Chiari手術後における運動療法の客観的指標

• Published in: 理学療法学 Vol. 30; no. 6; pp. 362 - 370
• Main Authors: 永井 良治, 上田 信弘, 野上 正太, 奥村 哲生, 井上 明生, 山本 耕之
• Format: Journal Article
• Language: Japanese
• Published: 日本理学療法士学会 20.10.2003; Japanese Society of Physical Therapy
• Subjects: Chiari手術; トレンデレンブルグ徴候; 外転筋筋力
• ISSN: 0289-3770; 2189-602X
• DOI: 10.15063/rigaku.kj00001019827

Patients with progressive or end stage arthrodesis often receive a Chiari pelvis osteotomy operation combined with ectropion bone cutting operation. Those patients shall be subject to postoperative exercise therapy for reinforcing muscle strength of the abductors of their hip joints. This report is to examine the ideal method of abductor strength reinforcing exercise. We made a survey on 21 hip joints of 21 patients with progressive and/or end stage arthrodesis to determine when we should start such a exercise for the patients, how much amount of exercise we should increase for the therapy and what target values we should achieve in the exercise therapy. The survey result showed that the safer exercise therapy could be started by the face-up position in case of 1/3 loaded walking and by lateral recumbent position in case of 1/2 loaded walking. This idea reflects the resultant relationship between hip joints which occurs in case of abduction, in case of relief and in case of fully loaded walking. As for the target value of abductor, the result also showed that the Trendelenburg symptoms all became negative with the below-mentioned conditions in case of good occlusion of joints with Sharp Angle less than 50°and with AHI more than 70%. The conditions go that the afferent or efferent contraction shall be over 1.00 Nm/kg when the rate of lever is under 2.5〜3.0 and shall be over 1.10 Nm/kg when the rate of lever is under 3.0〜4.5. The conditions also go that the even contraction shall be over 0.60 Nm/kg when the rate of lever is under 2.5〜3.0 and shall be over 0.70 Nm/kg when the rate of lever is under 3.0〜4.5. 進行期・末期関節症に対して外反骨切り術併用のChiari手術を施行した21例21股関節を対象に，術後の経過における外転筋に対する適正な筋力増強運動の開始時期，増加量及び到達目標について検討した。その結果，外転運動時と免荷から全荷重歩行までの各股関節合力の関係より，1/3部分荷重歩行時期までは背臥位で，1/2部分荷重歩行時期から側臥位で外転筋の筋力増強運動を開始すれば，股関節に過負荷なく安全に行うことができると考えられた。また外転筋筋力の到達目標はSharp角50度以下，臼蓋骨頭指数70%以上の関節適合性良好例では，生体力学的に，てこ比と外転筋筋力の関係において求心性・遠心性収縮は，てこ比2.5〜3.0未満では1.00Nm/kg以上，てこ比3.0〜4.5未満では1.10Nm/kg以上また等尺性収縮は，てこ比2.5〜3.0未満では0.60Nm/kg以上，てこ比3.0〜4.5未満では0.70Nm/kg以上の3収縮条件を満たせば，すべてトレンデレンブルグ徴候が陰性になることが示唆された