臨床整形外科54巻2号

2019年02月発行

誌上シンポジウム 足部・足関節疾患と外傷に対する保存療法　Evidence-Based Conservative Treatment

アキレス腱障害に対する保存療法

著者： 篠原靖司¹ 熊井司²

所属機関： ¹立命館大学スポーツ健康科学部 ²早稲田大学スポーツ科学学術院

ページ範囲：P.125 - P.132

　アキレス腱障害は近位のアキレス腱症(non-insertional Achilles tendinopathy：NIT)とアキレス腱付着部症(insertional Achilles tendinopathy：IAT)および踵骨後部滑液包炎(retrocalcaneal bursitis：RB)に分類されるが，いずれも変性を基盤とした病態であるためアスリートだけでなく，中高年にも発症する．診断は圧痛部位やX線，MRI，エコーなどの画像検査で行うことができる．保存療法が第一選択となり，伸張性運動(eccentric exercise)を軸とし，体外衝撃波(extracorporeal shock wave therapy：ESWT)やブロック注射を必要に応じて組み合わせて行うと効果的である．ブロック注射は腱の断裂を避けるためにエコーガイド下で実施する．適切に診断し，病態に応じた治療を選択することがポイントとなる．

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