アブストラクト
Title | 骨粗鬆症性椎体骨折後のリハビリテーション |
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Subtitle | 特集 脊椎脊髄疾患に対するリハビリテーション 〜 Now and the Future 〜 |
Authors | 粕川雄司1), 宮腰尚久2) |
Authors (kana) | |
Organization | 1)秋田大学医学部附属病院リハビリテーション科, 2)秋田大学大学院医学系研究科医学専攻機能展開医学系整形外科学講座 |
Journal | JOURNAL OF CLINICAL REHABILITATION |
Volume | 32 |
Number | 13 |
Page | 1291-1297 |
Year/Month | 2023 / 11 |
Article | 報告 |
Publisher | 医歯薬出版 |
Abstract | 「内容のポイントQ&A」「(Q1) 骨粗鬆症性椎体骨折の病態と症状は?」原発性骨粗鬆症では, 骨吸収と骨形成が亢進し高骨代謝回転となり骨量が減少する. 最大骨密度の低値や既存椎体骨折, オステオサルコペニアの合併が椎体骨折の危険因子となる. 病期は, 骨折後4週までの急性期, 4〜12週までの亜急性期, 3カ月以降の慢性期に分けられる. 症状は, 腰背部痛, 後弯変形, 脊柱アライメント不良, 胃食道逆流症等がある. 椎体骨折を生じると生活の質の低下に加え, 生命予後が悪化する. 「(Q2) 骨粗鬆症性椎体骨折の治療法は?」椎体骨折が生じると骨粗鬆症と診断されるため, 薬物治療を開始する. 複数の骨形成促進薬と骨吸収抑制薬があり, 各薬剤とも大規模臨床試験で椎体骨折の抑制効果が明らかとなっている. 装具治療を実施するが, 疼痛軽減効果・体幹筋力・後弯変形・生活の質に対する効果は一定の見解に至っていない. 亜急性期以降で腰背部痛が遷延する例や, 骨折部位の不安定性や変形・狭窄により遅発性神経麻痺を生じる例では手術治療の適応となる. 「(Q3) 骨粗鬆症性椎体骨折に対する最新のリハビリテーションは?」骨粗鬆症性椎体骨折患者に対する運動療法は, 毎日の低頻度の背筋訓練, 筋緊張改善, 疼痛軽減, 可動性の改善, より適正な姿勢の指導等, 複数種類の運動プログラムを理学療法士の指導のもとに行うことが推奨されている. また, 運動療法単独ではなく薬物治療との併用が重要となる. 最近の報告では, オステオサルコペニアに対する運動療法により, 骨密度と筋量が改善することが明らかとなっている. |
Practice | 臨床医学:外科系 |
Keywords | 骨粗鬆症性椎体骨折, 骨密度, オステオサルコペニア, 背筋力, 複数運動プログラム |
- 全文ダウンロード: 従量制、基本料金制の方共に1,243円(税込) です。
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