ç§ãç±³åœå ¬èªã¢ã¹ã¬ãã£ãã¯ãã¬ãŒããŒïŒBOC-ATCïŒã®è³æ ŒãååŸããã®ã¯2013幎ãªã®ã§ãã4幎ã»ã©çµã¡ãŸãããåŸååé垯æè£ã¯ïŒåããã¿ãããšããããŸããããªã®ã§ãåŸååéåž¯ã®æè£ãšããæªæã¯ã¹ããŒãçŸå Žã§ã¯ããŸãèµ·ããªãæªæã ãšæã£ãŠããŸããã
ã§ãããã©ãããåŸååéåž¯ã®æè£ã¯æ» å€ã«èµ·ããªãããã§ã¯ãªããèµ·ããŠããããã©æè£ããŠããããšã«æ°ã¥ããŠããªã人ãçµæ§ããããšããããšãããã®ã§ãããããªããšã£ãŠããã®ïŒã£ãŠæãã§ãããæ¬åœã«ãããªã®ã§ãã
ä»åã¯ãåŸååé垯ã¯ã©ã®ããã«æè£ããŠããŸãã®ããšããã¡ã«ããºã ãšãåŸååé垯ãåããŠããŸã£ãŠããã®ãïŒåããŠããªããŠç¡äºãªã®ãïŒã倿ããéã«ãã¢ã¹ã¬ãã£ãã¯ãã¬ãŒããŒãçŸå Žã§äœ¿ãã¹ãã¹ãã·ã£ã«ãã¹ãã玹ä»ããŠãããŸãã
ïŒïŒåèæç®ã¯ãã¡ãã§ãã
ãPhysical Examination Tests for the Diagnosis of Posterior Cruciate Ligament Rupture: A Systematic Reviewã
åŸååé垯æè£ãèŠæ¥µããããã®ã¹ãã·ã£ã«ãã¹ããç ç©¶ããè«æãéããã·ã¹ãããã£ãã¯ã¬ãã¥ãŒã§ãã
èã®ã¹ãã·ã£ã«ãã¹ãã«ã€ããŠã®èšäºã¯ä»ã«ãèã®ã¹ãã·ã£ã«ãã¹ãïœåååé垯ïŒACLïŒç·šããã¬ãŒããŒåããããèã®ã¹ãã·ã£ã«ãã¹ãïœå åŽåŽå¯é±åž¯ïŒMCLïŒç·šããã¬ãŒããŒåãããããããŸãããã²ãã¡ãããèªã¿ãã ããã
åŸååé垯æè£ã¯ã©ã®ããã«èµ·ããïŒæªæã®ã¡ã«ããºã
åŸååéåž¯ã®æªæã®ã¡ã«ããºã ã®è©±ãªã®ã«ããªãç»åãè»ãé転ããŠããã®ãªãã ïŒãšæã£ãæ¹ããããããããŸãããç¬
ã§ããé¢ä¿ãªãããã§ã¯ãã¡ãããªããåŸååéåž¯ã®æè£ãäžçªèµ·ãããããã®ã¯ã亀éäºæ ïŒè¿œçªäºæ ïŒã§è»ãäœãã«ã¶ã€ãã£ãæã«ãè»ã®ããã·ã¥ããŒãã«æãåãèãã¶ã€ããæããªã®ã§ãã
ãã®æã«èã«äœãèµ·ãã£ãŠããããšãããšãèã®ãç¿ã®äžã«ããå°ãåºã£åŒµã£ã骚ïŒïŒã¹ãã®éªšãè骚ããããã€ããã¶ã€ãããšãããçã骚ïŒããåæ¹ããäœãã«æãåãåœããããšã§ãã®éªšãåŸæ¹ã«æŒããããšãåŸååé垯ãåããŠããŸãã®ã§ãããšããã®ããåŸååé垯ã®åœ¹å²ã¯ããã®è骚ãåŸãåŽã«ãããªãããã«ãã圹å²ã®é垯ã ããã§ãã
ã¹ããŒãçŸå Žã§èµ·ããåŸååé垯æè£
ããã§ã¯ãã¹ããŒããããŠããæã«åŸååé垯ãæå·ã»æè£ããŠããŸãã·ãã¥ãšãŒã·ã§ã³ãšããã®ã¯ã©ããããã®ãèããããã®ã§ããããã
