed safely via the carpal tunnel. The carpal tunnel approach reportedly provides superior benefits over other approaches.

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In Vivo Metacarpophalangeal Joint Kinematics After Silicone Implant Arthroplasty in Patients With Rheumatoid Arthritis

Ishii K., Iwamoto T., Oki S., Nagura T., Matsumoto M., Nakamura M.

Journal of Hand Surgery 48 ( 1 ) 88 - 88.e11 2023.01

ISSN  03635023

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Purpose: The aim of this study was to determine the potential mechanism of implant fracture using 3-dimensional motion analysis of patients with rheumatoid arthritis. Methods: Active flexion motion in 9 hands (34 fingers) of 6 female patients with rheumatoid arthritis who previously underwent hinged silicone metacarpophalangeal joint arthroplasty was examined using 4-dimensional computed tomography. Positions of the proximal phalanges relative to the metacarpals were quantified using a surface registration method. The deformation of the silicone implant was classified in the sagittal plane in the maximum flexion frame. The longitudinal bone axis of the proximal phalanx and the helical axis of the proximal phalanx were evaluated in 3-dimensional coordinates based on the hinge of the silicone implant. Results: Nineteen fingers were classified into group 1, in which the silicone implant moved volarly during flexion without buckling of the distal stem. Twelve fingers were classified into group 2, in which the distal stem of the silicone implant buckled. Three fingers were classified into group 3, in which the base of the distal stem had already fractured. Quantitatively, the longitudinal bone axes of the proximal phalanges were displaced from dorsal to volar in the middle stage of flexion and migrated in the proximal direction in the late phase of flexion. The helical axes of the proximal phalanges were located on the dorsal and proximal sides of the hinge, and these tended to move in the volar and proximal directions as the metacarpophalangeal joint flexed. Conclusions: Volar and proximal translation of the proximal phalange was observed on 4-dimensional computed tomography. Clinical relevance: Proximal displacement of the bone axis late in flexion appears to be a contributing factor inducing implant fractures, because the pistoning motion does not allow the implant to move in the proximal direction.

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COVID-19 Vaccination-associated Thoracic Outlet Syndrome

Suzuki T., Furuhata R., Iwamoto T.

Internal Medicine 62 ( 1 ) 143 - 145 2023

ISSN  09182918

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肘部管症候群手術症例の臨床的・電気生理学的特徴と治療成績への影響

木村 洋朗, 松尾 知樹, 鈴木 拓, 佐藤 和毅, 岩本 卓士

日本肘関節学会雑誌 (日本肘関節学会)  30 ( 2 ) 357 - 360 2023

ISSN  1349-7324

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肘部管症候群手術症例を対象に,臨床的特徴や電気生理学的所見,術後成績に及ぼす因子について検討を行った.対象は71肘で,平均年齢59歳,男性44肘,女性27肘,利き手44肘,非利き手27肘,平均BMI25kg/m2,平均罹病期間13ヵ月,糖尿病合併11肘,頸椎疾患合併19肘,変形性肘関節症18肘,McGowan分類はI度9肘,II度23肘,III度39肘,術者5名,術式は単純除圧16肘,King変法5肘,前方移動術50肘であった.術後2年時点におけるMessina評価基準は優7肘,良28肘,可30肘,不可6肘であり,統計学的に有意な相関を認めたのは術前McGowan分類のみであった.また,電気生理学的検査では7例がインチング法のみで伝導異常を認めた.術前重症度が手術成績に影響することが示され,また,肘上下の伝導速度や振幅に異常を認めない場合にはインチング法が有用であると考えられた.(著者抄録)

Risk factors of radiographic severity of massive rotator cuff tear

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

Scientific Reports 12 ( 1 ) 13567 2022.12

ISSN  2045-2322

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As massive rotator cuff tears progress, various radiographic changes occur; however, the factors associated with radiographic changes remain largely unknown. This study aimed to determine the factors that affect radiographic severity in massive rotator cuff tears using multivariate analyses. We retrospectively reviewed 210 shoulders with chronic massive rotator cuff tears. The dependent variables were superior migration of the humeral head (Hamada grades 2–3), narrowing of the glenohumeral joint (grade 4), and humeral head collapse (grade 5). Baseline variables that were significant in univariate analyses were included in multivariate models. There were 91, 59, 43, and 17 shoulders classified as Hamada grades 1, 2–3, 4, and 5, respectively. Multivariate analysis showed that infraspinatus tear (P = 0.015) and long head of biceps (LHB) tendon rupture (P = 0.007) were associated with superior migration of humeral head. Superior subscapularis tear (P = 0.003) and LHB tendon rupture (P < 0.001) were associated with narrowing of glenohumeral joint. Female sex (P = 0.006) and superior subscapularis tear (P = 0.006) were associated with humeral head collapse. This study identified the rupture of infraspinatus and LHB as risk factors of superior migration of humeral head, and the rupture of subscapularis and LHB and female sex as risk factors of cuff tear arthropathy.

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上腕骨内側上顆炎に対するPRP療法の治療およびMRI画像成績

鈴木 拓, 早川 克彦, 中根 高志, 武谷 博明, 松尾 知樹, 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 ( 2 ) 222 - 224 2022.12

ISSN  1349-7324

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【目的】上腕骨内側上顆炎に対するPRP療法の臨床成績,MRI画像成績について報告する.【対象と方法】上腕骨内側上顆炎に対してPRP療法を施行した5例を対象とした.評価はPRP療法施行前,施行後1,3,6,12ヵ月時の疼痛(VAS),握力健側比,屈筋腱付着部のMRI像に関して調査した.MRIの評価は正常(0),軽度(1),中程度(2),重度(3)の4段階にて評価した.【結果】PRP療法施行前,施行後1,3,6,12ヵ月における平均VASは78→68→50→35→20,平均握力健側比も75→83→89→93→95%と経時的に低下し,MRI評価も1.6→1.0→0.4→0.2→0.2と治療前と比べて改善した.【考察】上腕骨内側上顆炎に対するPRP療法は臨床成績,画像成績共に良好であった.(著者抄録)

胸郭出口症候群に対するparaclavicular approachを用いた第1肋骨切除術の臨床成績

鈴木 拓, 木村 洋朗, 松村 昇, 武谷 博明, 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)  39 ( 3 ) 328 - 330 2022.12

ISSN  2185-4092

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胸郭出口症候群(血管性3例,神経性2例)に対して,鎖骨上と鎖骨下のparaclavicular approachによる第1肋骨切除術を施行した.術後,全例,術前の症状は軽快し,Derkash評価では,優3例,良2例であった.術前,造影CTによる鎖骨下動脈の圧迫の所見を認めた3例も,術後に圧迫は改善した.本法は,特殊な機器も必要なく,技術的にも比較的容易である.その成績は概ね良好であるが,侵襲も大きく,適応は慎重に検討する必要がある.(著者抄録)

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 ( 2 ) 85 - 89 2022.12

ISSN  1349-7324

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【目的】尺骨鉤状突起低形成による後外側不安定性に対して腸骨移植を用いた鉤状突起再建と外側側副靱帯縫合術を行った1例を報告する.【症例】13歳,男児.1年前より左肘可動時に違和感が持続するが近医では診断がつかず,改善がないために当院紹介受診となった.肘関節伸展時に脱臼感を認めた.画像所見では,両側尺骨鉤状突起低形成とCTや伸展位での単純X線で左肘関節後方脱臼を認めた.尺骨鉤状突起低形成による後外側不安定性と診断し,腸骨を用いた鉤状突起再建と弛緩した外側側副靱帯を縫縮した.術後18ヵ月の観察時に再脱臼は認めず,骨癒合も得られ良好な経過であった.【考察】鉤状突起低形成を認める症例において,腸骨移植による鉤状突起の再建ならびに外側側副靱帯縫合によって肘関節の安定性が獲得できた.また通常のX線撮影は肘関節屈曲位で施行するため,本病態を疑った場合は,CTや伸展位のX線が有用であった.(著者抄録)

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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＜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.

Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

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

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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

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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

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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)

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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【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)

胸鎖関節前方不安定症に対して関節外制動を行った2例

小林 高之, 松村 昇, 田崎 篤, 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 ) 141 - 141 2021.03

ISSN  0389-7087

Quantitative analysis of metacarpophalangeal joints during active flexion using four-dimensional computed tomography

Ishii, K; Oki, S; Iwamoto, T; Jinzaki, M; Nagura, T; Matsumoto, M; Nakamura, M

CLINICAL BIOMECHANICS 80 2020.12

ISSN  0268-0033

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生物学的製剤時代における関節リウマチに対する上肢手術の傾向

久島 雄宇, 岩本 卓士, 木村 洋朗, 鈴木 拓, 松村 昇, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  37 ( 2 ) 152 - 156 2020.12

ISSN  2185-4092

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2012年1月から2019年7月に当院整形外科で関節リウマチに対する上肢手術を行った505例を対象として,術式,生物学的製剤使用率,抗リウマチ薬使用率,ステロイド製剤使用率,術後合併症(感染,再置換)について調査を行った.結果から,当院では関節リウマチ関連上肢手術は減少傾向にはなく,明らかな増減傾向を示す術式はなかった.生物学的製剤は62%の症例で使用されていたが術後感染症例は0.8%と少なく,生物学的製剤使用下でも比較的安全に手術は実施可能であった.関節リウマチ患者の日常生活動作が向上していることから上肢領域では手指変形に対する手術を中心に現在でも高い需要があると考えられた.また人工関節再置換例が散見され,初回手術では再置換を念頭に置いた治療戦略が必要である.(著者抄録)

Acute blocking of forearm supination secondary to tearing of the triangular fibrocartilage complex

Suzuki, T; Nakamura, T; Tanino, Y; Obara, Y; Yoshikawa, Y; Iwamoto, T

JOURNAL OF HAND SURGERY-EUROPEAN VOLUME 45 ( 9 ) 939 - 944 2020.11

ISSN  1753-1934

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Smoking cessation increases levels of osteocalcin and uncarboxylated osteocalcin in human sera

Kiyota, Y; Muramatsu, H; Sato, Y; Kobayashi, T; Miyamoto, K; Iwamoto, T; Matsumoto, M; Nakamura, M; Tateno, H; Sato, K; Miyamoto, T

SCIENTIFIC REPORTS 10 ( 1 )  2020.10

ISSN  2045-2322

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ロッククライミングにより生じたPIP関節屈曲拘縮の1例

飯塚 藍, 岩本 卓士, 鈴木 拓, 松村 昇, 佐藤 和毅, 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)  51 ( 5 ) 383 - 387 2020.10

ISSN  0389-7087

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34歳男性。ロッククライミング中に左小指の断裂音と疼痛を認めるも放置し、ロッククライミングを継続していた。その後、徐々にPIP関節の伸展障害を生じたため、受傷後7ヵ月で当科を受診した。病歴、身体所見および画像所見から、A3腱鞘断裂およびA2、A4腱鞘部分断裂によるclimber's fingerを受傷し、陳旧化したことにより生じたPIP関節屈曲拘縮と診断し、PIP関節授動術およびA3腱鞘断裂の再建術を行った。術後1年の時点で屈曲拘縮は認めず、競技に完全復帰することができた。

胸郭出口症候群における造影3D-CTと血管造影検査の比較

鈴木 拓, 木村 洋朗, 松村 昇, 岩本 卓士

臨床整形外科 ((株)医学書院)  55 ( 10 ) 1169 - 1172 2020.10

ISSN  0557-0433

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＜文献概要＞圧迫型の胸郭出口症候群2例に対して,造影3D-CTと血管造影を施行し,絞扼部位を評価した.造影3D-CTは血管造影と比較して絞扼部位の診断に関しては劣るものではなく,低侵襲で有用な検査であると思われた.

リバース型人工肩関節置換術後に仮性動脈瘤を生じた1例

三輪 祐揮, 松村 昇, 木村 洋朗, 鈴木 拓, 岩本 卓士, 中村 雅也, 松本 守雄

東日本整形災害外科学会雑誌 (東日本整形災害外科学会)  32 ( 3 ) 400 - 400 2020.08

ISSN  1342-7784

上腕骨近位部転移性骨腫瘍に対してリバース型人工肩関節置換術を施行した2例

丹羽 隆文, 松村 昇, 小林 英介, 丹澤 義一, 木村 洋朗, 鈴木 拓, 中山 ロバート, 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)  51 ( 4 ) 352 - 358 2020.08

ISSN  0389-7087

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症例1(63歳男性)。右腎癌と両側副腎転移に対する右腎部分切除、両側副腎腫瘍摘出術後より左肩関節痛が出現し、徐々に疼痛が増強したため当院へ受診となった。所見では自動挙上は30°と著明に制限され、画像所見より病的骨折を伴った左上腕骨近位部腎癌骨転移と診断された。治療として腫瘍切除とリバース型人工肩関節置換術を行った結果、術後1年3ヵ月経過で自動挙上は140°に改善し、疼痛もみられていない。症例2(76歳女性)。子宮平滑筋肉腫に対する子宮全摘術+両側付属器切除術後に左肩関節痛が生じ、当科へ受診となった。精査により左上腕骨近位部への骨転移と診断され、腫瘍切除とリバース型人工肩関節置換術を行った結果、術後1年経過現在、肩関節の疼痛や合併症はみられていない。

示指深指屈筋腱皮下断裂に対して端端縫合術を施行した1例

小野 匠, 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)  51 ( 3 ) 99 - 102 2020.06

ISSN  0389-7087

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67歳男性。右示指痛と屈曲障害を主訴とした。毛抜きで右示指に力を入れた際に指尖部で音がした後に疼痛と屈曲障害が出現した。右示指の遠位指節間(DIP)関節の自動屈曲が不能で、MRIで骨傷を伴わない屈筋腱の裂離損傷を認めた。Zone 1とzone 3での断裂を疑い、受傷後19日に手術を施行した。深指屈筋腱はzone 3で断裂し、近位断裂はzone 4まで短縮していた。断裂の不整を認めたため、新鮮化を行った。近位および遠位断端に間隙を認めたが、断端を牽引すると無理なく縫合できたため、津下法を用いて端端縫合術を行った。術後経過は良好で、術後10ヵ月にDIP関節は屈曲70°、伸展0°に改善し、PIP関節やMP関節の伸展制限を認めなかった。

筋弁を併用したMasquelet法で髄内釘を温存できた脛骨開放骨折術後感染の1例

佐藤 大輝, 大木 聡, 鈴木 拓, 松村 昇, 岩本 卓士, 佐藤 和毅, 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)  51 ( 3 ) 210 - 214 2020.06

