研究者詳細 - 渡邉　耕太

論文 - 渡邉　耕太

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下肢スポーツ障害、外傷の手術における術中エコーの有用性

山村祐司, 神谷智昭, 寺本篤史, 渡邉耕太, 成田有子, 池田康利, 宮川健, 山下敏彦

日本整形外科スポーツ医学会雑誌 ( (一社)日本整形外科スポーツ医学会 ) 39 ( 4 ) 546 - 546 2019年08月

肩甲骨面挙上角度による棘上筋腱深層線維の伸び率計測未固定人体標本を用いた棘上筋腱表層断裂モデル

宮本浩樹, 飯田尚哉, 谷口達也, 廣田健斗, 山下敏彦, 渡邉耕太

日本整形外科スポーツ医学会雑誌 ( (一社)日本整形外科スポーツ医学会 ) 39 ( 4 ) 483 - 483 2019年08月

手術により固定性の得られたリスフラン関節損傷症例に対する後療法の試み

谷口達也, 斎藤丈太, 渡邉耕太

日本足の外科学会雑誌 ( (一社)日本足の外科学会 ) 40 ( 1 ) 199 - 202 2019年08月

手術により固定性が得られたリスフラン関節損傷手術患者5例に対し統一的な後療法を試み、治療成績を調査した。対象は男性5例で、手術では全例に観血的整復とスクリュー固定を行った。後療法は術翌日より足関節運動、可及的早期に踵歩行を開始し、12週で全荷重とした。荷重時痛のある場合、理学療法士が足底挿板を作製した。評価項目はプロトコール逸脱例、足底挿板作製数、再転位や再手術例、復職までの期間と、術後1年時の足関節可動域、JSSF midfoot scale、VAS(歩行時痛)とした。全例でプルトコール通りに後療法を行え、再転位や再手術例もなかった。足底挿板は3例で作製した。復職期間は平均16週だった。術後1年時の各平均値は足関節背屈20°、底屈45°、JSSF midfoot scale 88点、VAS 20mmだった。リスフラン関節損傷術後に理学療法士の管理下で行う早期運動療法は安全で有効だった。復職期間にはばらつきがあり、今後の検討課題と考えた。(著者抄録)

野球投手に発生した脛骨天蓋骨軟骨損傷

濱岡航大, 寺本篤史, 神谷智昭, 渡邉耕太, 山下敏彦

日本整形外科スポーツ医学会雑誌 ( (一社)日本整形外科スポーツ医学会 ) 39 ( 3 ) 307 - 312 2019年07月

脛骨天蓋骨軟骨損傷は比較的まれである。今回筆者らは野球投手に発生した脛骨天蓋骨軟骨損傷を2例経験した。2例とも右投げの投手で、投球動作時に前足として踏み込む左足に病変が発生していた。術後のリハビリテーションにおいて投球フォームの修正を行ない、ストライドを狭くして底屈位での踏み込みを回避することで再発予防を行なった。2例とも投手として試合に復帰した。野球投手の脛骨天蓋骨軟骨損傷は、投球動作の際にマウンドでストライドを大きくとり、足関節底屈位で踏み込む慢性ストレスが発生原因と考えられた。(著者抄録)

エコーによる足部腱の滑走距離計測異なる足関節肢位の影響

谷口達也, 渡邉耕太, 廣田健斗

日本足の外科学会雑誌 ( (一社)日本足の外科学会 ) 40 ( Suppl. ) S217 - S217 2019年07月

The Effect of Novel Ankle-Realigning Socks on Dynamic Postural Stability in Individuals with Chronic Ankle Instability.

Kobayashi T, Watanabe K, Ito T, Tanaka M, Shida M, Katayose M, Gamada K

International journal of sports physical therapy 14 ( 2 ) 264 - 272 2019年04月 [査読有り] [国際誌]

