腰椎分離症を呈する成長期スポーツ選手の競技復帰状況

Status of Return to Play in Growing Athletes with Lumbar Spondylolysis

要旨

目的：腰椎分離症を呈する成長期スポーツ選手の治療は，骨癒合を目的とした装具療法が主に選択され，装具期間中の運動は中止されることが多い．本研究は，腰椎分離症の治療として，装具療法と早期理学療法の併用が競技復帰にどのような効果や影響を与えるか検討した．

方法：片側第5腰椎分離症と診断され，骨癒合を目的として装具装着を指示された成長期スポーツ選手37名を対象とした．装具期間中に安静にしていた17名（装具群）と，早期理学療法を併用した20名（併用群）の2群に分類した．検討項目は，装具期間，装具療法終了から復帰までの期間（アスリハ期間），癒合率とした．統計処理はMann-Whitney U検定，χ²検定を用い，有意水準は5％とした．

結果：装具期間は装具群96日，併用群87日で，両群間に有意差はなかった．アスリハ期間は装具群29日，併用群19日で，併用群は装具群よりも有意に短かった．癒合率は装具群76％，併用群75％で有意差はなかった．最終競技復帰状況は装具群17名，併用群19名が完全競技復帰していた．

結論：両群とも装具期間に有意差がなく，同等な骨癒合率がみられたことから，早期理学療法の介入は骨癒合に悪影響を与えないと考える．併用群は，装具群より有意にアスリハ期間が短いことから，装具療法と早期理学療法の併用は，早期に柔軟性・筋力が向上し，装具療法終了後にスムーズなスポーツ動作の獲得が図れることで早期の練習復帰が可能であると考えられる．

Objective：In athletes who are still in the growing period, lumbar spondylolysis is mainly treated with brace therapy to enable bone fusion. During the brace period, sports activities are often discontinued. The purpose of this study was to investigate how the combination of brace therapy and early physiotherapy affects the duration of return to play in athletes with lumbar spondylolysis.

Methods：Thirty-seven athletes in the growing period with unilateral spondylolysis were included in the study. They were classified into two groups：17 patients who rested during the brace period (brace group) and 20 patients who combined the brace with early physical therapy (combination group). The examined items were duration of the brace period and duration from the end of the brace therapy to return to play (return period). Both these items were compared between the brace group and the combination group. In addition, the union rate of both groups was also calculated.

Results：The return period was significantly shorter in the combination group than in the brace group. However, there were no statistically significant differences between the groups with respect to other data.

Conclusion：Since there was no significant difference in the duration of the brace period and the union rate between both groups, we believe that early physical therapy intervention does not adversely affect bone union in athletes with spondylolysis who are in the growing period. Therefore, it is considered that the combined use of brace therapy and early physical therapy can maintain flexibility and muscular strength during the brace period and can enable a smooth transit to playing after the bone union is complete.