Spaghetti wrist症例の作業療法による上肢能力の機能的帰結

Upper limb dysfunction resulting from spaghetti wrist: A long-term analysis of functional outcomes

要旨：今回，我々は仕事中の挫傷事故により，Spaghetti wristを呈した症例に対して，術後早期から段階的なスプリント療法と独立屈曲運動を行った．また長期にわたって知覚再教育，機能訓練を実践した．術後19ヵ月まで把持能力と正中神経領域の感覚機能の改善を認めたが，尺骨神経領域の改善は乏しかった．Spaghetti wrist症例では，血管や神経，腱断裂が多数あるため縫合腱の緊張度を確認し，単独指の独立運動は術後4週以降に開始することが望ましいが，神経や動脈損傷の程度を見極めて実践することが重要である．

　We investigated the occupational therapy for a case of spaghetti wrist due to a work-related contusion accident. Early post-operative OT interventions included splinting, graded tendon exercises for independent flexor digits, and perceptual and functional training. Although improvement in both grasping ability and sensory function of the median nerve area were observed until 19 months after the operation, ulnar nerve palsy remained. Therefore, by confirming the tension of the suture tendon and vasculature, early nerve mobilization and perceptual training can improve motor and sensory function. Therapy should include exercise of the flexor digit tendons independently 4 weeks after surgery. However, it is important to confirm the degree of nervous and vascular injury.