脳卒中片麻痺に対する円型下腿カフ(膝窩部補正)付き短下肢装具の考察
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概要
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Brace therapy is indispensable for cerebral apoplexy. For insufficient correction with a short leg brace (SLB), a dynamic long leg brace (LLB) has been developed, and now advances have been made in research concerning a polypropylene (PP) lower limb brace. In consideration of the activities of daily living (ADL), however, an SLB is more beneficial than an LLB, but the use of an SLB for a Crenzack-type Ankle joint cannot prevent the occurrence of secondary impairments. Secondary impairment caused by the use of an SLB includes genu recurvatum, flail joint, rapid knee elongation, locking knee, a drawn sign, and aggravated spasticity in extension patterns. It was found that a drawn sign occurred in proportion to the degree of genu recurvatum and was complicated by flail joint when it was severe. With a view to contributing to the solution of these problems, correction of the popliteal space with a polypropylene round-shaped lower-femur cuff was experimented with 50 patients. In comparison with the conventional lower femur cuff (the upper end of the cuff is positioned about 3 cm below the lower end of the head of the fibula), the round-shaped lower-femur cuff is elongated maximally at the middle of the popliteal space on a horizontal lire from the lower end of the head of the fibula and descends in a circle from the middle of the popliteal space on the fibular side from the lower end of the head of the fibula toward cm below, adding 2 oppression, while on the tibial side, the descending angle was made stronger in order to prevent oppression. When a gypsum mould was made, an earmark was made on the head of the fibula with a water pencil, and the tibial side was pressed from the middle of the popliteal space, while on the tibial side aspace was maintained between the cuff and the body. It was found, as a result, that the secondary impairments observed with the conventional SLB could be prevented, and the stability was supported and the gait was improved. However, severe flail joint in 2 patients was not improved with the correction of the outer sole by 1cm. It was necessary for 10 patients to shift the foot to the anterior to correct the lower end of the support, whereas in 15 patients with a severe extension pattern, the author attached a dynamic LLB equipped with a polypropylene round-shaped lower-femur cuff. It is considered from these findings that both an LLB and an SLB require a round-shaped lower-femur cuff to control extension of the lower limb and the flail joint.
- 1985-08-10
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