| 特集名 | 透析患者のリハビリテーション―訓練と支援 | |
|---|---|---|
| 題名 | 大腿骨近位部骨折後のリハビリテーション | |
| 発刊年月 | 2018年 02月 | |
| 著者 | 緒方 直史 | 帝京大学医学部リハビリテーション科 |
| 【 要旨 】 | 長期透析患者では骨の脆弱性により少ない外力でも骨折を起こしやすく，なかでも大腿骨近位部骨折は，歩行機能の低下によりADLを著しく障害することが多い．透析患者では，術後も全身のアミロイドーシスの沈着に伴う骨癒合の遅延，細胞性免疫の低下による易感染性，易出血性などが問題となることも多く，術後1年以内の死亡率は高率で，一般と比較して大腿骨近位部骨折の予後が決して良いわけではない．そのため，機能回復を目指すために，合併症のコントロールと同時に術後早期からの適切なリハビリテーションを行うことが重要となる．透析患者における大腿骨近位部骨折後のリハビリテーションについて，骨折予防も含めて概説する． | |
| Theme | Rehabilitation therapy in dialysis patients -- training and support | |
|---|---|---|
| Title | Rehabilitation for hip fracture | |
| Author | Naoshi Ogata | Department of Rehabilitation Medicine, Teikyo University School of Medicine |
| [ Summary ] | In Japan, nearly 100,000 hip fractures occur annually, and most of these hip fractures require operative treatment. Because of the osteopenia frequently observed in HD patients, CKD increases the risk of hip fractures, which are accompanied by high rates of complications and morbidities, resulting in high patient mortality and morbidity. Previous studies have reported high rates of nonunion, infection, and avascular necrosis in HD patients. In these patients, hip fractures occur even after minimal force, and the potential complications and required management strategies for each fracture type depend on the patient's age and physical condition. Rehabilitation for hip fractures in HD patients is performed immediately after surgery with transfer to a wheelchair, standing, and if possible, walking exercises. The programs for hip fracture rehabilitation are similar to those for ordinal hip fractures ; however, because of the various complications in HD patients, multidisciplinary rehabilitation is effective and highly recommended. Preventive management of hip fractures in HD patients is also important. Particularly, prevention of fall using physical, nutritional, and mental training decreases the rate of hip fractures. |
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