服部 惣一, 小山 稔, 大内 洋

Soichi HATTORI, Minoru KOYAMA, Hiroshi OHUCHI

亀田メディカルセンタースポーツ医学科

Kameda Medical Center, Department of Sports Medicine

キーワード : musculoskeletal ultrasound, visual feedback, vastus medialis, medial patellofemoral ligament, transversus abdominis

運動器エコーは静的な構造の把握のみならず，リアルタイムで動的な評価を可能とするツールである．本稿ではこのツールがリハビリテーションにおいてどのような場面で応用可能かを提示する．リハビリテーションの領域では，視診，触診，経験に頼った評価が主流である．運動器エコーは，これらの項目を補完する新たな指標の一つとなり得る．それによって筋力強化の効果判定や，病的な構造や動作の同定といったリスク管理がより正確なものになる．また，視覚的なバイオフィードバックを可能にするため，筋電図や他の画像装置と比較してより簡便で非侵襲的に，運動制御の方法を対象者に伝えることができる．運動器エコーはこのような簡便性に強みを持つが，一方で検者依存性が高く客観性に問題があるといわれる．本稿では運動器エコーが持つこの弱みも勘案し，先行研究において正確性や信頼性の高いと認められた方法を提示するよう留意する．リハビリテーションにおいて扱う頻度が高い大腿四頭筋や体幹筋といった筋・筋膜における運動器エコーの使用方法を紹介する．さらには，腰椎や内側膝蓋大腿靱帯などの骨・靱帯に対する運動器エコーのリハビリテーションにおける有用性についても言及する．

Musculoskeletal (MSK) ultrasonography enables us not only to perform structural evaluation of various musculoskeletal tissues but also to perform a dynamic assessment. In this report, we present some cases in which MSK ultrasonography was efficiently employed in the dynamic assessment. In the field of rehabilitation, physiotherapy in particular, evaluation of subjects mainly depends upon the therapist's inspection, palpation, and experience. MSK ultrasonography is a new and effective tool that makes evaluation of subjects more accurate and effective. It serves in the evaluation of muscle strength training, and assesses various risks by identifying structures such as vessels and nerves and/or motion. It also gives both the therapist and patient visual feedback, providing information on the MSK system easily and noninvasively, in comparison to electromyography and traditional imaging modalities such as X-ray, CT, and MRI. Despite its ease of use and noninvasiveness, MSK ultrasonography is in general regarded as an operator-dependent imaging modality, which indicates it inherently has a problem in terms of reproducibility. Therefore, in the present report, we introduce ultrasonographic techniques that have been validated in previous reports in the literature. We focused on the clinical application of MSK ultrasound in the treatment of quadriceps and core muscles, which are common problems in the field of rehabilitation, and also discussed the importance of MSK ultrasonography in the rehabilitation of the lumbar spine and medial patellofemoral ligament.