71. 3 次元動作解析による人工股関節置換術後歩行時の杖の役割

 ᰴరേ૞⸃ᨆߦࠃࠆੱᎿ⢆㑐▵⟎឵ⴚᓟᱠⴕᤨߩ᧟ߩᓎഀ
ᓼፉᄢቇ∛㒮࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦㇱ 㧝㧘྾᪯⇨ቇ࿦ᄢቇℂቇ≮ᴺቇ⑼ 㧞
ᓼፉᄢቇ∛㒮ㆇേᯏ⢻ᄖ⑼ ٤ዊ᧻ ብᘏ 㧘ਛየ ᚑቁ 㧘ᄢỈ ବᢥ 㧘Ⴧ↰ ᦭♿ 㧘ጟਭ ື਽ 㧘ㄭ⮮ ᔃ
㧘⷏Ꮉ ᐘᴦ 㧘Ꮉፒ ⚐ 㧘㜞↰ ାੑ㇢ 㧘቟੗ ᄐ↢ ‫ޤߦ߼ߓߪޣ‬
᧟ߪᱠⴕ⵬ഥౕߣߒߡᴦ≮⠪ߦࠃࠅᦨ߽ㆬ
ᛯߐࠇࠆᯏળ߇ᄙߊ㧘ห᭽ߦ㜞㦂⠪ߦߣߞߡ
ኈᤃߦㆬᛯ㧘૶↪ߢ߈ࠆりㄭߥ߽ߩߢ޽ࠆ‫ޕ‬
᧟ߩᓎഀߪศ᧛ࠄߦࠃࠅ㧘‫ޟ‬቟ቯᕈߩ⏕
଻㧘ࡃ࡜ࡦࠬߩ⵬ഥ‫ޠ‬㧘
‫ޟ‬ᡰᜬᕈߩ⏕଻㧘⩄㊀࡮
−∩ߩシᷫ‫ޠ‬㧘‫ޟ‬ᱠⴕല₸ߩᡷༀ‫ߣޠ‬ㅀߴࠄࠇ
ߡ޿ࠆ‫ޕ‬
᧟ߩᱠⴕᤨਅ⢇߳ߩᓇ㗀ߪ᣿ࠄ߆ߦߐࠇߡ
޿ߥ޿‫ޕ‬ᱠⴕ⵬ഥౕߩㆬᛯߦߟ޿ߡߩႎ๔ߪ
ዋߥߊ㧘ᜰᮡߪਇ᣿⏕ߢ޽ࠆ‫ޕ‬
੹࿁㧘ੱᎿ⢆㑐▵⟎឵ⴚᓟ ࠞ᦬ߢߩㅌ㒮
ᤨߩ⒖േᚻᲑ߇ ᧄ᧟ᱠⴕߛߞߚ∝଀ߦኻߒ
ᰴరേ૞⸃ᨆⵝ⟎ࠍ↪޿ߡᱠⴕ⸃ᨆࠍⴕߞ
ߚߩߢႎ๔ߔࠆ‫ޕ‬
‫ޣ‬ኻ⽎‫ޤ‬
∝଀㧦 ᱦᅚᕈ㧘り㐳 FP㧘૕㊀ NJ㧘
%0,㧔ᮡḰ㧕㧘⸻ᢿߪవᄤᕈ⢆㑐▵⣕⥓㧘
ᐕ ᦬ᣣᒰ㒮ᢛᒻᄖ⑼ߦ౉㒮㧘ห ᦬
ᣣߦฝੱᎿ⢆㑐▵⟎឵ⴚࠍฃߌߚ‫ޕ‬ㆊ෰ ᐕ㑆ߩォୟᱧߪߥߒ‫ޕ‬േ૞⸃ᨆߪⴚᓟ ࡩ᦬
ߦ⸘᷹ߒߚ‫ޕ‬
‫ޣ‬ᣇᴺ‫ޤ‬
⸘᷹േ૞ߪ 㧦 ᧄ᧟ᱠⴕ㧘㧦ฝ ᧄ᧟ᱠ
ⴕ㧘㧦⁛ᱠߩ ᧦ઙߣߒߚ‫ޕ‬
⺖㗴േ૞ߪㅢᏱᱠⴕߢ㧘P ߩᱠⴕ〝ߢ ࿁
⸘᷹ߒߘߩᐔဋ୯ࠍ▚಴ߒߚ‫ޕ‬
ㆇേቇ⊛࠺࡯࠲ߪ ᰴరᐳᮡ⸘᷹ᯏེ
9,&21 ́ 0; V\VWHP 9,&21 027,21
6<67(06/7'́8.㧘⿒ᄖ✢ࠞࡔ࡜ บ 7
