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<title>極める膝・下腿骨骨折の理学療法（電子版のみ） | 株式会社文光堂</title>


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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">骨折の部位別に医師による執筆で骨折のタイプの特徴，手術方法，リスクについて正しい認識を持ってもらい，理学療法士が把握すべき病態に関する重要な知識を整理している．それと同時に，骨折後の機能障害を適切に評価し，改善するための理学療法の考え方を，これまでの慣習に捉われることなく，患者のもつ様々な問題に対して真摯に向き合うため，理学療法士が受傷機転や手術方法などによって理学療法をどのように展開するのかについて解説している．</section><section class="preface">序<br><br>　今後ますます進んでいく高齢社会への対応に向けて，国は地域包括ケアシステムの構築を進めている．全国各地でさまざまな会議が開催されているが，そうした中で，理学療法士には地域における専門性が求められている．特にこれからの時代は，理学療法士は理学療法という専門性を提供しているという原点を強く認識して進んでいく必要がある．<br>　これまで膝・下腿骨骨折後においては，保存療法や手術にかかわらず，骨癒合が進行してある程度の期間が過ぎると，関節可動域運動や筋力増強運動が許可されて荷重歩行が開始となり，理学療法士が「訓練」をしてきた．しかし，単なる「訓練」は理学療法士の専門性とは異なる．理学療法は医学的管理のもと，教育的アプローチ，運動療法や徒手療法，物理療法などを手段として，患者の持つ身体機能異常を正常な運動機能システムに正すことで身体活動性を改善し，患者をリハビリテートさせることが専門である．本書では，これまで実施されてきた骨折後の理学療法に不足していた専門性とは何かということについて，これまでとは別の視点から考え，骨折後の理学療法の本質を考えることに主眼を置いた．すなわち，骨折後理学療法の専門性の再考である．東京大学名誉教授の冲中重雄先生は「書かれた医学は過去の医学であり，目の前に悩む患者の中に明日の医学の教科書の中身がある」と述べられた．本書が，患者の中にある真実を探求（小牧順道先生）し，適切にアプローチをしていくための一助となれば幸いである．<br>　理学療法が発展するためには，垂直思考（既知の論理など）と水平思考（創造性など）をうまく織り交ぜて，効果的な理学療法の実施に向けた論理を構築していく姿勢が重要である．理学療法士が自分自身の限界を医学的限界にすり替え，患者の快復の可能性を妨げてはならない．常に患者にとって最高の結果が出せるよう，技術や知識の研鑽を積むとともに，患者に寄り添い，人として成長する努力を続けることで理学療法士としての基礎が構築されていく．悩みや不安が大きいほど，解決したときには，それはとても大きな財産となる．それが可能かどうかは，自分自身の行動にかかっていると言っても過言ではない．本書が悩み，迷い，試行錯誤している理学療法士を支える一助となれば，編集に携わった者として望外の喜びである．<br>　本書の編集にあたり，本当に多くの皆様にお世話になりました．大変貴重な機会を与えていただいた茨城県理学療法士会・筑波記念会の斉藤秀之先生，九州看護福祉大学の加藤浩先生には心より感謝申し上げます．文光堂の奈須野剛弘氏には多くのお心遣いをいただきました．厚く御礼申し上げます．ご執筆いただきました先生方には，無理難題をお願いしたにもかかわらず，快く素晴らしい内容をご提供いただきました．心より厚く御礼申し上げます．本書が，悩める患者の快復の一助となることを願って．<br><br>平成29年10月<br>ゲスト編集　常盤直孝</section><section class="indexes">Part I　膝・下腿骨骨折後理学療法の基礎知識<br>1　骨折治療に必要な単純X線画像のみかた<br>　単純X線画像の撮影肢位は決まっている<br>　画像解剖学というものがある<br>　骨折の形は外力の加わり方で決まる<br>　受傷からの経過期間により読影のポイントが異なる<br>　運動療法への利用の具体例<br>2　骨折治療の固定方法を知る<br>　固定方法の種類<br>　ギプス（キャスト）固定<br>　鋼線（ピン）固定（pinning）<br>　ネジ（スクリュー）固定<br>　プレート固定<br>　髄内釘固定<br>　創外固定<br>　おわりに<br>3　膝・下腿骨骨折の病態特性を理解する<br>　下腿骨近位端骨折<br>　下腿骨骨幹部骨折<br>　下腿骨遠位端骨折<br>　ミニレクチャー　膝・下腿骨骨折における高気圧酸素治療の有用性<br>4　膝・下腿骨骨折後の理学療法における問診<br>　健全な臨床推論こそ問題解決への近道<br>　臨床実践のプロセスとは？<br>　何を考えて，何を決めれば良いのか？<br>　問診を通して患者の物語を理解する<br>　問診の具体的な方法<br>　症例を通して考える<br>5　膝・下腿骨骨折に必要な機能評価と予後予測<br>　予後予測とは？