ISSN  0389-7087

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78歳男性。1.5mの高さから転落し、右下腿を受傷した。前医で右脛骨骨幹部開放骨折Gustilo分類type Iと診断され、洗浄処置と外固定が施行された。受傷後4日に髄内釘による観血的整復術が施行されたが、受傷後11日に脛骨近位骨折部の創離開、表皮壊死と液体貯留が出現した。術後感染と診断されたため、当科紹介受診となった。X線で良好な骨折部固定性を認め、感染は骨折部に限局していると考えられた。受傷後13日にデブリードマンを施行し、最大5.2cmの骨欠損が生じた。髄内釘は温存可能と判断し、骨欠損部に対しMasquelet法に準じてVCM含有セメントを充填した。軟部組織欠損部に対しては腓腹筋内側頭の筋弁術を施行した後、筋弁上に分層植皮術を施行した。術後10週に腸骨から採取した自家海綿骨と人工骨を混合し、骨欠損部に充填した。その後1年が経過したが、CTで良好な骨癒合を認め、2kmの連続歩行が可能であった。

Centerlineを用いたone portal鏡視下手根管開放術の小経験

木村 洋朗, 鈴木 拓, 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)  36 ( 6 ) 954 - 958 2020.04

ISSN  2185-4092

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Centerline Endoscopic Carpal Tunnel Release System(以下Centerline)を用いたone portal鏡視下手根管開放術の小経験について報告する.対象は保存加療に抵抗性の手根管症候群20手で,手術時平均年齢は66.7歳であった.経過観察期間中(平均19.6週)に18手で臨床症状の改善が得られた.術中に明らかな神経・血管・腱損傷は認めなかったが,1例で術後に第3総掌側指神経領域の知覚障害が出現した.Centerlineはpull bladeが一体型となった外套管に専用の斜視鏡を接続して使用するため,片手で操作することが可能である.そのため,既存の機器と比較して扱いが容易であり助手を必要としないなど優れた点を有するが,使用にあたっては本製品の特徴を十分に周知した上で適応を判断し,安全な手術を心掛けることが重要である.(著者抄録)

橈骨遠位端骨折に対する掌側ロッキングプレート固定後の抜釘による満足度の検討

萩原 健, 鈴木 拓, 松村 昇, 西脇 正夫, 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)  36 ( 6 ) 920 - 923 2020.04

ISSN  2185-4092

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橈骨遠位端骨折に対して掌側ロッキングプレートによる内固定を行った症例で,抜釘術後の自覚症状と満足度を検討した.2011年から2018年の間に掌側ロッキングプレートにより治療を行った橈骨遠位端骨折症例156例156手中,術後6ヵ月以降に抜釘を行った102例102手を対象とした.評価は(抜釘をしてよかった・かわらなかった・よくなかった)(手関節や創部の疼痛・手指の違和感・手指のしびれの有無)を記載する独自のアンケートにて行った.抜釘前症状の有無,プレートの設置位置が遠位設置か近位設置かによってそれぞれを2群に分け,抜釘後の満足度を比較検討した.結果はよかったと回答したのは21例(20%)であった.術前に症状があったのは29例で,抜釘をしてよかったと回答したのは13例,そのうち12例は症状が改善していた.遠位設置群は24例で,よかったと回答したのは9例(38%)であった.遠位設置群で有症状であった5例はすべて術後に症状が消失した.抜釘前有症状の群が無症状の群よりも有意に満足度が高くなり,遠位設置の群が近位設置の群よりも有意に満足度が高くなった.術後の合併症には手関節痛の出現,術後出血,再骨折,しびれの出現をそれぞれ1例ずつ認めた.抜釘前に症状のある症例や,遠位設置プレートの症例に対して,抜釘術は有用と考えられた.(著者抄録)

Clinical Results of Surgical Resection and Histopathological Evaluation of Synovial Chondromatosis in the Shoulder: A Retrospective Study and Literature Review

Utashima, D; Matsumura, N; Suzuki, T; Iwamoto, T; Ogawa, K

CLINICS IN ORTHOPEDIC SURGERY 12 ( 1 ) 68 - 75 2020.03

ISSN  2005-291X

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後方転位した鎖骨近位端骨折に対して骨接合を行った1例

水越 諒, 加藤 知行, 松村 昇, 鈴木 拓, 岩本 卓士, 佐藤 和毅

骨折 ((一社)日本整形外傷学会)  42 ( 2 ) 420 - 423 2020.03

ISSN  0287-2285

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鎖骨近位端骨折に対して骨接合を施行し、良好な成績が得られた1例を経験したので報告する。症例は34歳、男性。階段から転落して受傷し、右胸鎖関節部痛を自覚した。画像検査で遠位骨幹部骨片が後方に転位した鎖骨近位端骨折を認め、観血的整復固定術を施行した。術後6ヵ月のCTで後方転位なく、経過良好である。鎖骨近位端骨折は全鎖骨骨折の2.8%と稀な骨折である。転位を認める場合手術適応となるが、特に後方への転位は気管食道瘻など縦隔臓器合併症をきたしうる。今回の症例は近位骨片が小さく、後方へ転位していたため、遠位骨片はスクリューで制動し、近位骨片をアームで保持することで、後方転位を生じることなく良好な経過をたどった。(著者抄録)

掌側板およびPIP関節側副靱帯損傷に対し浅指屈筋腱を用いて靱帯再建をした1例

御子柴 直紀, 大木 聡, 岩本 卓士, 佐藤 和毅, 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)  51 ( 1 ) 1 - 5 2020.02

ISSN  0389-7087

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29歳女性。左小指の近位指節間(PIP)関節の痛みと変形を主訴に当院へ紹介受診となった。身体所見および画像所見から陳旧性掌側板損傷とPIP関節橈側側副靱帯損傷によるスワンネック変形と診断され、浅指屈筋腱を用いた靱帯再建術が行なわれた。更に術後2週よりは小指のPIP関節の伸展と尺屈を防止する様に伸展ブロックの状態で環指と小指をオーバーラップしてテーピングした上で可動域訓練が行なわれた。その結果、術後18ヵ月の最終観察時に尺側偏位・スワンネック変形は改善し、PIP関節可動域は屈曲90°、伸展0°と良好な可動域と関節安定性が保たれた。

示指深指屈筋腱皮下断裂に対して端端縫合を施行した1例

小野 匠, 鈴木 拓, 木村 洋朗, 松村 昇, 岩本 卓士, 中村 雅也, 松本 守雄, 佐藤 和毅

関東整形災害外科学会雑誌 (関東整形災害外科学会)  51 ( 1 ) 31 - 31 2020.02

ISSN  0389-7087

PIP関節掌側板裂離骨折に対する経皮的鋼線固定術

鈴木 拓, 松村 昇, 木村 洋朗, 岩本 卓士, 早川 克彦, 佐藤 和毅

骨折 ((一社)日本整形外傷学会)  42 ( 1 ) 15 - 18 2020.01

ISSN  0287-2285

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PIP関節掌側板裂離骨折は、保存的に加療されることが多いが、骨片が大きい症例や転位の強い症例は成績不良の症例も散見される。我々はPIP関節掌側板裂離骨折に対し、経皮的に鋼線を用いて整復および固定術を施行したので、その臨床成績を報告する。骨片の大きさが関節面の25～40%で転位のある症例に対して本法を施行した7例を対象とした。手術はK-wireを用いて経皮的に骨片を整復し、同骨片を掌側から経皮的にK-wireを用いて固定した。後療法は、術後1週以内に手指の可動域訓練を開始した。最終観察時において全例、骨癒合を認め、PIP関節の疼痛は認めなかった。術後平均自動運動可動域はPIP関節が屈曲95°、伸展-3°、DIP関節が屈曲73°、伸展0°であった。本法は経皮的に行うことが可能で比較的良好な成績が得られ、低侵襲である。骨片が比較的大きく、転位のある症例に対しては治療の選択肢として考慮してもよいと考えられた。(著者抄録)

スワンネック変形に対する新しい手術法　横支靱帯を用いた側索掌側移動術

佐藤 雅洋, 鈴木 拓, 岩本 卓士, 鳥居 暁子, 名倉 重樹, 加藤 知行, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  36 ( 4 ) 634 - 634 2020.01

ISSN  2185-4092

橈骨矯正骨切り術における採骨後に腸骨脆弱性骨折を生じた1例

名倉 重樹, 岩本 卓士, 加藤 知行, 鈴木 拓, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  36 ( 4 ) 649 - 649 2020.01

ISSN  2185-4092

手指変形性関節症における示指環指比の検討

石井 和典, 岩本 卓士, 稲葉 尚人, 林 健太郎, 寺坂 幸倫, 佐藤 和毅

日本手外科学会雑誌 ((一社)日本手外科学会)  36 ( 3 ) 344 - 347 2019.12

ISSN  2185-4092

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手指関節痛を有し当院外来を受診した女性患者における示指環指比を測定し,統計学的検討をおこなった.本研究では症候性の手指変形性関節症(HOA)群ではControl群と比較してType 3(示指<環指)の割合が多く,両群ともにType 1(示指>環指)の割合が少なかった.HOA群のOAスコアはType 3でType 2(示指=環指)よりも高値であったが有意差は認められなかった.第2/第4中手骨長の比とOAスコアの間には,前期高齢者群では正の相関を認め,後期高齢者群では負の相関を認めた.肢位によっては示指環指比の判別が困難であること,症例数の少なさが本研究における課題であった.(著者抄録)

後方転位した鎖骨近位端骨折に対して骨接合を行った1例

水越 諒, 加藤 知行, 松村 昇, 鈴木 拓, 岩本 卓士, 佐藤 和毅

骨折 ((一社)日本整形外傷学会)  41 ( Suppl. ) S268 - S268 2019.06

ISSN  0287-2285

The relationship between the morphological axis and the kinematic axis of the proximal radius

Oki S., Inaba N., Matsumura N., Iwamoto T., Yamada Y., Jinzaki M., Nagura T.

Surgical and Radiologic Anatomy (Surgical and Radiologic Anatomy)  41 ( 4 ) 423 - 429 2019.04

ISSN  09301038

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© 2018, Springer-Verlag France SAS, part of Springer Nature. Purpose: Surgical procedures for impaired forearm rotation such as for chronic radial head dislocation remain controversial. We hypothesized that the morphological axis of the proximal radius is important for stable forearm rotation, and we aimed to clarify the relationship between the morphological axis and the kinematic axis of the proximal radius using four-dimensional computed tomography (4DCT). Methods: Ten healthy volunteers were enrolled. Four-dimensional CT of the dominant forearm during supination and pronation was obtained. The rotation axis of forearm rotation was calculated from all frames during supination and pronation. The principle axis of inertia, which represents the most stable rotation axis of a rigid body, was calculated for the proximal radius by extending its surface data incrementally by 1% from the proximal end. The angle between the kinematic rotation axis and the morphological rotation axis of each length was calculated. Results: The rotation axis of the forearm was positioned on the radial head 0.0 mm radial and 0.4 mm posterior to the center of the radial head proximally and 2.0 mm radial and 1.2 mm volar to the fovea of the ulnar head distally. The principle axis at 15.9% of the length of the proximal radius coincided with the forearm rotation axis (kinematic axis). Individual differences were very small (SD 1.4%). Conclusion: Forearm rotation was based on the axis at 16% of the length of the proximal radius. This portion should be aligned in cases of severe morphological deformity of the radial head that cause “rattling motion” of the radial head after reduction procedures.

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Total finger joint arthroplasty with a costal osteochondral autograft: up to 11 years of follow-up

Sato K., Iwamoto T., Matsumura N., Suzuki T., Nishiwaki Y., Nakamura T.

Journal of Hand Surgery: European Volume (Journal of Hand Surgery: European Volume)  44 ( 2 ) 167 - 174 2019.02

ISSN  17531934

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© The Author(s) 2018. The purpose of this study was to evaluate the mid- to long-term clinical outcomes of total finger joint arthroplasty using a costal osteochondral autograft for joint ankylosis. Twenty-three joints (three metacarpophalangeal joints, 20 proximal interphalangeal joints) in 23 patients (19 men and four women) were treated with a costal osteochondral autograft and were evaluated after a mean follow-up of 77 months (60–138). Mean age was 33 years (18 to 55). Significant improvement in active finger extension/flexion was seen from a preoperative mean of −24°/26° (arc: 2°) to −13°/75° (arc: 63°) at latest follow-up. Mean preoperative Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand score was initially 24 and improved significantly to 5 at latest follow-up. Conclusion: total finger arthroplasty using a costal osteochondral autograft gave an anatomical and biological reconstruction and provided stable improvement at a mean follow-up of 77 months. Level of evidence: IV.

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Normal value and range of the humerus-elbow-wrist angle in a sample of healthy children with even distributions of age, sex, and laterality

Inaba N., Suzuki T., Iwamoto T., Matsumura N., Oki S., Nishiwaki M., Nakamura M., Matsumoto M., Sato K.

Journal of Pediatric Orthopaedics Part B (Journal of Pediatric Orthopaedics Part B)  28 ( 1 ) 57 - 61 2019.01

ISSN  1060152X

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© 2018 Wolters Kluwer Health, Inc. All rights reserved. This study was performed to evaluate the normal value of the humerus-elbow-wrist angle (HEWA) 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 with even distributions of age, sex, and laterality were reviewed. The mean HEWA was 12.1° (range: 5°-20°). The value of HEWA was significantly associated with increasing age. Neither sex nor side showed significant differences for the HEWA. The data should be useful for postoperative radiographic assessment of cubitus varus or valgus deformities.

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Computed tomography–based 3-dimensional preoperative planning for unlinked total elbow arthroplasty

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

Journal of Shoulder and Elbow Surgery (Journal of Shoulder and Elbow Surgery)  27 ( 10 ) 1792 - 1799 2018.10

ISSN  10582746

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© 2018 Journal of Shoulder and Elbow Surgery Board of Trustees Hypothesis: Three-dimensional (3D) surgical planning for unlinked total elbow arthroplasty (TEA) would be helpful for estimation of the implant size and accurate placement of implants. Methods: We included 28 patients who underwent TEA with an unlinked total elbow implant in this study. All patients underwent computed tomography scans of the elbow before surgery, and a 3D digital model of the elbow was reconstructed. After the appropriate size and position of the prosthesis were determined, 10 points around the bone tunnel (4 on the humerus and 6 on the ulna) were measured to plan the insertion of the humeral and ulnar stems. Two-dimensional planning was also performed using anteroposterior and lateral radiographs. Intraoperatively, the surgeon measured the planned parameters using a slide gauge to reproduce the 3D planned position of the stem insertion. Results: The stem sizes were accurately estimated in 57% of patients for the humerus and 68% for the ulna with 2-dimensional planning and in 86% for the humerus and 96% for the ulna with 3D planning. The mean differences between the positions of the prostheses after surgery with reference to the planned positions were 0.8° of varus and 1.5° of flexion for the humeral component and 0.7° of varus and 2.9° of flexion for the ulnar component. We did not evaluate rotational positioning in this study. Conclusions: The 3D surgical planning allowed accurate estimation of the implant size and appropriate placement of implants. This method may contribute to a reduced incidence of complications and improved long-term outcomes from TEA.