́ 㧘 ࠨ ࡦ ࡊ ࡝ ࡦ ࠣ ࡟ ࡯ ࠻ +] 㧘 ⋥ ᓘ
PP ߩ⿒ᄖ✢෻኿ࡑ࡯ࠞ࡯ࠍ૶↪ߒ 3OXJ
LQ JDLW PRGHO ߩቯ߼ࠆࡑ࡯ࠞ࡯૏⟎ߦ⾍ઃ
ߒߚ‫⸃ޕ‬ᨆߪ 9,&21 1(;686 ࠍ૶↪ߒ㧘
ᱠⴕᆫ൓㧔⍫⁁㕙࡮೨㗵㕙ߩ૕ᐙ㑐▵ⷺᐲ㧕㧘
ᱠⴕ቟ቯᕈ㧔㋦⋥࡮Ꮐฝᣇะߩ㊀ᔃ૏⟎㧕ࠍ
▚಴ߒߚ‫ޕ‬
‫⚿ޣ‬ᨐ‫ޤ‬
ᱠⴕࡄ࡜ࡔ࡯࠲࡯㧦ᱠⴕㅦᐲPVHFߪ㧘⁛
ᱠ 㧘 ᧄ᧟ 㧘 ᧄ᧟ 㧘ᱠⴕ₸
VWHSVPLQߪ⁛ᱠ r 㧘 ᧄ᧟ “
㧘 ᧄ᧟ “㧘ᱠ᏷Pߪ⁛ᱠฝ “ Ꮐ “ 㧘 ᧄ᧟ฝ “
Ꮐ “ 㧘 ᧄ᧟ฝ “ Ꮐ “ ߢ޽ߞߚ‫߽ᦨ߇᧟ᧄ ޕ‬ᱠⴕㅦᐲ߇ㅦ
ߊᱠ᏷߇ᄢ߈߆ߞߚ‫ޕ‬
㊀ᔃ㧦㊀ᔃߩᏀฝേំ᏷PPߪ㧘⁛ᱠ r㧘 ᧄ᧟ r㧘 ᧄ᧟ r㧘
਄ਅേំ᏷PPߪ㧘⁛ᱠ r㧘 ᧄ᧟
r㧘 ᧄ᧟ r ߢ޽ߞߚ‫ᧄ ޕ‬
᧟߇ᦨ߽Ꮐฝ㧘਄ਅߩ㊀ᔃേំ߇ዋߥߊ቟ቯ
ߒߚᱠⴕߢ޽ߞߚ‫ޕ‬
ㆇേቇ⊛࠺࡯࠲㧦቟㕒┙૏ᤨߣᱠⴕᤨߩ⢷
ㇳ஥ዮߩⷺᐲᄌൻࠍ࿑ ߦ␜ߔ‫ޕ‬
standing
degre
es
L
free gait
L
R
R
Rt crutch gait
2 crutch gait
L
L
R
R
15
10
5
0
-5
-10
-15
図1
㧙㧙
- 159 -
0
20 40 60 80 100 0
% gait cycle
胸郭側屈角度
20 40 60 80 100 0
% gait cycle
20 40 60 80 100
% gait cycle
ᧄ᧟ߢߪ૕ᐙ਄ㇱߩ஥ᣇേំ߇ᷫዋ㧘
ᧄ᧟ߢߪ᧟ᣇะ߳ߩേំ߇ᷫዋߒߚ‫ޕ‬
቟㕒┙૏ᤨ෸߮ᱠⴕᤨߩᐥ㕙ߦኻߔࠆ⢷ㇳ
ዮᦛિዷߩⷺᐲᄌൻࠍ࿑ ߦ␜ߔ‫ޕ‬
degre
es
free gait
standing
L
L
R
Rt crutch gait
R
L
2 crutch gait
R
