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<title>極める変形性股関節症の理学療法 | 株式会社文光堂</title>


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<meta name="description" content="変形性股関節症の機能解剖と病態を解説し，前・初期股関節症，進行期股関節症，末期股関節症，THA後の理学療法という病期別，さらに病期ごとに股関節・腰部，足部・膝，肩甲帯・上部体幹からの機能別アプローチを解説している．同じ疾患であっても，病期・機能ごとにその障害構造は全く異なるため，より細分化された理学療法モデルの確立を目指した．　☆表組11点，図版51点，モノクロ写真60点">

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					<span class="transparent">常任編集</span>　加藤　 浩（九州看護福祉大学看護福祉学部リハビリテーション学科教授）
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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">変形性股関節症の機能解剖と病態を解説し，前・初期股関節症，進行期股関節症，末期股関節症，THA後の理学療法という病期別，さらに病期ごとに股関節・腰部，足部・膝，肩甲帯・上部体幹からの機能別アプローチを解説している．同じ疾患であっても，病期・機能ごとにその障害構造は全く異なるため，より細分化された理学療法モデルの確立を目指した．<br>☆表組11点，図版51点，モノクロ写真60点</section><section class="preface">序<br><br>「臨床思考を究めて，理学療法を極める！」<br>　平成25年8月，内閣の社会保障制度改革国民会議において，今後わが国の進むべき社会保障制度についてのビジョンが示された．報告書の中では，高度経済成長期に確立した「1970年代モデル」の社会保障から超高齢化の進行，家族・地域の変容，非正規労働者の増加など雇用の環境の変化などに対応した全世代型の「21世紀（2025年）日本モデル」制度への改革の必要性が述べられている．中でも注目したいのが医療・介護分野の改革である．今後は「医療から介護へ」，「病院・施設から地域・在宅」の観点から，医療と介護の見直しは一体となって行われていくべきと明言されている．いわゆる，地域包括ケアシステムというネットワークの構築である．今後，この設計図に沿っ<br>て日本の医療制度改革は進み，医療のシステム自体が大きく変遷していくものと思われる．国家予算に占める医療費の割合は制限され，リハビリテーション医療（急性期，回復期，維持期リハビリテーション）における診療報酬も例外なくメスが入れられるであろう．厳しい時代はすぐそこまで来ている．<br>　先般，理学療法士協会会長の半田一登先生の講演を聴く機会があった．その講演の中で厚生労働省の診療報酬担当者から「なんちゃってリハビリ（理学療法）」という言葉がでたそうだ．悲しいことだが，これが今の厚生労働省からみた理学療法の評価なのだろう．我々理学療法士は，今一度，自らの専門性について問い直さなければならない．<br>科学的根拠に基づいた明確な結果を残せる医療を提供し，国に理学療法の必要性をアピールし，信頼の回復を目指さなければならない．なんちゃって理学療法ではこの先の未来はない．プロフェッショナルとしての知識と技術を極めるスピリットが必要である．極めるとは「これより先はないという所まで行き着く」ことである．即ち，これ<br>までの疾患別理学療法の概念にとどまらず，病期別理学療法，あるいは機能別理学療法といった，同じ疾患であってもその障害構造は全く異なり，より細分化された理学療法モデルの確立を目指すことが極めるということに他ならない．<br>　近年，様々な運動器理学療法関連の書籍が発刊されているが，1疾患で病期別，機能別に分類しまとめられた書籍は皆無である．このような意図から，このMOOKは今の理学療法士に最も必要なプロフェッショナルとしての「極める」ことの必要性をコンセプトにして企画された．このMOOKに書かれてある知識を，技術をフルに活かし，自<br>らの臨床思考を究め，日々，対峙する患者の理学療法を極めて頂きたい．<br>平成25年10月<br>加藤　浩</section><section class="indexes">PartI 変形性股関節症の機能解剖と病態<br>　1 股関節の機能解剖<br>　　骨学的にみた股関節<br>　　関節学的にみた股関節<br>　　運動学的にみた股関節<br>　2 変形性股関節症の病態特性と治療方針<br>　　変形性股関節症は，進行性の疾患である！<br>　　変形性股関節症には病期がある！　今はどんな状態なのか？<br>　　知っておこう．今，どのような治療が選択されるのか？<br>　　臨床における問題点の一つ；患者の背景<br>　　変形性股関節症における理学療法の一つの考え方<br>　　理学療法士を志す皆さんへ<br>　　まとめ<br>PartII 前・初期股関節症の理学療法<br>　1 理学療法評価と治療ガイド─股関節・腰部からのアプローチ─<br>　　股関節症の前・初期とは？<br>　　臨床症状は？<br>　　病期以外の分類は？<br>　　X線画像所見のみから機能障害を推察できるだろうか？<br>　　前・初期の主な症状は「痛み」<br>　　股関節痛の原因は？<br>　　股関節痛の評価<br>　　痛みがある股関節にアプローチするだけでよいのだろうか？<br>　　理学療法の目的と効果は？<br>　2 理学療法評価と治療ガイド─足部・膝からのアプローチ─<br>　　どんな症状を訴えて来院するのか？　前・初期股関節症患者の主訴は??<br>　　情報収集1─ カルテ情報の活用　どんな人なのか??　〜初期仮説の設定〜<br>　　情報収集2─ 主観的検査　カルテ情報を積極的に補おう!!　