人工股関節置換術と術後リハビリテーション

Effectiveness and Necessity of Early Postoperative Rehabilitation for Total Hip Arthroplasty

はじめに

　変形性股関節症は，かつては先天性股関節脱臼後に生じるものが大半を占め比較的若年期より発症したため，当時の人工股関節置換術の長期成績が不安定なこともあり，骨盤や大腿骨の骨切り術，臼蓋形成術などが盛んに行われていた．疾患の病期や変形形態によっては，これら関節温存手術の成績は長期にわたり良好であることが既に報告されているが，術後のリハビリテーション（以下，リハ）に長期を要するなどの難点もある．近年では乳幼児に対する股関節脱臼の診断や治療の目覚ましい進歩により先天性股関節脱臼治療後早期よりの股関節症患者は減少傾向にある．しかしながら，Developmental Dysplasia of Hip Joint（DDH）に対する治療については，未だ確立しておらず，青壮年期に至るまで発見されずにすごしてしまう症例も多々見られる．これらの症例は，青壮年になって初めて股関節症と診断されるが，すでに進行期に至った症例が多くを占めており，関節温存手術の適応とならない場合が多く見受けられる．一方で，過去30年間に人工股関節置換術の器械的，手術の技術的進歩は目覚ましく，近年では術後15～20年程度の安定した成績が期待できるようになってきており，我が国においても年々その数は増大している^1）．他方，技術の進歩と社会的ニーズも相まって，かつては除痛だけを目的とした手術から現在では生活の質（QOL）の向上を目指すための手術へと人工関節手術もその質を変化させることを迫られてきている．今回，これらのことを鑑み，現時点における患者サイドでのスポーツ・アクティビティにおける可能性などを含めた人工股関節置換術後の問題点と術後リハについて考察した．

Abstract : When treating coxarthrosis, each treatment method including conservative treatment, osteotomy, or artificial joint replacement, has an optimal stage for treatment of the disease. Joint preservation surgery has a good result for cases in the early stage, but total hip arthroplasty (THA) is selected for advanced stage hip osteoarthritis, and in Japan, more than a 40000 THAs are performed each year. Good postoperative results lasting up to 15 years are reported today, but, on the other hand, postoperative problems still clearly exist. Deep venous thrombosis/pulmonary embolism (VTE/PTE) are given as perioperative problems, and postoperative dislocation and postoperative range of motion of the hip joint are given as the problems that most relate to ADL. These days, information about THA is abundant so that there is extensive demand for the procedure amongst patients, and elevated technique is demanded of the surgeon. The onset of postoperative VTE/PTE as a lethal complication and interest about its prevention have risen these days with the increase in the number of artificial joint replacements performed in Japan. This time, we introduce a postoperative THA rehabilitation schedule and report the results of our postoperative complication prevention efforts carried out in our hospital. When THA of late years is thought about, for a patient, it is natural that the long-term results are good, and the postoperative satisfaction degree from an early stage is the demand that it is necessary. In consideration of these things, the range of hip motion needed about the origin and preventing dislocation that were one element of long-term satisfaction since only a short-term of normal ADL movement was investigated, and this was viewed from the aspect of joint stability against postoperative dislocation by difference in the approach method of surgery. Finally, we also discussed the importance of early rehabilitation after surgery for the prevention of VTE/PTE as a serious complication of surgery.