肩腱板断裂後患者の修復腱にかかる力学的ストレスへのシミュレーションアプローチ――再断裂リスク軽減にむけた援助方法のバイオメカニクス的検討
【目的】筋骨格筋シミュレーションソフトを用いて肩腱板断裂モデルを作成し，装具を外した際の援助を模した肢位の修復腱にかかる力学的ストレスを推定した．【方法】ソフトはAnyBody Modeling Systemを用いた．アウトカムは，棘上筋・棘下筋・肩甲下筋・小円筋・三角筋・僧帽筋の腱張力とした．援助を模した肢位は援助肢位（2肢位），援助部位（3箇所），援助部位に与えた力（4つ）および肩関節モデル（3つ）の全72パターンとした．【結果】棘上筋は，援助量の増加にて腱張力が減少した．棘上筋の援助量は，上肢重量の約半分で概ね最小化した．棘下筋の援助部位は，尺骨遠位端の支持にて腱張力が減少した．棘下筋の...
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| Published in | 日本運動器看護学会誌 Vol. 17; pp. 43 - 52 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本運動器看護学会
28.02.2022
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| Online Access | Get full text |
| ISSN | 2186-635X 2435-001X |
| DOI | 10.34324/jsmn.17.0_43 |
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| Abstract | 【目的】筋骨格筋シミュレーションソフトを用いて肩腱板断裂モデルを作成し，装具を外した際の援助を模した肢位の修復腱にかかる力学的ストレスを推定した．【方法】ソフトはAnyBody Modeling Systemを用いた．アウトカムは，棘上筋・棘下筋・肩甲下筋・小円筋・三角筋・僧帽筋の腱張力とした．援助を模した肢位は援助肢位（2肢位），援助部位（3箇所），援助部位に与えた力（4つ）および肩関節モデル（3つ）の全72パターンとした．【結果】棘上筋は，援助量の増加にて腱張力が減少した．棘上筋の援助量は，上肢重量の約半分で概ね最小化した．棘下筋の援助部位は，尺骨遠位端の支持にて腱張力が減少した．棘下筋の援助量は，尺骨遠位端に約1/3または尺骨遠位端と肘頭に上肢重量の約半分の援助量で腱張力を概ね最小化できるが，肘頭に対する援助量を増しても腱張力の減少に限りがあった．【考察】上肢重量と援助の方向から肩関節のモーメントを想定することで，修復腱の腱張力を推定することが可能であった．援助者は，自身の前腕全体を使って患者の腕を援助することで，棘上筋と棘下筋断裂の修復術後に対応することが可能である． |
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| AbstractList | 【目的】筋骨格筋シミュレーションソフトを用いて肩腱板断裂モデルを作成し，装具を外した際の援助を模した肢位の修復腱にかかる力学的ストレスを推定した．【方法】ソフトはAnyBody Modeling Systemを用いた．アウトカムは，棘上筋・棘下筋・肩甲下筋・小円筋・三角筋・僧帽筋の腱張力とした．援助を模した肢位は援助肢位（2肢位），援助部位（3箇所），援助部位に与えた力（4つ）および肩関節モデル（3つ）の全72パターンとした．【結果】棘上筋は，援助量の増加にて腱張力が減少した．棘上筋の援助量は，上肢重量の約半分で概ね最小化した．棘下筋の援助部位は，尺骨遠位端の支持にて腱張力が減少した．棘下筋の援助量は，尺骨遠位端に約1/3または尺骨遠位端と肘頭に上肢重量の約半分の援助量で腱張力を概ね最小化できるが，肘頭に対する援助量を増しても腱張力の減少に限りがあった．【考察】上肢重量と援助の方向から肩関節のモーメントを想定することで，修復腱の腱張力を推定することが可能であった．援助者は，自身の前腕全体を使って患者の腕を援助することで，棘上筋と棘下筋断裂の修復術後に対応することが可能である． |
| Author | 松尾, 福美 松浦, 恒明 烏山, 昌起 河上, 淳一 田川, 善彦 |
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| Copyright | 2022 日本運動器看護学会 |
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| References_xml | – reference: 12. Nové-Josserand L, Liotard JP, Godeneche A, Neyton L, Borel F, Rey B, et al. Occupational outcome after surgery in patients with a rotator cuff tear due to a work-related injury or occupational disease. A series of 262 cases. Orthopaedics & Traumatology: Surgery & Research. 2011; 97(4): 361–366. – reference: 43. 藤原麻由，段林圭吾，南田喜久美．腱板修復術後患者の入院生活上の不自由さとその対処．日本看護学会論文集：看護総合．2013; 43: 39–42. – reference: 2. 山本敦史，高岸憲二，大沢敏久，小林勉，中島大輔，設楽仁．無症候性腱板断裂の臨床像．肩関節．