全身性エリテマトーデスによるJaccoud関節症に対する軟部組織再建術後に作業療法を工夫した1例

Occupational therapy for a patent with systemic lupus erythematosus after soft tissue reconstruction surgery for Jaccoud's arthropathy: A case study

要旨：全身性エリテマトーデスによるJaccoud関節症では，軟部組織の弛緩により手指変形を生じるため，手術療法では術後に変形再発が問題となる．本症例では，軟部組織再建術後に疾患特性を考慮した作業療法を行った．再建した組織保護のため，通常の関節リウマチ症例よりも各訓練の開始時期を繰り下げ，より長期間のスプリント療法を行った．また母指変形には装具療法を行い，尺側偏位の再発原因となりうる側腹つまみを正す生活動作訓練を行った．術後半年で変形再発を認めず生活動作が改善した．本症の後療法では再建組織の保護を重視した機能訓練が必要である．また変形の再発防止のために装具療法や誤用を修正する生活動作訓練も有効である．

　Jaccoud's arthropathy with systemic lupus erythematosus causes hand deformities which are characterized by loose soft tissue; furthermore, deformity often recures after surgery. We describe the prudent rehabilitation for a case who underwent soft tissue reconstruction surgery. Post-op OT included protecting the reconstructed soft tissue, Jaccoud's arthropathy exercises, and utilizing a splint longer than that used for rheumatoid arthritis. The patient also used a splint for thumb buttonhole deformity and was given guidance on preventing recurrence through misusing of hands. Six months after the surgery, there was no deformity, and the subject could live comfortably. Functional exercise that emphasizes the protection of reconstructed tissue is required for the treatment of this disease. In addition, orthotic therapy, and exercises for activities of daily living to correct misuse are also important to prevent recurrence of deformity.