後方進入法による人工股関節全置換術後5カ月における靴下着脱動作の獲得状況と獲得するために必要な機能的な目標値の検討—多施設間での縦断的研究

Investigation of the Conditions Required for Acquiring of Socks-handling Ability 5 Months after Total Hip Arthroplasty（Posterior Approach）with Consideration of the Functional Goals : A Longitudinal Study

要旨

目的：本研究の目的は，後方進入法による人工股関節全置換術（THA）を施行し，術後5カ月での股関節屈曲，外転，外旋位における靴下着脱動作（以下，股関節開排法）の獲得状況を調査し，術後5カ月で股関節開排法が可能となるためのリハビリテーション治療の目標値を明らかにすることである．

方法：対象は本学附属4病院で後方進入法THAを施行した変形性股関節症101例104股とした．調査項目は年齢，Body Mass Index，股関節可動域，膝関節と足関節の可動域制限の有無，上肢長，術前および術後5カ月時の股関節開排法の可否とし，術後5カ月での股関節開排法の獲得に関与する因子を検討した．

結果：股関節開排法の獲得に関与する因子として，術前の靴下着脱の可否，術前の股関節外旋可動域，退院時の股関節外転可動域が抽出され，その目標値は股関節外旋可動域27.5°，股関節外転可動域17.5°であった．

結論：股関節開排法による靴下着脱動作を獲得するには，術前から股関節開排法による動作が可能であること，THAの周術期に股関節外旋可動域，股関節外転可動域が目標値に到達していることが必要である．

Objective：This study was aimed at investigating the acquirement of socks-handling ability with hip flex, abduction, and external rotation position (hip open position）in 5 months after the posterior approach to total hip arthroplasty (THA), with consideration of the functional goals by conducting a multicenter cooperative study.

Methods：The study included 101 patients (104 hip joints) with hip osteoarthritis. We evaluated patient attribution；ranges of motion of the hip, knee and ankle；hip pain in socks-handling；and upper extremity length, which were evaluated before the operation, upon hospital discharge and at 5 months after the posterior approach to THA. The patients were classified into those who attained and did not attain socks-handling ability in open hip position until 5 months after THA. We investigated the factors for acquiring socks-handling ability by using a multiple logistic regression analysis.

Results：We identified three factors that significantly correlated to socks-handling ability as follows：(1) socks-handling ability before the operation, (2) range of hip external rotation before operation, and (3) range of hip abduction before discharge. The goal to acquire socks-handling ability is 27.5° hip external rotation and 17.5° hip abduction.

Conclusion：We suggest that socks-handling ability must be acquired before THA and that the target range of hip abduction and external rotation must be attained during the early post-THA stage.