転移性胸椎腫瘍に対し最小侵襲脊椎安定術を実施した患者への作業療法—症例報告

Occupational therapy for a patient with metastatic thoracic tumor who underwent minimally invasive spine stabilization: A case study

要旨：乳がん転移性胸椎腫瘍により切迫麻痺を認めた症例に対し，最小侵襲脊椎安定術前後の入院作業療法を実施した．当初，背部疼痛や神経症状に加え，家事や子育てが行えないことによる精神的・社会的苦痛を認めていた．術前安静時から生活行為の評価を行い，術後の動作指導を円滑に行うことで術後8日目に退院し，家事と子育てに復帰した．術後1年が経過し，役割を変えることなく生活を送っている．乳がんは骨転移後も放射線や化学療法の併用により長期予後が見込めることが多い．術前・術後の症状や生活行為を他職種とともに評価し，骨転移部に対する愛護的な動作指導や環境調整，社会資源の提案など退院後の生活に向けた支援が有効であったと考えられた．

　We describe occupational therapy for a case with metastatic tumor who underwent minimally invasive spine stabilization. Initially, in addition to back pain and neurological symptoms, she suffered from social and psychological pain due to difficulty performing housework and parenting. We assessed occupational performance and movement before surgery, and upon discharge she returned to her daily roles eight days after surgery. One year has passed since the operation, and she has continued her ADL without changing her role. Breast cancer patients treated with a combination of radiation and chemotherapy often have a long-term prognosis even with bone metastases. The results of this case study suggest that evaluation of pre/post-operative symptoms and occupational performance and support for how to move, environmental adjustment, and proposal of social resources with other professionals are effective.