研究者詳細 - 岩本　卓士

論文 - 岩本　卓士

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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年04月

ISSN 09301038

© 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年02月

ISSN 17531934

© 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年01月

ISSN 1060152X

© 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年10月

ISSN 10582746

© 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年08月

ISSN 03635023

© 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年

ISSN 00219355

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., Sato K.

Keio Journal of Medicine （Keio Journal of Medicine） 67 （ 2 ） 19 - 25 2017年08月

ISSN 0022-9717

© 2017 by The Keio Journal of Medicine. 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年08月

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 2017年06月

ISSN 0890-5339

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年05月

ISSN 0363-5023

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年05月

ISSN 0949-2658

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年05月

ISSN 0266-7681

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年05月

ISSN 1022-5536

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年12月

ISSN 0148-639

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年11月

ISSN 1439-7595

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年07月

ISSN 1439-7595

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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., Toyama Y.

Journal of Orthopaedic Science （Journal of Orthopaedic Science） 23 （ 1 ） 202 - 204 2016年06月

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年06月

ISSN 0363-5023

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年04月

ISSN 0973-6042

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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年03月

ISSN 1058-2746

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年

ISSN 1439-7595

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年11月

ISSN 2163-3916

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年09月

ISSN 1058-2746

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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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年10月

ISSN 0722-1819

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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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 2013年10月

ISSN 1531-6564

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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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年04月

ISSN 1439-7609

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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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年02月

ISSN 2185-4092

【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年02月

ISSN 0387-4095

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年12月

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年11月

ISSN 0914-8124

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年10月

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年09月

ISSN 0557-0433

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年08月

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年08月

ISSN 1439-7609

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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【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年04月

ISSN 1882-9163

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)

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年04月

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年04月

ISSN 2186-1110

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年02月

ISSN 2185-4092

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。

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年02月

ISSN 1439-7609

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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年01月

ISSN 2185-4092

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。

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年01月

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年01月

ISSN 2185-4092

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年01月

ISSN 2185-4092

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。

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年12月

ISSN 1345-7608

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年09月

ISSN 2185-4092

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年09月

ISSN 2185-4092

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年07月

ISSN 0557-0433

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年06月

ISSN 1546-1718

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年05月

ISSN 1884-8842

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年05月

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年05月

ISSN 0914-8124

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年04月

ISSN 1439-7609

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年12月

ISSN 1349-7324

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年01月

ISSN 1531-6564

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年09月

ISSN 1462-0332

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年09月

ISSN 1742-464X

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年03月

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年09月

ISSN 1742-464X

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年02月

ISSN 0315-162X

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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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年

ISSN 1439-7595

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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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年

ISSN 1434-5161

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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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年12月

ISSN 0287-2285

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年10月

ISSN 0910-5700

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。

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年07月

ISSN 1462-0324

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年04月

ISSN 1462-0324

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年02月

ISSN 0003-4967

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年

ISSN 1439-7595

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年11月

ISSN 0910-5700

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

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年04月

ISSN 0030-5901

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年12月

ISSN 1349-7324

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年11月

ISSN 0910-5700

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年10月

ISSN 0389-7087

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年07月

ISSN 1340-492X

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年05月

ISSN 0287-2285

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年07月

ISSN 1340-492X

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

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