理学療法ジャーナル52巻4号

2018年04月発行

特集 変形性膝関節症に対する最新の保存療法

変形性膝関節症に対する保存療法の変遷

著者： 木藤伸宏¹ 小澤淳也¹ 森山英樹² 德田一貫³ 澤田智紀⁴ 阿南雅也⁵

所属機関： ¹広島国際大学総合リハビリテーション学部 ²神戸大学大学院保健学研究科 ³社会医療法人敬和会大分岡病院 ⁴慶應義塾大学医学部整形外科学教室 ⁵大分大学福祉健康科学部理学療法コース

ページ範囲：P.287 - P.300

はじめに

　変形性膝関節症（膝osteoarthritis；以下，膝OA）は，以前より理学療法対象疾患であった．人工膝関節の構造および機能の技術的進歩によって，人工膝関節の関節可動増大，耐久性は大幅に改善した．人工膝関節置換術後の理学療法の役割は，その手術方法や人工膝関節の構造と機能の進歩によって大きく変遷してきた^1,2）．特に，低侵襲手術の普及や術後の疼痛管理の進歩は，積極的な術後早期理学療法介入と早期膝関節可動域運動を可能にした^3）．そのことは，患者の日常生活活動の早期回復を可能にし，一般的な術後ケアのプロトコルとなっている．現在では，術後2週間以内の入院が一般的となり，先進的な病院では術後3日での退院を目標としている．

　症状を有する膝OA罹患者のなかで人工関節置換術を受ける患者の割合は年々増加しているが，全体の1〜2割程度にすぎない．よって残りの8〜9割の膝OA罹患者は，薬剤処方，ヒアルロン酸などの関節内注射，そして理学療法などの保存的治療を受けているか，医療機関に受診していない状態である^4,5）．よって，膝OAに対する理学療法に効果があるのか，薬剤にかわる病態修飾治療となり得るかを示すことは非常に重要である．しかしながら保存療法においては，数十年前と比較した場合，臨床場面は人工関節置換術後の理学療法ほど飛躍的に進歩しているとは言いがたい．効果のない関節可動域運動や筋力増強運動を漠然と続けていたり，ただの散歩に外来理学療法の時間を費やしている現状もある．

　本稿では，日本における膝OAの疫学，変形性関節症（osteoarthritis：OA）の病態解明，そして保存療法のエビデンスを紹介する．

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