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<title>人工股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="これからのTHAにおける理学療法では，関節・身体機能の回復・改善・向上に主眼を置くエビデンスに基づく理学療法を中心に，術前のうちから術後の身体機能低下を最小限に抑える対策や，術後の自己管理，生活方法の指導，原疾患によって引き起こされる二次的な障害発生の予防も必要とされる．本書は術前から術後にわたって，人工股関節とうまく付き合っていく生活の補助を担うTHAの理学療法に関わるあらゆる知識・技術について">

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		<h1 class="catchCopy">THAの理学療法を術前から術後まで網羅し，エビデンスに基づく臨床実践を解説する決定本！</h1>
		

		<h1 class="title">人工股関節全置換術の理学療法<span class="version"></span></h1>
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					編集：対馬栄輝（弘前大学大学院保健学研究科教授）
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				<ul class="property"><li class="disc">B5判・384頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-4585-3</li><li class="disc">2020年10月28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">これからのTHAにおける理学療法では，関節・身体機能の回復・改善・向上に主眼を置くエビデンスに基づく理学療法を中心に，術前のうちから術後の身体機能低下を最小限に抑える対策や，術後の自己管理，生活方法の指導，原疾患によって引き起こされる二次的な障害発生の予防も必要とされる．本書は術前から術後にわたって，人工股関節とうまく付き合っていく生活の補助を担うTHAの理学療法に関わるあらゆる知識・技術について網羅されている．</section><section class="preface">序　文<br><br>　開発から130年ほど経過している人工股関節全置換術（THA）は，ここ数年で目まぐるしく発達している．インプラント材質と術操作の改良によって術後療法は短期化し，その耐用期間も長期に及ぶものとなってきた．比較的若年者にも適用されるようになり，近年行われてきている最小侵襲手術（MIS）は，特にその恩恵が大きい．<br>　数十年前は変形性股関節症（以下，股関節症）に対する手術療法と言えば骨切り術が主流であった．当時の理学療法では免荷期間が長期に及ぶ例の筋力増強運動に四苦八苦し，疼痛の残存する例や，関節可動域の拡大に難渋する例も少なくはなかった．その時代と比較すると，理学療法でもTHA後患者を対象とする機会はかなり増えたが，手術療法によって短期間で身体機能の回復を遂げ，理学療法の効果を疑問視せざるを得ない例も珍しくなくなった．THA開発の初期に多大な貢献をされたCharnley氏は，将来的に術後療法の不要なTHAが目標であると言われたそうだが，確かにその発言も一理ある．そうなると手術療法による身体機能の回復が著しい患者を目の当たりにして，従来の理学療法の目的とは異なった，新たな目的を考えなければならないのではないだろうか．<br>　これからのTHA後患者に対する理学療法では，単に股関節機能や身体機能の改善を目標とするだけでは十分と言えない．術前から術後の身体機能低下を最小限に抑える対策や，術後における自己管理や生活方法の指導を行っておくのも効果的であろう．原疾患に由来する臨床像の性状をよく理解かつ考慮し，それによって引き起こされる二次的な障害発生の予防も必要である．例えば慢性進行性疾患である股関節症であれば，術後も継続して異常な姿勢・動作を繰り返すと，股関節以外の部位に二次的障害が発生したり，人工関節の耐用性に問題を起こしてしまったりする可能性もある．理学療法は身体機能の向上ばかりではなく，術前から術後にわたって人工股関節とうまく付き合っていく生活の補助をなす役割も大きいと考えれば有用であり，可能性も広がると考える．<br>　本書はTHA後の症例に対する関節機能の回復や改善に主眼を置く理学療法は基盤に置きつつ，時間空間的にもっと広い範囲でTHA後の障害を捉えていこうという考えを得るためのヒントとなる．THA後の理学療法とは，どうなるべきかを共に考えていくきっかけとなれば幸いである．<br><br>2020年10月<br>対馬栄輝</section><section class="indexes">Ⅰ　総　説<br>　THAの理学療法の現状と今後の課題<br>　　１　THAの特徴と問題<br>　　２　理学療法の現状と問題<br>　　３　ホームエクササイズと生活指導<br>　　４　理学療法への課題<br><br>Ⅱ　THAとは<br>　１　理学療法士のためのTHAの基礎<br>　　１　適　応<br>　　２　術式（手術進入法）<br>　　３　機　種<br>　２　周術期・術後の医学的治療<br>　　１　THAの麻酔管理<br>　　２　術中術後の出血，貧血予防対策<br>　　３　術後疼痛対策<br>　　４　高齢者や全身状態不良例に対する注意点<br>　３　術後脱臼・ゆるみ・静脈血栓塞栓症<br>　　１　THA 後脱臼<br>　　２　骨溶解とゆるみ<br>　　３　静脈血栓塞栓症（VTE）<br><br>Ⅲ　理学療法実践<br>【１　評　価】<br>　１　X線画像―評価（術前と術後所見）<br>　　１　主要な股関節の評価指標<br>　　２　理学療法でのX線画像からの情報収集<br>　　３　骨盤体表触診評価や姿勢評価とX線画像との関連<br>　　４　経験上のX 線画像の見るべき所見<br>　　