L
R
15
10
5
0
-5
0
20 40 60 80 100 0
20 40 60 80 100 0
% gait cycle
20 40 60 80 100
% gait cycle
% gait cycle
࿑ ᐥ㕙ߦኻߔࠆ⢷ㇳዮᦛિዷⷺᐲ
ᧄ᧟߇ᦨ߽૕ᐙࠍዮᦛߒߚᱠⴕߢ޽ߞߚ‫ޕ‬
ᱠⴕᤨߩ⣶ㇱ⣄ᬁዮᦛિዷࠍ࿑ 㧘㛽⋚೨
ᓟ௑ⷺᐲᄌൻࠍ࿑ ߦ␜ߔ‫ޕ‬
L
2 crutch gait
Rt crutch gait
free gait
degrees
degrees
R
L
R
-25
-25
-30
-30
-30
-35
-35
-35
-40
-40
0
20
40
60
80
20
% gait cycle
図3
40
60
80
% gait cycle
0
100
L
Rt crutch gait
L
R
40
60 80
% gait cycle
100
2 crutch gait
R
L
degrees
degrees
degrees
40
38
36
34
32
30
40
38
36
34
32
30
40
38
36
34
32
30
20
20
腰部脊椎屈曲伸展角度
free gait
0
R
-40
0
100
L
degrees
-25
40
60
% gait cycle
80
100
0
20
40
60
% gait cycle
80
100
0
20
40
R
60
80
100
% gait cycle
࿑ 㛽⋚೨ᓟ௑ⷺᐲ
ᧄ᧟ࠍ૶↪ߔࠆߣ⣄ᬁዮᦛ㧘㛽⋚ߪ೨௑
ⷺᐲ߇Ⴧᄢߒߡ޿ߚ‫ޕ‬
‫ޣ‬⠨ኤ‫ޤ‬
ੱᎿ⢆㑐▵⟎឵ⴚᓟߩ∝଀ߦኻߒ㧘᧟ߩᓎ
ഀࠍ㊀ᔃേំ㧘૕ᐙⷺᐲᄌൻߦᵈ⋡ߒ ᰴర
േ૞⸃ᨆࠍⴕߞߚ‫ޕ‬
ᧄ⎇ⓥ⚿ᨐߪ᧟૶↪ߦࠃࠆᱠⴕㅦᐲߪะ਄
ߔࠆㆊ෰ߩႎ๔ߣߪ⇣ߥߞߚ⚿ᨐߣߥߞߚ‫ޕ‬
᧟૶↪ߦࠃࠆᱠⴕേ૞ߦߟ޿ߡ㧘(O\ ࠄߪ