äžçªèµ·ããããšãå€ãã¡ã«ããºã ã¯ããèãæ²ããç¶æ ïŒïŒçŽ90°ïŒã§åæ¹ã«è»¢ãã§ãèïŒæ£ç¢ºã«ã¯è骚ïŒãå°é¢ã«åŒ·ãæã£ãŠããŸã£ããšããã§ããæ¿ããã¹ããŒãã»åãã®äžã§ã¯ããèãæ²ããç¶æ ã§å°é¢ã«ã€ãããšããã·ãã¥ãšãŒã·ã§ã³ã¯ããããåºãŠããŸããã¡ã«ããºã çã«èããã°ããã€èµ·ããŠããããããªãæªæãšèšããã§ãããã
ã§ããæåã«ãèšã£ãããã«ãåŸååéåž¯ã®æè£ã«ã¯æ°ã¥ããŠããªã人ããšãŠãå€ãããã§ããé垯ãæè£ããŠæ°ã¥ããªããªããŠããšã¯ããã®ãïŒã£ãŠæãã§ãããåŸååé垯ã«é¢ããŠèšããšãæè£ãããŠããçç¶ãããŸããªããã®ã§ãã
åå玹ä»ãããåååé垯æè£ãã§ããã°ããã®ãããçã¿ãšãšãã«ãé垯ãåããç¬éã«ããã£ãšé³ãèãããããèãããã«è «ããŠããããšãïŒããŒãæªæãããªãŒãªãããåãããªãŒïŒãšããæãããããããããåå¿ãèŠããŸããã§ããåŸååéåž¯ã®æè£ã¯ãå€ãã®å Žåçã¿ããªããã°ãè «ããããŸãèµ·ãããããããåããããšç®ç«ã£ãå€åãç¡ãã®ã§ãããããšããŠãïŒãªããšãªãéåæããããªãããïŒãããã®ãããªã®ã§ãæ®æ®µããæ¿ããéåã»ã¹ããŒããããŠããéžæããããŠã¿ãã°ãã¡ãã£ãšããéåæãããã ãšå¥ã«ç¹å¥ãªããšã§ã¯ãªãããšãå€ããã€ãèŠéãããŠããŸãã®ã§ãã
ã§ããããã¯ãèé¢ç¯ã®éèŠãªé垯ãïŒã€åããŠããŸããšãæ°ã¥ãã«ãããšã¯ãããåŸã ã«çã¿ãå¢ããŠããããè «ããŠãããããªããšãªãããŸãåããªãïŒïŒèããã£ããå®å®ããªããããªæèŠã«ãªãïŒãšãã£ãçç¶ãåºãŠããããã§ãã
æŸã£ãŠãããšãæ ¢æ§çãªçã¿ã«ãªã£ãŠããŸã£ãããä»ã®èã®æªæã䜵çºããŠããŸãããšãã£ãããšãå åã«èããããŸããç¹ã«ãäžã§ç޹ä»ãããèãæ²ãã£ãç¶æ ã§å°é¢ã«æãåãã€ããããããããªããèã«éåæãããããã¿ãããªå Žåã¯ãå¿ ãåŸååéåž¯ã®æªæãçããŸãããããã¬ãŒããŒã¯ããéžæã®éåæããèŠéãããã«å€æããŠã»ãããªãšæããŸãã
èã®åŸååé垯ã®ã¹ãã·ã£ã«ãã¹ãïŒéž
ä»åã®åèæç®ã§ã¯ãïŒïŒçš®é¡ã®åŸååé垯ã«é¢ããã¹ãã·ã£ã«ãã¹ãã®æ£ç¢ºæ§ã調æ»ãããŸããããŸãã¯ãã®ïŒïŒçš®é¡å šéšã®ååã ã玹ä»ããŸãã
- Posterior Drawer TestïŒåŸæ¹åŒãåºããã¹ãïŒ
- Quadriceps Active TestïŒå€§è ¿åé çã¢ã¯ãã£ããã¹ãïŒ
- Recurvatum TestïŒå匵ãã¹ãïŒ
- Posterior Sag SignïŒåŸæ¹èœã¡èŸŒã¿ãµã€ã³ïŒ
- Varus/Valgus Test at 0°ïŒå åã»å€åãã¹ãïŒ 0°ïŒ
- Varus/Valgus Test at 30° of flexionïŒå åã»å€åãã¹ãïŒ 30°è屿²äœïŒ
- Reverse Lachman TestïŒãªããŒã¹ã»ã©ãã¯ãã³ãã¹ãïŒ