〜仮説の修正・再検討〜<br>　　情報収集3─ 客観的検査　「なぜ痛みが生じてしまうのか??」を明らかにしていく〜仮説の順位付け・絞り込み〜<br>　　治療・再評価─治療を通した仮説検証<br>　3 理学療法評価と治療ガイド─肩甲帯・上部体幹からのアプローチ─<br>　　なぜ変形性股関節症になるの？<br>　　現在と過去を知る問診は重要！<br>　　変形性股関節症の評価は歩行分析からはじめてみよう！<br>　　股関節と体幹の動き（股関節症の歩行特徴〜肩甲帯・上部体幹の使い方〜）<br>　　歩行分析を歩行観察に終わらせないために<br>　　荷重位股関節回旋ストレステスト<br>　　歩行時股関節痛から逃げる補償・代償方法とは？（体幹・上肢による）<br>　　即座に痛みをとる！<br>　　治療に生かす歩行動作の捉え方<br>PartIII 進行期股関節症の理学療法<br>　1 理学療法評価と治療ガイド─股関節・腰部からのアプローチ─<br>　　X線画像から病態を紐解く！<br>　　疼痛の再現性がアプローチのヒントに！<br>　　身体から股関節の病態を読み解く！<br>　　評価による臨床推論の形成<br>　　進行期変形性股関節症に対するアプローチ<br>　　　ミニレクチャー 変形性股関節症に起因する仙腸関節の痛みを取るコツ<br>　　　ミニレクチャー 下肢筋力トレーニングのコツ<br>　2 理学療法評価と治療ガイド─足部・膝からのアプローチ─<br>　　理学療法の考え方を変える！<br>　　幅広い知識のなかで評価項目を考え臨床推論しているだろうか？<br>　　筋肉が硬いって･･･本当!?<br>　　重力環境下での活動を考えているだろうか!?<br>　　姿勢制御には大きく2つある!?<br>　　足関節背屈における距骨の重要性は考えているだろうか!?<br>　　足関節背屈における腓骨の重要性を考えているだろうか!?<br>　　歩行時の足指の動きをみているだろうか!?<br>　　歩行時の股関節への衝撃緩衝を考えているだろうか!?<br>　　筋腱複合体について考えているだろうか!?<br>　　荷重は正確に関節に伝達されているだろうか!?<br>　　下肢運動連鎖を考えて評価しているだろうか!?<br>　　下肢のアライメントの評価から治療の一つ<br>　　膝関節の水平面上の動きを考えているだろうか!?<br>　　効率的な動作を考えているだろうか!?<br>　　膝関節の伸展制限が与える影響を考えているだろうか!?<br>　　膝関節伸展制限の要因を考え，戦略と戦法を変えて結果を出す<br>　　今後の理学療法の臨床推論や治療を考えているだろうか!?<br>　　　ミニレクチャー 歩行分析のポイント<br>　　　ミニレクチャー 歩行練習のコツ<br>　3 理学療法評価と治療ガイド─肩甲帯・上部体幹からのアプローチ─<br>　　上肢・体幹の機能低下から進行期股関節症の障害構造を理解する<br>　　進行期股関節症に対する理学療法評価<br>　　進行期股関節症患者に対するアプローチ<br>　　　ミニレクチャー 安定性・運動性向上のための体幹筋に対する理学療法のコツ<br>PartIV 末期股関節症の理学療法<br> 1 理学療法評価と治療ガイド─股関節・腰部からのアプローチ─<br>  末期股関節症を理解しよう<br>  機能障害は動作評価→理学療法評価→動作評価で把握しよう<br>  アプローチは無理のない方法を選択する<br>  アプローチの効果は客観的に，主観的に<br>   ミニレクチャー Hip─spine syndromeとは<br>   ミニレクチャー 関節可動域運動のコツ<br> 2 理学療法評価と治療ガイド─足部・膝からのアプローチ─<br>  変形性股関節症と足部・膝<br>  どんな問題があるか？<br>  問題解決のために情報を集めよう<br>  情報を批判的に吟味してみる<br>  目の前の患者にどう適用するか？<br>  効果の判断をどうするか？<br>   ミニレクチャー 痛みを取るための足底板の工夫<br> 3 理学療法評価と治療ガイド─肩甲帯・上部体幹からのアプローチ─<br>  問診で患者の生活や価値観を確認しよう<br>  問診で患者の症状や徴候を確認しよう<br>  問題点について優先順位をつけながら可能な範囲で羅列してみよう<br>  画像所見で病態を確認しよう<br>  除重力下での自動運動を評価しよう<br>  重力下での自動運動を評価しよう<br>  どのような姿勢制御戦略をとっているのだろう<br>  変形性股関節症における体幹機能を考えてみよう<br>  体幹に対する評価とアプローチの例<br>Part Ⅴ THA 後の理学療法<br> 1 理学療法評価と治療ガイド─股関節・腰部からのアプローチ─<br>  人工股関節置換術（total hip arthroplasty：THA）後はどうなるの？<br>  股関節<br>  心的要因が身体機能に与える影響<br>  脚長差に対してどんなアプローチがあるか？<br>  腰痛の要因は？<br>  歩行速度の低下の要因は？<br>   ミニレクチャー THA術後早期のADL指導：靴下着脱動作と足趾爪切り動作<br> 2 理学療法評価と治療ガイド─足部・膝からのアプローチ─<br>  まずはTHA後の『臥位姿勢』に着目してみよう！<br>  THA後の臥位姿勢に対するアプローチ方法<br>  治療効果の検証<br>   ミニレクチャー 人工股関節の種類と最近の動向について<br>   ミニレクチャー 痛みを取るための物理療法選択のコツ<br> 3 理学療法評価と治療ガイド─肩甲帯・上部体幹からのアプローチ─<br>  ステップ1：はじめに<br>  ステップ2：上半身の下肢筋群への影響を調べる<br>  ステップ3：表面筋電図計による動作解析<br>  ステップ4：APDF解析による歩行分析<br>  ステップ5：具体的な理学療法<br>付録　日本整形外科学会股関節疾患評価質問票（JHEQ）<br>索引</section></article>
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