臨牀透析 Vol.18 No.9(4)


特集名 透析患者へのリハビリテーション
題名 整形外科的リハビリテーション
発刊年月 2002年 08月
著者 千田 益生 岡山大学リハビリテーション部
著者 橋詰 博行 岡山大学リハビリテーション部整形外科
著者 原田 良昭 岡山大学リハビリテーション部整形外科
【 要旨 】 透析による代表的な整形外科的合併症としては,筋力低下,透析肩,手根管症候群,脊椎症,および下肢の阻血性壊死などがある.筋力低下に対するリハビリテーションとしては,運動療法が主体であり,効果があるとした報告が多い.透析肩,手根管症候群,脊椎症は透析アミロイドーシスによる疾患であり,透析肩や手根管症候群では鏡視下の開放術が適応であり成績も良い.脊椎症では,破壊型脊椎関節症や軟部組織の変化による脊髄圧迫が特徴的であり,X線に加えMRI像による検索が必要である.下肢の阻血性壊死による下肢切断では,笘骨前面の血行の乏しい皮膚をできるだけ用いない矢状皮弁法を用い,膝下切断を行っている.TSBソケットで早期歩行を目指している.
Theme Rehabilitation in Hemodialysis Patients
Title Rehabilitation of patients with orthopaedic disorders secondary to dialysis
Author Masuo Senda Division of Physical Medicine and Rehabilitation, Okayama University Hospital
Author Hiroyuki Hashizume Division of Physical Medicine and Rehabilitation, Okayama University Hospital
Author Yoshiaki Harada Division of Physical Medicine and Rehabilitation, Okayama University Hospital
[ Summary ] Orthopaedic disorders secondary to dialysis involve muscular weakness, dialytic shoulder, carpal tunnel syndrome, spinal disorder, and necrosis of the lower leg. As rehabilitation of muscular weakness, aerobic exercises are usually performed. Many authors have reported that the results were effective. For dialytic shoulder and carpal tunnel syndrome, secondary to dialytic amyloidosis, arthroscopic release operations are usually indicated. The results of such arthroscopic operations are reported to be superior to the open method. In spinal disorders, due to amyloidosis, soft tissues such as ligaments and discs are typically affected, these findings are detected more easily with MRI than with X-ray examination. In cases of lower limb amputation, due to ischemic necrosis, secondary to dialysis, it is often difficult to repair the skin. We usually use the sagittal incision technique for below-knee amputations of ischemic limbs, in order to reduce the risk of skin necrosis. The results of this amputation technique have been reported to be better than those from the long posterior technique. A total surface bearing (TSB) socket is indicated as a prosthesis for ischemic limbs after below-knee amputations.
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