- Dynamic Posterior ShiftïŒãã€ãããã¯åŸæ¹ã·ããïŒ
- Reverse Pivot ShiftïŒãªããŒã¹ã»ããããã·ããïŒ
- Reverse Lachman end pointïŒãªããŒã¹ã»ã©ãã¯ãã³ã»ãšã³ããã€ã³ãïŒ
ïŒïŒçš®é¡ã®ã¹ãã·ã£ã«ãã¹ãã®ååãæããŸããããä»åã®ã·ã¹ãããã£ãã¯ã¬ãã¥ãŒã§ã¯ããã®äžã§å®éã«çŸå Žã§äœ¿ãã¹ãã§ããä¿¡é Œã§ãããã¹ããšç޹ä»ããŠããã®ã¯ïŒã€ã§ãããã©ããïŒã€ã ãããã£ãŠå€æããã®ã¯ãšãŠãå±éºã§ãã以äžã§ç޹ä»ããïŒã€ãå šãŠãã£ãŠã¿ãããšã§ãç·åçã«å€æããŸãããã
ãä»ã®ïŒã€ã®ãã¹ãã¯ïŒããäžã§ç޹ä»ãããã®ä»¥å€ã®ïŒã€ã®ã¹ãã·ã£ã«ãã¹ãã¯ããã®æ£ç¢ºæ§ã調ã¹ãç ç©¶ãã©ããä¿¡é Œã§ãããã®ã§ã¯ãªãããšçµè«ã¥ããŠããŸãããŸãããããã®ã¹ãã·ã£ã«ãã¹ãã¯ããæ¹ãè€éã§é£ããããã䜿çšã¯ããŸããªã¹ã¹ã¡ããŸããã
ïŒïŒPosterior Sag SignïŒåŸæ¹ãµã°ãµã€ã³ïŒ
äžçªSensitivityïŒïŒæåºŠïŒãé«ããã¹ããããã®Posterior Sag Signãšãããã¹ãã§ããã
ãSensitivityïŒæåºŠïŒããšã次ã«åºãŠãããSpecificityïŒïŒç¹ç°åºŠïŒãã«ã€ããŠã¯ãéå»ã®èšäºãèã®ã¹ãã·ã£ã«ãã¹ãã»åååé垯ïŒACLïŒç·šããã¬ãŒããŒåãããã§è©³ãã解説ããŠããã®ã§ãã¡ããèªãã§ã¿ãŠãã ããã
æåºŠãé«ããã¹ããšããããšã¯ã€ãŸãããã®Posterior Sag Signãé°æ§ã ã£ãïŒïŒãµã°ãµã€ã³ããªãïŒå ŽåãåŸååéåž¯ã®æè£ãèµ·ããŠããå¯èœæ§ã¯äœãããšããããšã«ãªããŸãã
â»å®éã®ãã¹ãã¯ã1:04ããããããå§ãŸããŸã
ããæ¹ã¯ä»¥äžã®éãã
- æ£è ã¯ä»°åãã«ãªã£ãŠãæªæãããæ¹ã®èãæ²ããïŒè¡é¢ç¯45Â°å±æ²ã»èé¢ç¯90Â°å±æ²äœïŒ
- æ£è ã¯å®å šã«ïŒã§ããã ãïŒèããªã©ãã¯ã¹ããã
- ãã¬ãŒããŒã¯æšªããæ£è ã®èåŽã®è骚ã®äœçœ®ã確èªãèåŽã®è骚ãäžãã£ãŠãããïŒïŒèäžã«æãããªå¹ã¿ããã£ããïŒéœæ§ãåŸååé垯ãæè£ããŠããå¯èœæ§ããããŸãã
ãè¶³ã¯æã¡äžããã«è¡é¢ç¯45Â°å±æ²äœãå人çã«ã¯ãªã¹ã¹ã¡ãããã®åç»ãæåŸãŸã§ã¿ãŠããããšããããŸãããæ£ç¢ºã«ã¯ãã®Posterior Sag Signã®ããæ¹ã¯ïŒçš®é¡ãããŸããäžã€ç®ã¯ãäžèšããè¡é¢ç¯45åºŠå±æ²äœã§è¶³ãå°é¢ã«ã€ããŠè¡ãæ¹æ³ãäºã€ç®ããè¡é¢ç¯90åºŠå±æ²äœã§è¶³ãæã¡äžããŠè¡ãæ¹æ³ãã©ã¡ãã§ãè¯ãã®ã§ãããå人çã«ã¯äžã€ç®ããªã¹ã¹ã¡ããŸããçç±ã¯ãè¶³ãæã¡äžãããããšã©ãããŠãå€§è ¿åé çã«å°ãªãããåãå ¥ã£ãŠããŸãããã§ãïŒïŒå®å šã«ãªã©ãã¯ã¹ãã¥ããïŒãå€§è ¿åé çã«åãå ¥ã£ãŠããŸããšããã®çèã«ãã£ãŠè骚ãåæ¹ã«æã¡äžãããããããããšãåŸååé垯ãæè£ããŠããŠãSag SignãçŸããªãå¯èœæ§ããããŸãã
