術前の歩行能力と術後下肢深部静脈血栓症合併の関連性について

• Published in: 理学療法学 Vol. 31; no. 2; pp. 113 - 118
• Main Authors: 佐々木 賢太郎, 千田 益生, 石倉 隆, 太田 靖之, 森 剛士, 築山 尚司, 井上 一
• Format: Journal Article
• Language: Japanese
• Published: 日本理学療法士学会 20.04.2004; Japanese Society of Physical Therapy
• Subjects: DVT; 歩行能力; 術前
• ISSN: 0289-3770; 2189-602X
• DOI: 10.15063/rigaku.kj00001021033

The aim of this study was to examine the relation between gait ability before operation and complication of deep vein thrombosis on lower limb after operation. Subjects were 34 patients with rheumatoid arthritis who had undergone total knee arthroplasty. We separated patients into two groups based on D-dimer value on post-operative 7 day. If D-dimer on post-operative 7 day was more than 10 μg/ml, patients belonged to Group D, or if D-dimer was less than 10 μg/ml, they were Group N. We evaluated 8 factors; age, sex, operated side, Steinbrocker's stage and class, body weight, Functional Independence Measure, and the taken time of “The Timed Up & Go test”. All data were acquired before operation and compared these factors between two groups. Among 8 factors, only the taken time of “The Timed Up & Go test” measured before operation was significantly different. Group D took significantly longer time to perform it than Group N. Other factors were not statistically different And the taken time of “The Timed Up & Go test” was dependent on progression of disease expressed by Steinbrocker's stage in the result of simple regression analysis. This result suggests that patient with poor gait ability before operation has a high risk of complicated deep venous thrombosis after total knee arthroplasty. Thus, the improvement of gait ability not from after operation, but from before operation is important for patients with rheumatoid arthritis and it has a possibility to decrease the prevalence of complicated deep venous thrombosis after total knee arthroplasty. 本研究の目的は，術前の歩行能力と術後の深部静脈血栓症合併の関連性を明らかにすることにある。全人工膝関節置換術が施行された関節リウマテ患者34例を，術後7日目のD-dimer値が10μg/ml以上（D群），あるいは未満（N群）の2群に分けた。各群の術前における年齢，性別，術側，Steinbrocker分類によるstage，ならびにclass，体重，Functional Independence Measure，およびThe Timed up & GO testの8項目について，比較検討した。その結果，歩行能力を表すThe Timed up & Go testの所要時間のみに有意な差が認められ，術前においてD群はN群よりも時間を要していた。また，回帰分析の結果，The Timed up & Go testの所要時間は，Steinbrockerのstage，つまり疾病の進行度に依存していた。このことから，術前における歩行能力の低下は，術後深部静脈血栓症合併のリスクファクターであり，術前から歩行能力を改善していく必要性が示唆された。