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<title>人工膝関節全置換術の理学療法 | 株式会社文光堂</title>


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<meta name="description" content="今日の理学療法は効率化し，短期間での結果が求められているが，理学療法士には動作の可否だけでなく，質的な機能向上を重視することなど，役割の再考が必要とされている．本書は，重度膝OA唯一の根本治療として，益々施行数が増えていくとされるTKA術前・周術期・術後の理学療法技術を解説．TKAにまつわる最新のエビデンスと臨床実践のためのポイントが紹介されており，より良い理学療法を提供するために必読の内容となっ">

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		<h1 class="catchCopy">TKAにまつわる理学療法技術向上のために．エビデンスにもとづく臨床実践をレクチャー！</h1>
		

		<h1 class="title">人工膝関節全置換術の理学療法<span class="version"></span></h1>
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					編集：山田英司（岡山専門職大学設置準備室）
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					<span class="transparent">編集</span>　井野拓実（北海道科学大学保健医療学部）
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				<ul class="property"><li class="disc">B5判・344頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4574-7</li><li class="disc">2018年12月19日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">今日の理学療法は効率化し，短期間での結果が求められているが，理学療法士には動作の可否だけでなく，質的な機能向上を重視することなど，役割の再考が必要とされている．本書は，重度膝OA唯一の根本治療として，益々施行数が増えていくとされるTKA術前・周術期・術後の理学療法技術を解説．TKAにまつわる最新のエビデンスと臨床実践のためのポイントが紹介されており，より良い理学療法を提供するために必読の内容となっている．</section><section class="preface">序　文<br><br>　1940年代に開発された人工関節置換術は，関節鏡とともに20世紀の整形外科の歴史の中で最も輝かしい功績とされ，2013年の人工膝関節置換術の手術件数は81,300件とされている．術後の理学療法の変遷も大きく，クリニカルパスの使用により効率化が進められ，在院日数も大幅に短縮された．短期間での退院を可能にするためには，効率的な理学療法を実施することが必要不可欠である．しかし，早期退院のみを重視しすぎると本来の理学療法の目的を見失いそうになる場合もある．例えば早期から可動域練習，筋力トレーニングや起立・歩行練習を積極的に施行するが，歩行や階段昇降の可，不可，また，基本動作の可，不可の判断基準で退院を決定されることが多い．事実，一般に用いられている治療成績の判定基準や日常生活動作の評価基準もこれらの尺度で判断されており，重要な因子であることは間違いない．しかし，理学療法士としての治療のアウトカムはこれだけで良いのであろうか？ 早期離床，早期歩行を実施し，歩行が可能となるという結果を出すだけであれば他職種でも可能なのではないか？ 理学療法士としての責務は運動療法を用いて，機能を再構築することであり，歩けるということは理学療法を行った結果の一つなのである．短期間での結果が理学療法に求められる今，動作の可否のみでなく，外科的な運動器の構築学的な変化に対して，重力下での効率の良い姿勢，動作戦略をいかに再構築するかという質的な機能の向上も重視し，もう一度，理学療法士としての役割を再考する必要があると思われる．<br>　医療効率を改善し，患者満足度を向上させるためには一定レベルの医療サービスを提供することが必須であることは言うまでもない．しかし，理学療法士としては，チーム医療の標準化，均一化が重要視されすぎると，理学療法の内容もマニュアル化される傾向があり，流れ作業のようなベルトコンベア式治療に陥る危険性もある．クリニカルパスと理学療法士との関係を考える上で重要なことは，クリニカルパスは患者に提供する最低限の医療サービスを示すものであり，クリニカルパスに沿って順調に経過しているからといって理学療法士として十分に責務を果たしているとは限らないことに注意する必要がある．マニュアルどおりに動作の可，不可のみに注目し，移動能力の獲得だけを術後運動器理学療法の帰結として考えると，理学療法ではなくただの作業となってしまう可能性がある．<br>　本書はこのような問題点に対して，もう一度理学療法の目的を再確認し，理学療法士として何を評価し，どのような思考過程で，どのような結果を出すべきかを再考する一助として企画したものである．また，最新のエビデンスを確認し，これまでの歴史を振り返り，取捨選択し，より良い理学療法を提供することの支援となれば幸いである．