ïŒïŒQuadriceps Active TestïŒå€§è ¿åé çã¢ã¯ãã£ããã¹ãïŒ
Quadriceps Active Testã¯ãäžçªSpecificityïŒïŒç¹ç°åºŠïŒãé«ããã¹ãã§ãããäžçªç¹ç°åºŠãé«ãã£ããšããããšã¯ã€ãŸããQuadriceps Active Testãéœæ§ã ã£ãïŒïŒããžãã£ãã ã£ãïŒå ŽåãåŸååéåž¯ã®æè£ãããŠããå¯èœæ§ãé«ãããšèããããŸãã
â»ããã¯éœæ§ã®åç»ïŒåŸååé垯æè£ãçãããŸã
ããæ¹ã¯ä»¥äžã®éãã
- æ£è ã¯ä»°åãã«ãªã£ãŠãæªæãããæ¹ã®èãæ²ããïŒè¡é¢ç¯45Â°å±æ²ã»èé¢ç¯90Â°å±æ²äœïŒâãã®ããžã·ã§ã³ã¯ãäžã§ç޹ä»ããåŸæ¹ãµã°ãµã€ã³ãšäžç·ã§ãã
- èãæ²ããŠããæ¹ã®è¶³ã®äžã«åº§ããªã©ããŠïŒåç»ã§ã¯æã§ããããŠããŸãïŒãè¶³ãåããªãããã«ãã£ããæŒããã
- æ£è ã«ãèã䌞ã°ãããšããŠã¿ãŠïŒããªã©ãšèšã£ãŠãå€§è ¿åé çã«åãå ¥ããŠããã
- åç»ã®ããã«ãèåŽã®è骚ãåæ¹ã«åãã®ãããã£ããéœæ§ãåŸååé垯æè£ãçãããŸã
ïŒïŒPosterior Drawer TestïŒåŸæ¹åŒãåºããã¹ãïŒ
åŸååé垯ã®ã¹ãã·ã£ã«ãã¹ãã«é¢ããç ç©¶ã®äžã§ãäžçªå€ãç ç©¶ãããŠãããã¹ãããã®Posterior Drawer Testã§ããã§ããããã¹ãã®ä¿¡é ŒåºŠã«é¢ããŠèšããšãããããã®ç ç©¶çµæãããªããã©ãã©ã§ãä¿¡é Œã§ãããã¹ããªã®ãã©ããã¯ã€ãã€ãããããçµè«ã¯åºããªãããšä»åã®åèæç®ã«ã¯æèšãããŠããŸããã
äžèšããŸããããä»åã®åèæç®ã§ã¯çµè«ãšããŠããïŒã€ã®ã¹ãã·ã£ã«ãã¹ãã«é Œãããšãªããè€æ°ã®ã¹ãã·ã£ã«ãã¹ãã䜿ã£ãŠç·åçã«å€æããããšã倧åã§ããããšããŠããŸããããã¯ä»åã®åŸååé垯ã®ã¹ãã·ã£ã«ãã¹ãã«éãããã©ã®éšäœãã©ã®æªæã«å¯Ÿããã¹ãã·ã£ã«ãã¹ãã§ãåãããšãèšããŸãã
ãã®åŸæ¹åŒãåºããã¹ãã¯ãä¿¡é ŒåºŠã«ã€ããŠã¯ãŸã 倿ãã€ããŠããªãããã§ããããåŸååéåž¯ã®æè£ããç·åçã«å€æããããã®ïŒã€ã®ããŒã¹ãšããŠãïŒïŒç°¡åã«ã§ãããã¹ãã§ããããšãïŒïŒäžèšããïŒã€ã®ã¹ãã·ã£ã«ãã¹ããšã»ãŒåãããžã·ã§ã³ã§è¡ãããšãã§ããããšãïŒïŒåŸæ¹åŒãåºããã¹ãããã£ãããšãã®ãŸãŸåæ¹åŒãåºããã¹ããããããšãã§ããïŒïŒåååé垯æè£ã®ã¹ãã·ã£ã«ãã¹ãïŒããšããïŒã€ã®çç±ãããããã¹ããã¹ããšèšãããšç§ã¯æããŸãã