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Surgical Treatment for Chronic Tendon Mallet Injury

Suzuki T., Iwamoto T., Sato K.

Journal of Hand Surgery (Journal of Hand Surgery)  43 ( 8 ) 780.e1 - 780.e5 2018.08

ISSN  03635023

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© 2018 American Society for Surgery of the Hand A variety of surgical options for chronic tendon mallet fingers have been reported. There are advantages and disadvantages to current surgical approaches. We introduce a surgical treatment for chronic tendon mallet injury that involves anatomical reconstruction of the terminal tendon and lateral band with palmaris longus (PL) tendon grafting. Harvested PL tendon is folded in 2 or divided into 2 slips. The graft is attached to a remnant of the original terminal tendon at the distal interphalangeal joint. Both half-slip tendons are passed under the transverse retinacular ligament and sutured side to side to the lateral band at the level of the proximal phalanx. This surgical technique has these advantages: (1) it provides anatomical reconstruction of the terminal tendon; (2) it is indicated regardless of the condition of the terminal tendon and the interval from the initial injury; and (3) it is easy to determine the tension of the grafted tendon. Anatomical reconstruction of the terminal tendon and both lateral bands with PL tendon grafting is useful for chronic tendon mallet injury.

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Costal osteochondral autograft for advanced osteochondritis dissecans of the humeral capitellum in adolescent and young adult athletes clinical outcomes with a mean follow-up of 4.8 years

Sato K., Iwamoto T., Matsumura N., Suzuki T., Nishiwaki Y., Oka Y., Nakamura T.

Journal of Bone and Joint Surgery - American Volume (Journal of Bone and Joint Surgery - American Volume)  100 ( 11 ) 903 - 913 2018

ISSN  00219355

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Copyright © 2018 By The Journal Of Bone And Joint Surgery, Incorporated. Background: Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. The purpose of this study was to clarify longer-term clinical outcomes of costal osteochondral autografts in the treatment of advanced osteochondritis dissecans of the humeral capitellum. Methods: Seventy-two patients with an osteochondral defect of the humeral capitellum were treated with costal osteochondral autograft and followed for a minimum of 3 years (mean follow-up, 57 months; range, 36 to 147 months). The mean patient age was 14.3 years. Clinical outcomes, including elbow range of motion, Timmerman and Andrews clinical rating score, donor-site morbidity, responses to a questionnaire regarding a return to sporting activities, and radiographic findings, were evaluated. Results: The mean elbow range of extension/flexion increased significantly, from 221/122 preoperatively to 24/ 136 postoperatively (p < 0.001). The mean clinical rating score improved significantly, from 101 to 190 by the latest follow-up (p < 0.001). The overall clinical score-based assessment was excellent for 60 patients, good for 9, and fair for 3. Seventy of the 72 patients returned to their original sport. The remaining 2 patients had changed sporting activities before surgery and did not return to baseball, despite satisfactory clinical results. Conclusions: Costal osteochondral autograft successfully achieved anatomical and biological reconstruction in the treatment of advanced osteochondritis dissecans of the humeral capitellum.

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The History and Future of Unlinked Total Elbow Arthroplasty

Iwamoto, T., Ikegami, H., Suzuki, T., Oki, S., Matsumura, N., Nakamura, M., Matsumoto, M. and Sato, K.

Keio J Med (Keio Journal of Medicine)  67 ( 2 ) 19 - 25 2017.08

ISSN  0022-9717

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Unlinked total elbow arthroplasty (TEA), which has no mechanical connection between the humeral and ulnar components, has theoretical advantages based on its near-normal elbow kinematics and the preservation of bone stock. Unlinked TEA is appropriate only for patients who have limited bone loss or limited deformity and good ligamentous function. This is because postoperative instability has been a major complication of unlinked prostheses. The concept and goal of unlinked TEA is to share the loading stress on the bone implant interface with the surrounding tissues. Although the loosening rate of unlinked prostheses theoretically should be lower than that of linked prostheses (which have a mechanical connection between the humeral and ulnar components), there is no clear evidence that unlinked TEAs are superior to linked TEAs in this respect. However, we believe that primary TEA should be performed using an unlinked TEA, especially for younger patients, because revision surgery for unlinked TEA results in longer prosthesis survival than revision surgery for linked TEA. Improvement of the design of unlinked prostheses and the introduction of less invasive surgical techniques are required to reduce postoperative instability.

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Migration of a Kirschner wire into the lung with shoulder dislocation

Suzuki, T., Matsumura, N., Iwamoto, T. and Sato, K.

BMJ Case Rep 2017 2017.08

ISSN  1757-790

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Three-dimensional Deformities of Non-operative Midshaft Clavicle Fractures: A Surface Matching Analysis

Oki, S., Matsumura, N., Kiriyama, Y., Iwamoto, T., Sato, K. and Nagura, T.

J Orthop Trauma 31 ( 11 ) E385 - E389 2017.06

ISSN  0890-5339

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OBJECTIVE: The purpose of this study was to describe the three-dimensional deformities of midshaft clavicle fractures, which had been treated nonoperatively, using computed tomography (CT) surface matching. METHODS: Twenty-one patients with unilateral midshaft clavicle fracture, who had been treated nonoperatively, were enrolled and evaluated retrospectively. The three-dimensional deformity of the fractured clavicle was evaluated by CT surface matching. CT scans of 21 age- and sex-matched patients with initial traumatic shoulder dislocation or proximal humeral fracture were enrolled as a control group, and the differences in three-dimensional deformities and lengths of the clavicles between the fracture group and the control group were evaluated. A correlation analysis was also performed between rotational deformities and clavicular length shortening. RESULTS: The affected clavicle showed 1.3 +/- 6.9 degrees of downward angular deformity, 2.1 +/- 8.0 degrees of anterior angular deformity, and 5.0 +/- 4.9 degrees of anterior rotational deformity. Compared with the control group, the fractured clavicle showed larger anterior rotational deformity (P = 0.021). Shortening of the clavicle demonstrated negative correlation with anterior axial rotation (R = -0.534, P = 0.013), but no correlation was found between clavicular shortening and the other two rotational deformities. CONCLUSION: In cases of midshaft clavicle fracture, the distal fragment usually rotates anteriorly due to its anatomical relationships. Shortening deformity following clavicle fracture was reported to change shoulder kinematics, and anterior rotational deformity might adversely affect scapular motion.

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Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture

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

J Hand Surg Am 42 ( 5 ) 344 - 350 2017.05

ISSN  0363-5023

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PURPOSE: To assess the outcomes of the lateral para-olecranon triceps-splitting approach for the treatment of distal humeral fracture. METHODS: Ten patients (3 males, 7 females) with a mean age of 59 years were retrospectively reviewed. There were 2 A2, 3 C1, and 5 C2 fractures according to the AO/ASIF classification. Types B3 and C3 fractures were excluded from this study because the olecranon osteotomy approach was indicated to visualize the anterior fragment. The triceps was split at the midline, and the anconeus muscle was incised from the proximal ulna. The lateral half of the triceps along with anconeus was retracted laterally as a single unit. The distal part of the humerus could be visualized from medial and lateral windows by retracting the medial half of the triceps. The articular fragment was anatomically reduced and fixed temporarily with a Kirschner wire, and the reconstructed distal articular block was then fixed to the humeral shaft with double locking plates. RESULTS: After surgery, average elbow flexion was 127 degrees (range, 110 degrees -145 degrees ), and extension was -10 degrees (range, -20 degrees -0 degrees ) at the average follow-up time of 12.4 months (range, 820 months). Seven patients had normal muscle strength against full resistance (manual muscle testing grade 5), and the other 3 patients had slightly reduced muscle strength (grade 4). No articular stepoffs of more than 1 mm were seen on postoperative radiographs. There were no cases of triceps insufficiency and nonunion. The average (+/- SD) Mayo Elbow Score was 93.5 +/- 5.8 points at the final follow-up. CONCLUSIONS: The lateral para-olecranon approach is useful for the management of selected fractures of the distal humerus, preserving extension strength and providing satisfactory clinical outcomes, with no risk of olecranon osteotomy-related complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

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Predictors of postoperative outcomes of cubital tunnel syndrome treatments using multiple logistic regression analysis

Suzuki, T., Iwamoto, T., Shizu, K., Suzuki, K., Yamada, H. and Sato, K.

J Orthop Sci 22 ( 3 ) 453 - 456 2017.05

ISSN  0949-2658

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BACKGROUND: This retrospective study was designed to investigate prognostic factors for postoperative outcomes for cubital tunnel syndrome (CubTS) using multiple logistic regression analysis with a large number of patients. METHODS: Eighty-three patients with CubTS who underwent surgeries were enrolled. The following potential prognostic factors for disease severity were selected according to previous reports: sex, age, type of surgery, disease duration, body mass index, cervical lesion, presence of diabetes mellitus, Workers' Compensation status, preoperative severity, and preoperative electrodiagnostic testing. Postoperative severity of disease was assessed 2 years after surgery by Messina's criteria which is an outcome measure specifically for CubTS. Bivariate analysis was performed to select candidate prognostic factors for multiple linear regression analyses. Multiple logistic regression analysis was conducted to identify the association between postoperative severity and selected prognostic factors. RESULTS: Both bivariate and multiple linear regression analysis revealed only preoperative severity as an independent risk factor for poor prognosis, while other factors did not show any significant association. CONCLUSIONS: Although conflicting results exist regarding prognosis of CubTS, this study supports evidence from previous studies and concludes early surgical intervention portends the most favorable prognosis.

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Medium- to long-term outcomes of anatomical reconstruction of the radioulnar ligament to the ulnar fovea

Nakamura, T., Abe, K., Nishiwaki, M., Iwamoto, T. and Sato, K.

J Hand Surg Eur Vol 42 ( 4 ) 352 - 356 2017.05

ISSN  0266-7681

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We examined the medium- to long-term outcome of the original reconstruction technique of the radioulnar ligament using a half-slip of the extensor carpi ulnaris tendon for chronic foveal avulsion of the triangular fibrocartilage complex. We treated 37 wrists in 36 patients with a minimum follow-up of 5 years. Of 36 patients, 12 had more than 10 years follow-up. At final follow-up, 30 patients (31 wrists) reported no pain, five patients (five wrists) reported mild occasional pain and one patient reported severe persistent pain. Two patients had lost 30 degrees of supination. Complete stability of the distal radio-ulnar joint was achieved in 31 wrists, moderate instability was noted in five and severe distal radio-ulnar joint instability remained in one. The size of the bone tunnel was assessed radiologically: in two it had enlarged; in 23 it was unchanged; and in 12 it appeared to have closed over the tendon graft. The overall clinical outcomes were 28 excellent, four good, four fair and one poor. The 12 wrists with more than 10 years follow-up had seven excellent, three good and two fair clinical results. This reattachment technique appears to work and last over the medium- to long-term. LEVEL OF EVIDENCE: IV.

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Chronic calcific periarthritis of the elbow treated by cimetidine administration: Five cases

Kimura, H., Iwamoto, T., Oki, S., Matsumura, N., Nakamura, M., Matsumoto, M. and Sato, K.

J Orthop Surg (Hong Kong) 25 ( 2 ) 2309499017717193 2017.05

ISSN  1022-5536

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Calcific periarthritis or calcific tendinitis occurs most frequently in the shoulder and rarely in the elbow. Cimetidine was previously reported to be effective for chronic calcific periarthritis of the shoulder. Here, we present five patients with chronic calcific periarthritis of the elbow treated by administration of cimetidine; there were six affected elbows in these five patients. Although all patients had been treated with nonsteroidal anti-inflammatory drugs for at least 3 months, their symptoms were not relieved. All patients took oral administration of cimetidine 400 mg daily. The pain was completely relieved in an average of 1.8 months after the administration of cimetidine, and the calcification of the elbow disappeared in an average of 5.1 months. During the follow-up period, there were no symptoms suggesting a recurrence. Although the detailed mechanism of action of cimetidine on periarticular calcifications remains to be understood, cimetidine appears to be a potential therapeutic agent for chronic calcific periarthritis.

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Cigarette Smoking Is Associated With Cubital Tunnel Syndrome

Suzuki, T., Iwamoto, T., Ochi, K., Mito, K., Nakamura, T., Suzuki, K., Yamada, H. and Sato, K.

Muscle Nerve 54 ( 6 ) 1136 - 1138 2016.12

ISSN  0148-639

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INTRODUCTION: The aim of this study was to validate the potential association between cigarette smoking and cubital tunnel syndrome (CubTS). METHODS: One hundred patients with CubTS were compared with 100 controls with ulnar abutment syndrome matched for age, gender, and body mass index. The smoking status was compared between patients and controls using the sign test and the Wilcoxon signed rank test. Conditional logistic regression was used to calculate the association between CubTS and pack-years smoked. RESULTS: A significant association was found between increased pack-years smoked and CubTS. A significant difference in the number of never smokers and ever smokers was observed between the patients with CubTS and controls. The difference in mean pack-years in the patients and controls was highly significant. A dose-dependent association with pack-years was found between patients and controls. CONCLUSIONS: High cumulative cigarette smoking is associated with CubTS. Muscle Nerve 54: 1136-1138, 2016.

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Subcutaneous flexor tendon rupture in patients with rheumatoid arthritis

Funahashi, T., Suzuki, T., Iwamoto, T., Shizu, K., Matsumura, N., Ochi, K., Ikari, K., Sato, K., Nakamura, M., Matsumoto, M., Momohara, S., Suzuki, K. and Yamada, H.

Mod Rheumatol 26 ( 6 ) 869 - 872 2016.11

ISSN  1439-7595

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OBJECTIVE: We examined the clinical features and functional outcomes of surgically repaired subcutaneous flexor tendon ruptures in patients with rheumatoid arthritis (RA). METHODS: This retrospective study included 41 fingers of 24 RA patients who underwent surgical treatment for flexor tendon ruptures. Evaluations performed at the time of presentation following rupture were C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and disease activity score in 28 joints (DAS28)-ESR, as well as Larsen grading for carpal bone destruction. The ruptured tendon and postoperative active range of motion (ROM) of digits were also examined. RESULTS: The mean CRP was 2.4 mg/dl, ESR was 52 mm/h, and the DAS28-ESR was 4.5. Carpal bone destruction according to Larsen grade IV-V was observed in 18/24 patients. Affected digits were most commonly the thumb (12) and the ring and little fingers (9 each). Tendon ruptures were most common in the carpal tunnel in zone IV. The mean postoperative finger ROM (flexion/extension) was 38 degrees /2 degrees for the interphalangeal (IP) joint of the thumb and 23 degrees /-2 degrees for the distal interphalangeal joint of the other four fingers. CONCLUSIONS: Patients with flexor tendon ruptures present with high disease activity and advanced bone destruction. It is important to reduce the risk of progressive bone destruction and subsequent tendon rupture via tight control of disease activity.

