PIP関節背側脱臼骨折によるPIP関節拘縮および屈筋腱癒着に対する作業療法

Occupational therapy for contracture and adhesion of the flexor tendon after dorsal fracture-dislocation of the proximal inter-phalangeal joint: A case study

要旨：PIP関節背側脱臼骨折後にPIP関節拘縮および屈筋腱癒着を起こし，2度にわたる手術と作業療法（以下，OT）を実施した症例を経験した．癒着防止およびROM改善にはDIPブロック下にてFDP滑走訓練，Active place and hold，FDP軽度抵抗運動などの屈曲角度改善のための治療を行った．また，虫様筋ストレッチ，虫様筋収縮運動，骨間筋筋力増強運動などの伸展角度改善のための治療も行い屈曲・伸展ともROM改善につながった．特にPIP関節は屈曲拘縮をきたしやすいため伸展に対する治療は重要である．初期治療における固定肢位と早期のOTによる治療が重要と痛感した症例であった．

　The case underwent two surgical procedures and occupational therapy for contracture and adhesion of the flexor tendon after conservative treatment fixed at the extension position for dorsal fracture-dislocation of the proximal inter-phalangeal joint. Flexor digitorum profundus sliding exercise, active place and hold, and mild resistance exercises were performed to improve adhesion of the flexor tendon and range of flexion motion. Stretching and contraction exercises of the lumbrical muscle and muscle strengthening exercises of the inter-osseous muscle were performed to improve the range of extension motion. Thus, occupational therapy led to improved range of flexion and extension motion of the proximal inter-phalangeal joint. This case suggests that fixed positions in the initial treatment and early occupational therapy are important for treatment of dorsal fracture-dislocation of the proximal inter-phalangeal joint.