Duchenne型筋ジストロフィー症の立位・歩行障害

Pathological gait and standing balance of patients with Duchenne muscular dystrophy.

はじめに

　Duchenne型筋ジストロフィー症では，年齢が7歳から15歳までの間に急激にADLの低下がみられる^1）。とくに下肢を主体とする立位，歩行能は，8歳より11歳までのわずか数年で急激に低下・喪失する傾向がみられる。今回，この時期の10歳前後のambulatory phaseの施設入所中のDuchenne型筋ジストロフィー患者を対象にし，同年齢の健康児童17名を正常対照者として，歩行分析^2～5）および立位能^5～7）の分析を試みた。歩行分析には歩行足跡記録と，新しく開発した簡便で軽量な歩行測定器^2,8,9）を用いた。立位能の分析では，外力を加えたtilting反応^10～12）を行ない，姿勢反応の測定を行なった。

　It is well-known that the activity of daily living (ADL) decreases progressively from 7 to 15 years of age in patients with Duchenne muscular dystrophy (DMD). The ADL scores related to the gait and standing balance become smaller in short term from 8 to 11 years of age in this disease. For assessment of clinico-pathophysiological aspects of this disease, the objective, quantitative, and serial measurements of abilities in patient's gait and standing balance are needed.

　Thirteen hospitalized male patients with DMD, aged 7 to 15 years (mean of 10 years) were examined initially in the ambulatory phase: one patient in stage 2 of Swinyard's disability score, 3 patients in stage 3, and the remaining 9 patients in stage 4. During the 6 month of period of observation, the disease progressed so that one patient required braces for walking, and 5 became unable to walk due to increased muscle weakness in the lower limbs. The ADL of this patient group decreased gradually from 75.5±14.2 (46~94) to 69.5±16.7 (36~93) during this period. 17 normal children of similar age to patients with DMD were also examined as the control.