<br>　下腿骨骨折患者の予後予測に必要な判断材料<br>　症　例<br>　ミニレクチャー　外来（通所）理学療法でチェック・指導する身体運動機能面のポイント<br>Part II　部位別にみた膝・下腿骨骨折における理学療法<br>1 膝蓋骨骨折<br>　特　徴<br>　治　療<br>　手術アプローチ法<br>　術後理学療法<br>2　膝蓋骨骨折の理学療法<br>　理学療法の目的<br>　保存的治療と観血的治療の基本的な理学療法の流れ<br>　機能的評価<br>　理学療法アプローチ<br>　日常生活の注意事項<br>3　脛骨近位端骨折<br>　脛骨近位端骨折の特徴は？<br>　手術の適応<br>　手術アプローチ法<br>　周術期のリスク管理<br>　術後理学療法の注意点<br>4　脛骨近位端骨折の理学療法<br>　脛骨近位端骨折の分類と頻度，治療の流れ<br>　脛骨近位端骨折術後の理学療法上でのリスク管理<br>　理学療法評価<br>　術後の理学療法<br>　ミニレクチャー　関節可動域運動の意義<br>5　脛骨骨幹部骨折<br>　脛骨骨幹部骨折の受傷機転は？<br>　脛骨骨幹部の臨床所見ならびに診断は？<br>　初期診療から根治治療について<br>　骨折型からの治療戦略はどう変わるか？<br>　軟部組織の状態，開放骨折の有無で治療戦略はどう変わるか？<br>　脛骨骨幹部骨折に対する手術療法について<br>6　脛骨骨幹部骨折の理学療法<br>　脛骨骨幹部骨折とは？<br>　術後理学療法の流れ：骨折重症度の理解はリスク管理につながる<br>　理学療法評価と具体的治療：全身と局所，両方診ることができるようになろう<br>7　脛骨遠位端骨折<br>　治療方針の考え方<br>　骨折型の分類について理解しよう<br>　保存治療を忘れない<br>　手術法とその特徴について理解しよう<br>　手術アプローチについて<br>　術後管理で大切なことは何か<br>　術後理学療法は画一的ではいけない<br>　リスク管理<br>　最後に<br>8　脛骨遠位端骨折の理学療法<br>　情報収集は理学療法計画に役立つ<br>　骨折部の軟部組織の損傷を推測し，時期に応じたROM運動を実施する<br>　術後荷重開始時期を医師と協議することがポイント<br>　術後の運動療法で注意すること<br>　免荷期間の理学療法<br>　荷重開始時期からの理学療法<br>　脛骨遠位端骨折術後の治療満足度を向上させるためには？<br>　種々の因子に対する具体的アプローチ<br>　ミニレクチャー 装具のチェックポイント<br>9　足関節果部骨折<br>　外果，内果の骨折の特徴<br>　保存療法と手術適応<br>　アプローチと注意点やリスク管理<br>　術後理学療法における注意点　ズバリ脛腓固定の有無！<br>　ポイント<br>10　足関節果部骨折の理学療法<br>　足関節の構造を理解する<br>　足関節はアライメントの影響を受ける!?<br>　足関節果部骨折とは？<br>　足関節果部骨折の理学療法に必要な知識とは？<br>　足関節果部骨折の手術と退院までの流れについて<br>　足関節果部骨折の理学療法評価について<br>　足関節果部骨折術後に対する理学療法<br>　足関節果部骨折術後の理学療法の実際<br>　ミニレクチャー　開放骨折時におけるリスク管理のポイント<br>Part III　膝・下腿骨骨折における理学療法のポイント─熟練者における全身的アプローチ<br>1　膝・下腿骨骨折後の理学療法の本質を考える<br>　これまでの骨折後の理学療法を振り返る<br>　下腿骨骨折後の理学療法の役割を考える<br>　骨折後理学療法の根本的考え方<br>　骨折に対する姿勢の影響を考える<br>　ミニレクチャー 筋機能とバランス機能改善のポイント<br>2　膝・下腿骨骨折と自律神経機能<br>　はじめに<br>　自律神経機能の時間的関係<br>　組織修復と自律神経<br>　なぜ，組織の修復は遅れるのか<br>　チェックポイント<br>　自律神経のコントロール方法<br>　おわりに<br>　ミニレクチャー　関節因性筋抑制について<br>3　膝・下腿骨骨折と身体重心補正<br>　骨折と理学療法のつながり<br>　下腿骨骨折修復に影響を及ぼす因子<br>　良い荷重ストレスと悪い荷重ストレスの違いは？<br>　身体重心補正と理学療法<br>　脊柱機能評価と運動療法<br>　ミニレクチャー　歩行分析のポイント<br>4　膝・下腿骨骨折と胸郭機能<br>　はじめに―胸郭機能が下腿骨骨折に関係する理由<br>　胸郭運動システムとは<br>　胸郭運動システムの異常<br>　胸郭運動の特徴と胸郭の機能分類<br>　胸郭運動の3パターン<br>5　膝・下腿骨骨折と腰部・骨盤帯機能<br>　腰部・骨盤帯機能は下腿骨骨折へどのような影響を与えるのか？<br>　どのように腰部・骨盤帯の機能評価を行えば良いか？<br>　理学療法はどのように進めていくのか？<br>6　膝・下腿骨骨折と足部・足関節機能<br>　足部筋の機能と解剖を理解することが重要<br>　骨折治癒と力学的負荷<br>　歩行時の床反力と下腿制御<br>　理学療法評価<br>　理学療法<br>　ミニレクチャー 荷重感覚と脳機能<br>索引</section></article>
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