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The Japanese Journal of Rehabilitation Medicine Volume 55, Issue 2 （February 2018）

The Japanese Journal of Rehabilitation Medicine 55巻2号（2018年2月発行）

Japanese English

原著

鏡視下腱板修復（ARCR）術後のリハビリテーション期間延長に関与する因子の検討 What Influences Rehabilitation Outcomes after Arthroscopic Rotator Cuff Repair? Investigation of Risk Factors for Prolonged Rehabilitation 二宮晴夫 ¹ , 冨士武史 ¹ , 永冨孝幸 ² , 永渕輝佳 ² , 荒木直哉 ² , 水田典孝 ² Haruo Ninomiya ¹ , Takesi Fuji ¹ , Takayuki Nagatomi ² , Teruyoshi Nagafuchi ² , Naoya Araki ² , Noritaka Mizuta ² ¹地域医療機能推進機構（JCHO）大阪病院リハビリテーション科 ²地域医療機能推進機構（JCHO）大阪病院リハビリテーション室 ¹Department of Rehabilitation Medicine, Japan Community Healthcare Organization, Osaka Hospital ²Rehabilitation, Japan Community Healthcare Organization, Osaka Hospital キーワード：関節鏡視下肩腱板修復手術 , arthroscopic rotator cuff repair , リハビリテーション期間 , the duration of the rehabilitation , 危険因子 , risk factors Keyword: 関節鏡視下肩腱板修復手術 , arthroscopic rotator cuff repair , リハビリテーション期間 , the duration of the rehabilitation , 危険因子 , risk factors pp.160-167

発行日 2018年2月16日 Published Date 2018/2/16

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要旨

目的：鏡視下腱板修復術後のリハビリテーション期間延長に関わる因子を明らかにすること．

対象：当院で施行した576肩（男性331肩，女性245肩，平均年齢63.9±12.3歳）を対象とした．後療法は3週間の固定を基本とし，術後翌日よりリハビリテーション開始．

方法：術後リハビリテーション期間が6カ月で終了した376肩（男性228肩，女性148肩，平均年齢63.9±11.8歳）をA群，6カ月以上リハビリテーション継続を必要とした200肩（男性103肩，女性97肩，平均年齢63.5±13.3歳）をB群として2群に分類．検討因子は，保険種別，罹病期間，術前の可動域・筋力・運動時痛・肩関節疾患治療成績判定基準，断裂の部位・形態・修復状況，術後3カ月時の可動域ならびに6カ月時の可動域と筋力を独立変数とし，2群のリハビリテーション期間を従属変数としてロジスティック回帰分析を行った．統計学的検討はEZRを使用．有意水準は5％．

結果：リハビリテーション期間には保険種別・術前の断裂形態・術後3カ月の屈曲角度ならびに外旋角度・術後6カ月時の外転筋力が有意に関連していた．

Purpose：Good functional results have been reported for arthroscopic repair of rotator cuff tears (ARCR) by several orthopedic surgeons, but few studies have examined the factors affecting rehabilitation outcomes.

This study was conducted to identify the factors associated with clinical outcome and the duration of rehabilitation after ARCR.

Subjects and methods：This was a retrospective evaluation of 576 patients who underwent ARCR between January 2009 and December 2013 (Men：331, Women：245；mean age：63.9±12.3 years).

Patients were divided into groups based on the duration of rehabilitation：less than or more than 6 months. Preoperative and postoperative evaluations, including outcome assessments and physical examination parameters, were reviewed：

① type of insurance, ② duration of illness, ③ pain on motion, ④ Japanese Orthopaedic Association Score, ⑤ site of cuff tear, ⑥ thickness of cuff tear, ⑦ repair conditions, ⑧ range of motion (ROM) before surgery, ⑨ ROM at 3 months after surgery, ⑩ ROM at 6 months after surgery, ⑪ muscle strength before surgery, and ⑫ muscle strength at 6 months after surgery．

Results：Factors influencing the duration of rehabilitation included traffic accident and workman's compensation insurance coverage, thickness of tear, range of motion of flexion and external rotation at 3 months after surgery, and strength on abduction at 6 months after surgery.

Conclusions：When beginning rehabilitation, the type of insurance and thickness of tear must be considered；during rehabilitation, ROM at 3 months and strength at 6 months after surgery must be considered.