大腿骨近位部骨折患者における立ち上がり動作の運動力学的・筋電図学的分析

• Published in: 理学療法学 Vol. 42; no. 3; pp. 228 - 236
• Main Authors: 上野 貴大, 高橋 幸司, 座間 拓弥, 鈴木 英二, 原 和彦
• Format: Journal Article
• Language: Japanese
• Published: 日本理学療法士学会 2015; Japanese Society of Physical Therapy
• Subjects: Pain; Proximal Femoral Fracture; Sit-To-Stand Motion; 大腿骨近位部骨折; 疼痛; 立ち上がり動作
• ISSN: 0289-3770; 2189-602X
• DOI: 10.15063/rigaku.kj00009989971

Objective: The purpose of this study is to make kinetic and electromyographic analyses on sit-to-stand motion of patients with proximal femoral fracture and to reveal differences in motion patterns and muscular activities during motion according to presence or absence of pain on motion. Method: Twenty one patients with proximal femoral fracture who had maintained cognitive function and had no serious past medical history were included in the study. Sit-to-stand motion without upper limb support from a chair as high as 120% of the length of lower limbs was studied using 3D motion analysis system and surface electromyogram. Subjects were classified into groups with and without pain according to presence or absence of pain during motion, and results of motion analyses were compared between the groups. Result: Pain was detected mainly in quadriceps muscle. Range of hip motion and hip extension moment were significantly small in patients with pain. Knee extension moment was significantly large in patients with pain. The ratio of muscular activities for the affected versus unaffected sides was significantly large in vastus lateralis muscle of patients with pain. Conclusion: Comprehension by knee joint function for decreased hip joint function was observed in patients experiencing pain during motion, suggesting involvement of compensatory movement in muscular pain development during the recovery phase. 【目的】大腿骨近位部骨折患者の立ち上がり動作を運動力学的・筋電図学的に解析し,疼痛の有無による運動様式とその際の筋活動の差異を明らかにすることとした。【方法】対象は,認知機能が保たれ,重篤な既往を有さない大腿骨近位部骨折患者21名であった。下腿長の120%の高さの椅子からの上肢支持を用いない立ち上がり動作を対象動作とし,3次元動作解析装置,表面筋電計を用い計測を行った。対象を疼痛あり群・疼痛なし群に分類し,動作分析結果を群間で比較した。【結果】疼痛はおもに患側大腿四頭筋に認めた。患側股運動範囲・患側股伸展モーメントは,疼痛あり群で有意に小さかった。患側膝伸展モーメントは疼痛あり群で有意に大きかった。筋活動量健側比は,疼痛あり群の外側広筋で有意に大きかった。【結論】疼痛を生じている例では,患側股関節機能低下に対する患側膝関節機能による代償が確認され,回復期に生じる筋痛発生への関与が示唆された。