Background: A dynamic postural stability deficit has been suggested to be present in individuals with chronic ankle instability (CAI). Interventions to improve postural control in individuals with CAI have been reported, but they required a long period of and compliance with interventions. Purpose: To examine the effect of novel ankle-realigning socks on dynamic postural stability in individuals with CAI using the star excursion balance test (SEBT). Study Design: Case-control study. Methods: Twenty-eight control and 22 subjects with CAI (who were tested in both barefoot and with socks) were enrolled. The weight-bearing ankle dorsiflexion range of motion (DF-ROM) and SEBT were measured in the control group, the barefoot CAI group, and the CAI with socks group. In addition, subjective ankle instability during SEBT was measured using a visual analog scale (0 - 100). Results: DF-ROM was 48.3 ± 7.4 º in the control group, 43.3 ± 8.0 º in the barefoot CAI group, and 45.7 ± 6.8 º in the CAI with socks group. DF-ROM was significantly less in the barefoot CAI group than in the control group. The SEBT scores were significantly less in the barefoot CAI group than in the control group in all directions. The SEBT score was significantly larger in the CAI with socks group than in the barefoot CAI group in the posteromedial, posterior, and posterolateral directions. In addition, there were no significant differences between the control group and the CAI with socks group in six directions. Conclusion: Wearing the novel ankle-realigning socks immediately improved dynamic postural stability as measured by the SEBT and subjective ankle instability in individuals with CAI. Level of Evidence: Level 3b.

PubMed

Kinematics and Laxity of the Ankle Joint in Anatomic and Nonanatomic Anterior Talofibular Ligament Repair: A Biomechanical Cadaveric Study

Hiroaki Shoji, Atsushi Teramoto, Yuzuru Sakakibara, Tomoaki Kamiya, Kota Watanabe, Hiromichi Fujie, Toshihiko Yamashita

American Journal of Sports Medicine 47 ( 3 ) 667 - 673 2019年03月 [査読有り]

© 2019 The Author(s). Background: Although it is crucial to accurately identify the anterior talofibular ligament (ATFL) attachment site, it may not be feasible to fully observe the ATFL attachment site during arthroscopic surgery. As a result, the repair position might often be an unintentionally nonanatomic ATFL attachment site. Hypothesis: Anatomic ATFL repair restores kinematics and laxity to the ankle joint, while nonanatomic ATFL repair does not. Study Design: Controlled laboratory study. Methods: Seven normal fresh-frozen human cadaveric ankles were used. The ankles were tested with a 6 degrees of freedom robotic system. The following ankle states were evaluated: intact, ATFL injured, ATFL anatomic repair, and ATFL nonanatomic repair. The ATFL nonanatomic repair position was set 8 mm proximal from the center of the ATFL attachment site of the fibula. For each state, a passive plantarflexion (PF)–dorsiflexion (DF) kinematics test and a multidirectional loading test (anterior forces, inversion moment, and internal rotation moment) were performed. Results: The kinematics and laxity of the anatomic repair were not significantly different from those of the intact state. In nonanatomic repair, the inversion-eversion angle showed significant inversion (3.0°-3.4°) from 5° to 15° of DF, and the internal rotation–external rotation angle showed significant internal rotation (2.0°) at neutral PF-DF versus the intact state. In addition, internal rotation laxity was significantly increased (5.5°-5.8°) relative to the intact state in the nonanatomic repair at 30° and 15° of PF. There were no significant differences in anterior-posterior translation between the repairs. Conclusion: Although the anatomic ATFL repair state did not show significant differences in kinematics and laxity relative to the intact state, the nonanatomic ATFL repair state demonstrated significant inversion and internal rotation kinematics and internal rotation laxity when compared with the intact state. Clinical Relevance: Nonanatomic repair alters kinematics and laxity from the intact condition.

DOI PubMed

Modified distal tibial oblique osteotomy for osteoarthritis of the ankle: Operative procedure and preliminary results.

Kota Watanabe, Atsushi Teramoto, Takuma Kobayashi, Yuzuru Sakakibara, Hiroaki Shoji, Shinichiro Okimura, Satoshi Nuka, Toshihiko Yamashita

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 24 ( 2 ) 306 - 311 2019年03月 [国内誌]

