理学療法ジャーナル42巻10号

2008年10月発行

特集 骨関節疾患の理学療法とバイオメカニクス

変形性膝関節症に対する理学療法とバイオメカニクス

著者： 西上智彦¹ 奥埜博之² 中尾聡志¹ 芥川知彰¹ 榎勇人¹

所属機関： ¹高知大学医学部附属病院リハビリテーション部 ²摂南総合病院認知神経リハビリテーションセンター

ページ範囲：P.837 - P.846

はじめに

　変形性膝関節症（knee osteoarthritis：以下，膝OA）は，本邦において年間約90万人が新たに発症し，国内の総患者数は1,000万人と推計されている．また，膝OAに対する手術は年間4万件も実施されており，理学療法の対象となる機会が多い疾患である．膝OA発症のリスクファクターとしては，機械的因子，生化学的因子，遺伝的因子などが挙げられている．大森ら^1,2）は縦断的研究を行い，膝OAの発症・進行に関わる因子として大腿四頭筋筋力の低下，膝関節内反変形と歩行時のlateral thrust（外側方向への動揺）を挙げている．Prodromosら^3）は膝関節内側への荷重が痛みや症状の進行を誘発する重要な因子であるとしている．このように，膝OAの発症・進行を惹起する機械的因子をバイオメカニクスの観点から抽出することは極めて重要である．

　本稿では，バイオメカニクスの視点から治療対象を明らかにし，それに対する病態仮説を立案し，認知神経科学や運動学習のメカニズムについての知見を考慮した理学療法プログラムを紹介する．

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