５　股関節症に合併しやすい隣接関節障害<br>　　６　THA施行前後のX線画像の変化<br>　　７　THA後のX線画像で見るべき注意点<br>　　８　THA施行後の長期経過の注意点<br>　２　医療面接と聴取事項<br>　　１　医療面接を行う前にすべきこと<br>　　２　医療面接の環境設定<br>　　３　医療面接の手順<br>　　４　医療面接と臨床思考過程の実際<br>　３　股関節機能の評価<br>　　１　股関節のROM-Tと筋力検査<br>　　２　理学療法展開に向けた股関節機能評価の考え方<br>　　３　股関節機能の評価での臨床的な工夫<br>　　４　臨床での股関節機能の評価方法の工夫<br>　　５　術前評価と要点<br>　４　疼痛の特徴と評価<br>　　１　THA患者における疼痛に関連する特徴<br>　　２　評　価<br>　５　隣接関節との関連を考慮した評価<br>　　１　脚長差との関連<br>　　２　腰椎・骨盤との関連<br>　　３　膝関節との関連<br>　　４　足関節との関連<br>　　５　術後評価<br>　６　姿勢と動作の分析<br>　　１　進入法との関連性（術後急性期リスク管理）<br>　　２　THA後の姿勢・動作分析<br>　　３　高齢者の脊柱<br>　　４　立位体前後屈動作による簡便な評価<br>　　５　変形性股関節症と歩行<br>　７　歩行の評価<br>　　１　THA症例における歩行の評価<br>　　２　脚長差を合併したTHA症例の歩行の特徴<br>　８　ADL・生活関連動作の評価<br>　　１　Key ADLのチェックポイント<br>　　２　ADL動作制限の分析ポイント<br>　　３　ADL評価尺度使用のポイント<br>　９　臨床推論と問題点抽出・方針の立て方<br>　　１　臨床推論とは<br>　　２　現象を解釈するための思考の流れ<br>　　３　問題空間とは<br>　　４　問題空間を可視化する<br>　　５　予後予測と自己効力感　<br>　　６　気づきは臨床観察から<br>　　７　臨床推論の実際（1症例を通して）<br>【２　治　療】<br>　１　保存療法<br>　　１　THA前における理学療法<br>　　２　THA後維持期における理学療法<br>　２　術後合併症・リスクの特徴と管理<br>　　１　理学療法士が管理すべき合併症の特徴と対応<br>　　２　神経麻痺<br>　　３　早期荷重<br>　３　術直後の理学療法<br>　　１　術後早期における理学療法実施のための準備<br>　　２　術後早期における理学療法の実際<br>　４　関節可動性に対する運動療法<br>　　１　股関節の解剖学と運動学<br>　　２　THA後の構造学的変化<br>　　３　THA前後の隣接関節を含めた可動性<br>　　４　関節可動性改善のための理学療法の実践<br>　５　疼痛障害に対する対応<br>　　１　THA後の疼痛<br>　　２　THA後における疼痛の評価<br>　　３　急性期の疼痛管理と理学療法<br>　　４　慢性期の疼痛と理学療法<br>　６　筋力・筋機能に対する運動療法<br>　　１　筋力・筋機能の評価<br>　　２　THAに関する筋力のエビデンス　<br>　　３　筋力増強に関する基礎事項<br>　　４　運動療法の実際<br>　７　姿勢とバランス<br>　　１　立位姿勢の特徴<br>　　２　姿勢改善のための理学療法の実践<br>　　３　バランス<br>　　４　バランス改善のための理学療法の実践<br>　８　基本動作練習<br>　　１　起居動作<br>　　２　座　位<br>　　３　立ち上がり・着座<br>　９　歩　行<br>　　１　股関節症患者とTHA後の歩行特性<br>　　２　THA後の歩行能力の向上のための理学療法の実践<br>　10　日常生活動作<br>　　１　THA患者のADL障害の特徴<br>　　２　術式・インプラントの違いによる脱臼予防とADL<br>　　３　入院時，ADL獲得のための股ROMと脱臼予防を考慮したADL指導のポイント<br>　　４　退院に向けて<br>　11　脚長差に対する運動療法・装具療法<br>　　１　基本的な知識<br>　　２　運動療法<br>　　３　装具療法<br>　12　装具療法・歩行補助具・自助具<br>　　１　股関節装具<br>　　２　歩行補助具<br>　　３　THA患者に必要な自助具<br>　13　ホームエクササイズの効率的な方法<br>　　１　ホームエクササイズとは<br>　　２　ホームエクササイズの正確な実施と継続<br>　　３　ホームエクササイズの効率的な方法<br>　14　退院後生活指導<br>　　１　退院後生活指導とは<br>　　２　退院後生活指導において押さえておくべきポイント<br>　　３　退院後生活指導の実際<br>【３　症　例】<br>　１　THA後において体幹に対する理学療法が有効であった症例<br>　２　歩行時の股関節伸展角度減少に対して体幹機能に着目した症例<br>　３　THA後の末梢神経麻痺に対する理学療法が有効だった2症例<br>　　１　症例紹介<br>　　２　症例からの課題<br><br>付　録１<br>　生活指導・ホームエクササイズのパンフレット<br>　　１　生活指導<br>　　２　ホームエクササイズ<br>付　録２<br>　各種評価表<br>　　１　JOA hip score <br>　　２　Harris hip score<br>　　３　SF-36 v2<sup>Ⓡ</sup><br>　　４　WOMAC <br>　　５　OHS<br>　　６　HOOS<br>　　７　JHEQ<br>　　８　FJS-12 <br><br>人工股関節全置換術Q&amp;A―患者からよく聞かれる質問と考え方<br>　１　THA後の脱臼頻度は？ <br>　２　THAの挿入金属について（飛行機は乗れますか？ MRIは撮影できますか？）<br>　３　THA のゆるみ（リーズニング）とはどのような状態ですか？ <br>　４　術後の運動療法は続けるべきですか？<br>　５　THA後にスポーツは行ってもよいですか？<br><br>索　引</section></article>
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