BACKGROUND: Low tibial osteotomy is an effective joint-preserving surgery for ankle arthritis. However, poor postoperative wound healing, infection, and delayed or non-union of bones remain significant concerns. We describe a modified distal tibial oblique osteotomy procedure and report preliminary results for varus ankle arthritis. METHODS: The osteotomy path consisted of an oblique doglegged line from the lateral end of the distal tibia to a proximal point about one-third from the lateral edge and continuing along an arc defined by virtual coronal-plane rotation of the doglegged line to the medial edge. After osteotomy, the distal tibial fragment was rotated distally in the coronal plane for realignment while maintaining contact with the proximal tibia and the distal tibial fragment. The resulting wedge-shaped gap was filled with artificial bone blocks and tibial bone projecting medially from rotation. A locking plate was then applied for stabilization. We evaluated 7 ankles from 6 osteoarthritis patients both clinically and radiographically following this procedure. RESULTS: Bone union was achieved within 3 months for all patients. The Japanese Society for Surgery of the Foot ankle-hindfoot scale improved from a mean of 38.4 points preoperatively to 85.7 points at the latest follow-up. No wound healing problems, infections, or nerve disturbances were observed. Multiple radiographic parameters were also improved following the operation. CONCLUSIONS: This procedure maintains close bone contact for better postoperative union, obviates the need for iliac bone harvesting, and reduces tension on medial soft tissue. We believe these modifications are potential advantages for achieving stable results in patients with ankle osteoarthritis.

DOI PubMed

Morphological evaluation of the calcaneofibular ligament in different ankle positions using a three-dimensional MRI sequence.

Yoshihiro Akatsuka, Atsushi Teramoto, Hiroyuki Takashima, Kota Watanabe, Toshihiko Yamashita

Surgical and radiologic anatomy : SRA 41 ( 3 ) 307 - 311 2019年03月 [国際誌]

PURPOSE: Evaluating images of the lateral ligament of the ankle is not easy, and evaluation of the calcaneofibular ligament (CFL) in particular is difficult. We prospectively conducted morphological measurements of the CFL in different ankle positions and obtain basic data for use in functional assessment of the CFL, diagnosis of CFL injury, and determination of treatment effects. METHODS: The subjects were ten healthy volunteers (ten ankles) with a mean age of 27.8 years and no history of ankle disease. Imaging was done using a 3-T magnetic resonance imaging (MRI) machine and fast imaging employing steady-state acquisition cycled phases (FIESTA-C), a three-dimensional (3D) sequence, with the ankle in a neutral position, maximum dorsiflexion, and maximum plantar flexion. 3D images of the CFL, peroneal muscle tendons, fibula, and calcaneus were prepared at a workstation, and morphological measurements of the CFL were made. RESULTS: In all positions, the CFL showed a gently curving course with the peroneal muscle tendons as a fulcrum. The tortuosity angle was significantly smaller in plantar flexion (30.0° ± 7.4°) than in the neutral position (41.7° ± 8.3°). CONCLUSIONS: 3D MRI sequences showed that, in all positions, the CFL curved due to the influence of the peroneal muscle tendons. With maximum plantar flexion, the CFL tortuosity angle was small, which was thought to have been due to the tension in the CFL.

DOI PubMed

せん断波イメージングによる大腿直筋の組織弾性評価筋内の局在特性と膝関節受動トルクの関連に着眼して

小出所大樹, 谷口圭吾, 渡邉耕太, 片寄正樹, 山下敏彦

日本整形外科学会雑誌 ( (公社)日本整形外科学会 ) 93 ( 3 ) S638 - S638 2019年03月

距腿関節面における内側・中央・外側領域別の曲率半径の解析並進運動を規定する曲率特性に着目して

野崎修平, 渡邉耕太, 加藤拓也, 宮川健, 神谷智昭, 片寄正樹, 山下敏彦

日本整形外科学会雑誌 ( (公社)日本整形外科学会 ) 93 ( 3 ) S1188 - S1188 2019年03月

Radius of curvature at the talocrural joint surface: inference of subject-specific kinematics.