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Radial deviation of the finger caused by an occult intramuscular ganglion in a patient with rheumatoid arthritis

Kato, T., Iwamoto, T., Matsumura, N., Sato, K., Nakamura, T. and Toyama, Y.

Mod Rheumatol 26 ( 4 ) 607 - 9 2016.07

ISSN  1439-7595

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Ulnar deviation is a common complication in patients with rheumatoid arthritis (RA). We report a case of an unusual radial deviation of the middle finger caused by an occult intramuscular ganglion of the second interosseous muscle (IOM) in a patient with RA. The resection of the ganglion did not resolve the problem, and the full range of motion of the metacarpophalangeal (MP) joint was achieved through dissection of the tendon of the second dorsal IOM.

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Partial obturator nerve transfer for femoral nerve injury: A case report

Inaba, N., Sato, K., Suzuki, T., Iwamoto, T., Ochi, K., Nakamura, M., Matsumoto, M. and Toyama, Y.

J Orthop Sci (Journal of Orthopaedic Science)  23 ( 1 ) 202 - 204 2016.06

ISSN  0949-2658

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Modified Extensor Pollicis Longus Rerouting Technique for Boutonniere Deformity of the Thumb in Rheumatoid Arthritis

Iwamoto, T., Sakuma, Y., Momohara, S., Matsumura, N., Ochi, K. and Sato, K.

J Hand Surg Am 41 ( 6 ) e129 - 34 2016.06

ISSN  0363-5023

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PURPOSE: To assess the outcomes of a modified extensor pollicis longus (EPL) rerouting technique for boutonniere deformity of the thumb in patients with rheumatoid arthritis. METHODS: A total of 21 thumbs in 18 patients with a mean age of 63 years were retrospectively analyzed after an average follow-up period of 3.2 years. The preoperative deformities were classified as either mild (5 thumbs) or moderate (16 thumbs). After either metacarpophalangeal (MCP) joint synovectomy or implant arthroplasty, the ulnarly dislocated EPL tendon was reduced dorsally and sutured to the dorsal base of the proximal phalanx. If the interphalangeal (IP) joint extended with manual traction on the proximal portion of the extensor pollicis brevis tendon, no further treatment was considered. If the IP joint did not extend with this maneuver, the insertion of the extensor pollicis brevis tendon was dissected and transferred to the distal portion of the EPL tendon. RESULTS: The average MCP joint extensor lag improved from 62 degrees (range, 32 degrees to 85 degrees ) before surgery to 17 degrees (range, active extension 12 degrees to extensor lag 70 degrees ) at the final follow-up (P < .05), whereas average MCP joint flexion decreased from 83 degrees (range, 52 degrees to 95 degrees ) to 68 degrees (range, 30 degrees to 90 degrees ) (P < .05). Hyperextension at the IP joint was improved from 30 degrees (range, 10 degrees to 50 degrees ) before surgery to an average extensor lag of 2 degrees (range, extensor lag 24 degrees to hyperextension 20 degrees ) at the final follow-up. The average combined MCP and IP motion did not significantly change. The boutonniere deformity was improved in 18 of 21 thumbs. The 3 failures all had moderate-stage deformity prior to treatment. CONCLUSIONS: A modified EPL rerouting technique provided satisfactory results together with a low risk of IP joint extension loss. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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Osteochondritis dissecans on the medial aspect of the humeral head

Mima, Y., Matsumura, N., Ogawa, K., Iwamoto, T., Ochi, K., Sato, K. and Toyama, Y.

Int J Shoulder Surg 10 ( 2 ) 89 - 91 2016.04

ISSN  0973-6042

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The case of a 29-year-old man who had osteochondritis dissecans on the medial aspect of the humeral head is reported. Repetitive micro-trauma at a low elevated arm position was thought to have induced the osteochondral lesion.

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Three-dimensional anthropometric analysis of the glenohumeral joint in a normal Japanese population

Matsumura, N., Oki, S., Ogawa, K., Iwamoto, T., Ochi, K., Sato, K. and Nagura, T.

J Shoulder Elbow Surg 25 ( 3 ) 493 - 501 2016.03

ISSN  1058-2746

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BACKGROUND: An understanding of normal glenohumeral geometry is important for anatomical reconstruction in shoulder arthroplasty. Unfortunately, the details of the glenohumeral joint in Asian populations have not been sufficiently evaluated. The purpose of this study was to evaluate the 3-dimensional geometry of the glenohumeral joint in the normal Japanese population and to clarify its morphologic features. METHODS: Anthropometric analysis of the glenohumeral joint was performed using computed tomography scans of 160 normal shoulders from healthy Japanese volunteers. The glenohumeral dimensions and orientation were analyzed 3-dimensionally. Sex differences and correlations between sides and among the respective parameters in the glenohumeral dimensions were evaluated. RESULTS: The normal Japanese humeral head has an average width of 41.4 mm, thickness of 13.2 mm, diameter of 42.9 mm, retroversion of 32 degrees , and inclination of 135 degrees . The glenoid has an average height of 31.5 mm, width of 23.1 mm, diameter of 62.0 mm, retroversion of 0 degrees , and inferior inclination of 2 degrees . The values of the glenohumeral dimensions were uniform in men and women, and the humeral head and glenoid were larger in men than in women. The glenohumeral size was well correlated between the 2 sides, and there were direct correlations among the heights, humeral length, humeral head size, and glenoid size. CONCLUSIONS: The present study revealed the glenohumeral geometry in the normal Japanese population. The present results would be useful to determine the size of implants and to improve the design of shoulder prostheses that reflect the normal anatomy of the Asian glenohumeral joint.

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Comparison of surgical treatments for triple extensor tendon ruptures in rheumatoid hands: A retrospective study of 48 cases

Suzuki, T., Iwamoto, T., Ikegami, H., Sakuma, Y., Ikari, K., Matsumura, N., Ochi, K., Sato, K., Nakamura, M., Matsumoto, M. and Momohara, S.

Mod Rheumatol 26 ( 2 ) 206 - 10 2016

ISSN  1439-7595

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OBJECTIVE: This retrospective study was designed to evaluate the outcomes of four different surgical reconstructions for extensor tendon ruptures in ulnar three fingers in 48 patients with rheumatoid arthritis. METHODS: The following four techniques were performed; palmaris longus tendon grafting (PL group; n = 9), extensor indicis proprius (EIP) tendon transfers (EIP group; n = 8), end-to-side transfers with tension-reduced early mobilization (End-to-side group; n = 16), and a combination of end-to-side and EIP transfers (Combination group; n = 15). Loss of extension was evaluated to determine the mean postoperative range of motion of the metacarpophalangeal (MP) joint and clinical outcomes were categorized using modified Geldmacher criteria. RESULTS: Combination group demonstrated the best mean MP joint extension (-3 degrees ), followed by End-to-side group (-12 degrees ), EIP group (-16 degrees ), and PL group (-21 degrees ). Combination group yielded the best clinical outcomes with all cases showing good results. CONCLUSIONS: The combination of end-to-side and EIP transfer was an effective surgical reconstruction procedure for triple fingers extension loss.

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Reconstruction of the Scapholunate Ligament Using Capitohamate Bone-Ligament-Bone

Nakamura, T., Abe, K., Iwamoto, T., Ochi, K. and Sato, K.

J Wrist Surg 4 ( 4 ) 264 - 8 2015.11

ISSN  2163-3916

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Background The biomechanical properties of the capitohamate (CH) ligament are equivalent to those of the scapholunate (SL) interosseous ligament. We reconstructed the SL ligament using the CH bone-ligament-bone substitute for chronic injury of the SL ligament. Patients and Methods Beginning in 2008, 15 wrists of 14 patients with an average age of 38 years underwent this procedure with a minimum follow-up of 2 years. Thirteen wrists had an SL joint gap more than 3 mm, and two had a complete SL ligament disruption with a severe dorsal intercalated segment instability (DISI) deformity. Kirschner wires (K-wires) were removed 8 weeks after the surgery, then active ROM exercise began. Pain (on visual analog scale [VAS]), wrist motion (angle), radiographic characteristics, such as SL gap (mm) and SL angle, and Modified Mayo Wrist Score (MMWS) were evaluated. Technique The SL joint was reduced by manipulation or with the use of joysticks, then temporary fixed with K-wires. A dorsal trough was then made between the scaphoid and the lunate. The proximal half of the CH ligament was harvested with attached bone from the capitate and hamate (CH bone-ligament-bone), inset into the SL trough, and fixed firmly with 1.2-mm diameter titanium screws in the scaphoid and lunate, respectively. Results The VAS improved from 77 preoperatively to 12 postoperatively. The average wrist extension/flexion was 74 degrees /60 degrees . There was no ossification of the reconstructed SL at the final follow-up. The SL gap improved from an average of 4.8 mm to an average of 2.1 mm, and the SL angle changed from 67 degrees to 55 degrees . The MMWS improved to 82 points postoperatively from a preoperative average of 47 with eight excellent, five good, and two fair results.

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Shoulder position increases ulnar nerve strain at the elbow of patients with cubital tunnel syndrome

Ochi, K., Horiuchi, Y., Horiuchi, K., Iwamoto, T., Morisawa, Y. and Sato, K.

J Shoulder Elbow Surg 24 ( 9 ) 1380 - 5 2015.09

ISSN  1058-2746

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BACKGROUND: Previous studies have shown that the shoulder internal rotation elbow flexion (SIREF) test, which is a modified elbow flexion (EF) test, has significantly higher sensitivity than the EF test in patients with cubital tunnel syndrome (CubTS). Here, we hypothesized that this increase in sensitivity was due to increase in the ulnar nerve strain around the elbow introduced by the additional shoulder position. METHODS: Ulnar nerve strain at the elbow was intraoperatively measured at both the EF test and SIREF test positions in 20 patients with CubTS before simple decompression. Statistical analysis was performed with the Wilcoxon signed rank test at a confidence level of 99% (P < .001). RESULTS: Mean ulnar nerve strain in the EF test position was 18.9% +/- 12.1%, whereas that in the SIREF test position was 24.7% +/- 14.0%. Ulnar nerve strain was higher in the SIREF than in the EF test position in all cases, and the difference was significant (mean, 5.8% +/- 0.9%; 95% confidence interval, 3.90%-7.73%). CONCLUSION: This study indicated that increased sensitivity in the SIREF test compared with the EF test was due to the increase in ulnar nerve strain around the elbow. To the best of our knowledge, this is the first study showing that shoulder position changes the ulnar nerve strain around the elbow in living patients with CubTS.

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Construct validity, reliability, response rate, and association with disease activity of the quick disabilities of the arm, shoulder and hand questionnaire in the assessment of rheumatoid arthritis

Ochi, K; Iwamoto, T; Saito, A; Ikari, K; Toyama, Y; Taniguchi, A; Yamanaka, H; Momohara, S

MODERN RHEUMATOLOGY 25 ( 2 ) 241 - 245 2015.03

ISSN  1439-7595

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Arthroscopy of the distal radioulnar joint

Nakamura, T., Matsumura, N., Iwamoto, T., Sato, K. and Toyama, Y.

Handchir Mikrochir Plast Chir 46 ( 5 ) 295 - 9 2014.10

ISSN  0722-1819

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Wrist arthroscopy is now widely indicated for diagnosis and treatment of acute or chronic wrist pain, especially for triangular fibrocartilage complex (TFCC) lesions, as a gold standard. In most cases radiocarpal and midcarpal arthroscopy was performed, while DRUJ arthroscopy has been rarely performed because of its difficulties. Recent anatomic and biomechanical studies demonstrated that the radioulnar ligament (RUL), which is the proximal component of the TFCC facing to the DRUJ, is the primary stabilizer of the distal radioulnar joint (DRUJ). Rupture of the radioulnar ligament (RUL) at the fovea area, where it is the main attaching portion to the ulna and is the isometric point during forearm rotation as the rotation axis passes, is responsible for DRUJ instability. Although physical examination and imaging diagnosis may indicate a foveal detachment of the TFCC, DRUJ arthroscopy is potential for visualizing the RUL at the fovea. Role of DRUJ arthroscopy should be more important not only for diagnosis of rupture of the RUL but also for decision making of treatment option for RUL tear. DRUJ arthroscopy also demonstrates the joint surface of both the sigmoid notch and ulnar head, and the proximal surface of the TFCC.

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Ununited Fracture of the Hook of Hamate Treated With Low-Intensity Pulsed Ultrasound in an Older Middle-aged Patient

Sakuma, Y; Iwamoto, T; Momohara, S

CLINICAL JOURNAL OF SPORT MEDICINE 24 ( 4 ) 358 - 359 2014.07

ISSN  1050-642X

An Obliquely Placed Headless Compression Screw for Distal Interphalangeal Joint Arthrodesis

Iwamoto, T., Matsumura, N., Sato, K., Momohara, S., Toyama, Y. and Nakamura, T.

