10カ月間の床上安静の後より歩行を獲得するまでに至った骨盤輪骨折のリハビリテーションの実際

Late Reconstruction and Rehabilitation 10-months after Injury in a Patient with unstable Pelvic Ring Fracture

はじめに

　不安定型骨盤骨折は労働災害や交通事故，高所転落などが原因となり生ずるhigh energy traumaであり，迅速な高度初期治療が要求される．その際，外科，泌尿器科，放射線科，整形外科，リハビリテーション（以下，リハ）科など，各領域が短時間に的確に病態評価，情報共有し，重症度順に治療を行う必要がある．しかし，高度救急救命ケアユニットのない病院などでは，関係する診療科の連携・連絡，情報の共有がスムーズでなかったり，主科と他科において治療上の制約が相反する時などは，治療の遅延・欠落につながる危険性がある．今回，骨盤輪骨折に対し初期整復固定ができず，リハの介入も遅れたため，機能回復に難渋した症例を経験したので報告する．

Abstract : We report a patient who received pelvic reconstruction for unstable pelvic ring fracture with severe open-book deformity after 10 months of conservative therapy and regained the ability to walk. The present report indicates that patients with unstable pelvic ring fractures should undergo reduction and fixation in the early period. Unstable pelvic ring fracture is a result of high energy trauma. It is difficult to find the best time for intervention once it has been delayed. This AO Type C3 unstable pelvic ring fracture was examined by CT imaging for pelvic deformity. Independence in activities of daily living (ADL) was evaluated using the Functional Independence Measure (FIM). After pelvic ring deformity was reduced by an external fixation-traction system, anterior fixation was performed and contracture of short external rotators was released. The patient's hip function normalized after the procedures and he was able to walk again 6 months later. Concomitant nerve paralysis also recovered after the reduction and fixation of the pelvic deformity. Unstable pelvic ring fractures may progress to pelvic deformity and adversely affect the patient's ADL unless they are managed with reduction and fixation in the early period. Unstable pelvic ring injury should primarily be treated with reduction and fixation in the acute phase.