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変形股関節症の強い味方、外転枕を付ける時期と期間

病院

股関節が痛む病気にはいろいろなものがありますが、その代表的なものが「変形股関節症」です。関節軟骨がすり減ってしまって発症する病気で重たくなると手術で人工股関節に変えなければならなくなります。

手術後に使うのが「外転枕」とよばれる股関節の位置を固定する枕です。よくつかわれるものですが、どのように使ったらよいのか、いつまで使えばよいのかよく知られていません。

この記事では外転枕の正しい使い方や変形股関節症についてご説明いたします。

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変形股関節症の症状と原因

痛い

変形股関節症は、股関節の軟骨がすり減ることによる関節の障害を指します。軟骨がすり減るというのは事故もありますが、加齢(老化)による症状であるといってよいでしょう。一度発症したら慢性的に悪化していき徐々に関節が破壊されていきます。

この病気を自然治癒させる方法はありません。膝関節が悪くなる人が多く、患者数は二千万人とも三千万人とも言われています。40歳以上の女性の半数以上が変形股関節症にかかっているとすら言われています。股関節の変形性股関節症は300万人とも言われています。

骨粗しょう症とも関係がある変形性股関節症ですが、軟骨が減ってくることで股関節に炎症が発生し、強い痛みが感じます。さらに進行すると骨が表にでてきて動きがわるくなっていくのです。痛みや動作に関する障害はある程度人の防御反応ともみられてイますが、ある程度以上に悪化してしまうと動きが悪くなりすぎて股関節が損傷してしまうのです。

変形股関節症の症状の発生部位は股関節とは限らず、足や腕、膝などの痛み、だるさなども現れてきます。初期ではお尻や太もも、膝などにも症状がでるでしょう。早期発見早期治療によって痛みを和らげて進行を遅らせることができます。発症に関する危険因子としては、過度の肥満症、過度のスポーツによる運動、また重量物の上げ下げにをする作業十字のしごと、臼蓋形成不全といった発育上のトラブルも多数関かかわります。

骨切り手術と人工股関節置換術

大幅に悪化した場合には骨切りと人工股関節置換術が必要になります。股関節部に障害が発生すると、その発生部位を切断し人工股関節に変換する必要があります。また、人工股関節置換手術は大腿骨頸部骨折などによる人口骨頭置換術などもあります。何れも高度な手術ではありますが、非常に多くの臨床例があります。

人工股関節はクロスリンクポリエチレンと呼ばれる特殊な素材を使ったものが使われていますが、永続的に利用できるものではなく、まだまだ技術開発が必要だとされています。毎年のように新しい手術方法が開発されています。かつては難しいとされていた人工股関節の再置換術なども検討されています。

外転枕の利用

こうした人工股関節全置換術や、人工骨頭置換術などの手術を行ったあと、術後の脱臼予防のために「外転枕」を使用します。こうした手術はだいたいおしり側、つまり後方からのアプローチで行われた場合に、股関節が屈曲や内転・内旋位になった時に脱臼が起こりやすいことがしられています。

外転枕を使うことで、屈曲と内転を防ぐことができます。外転枕だけではすべての脱臼を防ぐことはできませんが、注意が必要です。

外転枕の使用期間と留意点

外転枕は手術後に必要なものですが、いつまで使えばよいのかということで悩ましく思われる方はいるでしょう。使用期間については、手術後の人工骨頭や人工股関節等の股関節への級外への吸着感で判断します。とはいえ、術後の軟部組織の修復には三週間必要とされており、この間は特に注意が必要です。

家に帰っても使うべきかどうか

外転枕は手術後、帰宅しても使うべきかどうかで悩まれている方も多くいるそうです。

結論から言えば、「三週間以上は使う」ことがよいでしょう。軟骨の摩耗と切断によって骨はとても厳しい状態になっています。外転枕だけでは内旋位を防ぐことができませんが、しっかりと体が回復するまではじっくり治療するのがよいでしょう。

変形性股関節症診療ガイドライン
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まとめ:外転枕は人工股関節がしっかり吸着するまでしっかり使おう

人工股関節置換術後、外転枕を使って足を固定させることが必要になっていますが、外転枕はなるべく長めに使うほうが良いようです。外転枕を使うさいには、マジックテープを締めすぎないように使うことや、足関節はしっかり動かしてもらうこと、褥瘡に気をつけることなどが必要とされます。

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