J Hand Surg Am 38A ( 12 ) 2360 - 2364 2013.10

ISSN  1531-6564

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PURPOSE: To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits. METHODS: A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. After the resection of synovium and joint cartilage by a dorsal approach, a 0.88-mm diameter guide wire was inserted at the ulnar side of the proximal phalanx in the thumb and radial side of the middle phalanx in the other digits from proximal to distal to fix the joint obliquely. We verified its position under fluoroscopic control and placed the cannulated screw from proximal to distal over the guide wire. RESULTS: Intraoperative rigid fixation was obtained except for 1 case, which required additional K-wire fixation. The overall union rate was 96%. Average time to fusion was 11 weeks (range, 8-30 wk), with 76% achieving union within 3 months. There were 2 complications, 1 nonunion and 1 late infection. Other complications such as dorsal skin necrosis, nail deformity, and paresthesia did not occur. CONCLUSIONS: Efforts to avoid invasion of the nailbed can be technically demanding. We believe that our proximal to distal technique with oblique placement of the headless compression screw is a straightforward and effective method with a relatively low risk of complication. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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Non-synonymous variant (Gly307Ser) in <i>CD226</i> is associated with susceptibility in Japanese rheumatoid arthritis patients

Suzuki, T; Ikari, K; Kawaguchi, Y; Yano, K; Iwamoto, T; Kawamoto, M; Toyama, Y; Taniguchi, A; Yamanaka, H; Momohara, S

MODERN RHEUMATOLOGY 23 ( 1 ) 200 - 202 2013.01

ISSN  1439-7595

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Meta-analysis identifies nine new loci associated with rheumatoid arthritis in the Japanese population

Okada, Y; Terao, C; Ikari, K; Kochi, Y; Ohmura, K; Suzuki, A; Kawaguchi, T; Stahl, EA; Kurreeman, FAS; Nishida, N; Ohmiya, H; Myouzen, K; Takahashi, M; Sawada, T; Nishioka, Y; Yukioka, M; Matsubara, T; Wakitani, S; Teshima, R; Tohma, S; Takasugi, K; Shimada, K; Murasawa, A; Honjo, S; Matsuo, K; Tanaka, H; Tajima, K; Suzuki, T; Iwamoto, T; Kawamura, Y; Tanii, H; Okazaki, Y; Sasaki, T; Gregersen, PK; Padyukov, L; Worthington, J; Siminovitch, KA; Lathrop, M; Taniguchi, A; Takahashi, A; Tokunaga, K; Kubo, M; Nakamura, Y; Kamatani, N; Mimori, T; Plenge, RM; Yamanaka, H; Momohara, S; Yamada, R; Matsuda, F; Yamamoto, K

NATURE GENETICS 44 ( 5 ) 511 - + 2012.05

ISSN  1061-4036

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Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute

Momohara, S., Inoue, E., Ikari, K., Yano, K., Tokita, A., Honjo, Y., Sakuma, Y., Hiroshima, R., Iwamoto, T., Seto, Y., Tanaka, E., Taniguchi, A. and Yamanaka, H.

Mod Rheumatol 22 ( 2 ) 209 - 15 2012.04

ISSN  1439-7609

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The treatment of rheumatoid arthritis (RA) has improved dramatically with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thereby necessitating surgical intervention to reduce pain and improve function. For RA treatment, Japanese orthopedic surgeons also prescribe medication. In this study, we examined whether this Japanese system is effective for RA treatment. We analyzed the clinical condition of RA patients treated by rheumatologists and those treated by orthopedists in a linked registry study using information from a large observational cohort of RA patients followed every half year from 2000 to 2010 (the IORRA cohort). Two groups of patients were compared: patients treated by rheumatologists (rheumatologic group) and patients treated by orthopedists (orthopedic group). The results revealed that patients in the orthopedic group were older, more likely to be female, and had a longer disease duration than patients in the rheumatologic group. The proportion of patients with a history of joint surgery was also much higher in the orthopedic group than in the rheumatologic group. The average scores on the Japanese version of the Health Assessment Questionnaire, and the remission ratio determined using a Boolean-based definition gradually increased from 2000 until 2010, and these findings were consistently better in the rheumatologic group than in the orthopedic group. These data suggest that patients treated primarily by orthopedists are more likely to have long-standing RA compared to patients treated by rheumatologists. Therefore, it is critical for rheumatologists and orthopedists to complement each other medically in the treatment of RA patients.

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【手指のリウマチに対する手術治療の現況】 関節リウマチによる母指変形に対する手術療法

岩本卓士

整形・災害外科 55 ( 2 ) 135 - 139 2012.02

ISSN  0387-4095

上肢整形外科手術における、鎖骨上窩アプローチによる超音波ガイド下腕神経叢ブロックの有効性

佐久間悠, 岩本卓士, 鈴木拓, 鴇田朝海 and 桃原茂樹

日本手外科学会雑誌 28 ( 5 ) 441 - 444 2012.02

ISSN  2185-4092

関節リウマチにおける同一上肢に橈骨頭切除と尺骨遠位切除を施行した際の上肢機能の評価

鈴木拓, 岩本卓士, 佐久間悠, 鴇田朝海 and 桃原茂樹

日本手外科学会雑誌 28 ( 3 ) 275 - 277 2011.12

ISSN  2185-4092

【リウマチ手指診療】 リウマチ手指に対する人工指関節置換術

岩本卓士

Orthopaedics 24 ( 12 ) 63 - 69 2011.11

ISSN  0914-8124

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関節リウマチにおける手指変形は多種多様であり、使用機種の選択にも一定の見解は得られていないのが現状である。本邦において最も使用されているのはシリコンインプラントであり、MP関節における尺側偏位の治療として機能的・整容的改善により良好な成績が得られている。一方、PIP関節ではシリコンインプラントの成績不良例も報告されており、表面置換型の人工関節も多く使用される。手術に際しては変形の解剖学的機序を理解したうえで、変形の程度、各指の機能を考慮して人工関節の適応を決定し、いずれのインプラントを使用する場合でも十分な軟部組織再建を併用することが重要である。(著者抄録)

Pseudotumor from a metal-on-metal hip

Iwamoto, T., Ikari, K. and Momohara, S.

J Rheumatol 38 ( 10 ) 2265 2011.10

ISSN  0315-162X

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生物学的製剤が与えた関節リウマチの病態・治療の変化 生物学的製剤時代の関節破壊制御と整形外科手術

岩本卓士 and 桃原茂樹

臨床整形外科 46 ( 9 ) 799 - 803 2011.09

ISSN  0557-0433

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関節リウマチの治療は早期からの強力な薬物治療により寛解を導入し関節破壊の進行を抑制することが目標となってきている.疾患活動性を十分にコントロールすることで,破壊された関節が修復する可能性も示されており,手術適応も変化してきている.傾向として滑膜切除術は漸減している一方で,足趾の関節形成術,手指の人工関節といった小関節の形成手術が増加しており,より高い目標に向けた機能回復へと今後さらに変遷していくものと思われる.しかしながら生物学的製剤使用下での手術は感染の発症に十分な注意が必要であり,術前術後に一定期間の休薬を行うことが望ましいが,いずれの生物学的製剤に関しても休薬期間に関するエビデンスが不足しており,整形外科医からの情報発信が必要である.(著者抄録)

目でみるシリーズ　リウマチ手の尺側偏位

岩本卓士 and 桃原茂樹

Frontiers in Rheumatology & Clinical Immunology 5 ( 3 ) 144 - 146 2011.08

ISSN  1882-1472

Recent trends in orthopedic surgery performed in Japan for rheumatoid arthritis

Momohara, S., Tanaka, S., Nakamura, H., Mibe, J., Iwamoto, T., Ikari, K., Nishino, J., Kadono, Y., Yasui, T., Takahashi, K., Takenouchi, K., Hashizume, K., Nakahara, R., Kubota, A., Nakamura, T., Nishida, K. and Suguro, T.

Mod Rheumatol 21 ( 4 ) 337 - 42 2011.08

ISSN  1439-7609

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The aim of this report was to review the use of orthopedic surgeries performed to manage rheumatoid arthritis (RA). Our review of studies published in English indicates that there has been a decrease in RA-associated surgeries in Western countries. Improvements in medical treatment may partly explain the reduction in numbers of orthopedic joint surgeries, which also suggests a worldwide trend toward improved long-term outcomes. However, the results of our multicenter study in Japan indicate that the number of RA-associated operations has not decreased, and that the numbers of operations performed annually have been relatively stable from 1998 to 2008. Although there definitely has been a decline in the numbers of synovectomy surgeries, the numbers of operations on the upper limbs and foot arthroplasties have increased. With the trend toward milder disease because of improved medical treatment, we speculate that RA patients may want and need better function for the activities of daily living. The combination of medical treatment and surgical intervention is thought to improve outcomes in RA patients who will develop joint destruction. Additional studies, including analyses of RA databases containing long-term data on a variety of surgical interventions, are needed.

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Reparative radiological changes of a large joint after adalimumab for rheumatoid arthritis

Momohara, S., Tanaka, E., Iwamoto, T., Ikari, K. and Yamanaka, H.

Clin Rheumatol 30 ( 4 ) 591 - 2 2011.04

ISSN  1434-9949

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【整形外科医のためのRA講座】 (Part4)整形外科医のための生物学的製剤講座　生物学的製剤時代におけるRA手術療法　上肢編<肩・肘関節>

岩本卓士

Bone Joint Nerve 1 ( 1 ) 146 - 152 2011.04

ISSN  2186-1110

【世界のリウマチガイドラインをみわたす】 各国の治療ガイドライン　ACR2008推奨

岩本卓士 and 桃原茂樹

分子リウマチ治療 4 ( 2 ) 71 - 76 2011.04

ISSN  1882-9163

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関節リウマチ(rheumatoid arthritis:RA)治療のパラダイムシフトに伴い、2008年に米国リウマチ学会(American College of Rheumatology:ACR)より、疾患修飾性抗リウマチ薬(disease-modifying antirheumatic drugs:DMARDs)使用のための推奨が発表された。罹病期間、疾患活動性、予後不良因子の有無により分類し、非生物学的および生物学的DMARDsの選択に関する推奨、使用禁忌および安全性のモニタリングに関しての推奨が示された。しかしながら、このACR2008推奨はあくまで「推奨」であり、個々の症例のおかれている状況を考慮に入れながら、臨床医が自らその適応を検討し最終決定すべきである。(著者抄録)

Analysis of C-reactive protein levels and febrile tendency after joint surgery in rheumatoid arthritis patients treated with a perioperative 4-week interruption of tocilizumab

Hiroshima, R., Kawakami, K., Iwamoto, T., Tokita, A., Yano, K., Sakuma, Y., Ikari, K. and Momohara, S.

Mod Rheumatol 21 ( 1 ) 109 - 11 2011.02

ISSN  1439-7609

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関節リウマチ患者におけるQuick DASHの妥当性、信頼性および、高齢者への適応の検討

鴇田朝海, 岩本卓士, 佐久間悠, 鈴木拓 and 桃原茂樹

日本手外科学会雑誌 27 ( 5 ) 630 - 633 2011.02

ISSN  2185-4092

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関節リウマチ患者94名を対象に、Quick DASHの妥当性および信頼性、更に高齢者への適応性について検討した。また、DASH、Quick DASHにて術前後の評価を行った。信頼性は内的整合性と再テスト法による再現性を検証し、妥当性は同時的妥当性、基準関連妥当性の評価のため相関性を検討した。内的整合性、相関性は術前後にDASHを集計し、再現性の評価は症状のほぼ固定した上肢機能障害を有する17名について間隔をあけて2回DASHを集計した。高齢者への適応の可否は、患者を65歳以上・未満に分けてDASH、Quick DASHの集計率と各項目の欠損値を検討した。内的整合性を示すクロンバックのα係数はDASH 0.98、Quick DASH 0.91で、十分な内的整合性が得られた。再テスト法による級内相関係数はDASH 0.96、Quick DASH 0.95で、再現性は高かった。同時的妥当性についてDASHとQuick DASHはピアソンの相関係数で高い相関を示し、基準関連性については、手関節手術患者では術前のCooneyの手関節機能評価とDASHおよびQuick DASHはいずれも高い相関を示したが、肘関節手術患者および肩関節患者ではJOAスコアとDASH、Quick DASHは低い相関を示した。高齢者の適応に関しては、65歳以上ではDASH、Quick DASHとも未回答項目が多いため集計不可能率が高く、特にDASHは65歳未満に比べ集計不可能率が有意に高かった。質問項目では、DASHの6・8・12・21・27において65歳未満と65歳以上の欠損率に有意差を認めた。術前後でのDASH、Quick DASHの改善の検討では、全体では有意な改善を認めなかったが、上肢大関節手術に限定して検討したところ、DASHでのみ術後有意な改善を認めた。

Clinical images: Solitary extranodal malignant lymphoma of the forearm in rheumatoid arthritis

Iwamoto, T., Seto, Y., Ikari, K., Yamanaka, H. and Momohara, S.

Arthritis Rheum 63 ( 1 ) 304 2011.01

ISSN  1529-0131

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表面置換型セメントレスPIP人工指関節置換術の治療成績

岩本卓士, 佐久間悠, 鈴木拓, 鴇田朝海 and 桃原茂樹

日本手外科学会雑誌 27 ( 4 ) 468 - 471 2011.01

ISSN  2185-4092

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RAまたはOAによるPIP関節症に対しナカシマメディカル社製の人工指関節Self-Locking Finger Joint Systemを用いて治療を行った11例の成績を報告した。男性1例、女性10例、年齢32～78歳、原疾患はRAが8例、OAが3例、術後観察期間は平均9.4ヵ月であった。術中の固定性は全例良好で、セメントレス固定であるため術中にインプラントの挿入深度を変更することにより屈曲伸展での軟部組織バランスの調整が可能であった。PIP関節の可動域は術前平均43.7°から術後69.1°に改善した。術前には10例が疼痛を訴えていたが、術後は1例で寒冷刺激時に軽度の疼痛を認めるのみであった。合併症として、X線でインプラント周囲の骨吸収を認めたものが1例(9%)あったが、インプラントの明らかな弛みや脱臼を生じたものはなかった。患者の主観的評価では9例(82%)が「満足」と回答した。代表例2例を提示した。

関節リウマチの母指ボタン穴変形に対する手術療法　EPL・EPB交叉腱移行の臨床成績

岩本卓士, 佐久間悠, 鈴木拓, 鴇田朝海 and 桃原茂樹

日本手外科学会雑誌 27 ( 4 ) 416 - 418 2011.01

ISSN  2185-4092

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母指ボタン穴変形に対して手術を行い術後3ヵ月以上経過観察しえた10例の成績を報告した。手術は全例背側アプローチで行い、MP関節の破壊が強い症例あるいは高度の屈曲拘縮により軟部組織のリリースのみでは矯正できない症例に対してはシリコンインプラントにて置換した。IP関節に対する処置は、側方不安定性の強い症例(3例)には関節固定を行い、側方の支持性が保たれた症例(7例)には背側関節包の切離による関節授動術を施行した。また、軟部組織バランスの再建として、尺側に脱臼したEPL(長母指伸筋腱)をMP関節高位にて切離し、MP関節に対する直接的な伸展力として基節骨基部背側に縫着した。EPB(短母指伸筋腱)は基節骨付着部から剥離したのち、IP関節を固定した3例ではEPLと共に基節骨基部に縫着し、IP関節の可動域を温存した7例では、切離したEPL末梢端にEPBを腱移行し、IP関節に対する伸展力とした。MP関節の自動可動域は術前平均19.2°から術後38.5°に改善し、屈曲は術前平均70.5°から術後57.4°と悪化したものの、伸展は術前平均-51.3°から術後-18.9°と有意に改善し、屈曲拘縮の伸展方向への改善が得られた。日手会版DASHスコアは術前平均25.3点、術後は24.3点で、機能障害の大きな改善は得られなかったが、外見上の改善によって患者満足度は8例(80%)が「満足」と回答した。代表例1例を提示した。