ããæ¹ã¯ä»¥äžã®éãã
- æ£è ã¯ä»°åãã«ãªã£ãŠãæªæãããæ¹ã®èãæ²ããïŒè¡é¢ç¯45Â°å±æ²ã»èé¢ç¯90Â°å±æ²äœïŒâåŸæ¹ãµã°ãµã€ã³ãå€§è ¿åé çã¢ã¯ãã£ããã¹ããšåãããžã·ã§ã³
- ãã¬ãŒããŒã¯æ²ããŠããæ¹ã®è¶³ã®äžã«åº§ã£ãŠãåããªãããã«åºå®
- äž¡æã§ãµããã¯ãã®äžã®æ¹ãã€ãã¿ã芪æãèã®é¢ç¯äžïŒïŒjoint lineïŒã«ãããæã®ä»ãæ ¹ãè骚ã®äžéšã«ãã
- æã®ä»ãæ ¹ã§è骚ãåŸæ¹ã«æŒãïŒãã£ããã§ã¯ãªããåç»ã®ããã«éãåãã§ïŒ
- åŸæ¹ã«ã·ãããããéœæ§ãåŸååé垯æè£ã®çãããããŸã
ã¹ãã·ã£ã«ãã¹ãã®ã¿ã§å€æããªãïœå¿ ãå»è ã®èšºå¯ãåãã

ãã¬ãŒããŒãšããŠçŸå Žã§ããã«ã§ãããåŸååé垯æè£ãã§ãã¯ã®ããã®ã¹ãã·ã£ã«ãã¹ãããããŸã§ç޹ä»ããŠããŸãããã§ããããããã®ã¹ãã·ã£ã«ãã¹ããä¿¡é Œããããããšã¯ãããããŸããããããå šãŠã®ãã¹ãçµæããã¬ãã£ãã§ãã£ããšããŠããæ°æ¥çµã£ãŠçç¶ãè¯ããªããªããéã«å°ãè «ããŠããŠãããéåæããã£ãšæ®ã£ãŠããããªã©ãªã©ã®çç¶ãããã®ã§ããã°ãå¿ ãç é¢ïŒïŒæŽåœ¢å€ç§ïŒã«è¡ã£ãŠãã¯ã¿ãŒã®èšºå¯ãåããŸãããã
åŸååé垯æè£ã®èšºæãšããŠã¯ãMRIã®æ®åœ±ã«ãã£ãŠããªãæ£ç¢ºã«å€æããããšãã§ããããšç ç©¶ã§æããã«ãªã£ãŠããŸãã
ãŸãšã
åŸååéåž¯ã®æè£ãããŠããŸã£ããšããŠããçã¿ãããã©ãŒãã³ã¹ã®äœäžãå¿ ãèµ·ããããã§ã¯ãªãããã§ãããŸãããããçç±ã§åŸååé垯æè£ã«æ°ã¥ããèŠéãããŠããŸãã®ã§ããã
ããã«ãå®å šæè£ãšå€æãããšããŠããçã¿ãæ©èœäœäžãªã©ã®çç¶ããªããã°æè¡ãããå¿ èŠã¯ãªãããªãããªã§åŒ·åãã€ã€æªåãé²ãã§ããããšã§ãããã©ãŒãã³ã¹ã®äœäžãæããããšãªãã¹ããŒããç¶ããŠããããšãå¯èœã§ãã
ã§ãããæè£ãç¥ããã«åãç¶ããŠããã°ãæªåãããŠããŸãå¯èœæ§ããã£ããä»ã®æªæã䜵çºããŠããŸã£ããããŠãçµå±æè¡ãããªããã°ãããªãããããšããç¶æ³ã«ãªã£ãŠããŸããããããŸãããæè£ããŠããŸã£ãããšãæ©ãã«ç¥ãããšã§ãæŽãªãæªåãé²ãããã®å¯Ÿçãåãããšãã§ããŸãã
æªæã®äœµçºãé²ãããã«ããåŸååé垯ã®ã¹ãã·ã£ã«ãã¹ãã¯ãã¬ãŒããŒãšããŠçµ¶å¯Ÿã«ç¥ã£ãŠããã¹ãã§ãããã²ç·Žç¿ããŠã¿ãŠãã ããã
Comments are closed.