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Please use this identifier to cite or link to this item: http://hdl.handle.net/10295/1824

Title: 人工膝関節全置換術(TKA) 施行患者の予後予測因子の検討 ―歩行自立と膝関節機能との関連性―
Other Titles: Factors correlating with duration for achieving independent gait after total knee arthroplasty.
Authors: 坂本, 和寛
岡田, 恭司
山平, 斉
工藤, 俊輔
Authors: SAKAMOTO, Tomohiro
OKADA, Kyoji
YAMAHIRA, Hitoshi
KUDO, Shunsuke
Publisher: 秋田大学大学院医学系研究科保健学専攻
Issue Date: Oct-2011
Type: Departmental Bulletin Paper
Abstract: 人工膝関節全置換術(TKA) 後に歩行自立となるまでの期間(days for independent gait, DIG) に影響する因 子を明らかにするため, 年齢, 性, 身体的特徴, 歩行時の疼痛の程度, 膝関節可動域, 膝関節筋力, 術側上肢と非術側上肢によるファンクショナルリーチテスト(FRT) 値の差(difference of FRT value, DFRTV) を検討した. 2010年3月~12月の期間に秋田赤十字病院で変形性膝関節症により片側TKA (ADVANCE Knee System ; Wright Medical Japan) が施行され, 術後は定められた同一のプログラムに従って機能訓練を受けた患者22名(男性2名,女性20名), 平均年齢73.2歳(61~84歳) を対象とした. 統計解析にはSPSS 12.0J for Windows を用いた. DIG は平均10.4日(4~21日) であった. 術前因子のうちではbody mass index (BMI) のみDIG と有意な相関を示した(P=0.01). 術後の因子では, 術後1週の膝伸展角度(P=0.002), 膝屈曲筋力体重比(P=0.006), 歩行時の疼痛(P=0.02), DFRTV (P=0.008) が有意な相関を示した. またDFRTV は年齢(P=0.03), BMI (P=0.045), 歩行時の疼痛(P=0.02) と有意に相関していた. TKA に関するプログラムでは術前の体重コントロール, 疼痛コントロールのための低侵襲の手術手技や適切な医療管理, 術後早期からの膝屈曲・伸展訓練が重要であると考えられた.また新たに考案したDFRTV はバランス能力だけでなく術後歩行時の疼痛を評価できる簡便なテスト法であると考察した.
Pre- and postoperative factors including age, sex, general physical characters, pain scale on gait, range of motion of the knee, muscle power of the knee, difference of functional reach test values between right and left upper extremities (DFRTV) were evaluated in order to clarify factors influencing the duration until DIG (days for independent gait) was achieved after total knee arthroplasty (TKA). The study involved 22 patients (male 2 ; female, 20), and the average age was 73 years (range, 61-84). All patients underwent unilateral TKA (ADVANCE Knee System ; Wright Medical Japan) due to osteoarthritis of the knee, and postoperative rehabilitation under the same program in Akita Red Cross Hospital from March to December, 2010. Statistical analysis was performed by SPSS 12.0J for Windows. The duration ranged from 4 to 21 days (mean 10.4). In preoperative factors, only body mass index (BMI) was associated with the duration (P=0.01). In postoperative factors, maximum knee extension angle (P=0.002), maximum isometric knee flexion muscle power weight ratio (P=0.006), pain on gait (P=0.01), DFRTV (P=0.008) 1 week after the surgery were significantly correlated with the duration. DFRTV were well correlated with pain scales (P=0.02), BMI (P=0.045) and age (P=0.03). These results indicated that preoperative control of body weight, less invasive surgical procedure and adequate medical care for pain control, early exercise of knee extension and flexion were important in rehabilitation programs for patients after TKA. Furthermore, DFRTV, newly developed test in this study, might be a simple and useful one to detect not only balance ability but also intensity of postoperative pain.
Keywords: TKA
歩行自立
予後予測
膝関節機能
FRT
URI: http://hdl.handle.net/10295/1824
Journal Title: 秋田大学大学院医学系研究科保健学専攻紀要
ISSN: 18840167
NCID: AA12447617
Volume: 19
Isuue: 2
Start Page: 135
End Page: 142
Textversion: publisher
Appears in Collections:第19巻2号 (20B1c)

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