関節リウマチにおける多数指伸筋腱皮下断裂に対する再建法の検討

鈴木拓, 岩本卓士, 佐久間悠, 鴇田朝海 and 桃原茂樹

日本手外科学会雑誌 27 ( 4 ) 419 - 421 2011.01

ISSN  2185-4092

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母指を除く4指のうち3指以上の伸筋腱皮下断裂を生じた症例に対して手術を行った19例の治療成績を再建法別に4群に分けて比較検討した。4群の内訳は、長掌筋腱を用いて遊離腱移植術を行った群(5例)、隣接指への端側縫合を行った群(3例)、固有示指伸筋腱(EIP)を中環小指に移行した群(7例)、断裂した中指の総指伸筋腱(EDC)を示指EDCに端側縫合するとともに、EIPまたは浅指屈筋腱を環小指EDCに移行した群(4例;端側縫合+移行群)である。検討の結果、最も良好な伸展力が得られていたのは端側縫合+移行群であった。

Coonrad-Morrey型インプラントを用いた人工肘関節置換術における上腕骨顆部骨折の検討

佐久間悠, 岩本卓士, 矢野紘一郎, 猪狩勝則, 斎藤聖二 and 桃原茂樹

日本人工関節学会誌 40   748 - 749 2010.12

ISSN  1345-7608

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関節リウマチ(RA)に対しCoonrad-Morrey型インプラントを用いて人工肘関節置換術(TEA)を施行した22名24関節を対象に、術中の上腕骨顆部骨折に関して検討を行った。術前後の単純X線正面像にて上腕骨のサイズとインプラントの設置位置について計測部位を設定し、骨折群と非骨折群で比較検討を行った。上腕コンポーネントのサイズは全例XSであった。術中骨折は24肘中6肘(25.0%)で、両顆骨折が1例、内顆のみ骨折が5例であった。骨片は切除・摘出され、整復固定された症例はなかった。骨折群では、いずれも上腕骨コンポーネントの挿入位置が尺側に偏位し、ステム先端は橈側に傾いていた。同様の傾向は非骨折群でも認めたが、ステムの橈側への傾きは骨折群の方が有意に大きかった。また、骨折群では患者の身長と上腕骨骨幹部径が小さく、術前の関節可動域も小さく、拘縮が強い傾向がみられた。更に、骨折群ではインプラントと上腕骨遠位の尺側皮質との距離も小さく、インプラントと皮質骨の間にある海綿骨が薄くなっている傾向がみられた。

Sharp-van der Heijdeスコアを用いた関節リウマチにおける関節破壊のレントゲン解析

望月猛, 岩本卓士 and 桃原茂樹

日本手外科学会雑誌 26 ( 5 ) 416 - 418 2010.09

ISSN  2185-4092

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発症より5年経過した関節リウマチ(RA)患者164例(男31例、女133例、平均年齢59.0歳)を対象として、単独の読影者が両手の単純X線正面像を読影し各部位のerosion(EN)、joint space narrowing(JSN)からSharp-van der Heijdeスコア(SHS)を計算した。また、指節間関節(IP)群、中手指節関節(MCP)群、手根骨群の満点スコアからの比率(%SHS)を算出し各群間での比較検討を行った。ENは手関節周囲で高値を示し、JSNにおいても手指関節に比して有頭骨-舟状骨間および橈骨手根関節で高値を示した。%SHSの比較では手根骨群がIP群およびMCP群と比較して有意に高値を示した。発症5年目のRA患者の骨関節破壊は手関節周囲に多く認めた。

リウマチ性手指関節炎に対するAVANTAシリコンインプラントを用いたPIP人工指関節置換術の臨床成績

岩本卓士, 宗定伸, 佐久間悠, 鴇田朝海 and 桃原茂樹

日本手外科学会雑誌 26 ( 5 ) 407 - 410 2010.09

ISSN  2185-4092

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対象は9例(男1例、女8例、平均年齢52.5歳)19関節で平均経過観察期間は53.5ヵ月であった。疼痛は術前に9関節で認めていたが最終観察時は全例改善した。近位指節間関節可動域は術前15.3度から術後12.9度へ減少し、特にスワンネック変形において術後の関節可動域が不良であった。整容的には11関節が、機能的には15関節が不満であると回答し、どちらも満足と回答したのは2関節のみでいずれもボタン穴変形に対する手術であった。最終観察時にインプラントの破損・変形を10関節で認め、このうち2関節で再手術を施行した。スワンネック変形では再発例を多く認め、適応を慎重に検討して十分な軟部組織再建を併用する必要があると考えられた。

手指以外の部位に発生したグロムス腫瘍の2例

今村仁, 岩本卓士, 望月猛, 西本和正 and 白旗敏克

臨床整形外科 45 ( 7 ) 637 - 641 2010.07

ISSN  0557-0433

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前腕および下腿に発生し,診断に難渋したグロムス腫瘍2例を経験したので報告する.症例1は41歳の男性で,4年前から右前腕に自発痛を自覚し,前医を受診したが確定診断には至らなかった.当科を受診し軟部腫瘍の診断で腫瘍切除術を施行した.症例2は37歳の男性で,約6ヵ月前から下腿に痛みを伴う小腫瘤を自覚したため,当科を受診した.軟部腫瘍の診断で腫瘍切除術を施行した.両症例の病理診断はグロムス腫瘍であった.術後症状は消失し良好な経過が得られている.爪下以外に発生したグロムス腫瘍は術前診断が困難であり,しばしば治療が遅れることがある.自発痛・圧痛を伴う小腫瘤の鑑別診断としてグロムス腫瘍を考慮することが重要である.(著者抄録)

A regulatory variant in CCR6 is associated with rheumatoid arthritis susceptibility

Kochi, Y., Okada, Y., Suzuki, A., Ikari, K., Terao, C., Takahashi, A., Yamazaki, K., Hosono, N., Myouzen, K., Tsunoda, T., Kamatani, N., Furuichi, T., Ikegawa, S., Ohmura, K., Mimori, T., Matsuda, F., Iwamoto, T., Momohara, S., Yamanaka, H., Yamada, R., Kubo, M., Nakamura, Y. and Yamamoto, K.

Nat Genet 42 ( 6 ) 515 - 9 2010.06

ISSN  1546-1718

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Rheumatoid arthritis is a common autoimmune disease with a complex genetic etiology. Here, through a genome-wide association study of rheumatoid arthritis, we identified a polymorphism in CCR6, the gene encoding chemokine (C-C motif) receptor 6 (a surface marker for Th17 cells) at 6q27, that was associated with rheumatoid arthritis susceptibility and was validated in two independent replication cohorts from Japan (rs3093024, a total of 7,069 individuals with rheumatoid arthritis (cases) and 20,727 controls, overall odds ratio = 1.19, P = 7.7 x 10(-19)). We identified a triallelic dinucleotide polymorphism of CCR6 (CCR6DNP) in strong linkage disequilibrium with rs3093024 that showed effects on gene transcription. The CCR6DNP genotype was correlated with the expression level of CCR6 and was associated with the presence of interleukin-17 (IL-17) in the sera of subjects with rheumatoid arthritis. Moreover, CCR6DNP was associated with susceptibility to Graves' and Crohn's diseases. These results suggest that CCR6 is critically involved in IL-17-driven autoimmunity in human diseases.

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術前から変形性膝関節症に対するTKAの軟部組織解離範囲を予測出来るか?

望月猛, 猪狩勝則, 二木康夫, 岩本卓士, 白旗敏克 and 桃原茂樹

JOSKAS 35 ( 3 ) 623 - 627 2010.05

ISSN  1884-8842

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著者らは術前ストレス撮影を行った後にTKA(人工膝関節全置換術)を施行した内側型変形性膝関節症患者のうち、術後安定性が良好であった25例30膝を対象に、軟部組織解離範囲の予測因子について検討した。重回帰分析の結果、1)術前ストレスFTA(S-FTA)はストレス圧が強力な予測因子であり、更にBMIおよび術前伸展角を加えることで、術前に軟部組織解離範囲が予測できることが明らかとなった。2)FTAが大きい症例であっても、S-FTAが小さくなる症例では軟部組織解離範囲が少なくなること、また、ストレス圧が少なくS-FTAが小さくなる症例では軟部組織解離範囲はより少なくてよいことが示唆された。

Reparative radiological changes of the hip joint in rheumatoid arthritis: do these findings indicate the true repair of the joint?

Sakuma, Y., Ikari, K., Iwamoto, T., Tokita, A. and Momohara, S.

Joint Bone Spine 77 ( 3 ) 278 - 9 2010.05

ISSN  1778-7254

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【関節リウマチの画像診断】 関節リウマチ手部変形の画像的特徴

岩本卓士 and 桃原茂樹

Orthopaedics 23 ( 6 ) 63 - 69 2010.05

ISSN  0914-8124

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関節リウマチは多関節に滑膜炎を生じ、進行すると手関節および手指に特徴的な変形を引き起こす。早期診断、滑膜炎の評価においてはMRI、超音波が優れているが、単純X線写真は関節破壊・変形の程度を経時的に観察することが可能であり、薬物療法の効果判定や外科的治療の適応を判断するうえでもRAの診療における基本となるものである。また変形を3次元的にとらえて評価するためには3DCTも極めて有用である。関節リウマチにおける手の特徴的な所見を十分に認識することは他の関節炎を生じる類縁疾患との鑑別診断を可能とし、適切な診断および治療につながる重要な要素であると考える。(著者抄録)

Multiple extensor tendon ruptures caused by tophaceous gout

Iwamoto, T., Toki, H., Ikari, K., Yamanaka, H. and Momohara, S.

Mod Rheumatol 20 ( 2 ) 210 - 2 2010.04

ISSN  1439-7609

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A 54-year-old woman presented with painless subcutaneous masses on her right hand and spontaneous loss of extension of her ring finger. Surgical exploration of the wrist showed hypertrophic white-colored crystal deposits that both surrounded and invaded into the extensor tendons (intratendinous invasion). Histopathologic examination of the specimen demonstrated findings consistent with gouty tophi. We conclude that tophaceous gout needs to be included in the differential diagnosis of chronic extensor tenosynovitis of the hand.

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K-NOW SNAP IN人工肘関節置換術を施行した関節リウマチの小経験

岩本卓士, 丹治敦, 中村俊康, 池上博泰, 戸山芳昭 and 桃原茂樹

日本肘関節学会雑誌 16 ( 2 ) 54 - 56 2009.12

ISSN  1349-7324

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関節リウマチによって不安定性を呈した肘関節に対し、K-NOW SNAP IN 人工肘関節置換術(TEA)を使用した5例6肘の短期成績を検討した。対象は全例女性で、手術時年齢は平均72歳、術後経過観察期間は平均8.6ヵ月であった。LarsenのX線分類でgrade IVが1肘、grade Vが4肘であった。手術は全例Campbell法による後方侵入で展開し、尺骨神経は皮下前方移行した。上腕骨・尺骨共にインプラントは全例セメントにて固定し、顆部の欠損が大きい場合は必要に応じて切除骨による骨移植を行った。JOA scoreは術前平均44点から術後81.6点に改善し、全例で不安定性は消失してADLの改善が得られた。疼痛は術前平均12.5点から術後平均26.7点と改善した。関節可動域は屈曲115度から128度と改善したが、伸展は-25度から-28度と屈曲拘縮は残存した。回内外可動域は術前114度から術後125度と改善した。合併症として脱臼はなく、上腕骨インプラントのセメント固定の打ち込みによる上腕骨内顆骨折を1例に生じ、キルシュナー鋼線による内固定を行った。

Corrective osteotomy for volarly malunited distal radius fracture

Sato, K., Nakamura, T., Iwamoto, T., Toyama, Y., Ikegami, H. and Takayama, S.

J Hand Surg Am 34 ( 1 ) 27 - 33, 33 e1 2009.01

ISSN  1531-6564

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PURPOSE: To retrospectively analyze consecutive cases with opening wedge corrective osteotomy of the volarly malunited distal radius with iliac bone graft, including preoperative and postoperative comparison of symptoms, visual analog scale (VAS), Japanese Society for Surgery of the Hand version of the Disabilities of the Arm, Shoulder, and Hand (DASH-JSSH) questionnaires, radiographic indices, clinical results as evaluated by modified Mayo wrist score, and complications. METHODS: Subjects were 28 patients with volarly malunited distal radius fracture treated by transverse opening wedge osteotomy with oblique iliac bone graft. Preoperative symptoms included wrist deformity, weakness of grip strength, and marked restriction of supination range. Postoperative symptoms, radiographic parameters, clinical results, and complications were analyzed at an average of 25 months of follow-up. We also analyzed the union period of the radius in younger patients (< or =45 years old) and older patients (>45 years old). RESULTS: Mean preoperative visual analog scale was 45, improving significantly to 3 postoperatively. Range of wrist motion improved in all 28 patients, with supination range improving from 16 degrees preoperatively to 80 degrees postoperatively. Mean preoperative DASH-JSSH score was 55, improving to 9 postoperatively. Radiography revealed that volar tilt improved from 32 degrees preoperatively to 10 degrees postoperatively, and radial inclination increased from 17 degrees to 21 degrees . Preoperative ulnar variance of +5.9 mm was corrected to -0.1 mm postoperatively. All 28 wrists demonstrated bony union at the osteotomy site after an average of 52 days (younger patients, 51 days; older patients, 54 days). No complications, significant radiographic correction loss, or nonunion were seen after at least 2 years of follow-up. Modified Mayo wrist score was excellent in 16 patients, good in 10 patients, and fair in 2 patients. CONCLUSIONS: Opening wedge osteotomy for volarly malunited distal radius fracture restored bony configuration of the distal radius, decreased pain, and improved grip strength and range of wrist motion, particularly for forearm supination. No complications or noteworthy correction loss were noted after surgery, even in older patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

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A role for the aryl hydrocarbon receptor and the dioxin TCDD in rheumatoid arthritis

Kobayashi, S., Okamoto, H., Iwamoto, T., Toyama, Y., Tomatsu, T., Yamanaka, H. and Momohara, S.