Nozaki S, Watanabe K, Kato T, Miyakawa T, Kamiya T, Katayose M

Surgical and radiologic anatomy : SRA 41 ( 1 ) 53 - 64 2019年01月 [査読有り] [国際誌]

PURPOSE: The coupled behavior of talocrural joint motion is primarily determined by the morphological features of the talar trochlea and tibiofibular mortise. Features of the radius of curvature of the talocrural joint, however, remain unclear. The objectives of this study were to evaluate the radius of curvature at the mid, medial, and lateral regions of both the talar trochlea and the tibial plafond, and to estimate subject-specific kinematics of the talocrural joint. METHODS: Computed tomography images of 44 subjects with healthy talocrural joints were assessed by creating three-dimensional bone models. The radii of curvature of the anterior and posterior regions at the mid, medial, and lateral regions of both the talar trochlea and the tibial plafond were calculated. Hypothetical dorsiflexion and plantarflexion axes of the talocrural joint were estimated from the shape of the talar trochlea. Orientations and distances of these axes were calculated. RESULTS: At both the talar trochlea and the tibial plafond, the anteromedial and posteromedial radii exhibited the largest coefficients of variation. The anterior-to-posterior radius ratio (APRR) of the medial talar trochlea significantly correlated with the mid APRR, anterior medial-to-lateral radius ratio (MLRR), and posterior MLRR of the trochlea (r = 0.45, 0.52, - 0.60, respectively, and all P < 0.01). CONCLUSIONS: The asymmetric shape of the medial talar trochlea seems to determine a fixed or changing axis of rotation at the talocrural joint. This subject-specific rotational axis of the talocrural joint should be considered in the management of patients with ankle injuries.

DOI PubMed

Antinociceptive effects of hyaluronic acid on monoiodoacetate-induced ankle osteoarthritis in rats.

Shunsuke Jimbo, Yoshinori Terashima, Atsushi Teramoto, Tsuneo Takebayashi, Izaya Ogon, Kota Watanabe, Tatsuya Sato, Nobutoshi Ichise, Noritsugu Tohse, Toshihiko Yamashita

Journal of pain research 12 191 - 200 2019年 [国際誌]

Purpose: Ankle osteoarthritis (OA) causes significant pain and debilitation; yet, its underlying mechanisms remain unclear. Clinically, hyaluronic acid (HA) is widely used to treat OA. The present study aimed to investigate the roles of HA in pain-related behavior, joint function, swelling, and pathological changes in cartilage in a rat model of monoiodoacetate (MIA)-induced ankle OA. Materials and methods: Male Sprague Dawley rats were assigned to three experimental groups as follows: 1) MIA rats injected with 1 mg MIA in the right tibiotarsal joint for two consecutive days; 2) sham rats injected with saline instead of MIA; and 3) MIA-HA rats injected with HA in the tibiotarsal joint at 7, 14, and 21 days after MIA injection. Joint swelling, range of motion (ROM), and pain-related behavior were evaluated 1 day before and on the 7th, 14th, 21st, and 28th day after MIA or saline injection. Pathological changes in the ankle joint were assessed 28 days after MIA or saline injection. Results: No significant difference in the degree of ankle swelling or ROM reduction was observed between MIA rats and MIA-HA rats. However, compared with those in MIA rats, mechanical and thermal hypersensitivity was significantly reduced and stride length significantly improved in MIA-HA rats. Histologic analysis revealed that cartilage degeneration was significantly suppressed in MIA-HA rats compared with that in MIA rats, reflecting the chondroprotective effects of HA. Conclusion: HA improved pain-related behavior and stride length and suppressed MIA-induced cartilage degeneration. HA may thus inhibit OA progression and suppress peripheral and/or central sensitization.

DOI PubMed

各足趾屈曲力の評価 FHL分枝パターンの違いによる影響

廣田健斗, 渡邉耕太, 片寄正樹, 山下敏彦

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 ) 61 ( 136th suppl ) 34 - 34 2019年

鏡視下足関節外側靱帯修復術におけるアンカー刺入位置の検討

小路弘晃, 寺本篤史, 神谷智昭, 山下敏彦, 渡邉耕太

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 ) 61 ( 137th suppl ) 69 - 69 2019年

陳旧性アキレス腱断裂に対する手術治療成績

寺本篤史, 神谷智昭, 山下敏彦, 渡邉耕太

北海道整形災害外科学会雑誌 ( 北海道整形災害外科学会 ) 61 ( 137th suppl ) 44 - 44 2019年

PS-fixed型TKAにおける内外側独立テンサーを用いた術中インプラントgapと臨床成績

鍋城尚伍, 寺本篤史, 神谷智昭, 岡田葉平, 山下敏彦, 渡邉耕太, 鈴木智之, 小路弘晃