2008; 32(2): 409–412. – reference: 28. Leschinger T, Birgel S, Hackl M, Staat M, Müller LP, Wegmann K. A musculoskeletal shoulder simulation of moment arms and joint reaction forces after medialization of the supraspinatus footprint in rotator cuff repair. Computer Methods in Biomechanics and Biomedical Engineering. 2019; 22(6): 595–604. – reference: 17. Slabaugh MA, Friel NA, Karas V, Romeo AA, Verma NN, Cole BJ. Interobserver and intraobserver reliability of the Goutallier classification using magnetic resonance imaging: proposal of a simplified classification system to increase reliability. The American Journal of Sports Medicine. 2012; 40(8): 1728–1734. – reference: 34. Kholinne E, Lee HJ, Kim SJ, Park SH, Jeon IH. The relationship between age, rotator cuff integrity, and osseous microarchitecture of greater tuberosity: where should we put anchor? Acta Orthopaedica et Traumatologica Turcica. 2018; 52(1): 22–26. – reference: 7. Burkhart SS, Danaceau SM, Pearce CE Jr. Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy. 2001; 17(9): 905–912. – reference: 20. Jung MC, Kim SJ, Rhee JJ, Lee DH. Electromyographic activities of the subscapularis, supraspinatus and infraspinatus muscles during passive shoulder and active elbow exercises. Knee Surgery, Sports Traumatology, Arthroscopy. 2016; 24(7): 2238–2243. – reference: 27. Jackson M, Sylvestre É, Bleau J, Allard P, Begon M. Estimating optimal shoulder immobilization postures following surgical repair of massive rotator cuff tears. Journal of Biomechanics. 2013; 46(1): 179–182. – reference: 24. 瀬尾充弘，松浦健司，兵頭惇，島田永和．腱板修復術後における外転装具状態での早期退院による影響．保健医療学雑誌．2018; 9(1): 31–38. – reference: 8. Bedeir YH, Jimenez AE, Grawe BM. Recurrent tears of the rotator cuff: effect of repair technique and management options. Orthopedic Reviews. 2018; 10(2): 70–76. – reference: 19. 望月智之，中川照彦，橋口宏，米田稔．「2013年度・肩の手術アンケート調査」報告．肩関節．2016; 40(2): 678–687. – reference: 31. Liu J, Hughes RE, O’Driscoll SW, An KN. Biomechanical effect of medial advancement of the supraspinatus tendon. A study in cadavera. The Journal of Bone and Joint Surgery. American Volume. 1998; 80(6): 853–859. – reference: 30. Rasmussen J, Damsgaard M, Voigt M. 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| Snippet | 【目的】筋骨格筋シミュレーションソフトを用いて肩腱板断裂モデルを作成し，装具を外した際の援助を模した肢位の修復腱にかかる力学的ストレスを推定した．【方法】ソフトはAnyBody Modeling... |
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| SubjectTerms | バイオメカニクス 援助 腱板断裂 |
| Title | 肩腱板断裂後患者の修復腱にかかる力学的ストレスへのシミュレーションアプローチ――再断裂リスク軽減にむけた援助方法のバイオメカニクス的検討 |
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| ispartofPNX | 日本運動器看護学会誌, 2022/02/28, Vol.17, pp.43-52 |
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