Rheumatology (Oxford) 47 ( 9 ) 1317 - 22 2008.09

ISSN  1462-0332

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OBJECTIVE: Environmental factors are involved in RA pathogenesis and epidemiological studies have suggested that smoking is an environmental risk factor for RA. The 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is one of the major toxic components in cigarettes. To clarify the biological effects of smoking in RA, we investigated the role of TCDD in RA pathogenesis. METHODS: Human synovial tissue was obtained from RA and OA patients and aryl hydrocarbon receptor (AhR) expression in these tissues was evaluated using immunohistochemistry and real-time PCR. Expression of various cytokines was measured by real-time PCR following stimulation of RA synoviocytes with different concentrations of TCDD. To study the role of AhR, we treated RA synoviocytes with alpha-naphthoflavone, a known AhR antagonist. To evaluate which signal transduction pathways were stimulated by the TCDD-AhR interaction, we used inhibitors of nuclear factor-kappaB (NF-kappaB) and extra-cellular stimulus-activated kinase (ERK). RESULTS: Higher AhR mRNA and protein levels were observed in RA synovial tissue than in OA tissue. TCDD up-regulated the expression of IL-1beta, IL-6 and IL-8 through binding to AhR, and this effect was transmitted via the NF-kappaB and ERK signalling cascades. AhR expression in synovial cells was up-regulated by TNF-alpha. CONCLUSION: TNF-alpha activates AhR expression in RA synovial tissue, and that cigarette smoking and exposure to TCDD enhances RA inflammatory processes. TCDD induces inflammatory cytokines via its association with AhR, resulting in stimulation of the NF-kappaB and ERK signalling cascades. Thus TCDD exposure, such as smoking exacerbates RA pathophysiology.

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Molecular aspects of rheumatoid arthritis: chemokines in the joints of patients

Iwamoto, T., Okamoto, H., Toyama, Y. and Momohara, S.

FEBS J 275 ( 18 ) 4448 - 55 2008.09

ISSN  1742-464X

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Rheumatoid arthritis (RA) is a chronic symmetric polyarticular joint disease that primarily affects the small joints of the hands and feet. The inflammatory process is characterized by infiltration of inflammatory cells into the joints, leading to proliferation of synoviocytes and destruction of cartilage and bone. In RA synovial tissue, the infiltrating cells such as macrophages, T cells, B cells and dendritic cells play important role in the pathogenesis of RA. Migration of leukocytes into the synovium is a regulated multi-step process, involving interactions between leukocytes and endothelial cells, cellular adhesion molecules, as well as chemokines and chemokine receptors. Chemokines are small, chemoattractant cytokines which play key roles in the accumulation of inflammatory cells at the site of inflammation. It is known that synovial tissue and synovial fluid from RA patients contain increased concentrations of several chemokines, such as monocyte chemoattractant protein-4 (MCP-4)/CCL13, pulmonary and activation-regulated chemokine (PARC)/CCL18, monokine induced by interferon-gamma (Mig)/CXCL9, stromal cell-derived factor 1 (SDF-1)/CXCL12, monocyte chemotactic protein 1 (MCP-1)/CCL2, macrophage inflammatory protein 1alpha (MIP-1alpha)/CCL3, and Fractalkine/CXC3CL1. Therefore, chemokines and chemokine-receptors are considered to be important molecules in RA pathology.

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CTLA-4 CT60 polymorphism is not an independent genetic risk marker of rheumatoid arthritis in a Japanese population

Tsukahara, S., Iwamoto, T., Ikari, K., Inoue, E., Tomatsu, T., Hara, M., Yamanaka, H., Kamatani, N. and Momohara, S.

Ann Rheum Dis 67 ( 3 ) 428 - 9 2008.03

ISSN  1468-2060

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A role of monocyte chemoattractant protein-4 (MCP-4)/CCL13 from chondrocytes in rheumatoid arthritis

Iwamoto, T., Okamoto, H., Kobayashi, S., Ikari, K., Toyama, Y., Tomatsu, T., Kamatani, N. and Momohara, S.

FEBS J 274 ( 18 ) 4904 - 12 2007.09

ISSN  1742-464X

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We studied the role of monocyte chemoattractant (MCP)-4/CCL13 in the pathogenesis of rheumatoid arthritis (RA). MCP-4 was highly expressed in cartilage from RA patients. Interferon-gamma significantly stimulated MCP-4/CCL13 production in human chondrocytes, and this effect was enhanced in combination with interleukin-1beta or tumor necrosis factor-alpha. MCP-4/CCL13 induces the phosphorylation of extracellular signal-regulated kinase in fibroblast-like synoviocytes and activates cell proliferation, and PD98059 completely inhibits these effects. These data suggest that interferon-gamma in combination with interleukin-1beta/tumor necrosis factor-alpha activates the production of MCP-4/CCL13 from chondrocytes in RA joints, and that secreted MCP-4/CCL13 enhances fibroblast-like synoviocyte proliferation by activating the extracellular signal-regulated kinase mitogen-activated protein kinase cascade.

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High CCL18/PARC expression in articular cartilage and synovial tissue of patients with rheumatoid arthritis

Momohara, S., Okamoto, H., Iwamoto, T., Mizumura, T., Ikari, K., Kawaguchi, Y., Takeuchi, M., Kamatani, N. and Tomatsu, T.

J Rheumatol 34 ( 2 ) 266 - 71 2007.02

ISSN  0315-162X

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OBJECTIVE: We studied the role of CCL18/pulmonary and activation-regulated chemokine (PARC) in rheumatoid arthritis (RA). METHODS: Human cartilage tissues and synovial membranes were obtained from patients with RA and with osteoarthritis (OA). Sera samples were obtained from RA patients, OA patients, healthy controls, and patients with flu, and synovial fluid (SF) from patients with RA and OA. Real-time PCR was performed with RNA from cartilage samples. Immunohistochemical analysis of CCL18/PARC was done with RA and OA cartilage and synovial tissue. Levels of CCL18/PARC in serum and SF were evaluated by ELISA. RESULTS: CCL18/PARC mRNA was expressed at significantly higher levels in RA cartilage than in OA (p = 0.0001) and control (p < 0.0001) samples. CCL18/PARC mRNA expression was much higher in RA synovial membrane than OA samples (p = 0.0001). All RA cartilage and synovial tissue samples exhibited medium to strong staining for CCL18/PARC. Serum levels of CCL18/PARC were higher in RA patients (156.21 +/- 125.73 ng/ml, n = 71) than in OA patients (64.54 +/- 40.90 ng/ml, n = 12) and controls (28.04 +/- 10.96 ng/ml, n = 20). Levels of CCL18/PARC in RA SF (275.20 +/- 228.16 ng/ml, n = 15) were higher than in OA (33.13 +/- 14.84 ng/ml, n = 6; p = 0.0198). CCL18/PARC levels correlated significantly with rheumatoid factor levels (r = 0.431, p = 0.0040), but not with matrix metalloproteinase-3, erythrocyte sedimentation rate, and C-reactive protein. CONCLUSION: CCL18/PARC was highly expressed in RA articular cartilage and synovial tissue compared with OA samples. Our data indicated that CCL18/PARC levels are not related to the conditions of generalized inflammation, but are related to the pathogenesis of RA.

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Failure to confirm association between PDCD1 polymorphisms and rheumatoid arthritis in a Japanese population

Iwamoto, T., Ikari, K., Inoue, E., Toyama, Y., Hara, M., Yamanaka, H., Tomatsu, T., Momohara, S. and Kamatani, N.

J Hum Genet 52 ( 6 ) 557 - 60 2007

ISSN  1434-5161

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Programmed cell death 1 (PDCD1) is a necessary negative regulator to maintain peripheral tolerance and is a key molecule in the development of autoimmune diseases. Although PDCD1 gene polymorphisms and haplotypes were reported to be associated with rheumatoid arthritis (RA), replication studies later on showed conflicting results. Here, we analyzed the association of PDCD1 with RA using a large series of Japanese RA patients and population-based controls. DNA samples were obtained from 1,504 RA patients and 449 sex-matched controls. All samples were genotyped for three SNPs on PDCD1 (PD-1.1, PD-1.3 and PD-1.5) using the TaqMan fluorogenic 5' nuclease assay. Chi-square testing was performed for a case-control study, and the PENHAPLO program was used for haplotype estimation. We could not observe any significant association of PD-1.1 or PD-1.5 polymorphisms between RA. PD-1.3, which was reported to be involved in susceptibility to RA in patients of European descent, was non-polymorphic in the Japanese population. We conclude that polymorphisms in the PDCD1 gene analyzed here are not associated with RA in a Japanese population.

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The serum concentration of infliximab in cases of autologous blood donation for patients with rheumatoid arthritis

Mochizuki, T., Momohara, S., Ikari, K., Okamoto, H., Kobayashi, S., Tsukahara, S., Iwamoto, T., Kawamura, K., Saito, S. and Tomatsu, T.

Mod Rheumatol 17 ( 1 ) 24 - 7 2007

ISSN  1439-7595

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Our aim was to determine whether the use of infliximab for rheumatoid arthritis (RA) patients is associated with an increased rate of postoperative complications. In this study we evaluated the serum concentration of infliximab to study the influence of autologous blood donation (AB donation) in patients who were administered infliximab and underwent total knee replacement (TKR). We examined five RA patients. Infliximab combined with methotrexate was administered at 3 mg/kg every 8 weeks for all patients. We carried out the TKR operation in the middle of the 8-week interval in which infliximab was administered. The AB donation consisted of 400 ml pooled AB drawn at one point 2 weeks following the final administration of infliximab. Serum infliximab levels were measured using an enzyme-linked immunosorbent assay. Mean serum infliximab levels were 5.46 +/- 5.62 microg/ml 2 weeks after the final administration of infliximab, 2.02 +/- 1.66 microg/ml just before the operation, and 1.48 +/- 1.31 microg/ml 1 day post operation. Moreover, the mean serum level in an autologous blood bag sampled just before AB donation was 5.02 +/- 4.79 microg/ml. This study indicated the serum level of infliximab in the stored blood remained at almost the same level as the collected autologous blood. However, even after autotransfusion those levels were decreased compared with levels measured just before the operation. Therefore, we conclude that there is little influence of AB donation on the risks of infliximab.

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舟状骨骨折に対する小皮切による骨接合術の治療成績

吉川泰弘, 岩本卓士, 竹田誠, 石井聖佳 and 池田崇

骨折 28 ( 4 ) 659 - 661 2006.12

ISSN  0287-2285

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舟状骨骨折29例に小皮切による骨接合術を行い、治療成績を検討した。骨折型(Herbert分類)は、A2型:10例、B1型:4例、B2型:5例、B3型:2例、B4型:1例、C型:7例であった。全例で骨癒合が得られ、A・B型22例中20例(91%)は8週以内の骨癒合であった。臨床評価(Cooneyの評価基準)はexcellent:24例、good:4例、fair:1例であった。固定材料にはHeadless bone screw、double threaded screw、Acutrak screw、Herbert screwを用いたが、骨癒合や臨床成績に明らかな違いはなかった。この方法は、小侵襲で良好な骨癒合が得られる有用な方法である。A型骨折への適応もあるが、B型骨折は手術操作における整復確認に、C型骨折は適応に注意する必要があると考えられた。

特発性前骨間・後骨間神経麻痺の保存的・外科的治療

岩本卓士, 松村崇史, 越智健介, 高木岳彦 and 別所祐貴

日本手の外科学会雑誌 23 ( 2 ) 71 - 74 2006.10

ISSN  0910-5700

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2000～2004年に受信した非外傷性の前骨間神経麻痺(AIN麻痺)6例(男1例、女5例)、後骨間神経麻痺(PIN麻痺)3例(男1例、女2例、発症時年齢12～66歳)の計9例を対象に検討した。発症後3ヵ月で手術を施行したPIN麻痺の1例を除き、原則として6～8ヵ月間の保存治療法を行い、回復傾向を認めない症例に対し神経内神経剥離術を行った。保存療法で回復を認めたものが6例(AIN麻痺4例、PIN麻痺2例)、手術を行った症例が3例(AIN麻痺2例、PIN麻痺1例)で、観察期間は5～31ヵ月の保存療法例で10日間～10ヵ月、手術療法例では8～16ヵ月であった。発症後6ヵ月以内に保存的で回復を認めたのは6例中2例であった。手術療法3例全てに外的圧迫因子のない部位に神経束の砂時計様くびれを認め、くびれ部の中枢から末梢にゼリー様浮腫を呈していた。さらに2例で斜走する線維状索状物(oblique fibrous band)が神経束を直接圧迫しており、これを切離することで除圧が得られ麻痺の回復に影響を与える一因子と考えられた。

Production of monocyte chemoattractant protein-4 (MCP-4)/CCL13 by interferon-γ-activated human chondrocytes and its role in rheumatoid arthritis.

Iwamoto, T; Okamoto, H; Ikari, K; Iikuni, N; Toyama, Y; Tomatsu, T; Kamatani, N; Momohara, S

ARTHRITIS AND RHEUMATISM 54 ( 9 ) S88 - S88 2006.09

ISSN  0004-3591

Association between PADI4 and rheumatoid arthritis: a meta-analysis

Iwamoto, T., Ikari, K., Nakamura, T., Kuwahara, M., Toyama, Y., Tomatsu, T., Momohara, S. and Kamatani, N.

Rheumatology (Oxford) 45 ( 7 ) 804 - 7 2006.07

ISSN  1462-0324

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OBJECTIVE: Polymorphisms and haplotypes of the peptidylarginine deiminase type 4 gene (PADI4) have been reported to be associated with rheumatoid arthritis (RA) in a Japanese population. However, subsequent replication studies showed conflicting results. The aim of this study was to determine whether meta-analysis would prove the existence of the association. METHODS: PubMed was searched using the term 'PADI4' for articles from the publication of the first study to December 2005. Replication studies that tested the association between PADI4 and RA were reviewed for meta-analysis. The Breslow-Day test for homogeneity across the studies was calculated. The Mantel-Haenszel procedure was used to pool odds ratios (OR) with 95% confidence intervals (CI) to evaluate the association. RESULTS: Six replication studies, one from Japan and five from Europe and North America, fulfilled the selection criteria for inclusion in the meta-analysis. Homogeneity was confirmed across the replication studies. The common OR was 1.14 (95% CI = 1.07-1.21) for allelic distribution. The association was confirmed when only five replication studies in the European descent populations were combined (P = 0.0096, common OR = 1.10). CONCLUSIONS: Our meta-analysis showed a positive association between PADI4 and RA not only in the Japanese population but also in populations of European descent.

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Monocyte chemoattractant protein-4 (MCP-4)/CCL13 is highly expressed in cartilage from patients with rheumatoid arthritis

Iwamoto, T., Okamoto, H., Iikuni, N., Takeuchi, M., Toyama, Y., Tomatsu, T., Kamatani, N. and Momohara, S.

