↓↓English Below↓↓
橘が続いての投稿を担当いたします！！
改めまして皆さんこんにちは^ ^
実は永田町駅からも徒歩圏内の千代田区内の整形外科クリニック One Clinic 麹町（ワンクリニック麹町）の理学療法士橘です。
西村と同じく、学会発表の機会を頂きましたので報告いたします！！
格闘家が多い印象の？当院ですが笑、実は野球やバスケットボール、ロードバイクの選手も来ています。
今回はロードバイク選手の骨折術後のリハビリにフォーカスを当てた発表を行いました。
以下、抄録をご参照ください^ ^
【はじめに】関節近傍の開放骨折は、低い骨癒合率のみならず関節拘縮が理学療法において課題となる。今回、開放骨折後の肘関節拘縮例に対し可動域改善を目的とした交代浴と拡散型衝撃波（RPW）を併用した理学療法を行った。
【対象と方法】30代女性ロードレース中に転倒し肘頭開放骨折を受傷。受傷当日に洗浄デブリドマンを行い、4週間の外固定後に骨折観血的内固定術を実施された。術後1週から当院で理学療法を開始した。初診時の肘関節可動域は屈曲45度、伸展・20度、回内外45度/45度であった。3ヶ月後のレース復帰を目標とし、早期の可動域改善目的に理学療法に加えて交代浴とRPWを併用した。週に3回交代浴（42度3分、15度1分）後に理学療法を実施し、理学療法中に
RPW（上腕筋、上腕二頭筋、上腕三頭筋、円回内筋へ各4千発）を行い、可動域の変化率を算出した。【結果】理学療法開始1か月後の肘関節可動域は、屈曲85度（変化率89％）、伸展10度（同50％）、回内・回外90度（同100％）と改善していた。可動域自体は健側には未達であったが、レース復帰可能なレベルであった。
【考察】拡散型衝撃波に関しては筋膜リリース・疼痛抑制・組織修復・抗炎症・創部癒着改善等の報告があり、理学療法単独では苦慮する深層組織の治療に有効な可能性がある。本症例では拡散型衝撃波と理学療法に加え、温熱効果による血行促進と冷水浴による炎症抑制双方の効果が期待できる交代浴も併用した事で疼痛軽減と軟部組織の機能向上を促し、関節可動域の改善に繋がったと考えられる。肘関節の拘縮に対し理学療法とRPWを併用した過去の報告と比しても本症例の屈曲・回内外の変化率は高かった。
【結語】受傷から理学療法開始までの期間や理学療法の頻度が異なるため今後さらなるデータ収集が必要ではあるが、外傷性拘縮を来した関節に対して交代浴と拡散型衝撃波を併用した理学療法が有効である可能性が示された。
実は院長とサウナに行っている際に「サウナの後って膝腰の痛みが少ないよね」という話になり、今回の交代浴を思いつきました笑笑
まだまだ研究・発展の余地がある分野ですが、その分掘り下げ甲斐のある分野でもあると思います。
当院に通ってくださる全ての患者さんに高い質の医学を提供できるよう精進してまいります。どうぞよろしくお願い申し上げます。
追記：実は今回人生初の学会発表でした。緊張で膝も腰も痛いので、まずはサウナで癒してきたいと思います笑笑
Tachibana will be in charge of the following post!
Once again, hello everyone ^ ^
I am Tachibana, a physical therapist at One Clinic Kojimachi, an orthopedic clinic in Chiyoda Ward, which is actually within walking distance from Nagatacho Station.
Like Nishimura, I was given the opportunity to present at an academic conference, so I am happy to report!
Do you have an impression that there are many martial artists in our clinic? But in fact, baseball, basketball, and road racers also come to our clinic.
This time, I made a presentation focusing on the rehabilitation of a road racer after fracture surgery.
Please refer to the abstract below ^ ^
Introduction: Open fractures near joints pose a challenge in physical therapy not only because of the low bone fusion rate, but also because of joint contracture. In this study, we performed physiotherapy using a combination of alternating baths and diffusion shock wave (RPW) to improve the range of motion of a patient with elbow contracture after an open fracture.
Subjects and Methods] A woman in her 30s fell during a road race and sustained an open fracture of the olecranon. She underwent a washout debridement on the day of injury, and after 4 weeks of external fixation, she underwent an internal contemplative fixation of the fracture. Physical therapy was started at our clinic 1 week postoperatively. The elbow joint range of motion at the initial visit was 45 degrees of flexion, 20 degrees of extension, and 45/45 degrees of internal/external rotation, with the goal of returning to racing after 3 months. Physiotherapy was performed three times a week after alternating baths (3 minutes at 42 degrees and 1 minute at 15 degrees), and during physiotherapy
RPW (4,000 rounds each to the brachialis muscle, biceps brachii, triceps brachii, and internal rotator cuff muscles) was performed during physical therapy, and the rate of change in range of motion was calculated. Results: One month after the start of physical therapy, the elbow joint range of motion had improved to 85 degrees of flexion (89% change), 10 degrees of extension (50% change), and 90 degrees of internal and external rotation (100% change). Although the range of motion itself had not reached that of the healthy side, it was at a level that would allow the patient to return to racing.
Diffusion shock wave therapy has been reported to release myofascia, suppress pain, repair tissues, anti-inflammation, and improve wound adhesion, and may be effective in the treatment of deep tissues that are difficult to treat with physical therapy alone. In this case, in addition to diffusion shock wave and physical therapy, a combination of alternating baths, which can be expected to both promote blood circulation by the warming effect and suppress inflammation by the cold water bath, was used to reduce pain and improve soft tissue function, which is thought to have led to an improvement in joint range of motion. The rate of change in flexion and rotation was higher in this case than in previous reports of combined physical therapy and RPW for elbow contracture.
Conclusion: Although further data collection is needed because the time from injury to the start of physical therapy and the frequency of physical therapy are different, this study showed that physical therapy using a combination of alternating baths and diffusion shock waves may be effective for joints that have suffered traumatic contractures.
Actually, when the director and I were going to a sauna, we talked about how there is less pain in the knees and back after a sauna, and we came up with the idea of this alternating bath lol.
There is still much room for research and development in this field, but I think it is a field that is worth delving into.
We will do our best to provide high quality medicine to all patients who come to our clinic. Thank you very much for your kind attention.
PS: This was actually my first conference presentation in my life. My knees and back ache from nerves, so I’m going to take a sauna first to heal them:)
