回復期リハビリテーション病棟における膝回転形成術後のリハビリテーション治療経験

Rehabilitation Treatment after Knee Rotationplasty in a Convalescent Rehabilitation Ward : A Case Report

はじめに

　膝回転形成術（ニー・ローテーションプラスティ)^{1, 2)}は，膝関節を病変含めて広範に切除した後に，残存した下腿部を180°回転させ大腿部と接合することで足関節を膝関節の代わりとして機能させる術式である．基本的に神経と血管は温存する．膝回転形成術のリハビリテーション治療の報告^{3, 4)}は存在するものの，同治療を治療期間に制限がある回復期リハビリテーション病棟で実施したという報告は見当たらない．今回われわれは回復期リハビリテーション病棟において膝回転形成術後のリハビリテーション治療を経験する機会を得たため，その経過を報告する．

　なお，本報告に関して患者本人から書面で同意を得ている．

Knee rotationplasty is a surgery wherein the rotated ankle serves as the new knee joint after resecting the original knee joint and lesion. However, details of postoperative rehabilitation treatment in a convalescent rehabilitation ward are not well-known. Therefore, we reported the rehabilitation progress of a 36-year-old man who underwent knee rotationplasty in the convalescent rehabilitation ward. In the early postoperative period, the surgery required no weight bearing on the operated lower limb until bone healing. Even during this period, we conducted physical therapies such as joint range of motion training and muscle strength training as outpatient rehabilitation therapy. After being admitted to the convalescent rehabilitation ward, physical therapy was intensified and the patient's rotationplasty prosthesis was then fabricated and fitted by a prosthetist and orthotist. The patient was discharged 80 days after his hospitalization and could eventually walk stably with his prosthesis and returned to work. In Japan, the length of stay in a convalescent rehabilitation ward is limited. If patients are provided with enough physical therapy during the postoperative course and rotationplasty prosthesis by a skilled prosthetist and orthotist, rehabilitation treatment after knee rotationplasty can achieve good results in a convalescent rehabilitation ward.