⢆㑐▵㓚ኂ଀ߢ᧟ߩ᦭ήߦࠃࠆᱠⴕㅦᐲߦᏅ
ߪߥ޿ߣႎ๔ߒߡ޿ࠆ‫ޕ‬
ᧄ᧟૶↪ߦࠃࠅ㧘㊀ᔃേំ߇ᷫዋߒ૕ᐙ
ߩᏀฝ௑ᢳⷺᐲᄌൻ߇ᷫዋߒߚ‫ޕ‬૒‫ࠄᧁޘ‬
ߪੱᎿ⢆㑐▵⟎឵ⴚᓟߩ᧟ߪ㧘ᄖォ╭ജ߇ᒙ
޿ߣ߈⢆㑐▵ߩ቟ቯᕈߣ】ⴕシᷫߦᓎ┙ߟߣ
ㅀߴߡ޿ࠆߎߣ߆ࠄ㧘ᧄ∝଀ߦኻߒߡߩ ᧄ
᧟૶↪ߪᱠⴕ቟ቯᕈࠍะ਄ߐߖߚߣ޿߃ࠆ‫ޕ‬
ᱠⴕᆫ൓ߪ ᧄ᧟ࠍ૶↪ߔࠆߎߣߢ૕ᐙ೨
ዮ㧘⣄ᬁዮᦛ㧘㛽⋚೨௑ߩᆫ൓ߢߩᱠⴕߣߥ
ߞߚ‫ޕ‬1DFKHPVRQࠄߦࠃࠆߣ૕ᐙዮᦛ૏
ߢߪ⣶ㇱ߳ߩ⽶⩄߇Ⴧᄢߔࠆߣㅀߴࠄࠇߡ޿
ࠆߚ߼㧘ᆫ൓ᄌൻߦࠃࠆ ᰴ㓚ኂߦᵈᗧࠍଦ
ߔᔅⷐ߇޽ࠆߣ⠨߃ࠆ‫ޕ‬
੹࿁ߪㆇേቇ⊛⠨ኤࠍⴕߞߚ߇㧘੹ᓟ⢆㑐
▵㧘⣶ㇱ߳ߩ⽶⩄ࠍ⠨ኤߔࠆߚ߼ㆇേജቇ⊛
ߥ⠨ኤ߇ᔅⷐߛߣ⠨߃ߡ޿ࠆ‫ޕ‬
‫ޤ⺰⚿ޣ‬
ᧄ᧟૶↪ߢߩᱠⴕᆫ൓ߪ૕ᐙ㧔⢷ㇳ㧘⣶
ㇱ⣄ᬁ㧘㛽⋚㧕ࠍ೨௑ߐߖ㧘⣶ㇱߦ⽶⩄߇Ⴧ
ᄢߔࠆ⁁ᘒߢ޽ߞߚ‫ޕ‬
ᧄ᧟૶↪ߢߩ቟ቯᕈߪᏀฝ਄ਅᣇะߩ㊀
ᔃേំ߇ᷫዋߒ቟ቯߒߚᱠⴕߛߞߚ‫ޕ‬
‫ޣ‬ᢥ₂‫ޤ‬
ศ᧛⨃๺㧘⋧㚍ᱜਯ㧦⑔␩ᯏེߩㆡᔕၮḰ
ᱠⴕ⵬ഥౕߩㆡᔕၮḰ㧚37 ࠫࡖ࡯࠽࡞
㧧㧦Ɇ
(O\''6PLGW*/(IIHFWRIFDQHRQYD
ULDEOH RI JDLW IRU SDWLHQWV ZLWK KLS GLV
RUGHUV3K\V7KHU㧙
૒‫ᧁޘ‬િ৻ ᎑↰⺈৻㇢ ㊁ἑᕶઍ ๺↰
⌀ ᄢ᫪ᒄೣ 㚍႐ਭᢅ㧦ੱᎿ⢆㑐▵⟎឵
ⴚᓟߩᱠⴕߦ߅ߌࠆ᧟ߩലᨐ ㆇേ࡮‛ℂ
≮ᴺ Ɇ $OI / 1DFKHPVRQ -RKQ + (YDQV 6RPH PHFKDQLFDO SURSHUWLHV RI WKH
WKLHG KXPDQ OXPEDU LQWHUODPLQDU OL
JDPHQW -RXUQDO RI %LRPHFKDQLFV
Ɇ
㧙㧙
- 160 -