手指MP関節伸展位拘縮解離術後に拘縮予防を目的として人工筋を用いた屈曲型動的牽引スプリントを使用した2症例

Use of the pneumatic-type dynamic traction and flexion splint artificial MP joints after the surgical release of extension contracture: A case study of two patients

要旨：MP関節伸展位拘縮の主因は側副靭帯の短縮と言われている．我々はスプリント素材で側副靭帯を牽引できる回転型動的牽引スプリントを考案し用いてきたが，従来装具の問題点改善のため，脱着が容易な人工筋（PAM）を用いた新しい屈曲型動的牽引スプリント（以下，DTF）を考案した．今回，拘縮解離術後の患者2名に術後翌日からDTFを使用し，術中可動域を術後8週時にも維持できた．DTFは，拘縮解離術後の患者が自主的管理，訓練機器（CPM）のみ使用，可動域練習のみ実施の場合と比較して，可動域の改善がほぼ同様もしくは上回った上に，可動域改善までの期間も短縮した．DTFは，術後早期に可動域改善を図る有用なスプリントの一つであることが示唆された．

　Collateral ligament shortening causes extension contractures of the metacarpophalangeal (MCP) joint, and dynamic flexion splinting (DFS) has been widely used to treat these contractures. However, extension contractures associated with bent MCP joints are not only ineffectively treated using DFS, the treatment may also lead to articular cartilage damage. We developed a novel pneumatic-type dynamic traction and flexion (DTF) splint using an artificial pneumatic muscle and MCP joints and applied it in two cases one day after undergoing surgically released extension contractures. The ROM of the DTF post-operative patients was compared with that of Continuous Passive Motion (CPM) therapy only during exercise and during self-training. The results indicate that as for DTF, the ROM of the DTF patients was equal to or exceeded that of the patients who used only CPM. Furthermore, DTF orthosis reduced the time needed to improve the ROM more than other methods. The results indicate that DTF is a useful splint to improve ROM after surgery.