血管柄付遊離腓骨移植による肩関節再建後の作業療法と家事動作能力—症例報告

Occupational therapy and functional abilities of housework after reconstructive surgery of the shoulder with free vascularized fibula bone graft : two cases report

要旨：近年，上腕骨近位部に発症した腫瘍に対し従来の切断・離断術に変わり，上肢・手指機能を温存する患肢温存手術が行われるようになってきた．今回，我々は上腕骨に発症した腫瘍の切除後，血管柄付遊離腓骨移植による肩関節機能再建を行った女性2例を経験した．その2症例に対して，術後1年の上肢機能(A-ROM，MMT)と，家事について評価を行った．症例1は，術後1年で肩関節の自動屈曲・外転110度，筋力はMMT3+，家事では91.0％が可能であった．症例2は自動屈曲・外転90度，MMT3，そして60.6％の良好な家事動作が獲得できていた．また，それぞれの症例は，家事において高い満足度が得られていた．

　We treated two patients with occupational therapy after reconstructive surgery of the shoulder with a free vascularized fibula bone graft following resection of a tumor in the proximal humerus. After one year, with regard to functional assessment, we evaluated active range of motion (A-ROM), manual muscle testing (MMT) and ability to perform routine domestic chores. Case 1 had active flexion and abduction of 110 degrees, MMT3 + , and became able to perform 91.0% on a housework evaluation test. Case 2 regained flexion and abduction of 90 degrees, MMT 3, and scored of 60.6% on the housework test. In the course of treatment, each case attained greater emotional acceptance of limitation in ability to perform housework. In addition, each case regained higher emotional acceptance for each item of housework evaluation.