僧帽筋麻痺に対するEden-Lange変法による筋移行術後のリハビリテーションの1例

Postoperative rehabilitation of chronic accessory nerve palsy: A case study

要旨：頭頸部癌リンパ節郭清後に僧帽筋麻痺が出現した60歳代男性に対し，Eden-Lange変法を用いた肩甲骨制動術後のリハビリテーションを経験した．症例は上肢挙上制限があり，上方リーチを伴う日常生活活動に困難さが生じていた．術後早期からリハビリテーションを行い，術後5ヵ月時点で150°の自動挙上可動域を獲得でき，電球の付け替えなど上肢挙上位での動作が円滑に可能となった．術後2年半時点で170°まで自動挙上可動域は改善した．移行筋の走行を意識した運動に加え，残存筋と連動させた肩甲上腕リズムの再建を促したことで，すみやかな上肢機能・生活機能の改善が得られた．

　The case was a 60-year-old man with cucullaris muscle paralysis after head and neck cancer lymph node dissection. Rehabilitation commenced after the Modified Eden-Lange Procedure. The patient had limited upper limb elevation and difficulty with activities of daily living requiring upward reaching. Rehabilitation began from the early postoperative period, and the patient acquired 150-degree active elevation range of motion at five months after surgery, and was able to smoothly change a light bulb, indicating improvement in arm elevation. The active elevation improved to 170 degrees two and a half years after surgery. Exercise of the transition muscle promoted reconstruction of the shoulder upper arm rhythm that linked to residual muscle and improved arm function and ADL.