当院における肥満症を伴う末期変形性関節症に対するリハビリテーション

Rehabilitation for Obese Patient with Severe Osteoarthritis

要旨：肥満症を伴う末期変形性関節症で人工関節の手術適応である患者に対して，術前に，減量，歩行能力・体力・筋力などの運動機能改善，生活習慣病改善，患者教育を目的として入院または外来でリハビリテーションを行った．対象は11名で，9名でメタボリックシンドロームを認めた．運動は関節可動域訓練，筋力増強訓練に加え，1回30分の平行棒内歩行訓練を入院では1日4回，外来では2回行った．また食事療法も併用した．結果は，平均体重は開始時73.5kgから終了時64.7kg，body mass indexは31から27，ウエスト周囲径は106cmから94cmへ減少した．血液検査は中性脂肪219mg/dlから127mg/dl，空腹時血糖146mg/dlから94mg/dlに改善した．1日の歩数は2840歩から6953歩へ改善し，SF36は全ての項目で改善した．術前リハビリテーションにより減量，生活習慣病の改善，下肢痛軽減，活動量増大，quality of life向上を図れ，術中高血圧症や術後の静脈血栓塞栓症などの周術期のリスク軽減に寄与できた可能性がある．

Abstract : To facilitate safer operations, we provided a preoperative rehabilitation and educational program covering exercise and diet for obese patients with severe osteoarthritis. Participants totaled 11 patients of which 9 had metabolic syndrome. Exercises included the usual muscle strengthening ones, a range of motion exercise and 30minutes of walking within parallel bars four times a day. This was combined with a diet program. The averaged results showed that body weight changed from 73.5kg to 64.7kg, body mass index from 31 to 27, and waist size from 106 to 94cm. Blood tests indicated that the average triglyceride level changed from 219 to 127mg/dL and fasting blood glucose from 146 to 94mg/dL. Total steps walked per day changed from 2840 to 6953 and SF36 improved in all items. Significant improvements were noted in all items tested. Our program provided an effective rehabilitation for patients before operation by reducing patient'symptoms due to metabolic syndrome, reducing leg pain and body weight - while increasing activity, and improving quality of life, while simultaneously decreasing the risk of postoperative venous thromboembolism.