<br><br>2018年12月<br>山田　英司</section><section class="indexes">I　総　説<br>　TKA後の理学療法の現状<br>　　１　在院日数の短縮化に起因する問題<br>　　２　クリニカルパスの功罪<br>　　３　外来理学療法の重要性<br>　　４　エビデンスと疾患のサブグループ化<br><br>II　TKAとは<br>　１　理学療法士のためのTKAの基礎<br>　　１　適　応<br>　　２　機　種<br>　　３　術　式<br>　２　周術期・術後のペインマネジメント<br>　　１　TKAの手術侵襲を受ける領域の神経支配<br>　　２　TKAの術後鎮痛方法<br>　３　創部の治癒過程<br>　　１　手術による組織侵襲<br>　　２　皮膚・皮下組織の構造・機能<br>　　３　皮膚の治癒過程<br>　　４　皮膚創傷のタイプ<br>　　５　創傷治癒が遷延する要因<br>　　６　創傷治癒に影響を与える要因<br><br>III　理学療法実践<br>【１　評　価】<br>　１　X線画像─評価の基礎<br>　　１　X線とは<br>　　２　X線像の形成<br>　　３　X線画像読影の基礎<br>　　４　変形性膝関節症の画像による分類<br>　２　X線画像─評価の活用<br>　　１　単純X線写真評価法<br>　　２　X線写真に基づくリハビリテーション介入 <br>　３　理学療法評価<br>　　１　人工膝関節の機械特性<br>　　２　術後経過における治療段階<br>　　３　評価各論<br>　４　能力評価スケール<br>　　１　自己記入式質問紙票<br>　　２　パフォーマンステスト<br>　　３　身体活動量<br>　５　バイオメカニクス・動作分析<br>　　１　人工膝関節に生じる負荷<br>　　２　人工膝関節のバイオメカニクス<br>　　３　生体膝関節と人工膝関節のバイオメカニクス<br>　　４　階段昇降時のバイオメカニクス<br>　　５　動作分析<br>　６　EMG<br>　　１　EMGの測定<br>　　２　TKA患者における筋電図学的研究<br>【２　治　療】<br>　１　TKA後の理学療法における治療段階<br>　　１　術前理学療法<br>　　２　術後理学療法<br>　　３　術後の治療段階<br>　２　合併症・リスク管理<br>　　A　深部静脈血栓症・コンパートメント症候群<br>　　　１　深部静脈血栓症とは<br>　　　２　DVTの診断<br>　　　３　理学的予防法<br>　　　４　薬物予防法<br>　　　５　わが国における予防法<br>　　　６　コンパートメント症候群（区画症候群）<br>　　B　腓骨神経麻痺<br>　　　１　腓骨神経の解剖<br>　　　２　腓骨神経麻痺の原因<br>　　　３　病　態<br>　　　４　症　状<br>　　　５　理学療法評価および診断<br>　　　６　治療および予後<br>　　　７　当院での取り組み<br>　　C　感　染<br>　　　１　TKA後感染の疫学<br>　　　２　感染の予防<br>　　　３　感染後の治療<br>　　D　腰痛・隣接関節障害<br>　　　１　下肢の多関節運動連鎖<br>　　　２　股関節・骨盤・腰椎の運動連鎖<br>　　　３　TKAにおける腰痛および隣接関節障害<br>　３　関節可動域<br>　　１　TKA前からTKA後までの理学療法<br>　　２　TKA後の理学療法<br>　　３　人工関節のタイプに合わせたROM運動<br>　　４　ROMの制限因子と理学療法<br>　４　筋機能トレーニング<br>　　１　筋機能<br>　　２　TKA後の筋機能のエビデンス<br>　　３　TKA前後の筋機能トレーニングのエビデンス<br>　　４　TKA前後の病期別における筋機能トレーニング<br>　５　疼痛の捉え方とその対応<br>　　１　痛みとは<br>　　２　痛みの評価の流れ<br>　　３　痛みに対する医療のパラダイムシフト<br>　６　歩行動作<br>　　１　押さえておくべき正常歩行の特徴<br>　　２　TKA術後の関節機能と歩行動作の診るべきポイント<br>　　３　歩行動作改善のための理学療法の実践<br>　７　日常生活動作<br>　　１　起居動作の指導方法と注意点<br>　　２　トイレ動作の指導方法と注意点<br>　　３　入浴動作の指導方法と注意点<br>　　４　階段昇降の指導方法と注意点<br>　　５　家事動作の指導方法と注意点<br>　８　スポーツ動作<br>　　１　TKAとスポーツ<br>　　２　TKA後のスポーツ動作に必要な身体機能<br>　　３　TKA後のスポーツの指導<br>　９　徒手療法<br>　　１　膝OA保存療法に対する徒手療法に基づく考察<br>　　２　TKA術後リハビリテーションで推奨される徒手療法<br>　　３　TKA術後リハビリテーションでの軟部組織モビライゼーション<br>　10　物理療法<br>　　１　TKA後の痛み<br>　　２　TKA後の痛みに対する物理療法<br>　11　装具療法<br>　　１　正常歩行とスラスト膝の運動連鎖動態の違い<br>　　２　連鎖比の定量化の方法<br>　　３　足底装具の機能<br>　　４　短下肢装具の機能<br>　　５　膝装具の機能<br>　12　患者満足度<br>　　１　患者が期待すること，優先していることは何か？<br>　　２　患者満足度に影響する要因は何か？<br>　　３　患者満足度をどのように評価するか？<br>　13　外来での理学療法・ホームエクササイズ<br>　　１　外来理学療法のゴール設定に必要な知識と決定するための評価指標<br>　　２　外来理学療法の重要性<br>　　３　ホームエクササイズ<br>　14　IT技術の応用<br>　　１　身体活動量遠隔モニタリング<br>　　２　遠隔リハビリテーション<br>【３　症　例】<br>　１　症例１　UKA術後にanterior knee painを呈した一例<br>　２　症例２　stiff knee gaitに対して歩行支援ロボットを活用した一例<br>　３　症例３　stiffness kneeを呈した腰椎後弯女性に対する理学療法経験<br><br>付　録<br>　ホームエクササイズのパンフレット<br>　　１　体幹のエクササイズ<br>　　２　膝のエクササイズ<br>　　３　立位のエクササイズ<br>　　４　ストレッチ<br><br>人工膝関節全置換術Q&amp;A―患者からよく聞かれる質問と考え方<br>　１　人工膝関節はどのような材質でできているのですか？<br>　２　いつ手術を受けるのが一番良いのでしょうか？<br>　３　手術後，なかなか自力で脚を上げることができなかったのですが，よほど人工膝関節が重たいのでしょうか？<br>　４　人工膝関節は10年くらいもつと聞きましたが，実際のところどのくらいもつのでしょうか？<br>　５　手術後の日常生活動作において制限はありますか？<br>　６　手術後，どのくらいのスポーツであれば行ってもよいのでしょうか？<br>　７　手術後に病院や整骨院などで物理療法治療器を使用したいのですが，使用してよいものと使用できないものがわからないので教えてください．<br><br>索　引</section></article>
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