Rheumatology (Oxford) 45 ( 4 ) 421 - 4 2006.04

ISSN  1462-0324

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OBJECTIVES: To study the role of monocyte chemoattractant protein-4 (MCP-4)/CCL13 in the pathogenesis of rheumatoid arthritis (RA), we analysed the expression of MCP-4/CCL13 in chondrocytes, synovial fluid and serum from patients with RA and investigated the effect of MCP-4/CCL13 on the proliferation of synovial cells. METHODS: Human articular cartilage specimens were obtained from joints from RA and osteoarthritis (OA) patients and normal joints (controls). Transcript levels of MCP-4 in cartilage were determined by real-time polymerase chain reaction. Protein levels were measured by enzyme-linked immunoassay. Cultured fibroblast-like synoviocytes (FLS) were treated with various concentrations of recombinant MCP-4/CCL13 protein, and cell proliferation was evaluated with a viability assay. RESULTS: The gene expression of MCP-4 was significantly higher in cartilage from RA patients than in that from OA patients (P = 0.00902) and in normal cartilage (P = 0.00902). The concentration of MCP-4/CCL13 protein in serum from RA patients (mean 94.7 +/- 37.6 pg/ml) was significantly higher than in serum from OA patients (mean 49.2 +/- 31.2 pg/ml, P = 0.0051) and controls (mean 32.6 +/- 23.9 pg/ml, P = 0.0001). The concentration of MCP-4/CCL13 protein in synovial fluid from RA patients (mean 247.2 +/- 161.2 pg/ml) was also significantly higher than in that from OA patients (mean 29.6 +/- 50.5 pg/ml, P = 0.000019). Moreover, MCP-4/CCL13 enhanced the proliferation of FLS in a dose-dependent manner. CONCLUSIONS: MCP-4/CCL13 is highly expressed in RA joints at the mRNA and protein levels. Our results suggest that MCP-4/CCL13 is secreted from chondrocytes and activates the proliferation of rheumatoid synovial cells, thereby leading to joint destruction in RA.

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Raised monocyte chemotactic protein-1 (MCP-1)/CCL2 in cerebrospinal fluid of patients with neuropsychiatric lupus

Iikuni, N., Okamoto, H., Yoshio, T., Sato, E., Kamitsuji, S., Iwamoto, T., Momohara, S., Taniguchi, A., Yamanaka, H., Minota, S. and Kamatani, N.

Ann Rheum Dis 65 ( 2 ) 253 - 6 2006.02

ISSN  0003-4967

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BACKGROUND: An imbalance in cytokine homoeostasis is thought to have a key role in the neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE), and recently, a role for chemokines has been noted. OBJECTIVE: To compare concentrations of monocyte chemotactic protein-1 (MCP-1)/CCL2 in cerebral spinal fluid (CSF) of patients with SLE, and with and without neuropsychiatric symptoms. METHODS: CSF was obtained from 185 patients with SLE: 96 with NPSLE and 89 patients with SLE without neuropsychiatric symptoms (non-NPSLE patients). MCP-1/CCL2 concentrations were measured with an ELISA. RESULTS: The average concentration of CSF MCP-1/CCL2 in patients with NPSLE was 1959 pg/ml, and in non-NPSLE patients 712 pg/ml. The average MCP-1/CCL2 concentration was significantly higher in the NPSLE group than in the non-NPSLE group (p<0.001). In one representative patient with NPSLE, MCP-1/CCL2 levels in the CSF decreased in parallel with a decline in neuropsychiatric symptoms. CONCLUSIONS: CSF MCP-1/CCL2 levels are higher in patients with NPSLE than in non-NPSLE patients. MCP-1/CCL2 may have an important role in the expression of NPSLE. These results indicate that CSF MCP-1/CCL2 reflects an inflammatory activity in the brain, suggesting that it might be used as a diagnostic tool and a monitor for therapeutic responses in patients with NPSLE.

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Acute destruction of the hip joints and rapid resorption of femoral head in patients with rheumatoid arthritis

Yoshino, K., Momohara, S., Ikari, K., Kawamura, K., Mochizuki, T., Iwamoto, T., Niki, Y., Saitou, S. and Tomatsu, T.

Mod Rheumatol 16 ( 6 ) 395 - 400 2006

ISSN  1439-7595

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We report three rheumatoid arthritis (RA) cases with acute destruction of hip joint and rapid resorption of femoral head. The condition occurred in less than 6 months and closely resembled rapid destructive coxarthrosis. All three patients were postmenopausal women with active RA who had been taking steroids. Two of the patients were taking prednisolone (PSL) of over 20 mg as maximum dose per day, and all patients were resistant to disease-modifying anti-rheumatic drugs (DMARDs). Other than the problems of their hip joints, one had a giant bursitis around the pathological side of the hip joint, another had multiple rheumatoid nodules and skin infarction, and the other suffered from insufficiency fracture of the contralateral femoral subcapital lesion. As a result, all of them had total hip arthroplasty. We recommend taking repetitive radiographs for RA patients with continuing severe hip pain.

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橈骨遠位端骨折に合併した尺骨遠位部骨折の治療

吉川泰弘, 岩本卓士, 石井聖佳 and 池田崇

日本手の外科学会雑誌 22 ( 4 ) 441 - 445 2005.11

ISSN  0910-5700

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橈骨遠位端骨折に合併した尺骨遠位部骨折24例(男4例・女20例,平均72歳)の成績を報告した.骨折型はBiyani分類1型8例,2型4例,3型5例,4型7例で,橈骨遠位端骨折はA2が1例,A3が6例,C1が6例,C2が7例,C3が4例であった.尺骨遠位部骨折の治療は保存療法2例,ピンニング2例,髄内釘3例,tension band wiring 8例,low-profile plate(LPP)9例で,橈骨遠位端骨折にはピンニング2例,プレート固定12例,創外固定10例を行った.術後4～28ヵ月で,骨幹端部は全例骨癒合したが,茎状突起では4例が偽関節となった.Fernandezの評価法による臨床成績はexcellent 8例,good 10例,fair 4例,poor 2例で,合併症はCRPSを1例に認めた.Biyani分類4型はfair以下が多く,治療法別ではLPPが比較的良好であった.成績不良の原因としては,粉砕の程度が強い骨折や開放骨折,茎状突起基部の偽関節,橈骨遠位端粉砕骨折の合併,尺骨のmalalignmentが考えられた

Monocyte chemoattractant protein-4/CCL13 is highly expressed in cartilage from patients with rheumatoid arthritis.

Iwamoto, T; Okamoto, H; Iikuni, N; Toyama, Y; Tomatsu, T; Kamatani, N; Momohara, S

ARTHRITIS AND RHEUMATISM 52 ( 9 ) S473 - S473 2005.09

ISSN  0004-3591

The possibility of peroxisome proliferator-activated receptor-alpha ligand for the treatment of osteoarthritis and rheumatoid arthritis.

Iwamoto, T; Okamoto, H; Iikuni, N; Toyama, Y; Tomatsu, T; Kamatani, N; Momohara, S

ARTHRITIS AND RHEUMATISM 52 ( 9 ) S243 - S244 2005.09

ISSN  0004-3591

逆行性浅腓腹動脈皮弁による下腿皮膚欠損の再建手術

岩本卓士, 吉川泰弘, 竹田誠, 石井聖佳 and 松林経世

整形外科 56 ( 4 ) 393 - 396 2005.04

ISSN  0030-5901

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逆行性浅腓腹動脈皮弁(sural flap)による下腿・足部の皮膚軟部組織欠損部の再建症例5例(男性4例,女性1例)を対象に,治療成績について検討した.なお,皮弁採取部は4例で一期的に縫縮し,皮弁の大きさが6×9であった1例は二期的な遊離植皮を行った.皮弁は全例で一期的に生着を認め,治療成績は良好であった.以上より,sural flapによる再建は,安全で容易に行うことができ有用である

肘関節伸展制限を生じた小児上腕骨小頭骨折の1例

吉川泰弘 and 岩本卓士

日本肘関節学会雑誌 11 ( 1 ) 105 - 106 2004.12

ISSN  1349-7324

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9歳女児.足を滑らせ転倒受傷した.近医で左肘関節後方脱臼の診断で徒手整復を受け,1週間の外固定後に可動域訓練を開始した.肘関節の可動域が改善しないため,受傷後8週で受診した.MRIでは正面像で外顆骨端核の外側遠位に骨折がみられ,側面像で小頭骨端核の後下方に骨性突出が存在し,基部は小頭骨端核と骨癒合し,その先端は橈骨頭と衝突していた.また,骨性突出に連続してすぐ後方には骨欠損部を認めた.上腕骨小頭後下方部分の関節内骨折の診断で,受傷後3ヵ月半で手術を行った.術後1週より可動域訓練を開始し,術後3週でROMは良好であった.術後3年の現在,X線上外顆中央部の骨性隆起は消失し,肘関節に不安定性,疼痛はなく,ROMも伸展+10°,屈曲145°で左右差はない

橈骨遠位端関節内骨折(AO分類C型)に対するCompack創外固定器による治療

吉川泰弘, 岩本卓士, 森田晃造 and 岩部昌平

日本手の外科学会雑誌 21 ( 4 ) 535 - 539 2004.11

ISSN  0910-5700

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橈骨遠位端関節内骨折(AO分類C型)18例18骨に対してnon-bridging型のCompack創外固定器による治療を行った.治療成績はexcellent 12例,good 5例,fair 1例で,合併症はピンの刺激症状が1例,complex regional pain syndrome(CRPS)が1例であった.CRPS例を除いた関節可動域の平均は掌屈52.2°,背屈58.7°,回内78.5°,回外72.9°であった.X線評価ではvolar tilt,radial inclination,ulnar varianceはいずれも術後から調査時まで僅かな矯正損失を認めたが,1mm以内に整復されたstep offは調査時まで良好に保たれていた.粉砕骨変例や骨粗鬆症例に対する整復位保持には,Kirschner綱線固定の併用や人工骨補填材が有効であった.また,5 part以上のC3型粉砕骨折例に対しては,ハープピンとKirschner鋼線により格子状の面を形成して関節面を保持する方法が有効であった

空洞-腹腔シャントが著効した広範な癒着性クモ膜炎による脊髄空洞症の1例

岩本卓士, 松本守雄, 西澤隆, 中村雅也, 丸岩博文, 千葉一裕 and 戸山芳昭

関東整形災害外科学会雑誌 34 ( 5 ) 336 - 340 2003.10

ISSN  0389-7087

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59歳女.歩行困難を主訴とした.深部腱反射は両上下肢で軽度の低下を認め,ホフマン反射,バビンスキー反射は陰性であった.筋力は両側前頸骨筋以下で低下し,特に左側で著明であった.知覚障害,膀胱直腸障害も認めた.MRIでC7～T12に脊髄空洞病変を認め,腰椎穿刺による脊髄造影及び後頭下穿刺で行ったCT所見を合わせ,T9～L1間の癒着性くも膜炎に伴う脊髄空洞症と診断し,空洞ー腹腔シャントを施行した.術後1年,長母趾の伸筋と屈筋に軽度の筋力低下を認めるのみで,筋力は両下肢とも著明に改善した.知覚障害,膀胱直腸障害も消失した.MRIでは,空洞は残存するが,術前と比較して著明に縮小した

創外固定及びKirschner鋼線を用いた経皮的整復固定により治療した肘関節脱臼骨折の1例

岩本卓士, 松村崇史 and 村山信行

日本肘関節研究会雑誌 10 ( 1 ) 181 - 182 2003.07

ISSN  1340-492X

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30歳女.乗用車運転中電柱に衝突し,左肘を受傷した.X線所見で左尺骨肘頭粉砕骨折を伴う左肘前方脱臼骨折が認められた.透視下で肘頭及び陥没骨片をK-wireにより経皮的に整復後ピンニングし,更にオーソフィックス肘用創外固定器を用いて創外固定した.術翌日より前腕の回内外及び肘関節の可動域訓練を開始したが,術後8日の時点で腕尺関節面の不適合を認め,再度K-wireによる経皮的整復固定を行った.骨癒合は良好で,再手術より6週で創外固定器を,7週でK-wireを抜去した.術後12週での可動域は伸展-15°,屈曲135°,前腕回内80°,回外90°で,疼痛はなく,橈骨頭の脱臼傾向も認めなかった.JOAスコアは93点であった

橈骨遠位端骨折に対する保存的治療の成績　X線成績とADL障害の相関について

山部英行, 松村崇史, 相羽整, 吉田祐文, 八代忍, 清水国章 and 岩本卓士

骨折 25 ( 2 ) 763 - 766 2003.05

ISSN  0287-2285

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農村型地方都市における60歳以上の橈骨遠位端骨折28例29関節(男7例,女21例,受傷時平均71歳)を対象に,保存的治療におけるX線成績と実生活レベルでの患者の満足度,ADL障害の関係を検討した.経過観察期間は平均1年5ヵ月であった.X線成績不良例12例はすべて不安定型Colles骨折であったが,そのうち9例は治療成績良好であった.一方,治療成績不良群3例は全例X線成績不良であり,全例握力低下,手関節尺側部痛,回内外制限によるADL障害が認められた.しかし,アンケート結果より,多少の変形治癒は必ずしも患者の満足度を損なわないことがわかった

肘用創外固定器による粉砕型Monteggia骨折の治療経験

松村崇史 and 岩本卓士

日本肘関節研究会雑誌 9 ( 1 ) 121 - 122 2002.07

ISSN  1340-492X

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62歳男.透析患者であり,バイク事故で右肘を受傷した.X線上尺骨近位関節内粉砕骨折を伴った閉鎖性Monteggia骨折(Bado 1型)であった.X線透視下に徒手整復を試みたところ,橈骨頭は容易に整復され,尺骨の形態はほぼ良好であった.しかし整復位の保持は困難で,更に患部の腫脹が著明な為,保持目的での肘の無理な屈曲肢位は血行障害の危惧から望ましくないと判断し,患部の安静のため橈骨頭脱臼のまま肘屈曲50°で外固定した.その後患部の腫脹と水疱形成が著明で,最小侵襲の観点からも内固定は回避すべきと判断し,受傷後1週に閉鎖的整復・創外固定術を施行した.使用機種はオーソフィックス肘用創外固定器とした.術後肘屈曲70°で創外固定器のジョイントをロックした.術中術後に有害事象は認めなかった.前腕の回旋は術直後から,肘の屈伸は5週間後ロックを解除して施行させた.骨癒合は順調で,術後14週で創外固定器を抜去した.術後23週で橈骨頭の整復位安定性は良好で,肘関節可動域は15～130°,前腕回内40°回外90°で疼痛はなく,ADL上支障はなかった.術後42週でも橈骨頭の再脱臼傾向は認めなかった