ポリオの極めて高度な反張膝に対する膝装具と靴型装具の一症例

抄録

Poliomyelitis anterior acuta epidmica is an infectious disease commonly abbreviated to Polio. In Japan, the incidence has been greatly reduced, and is now negligible thanks to the improvement of vaccines.
In the past, however, the disease was prevalent in cycles of about ten years, and in 1951 the incidence was the highest ever recorded in Japan. At that time the therapy for the limbs affected by poliomyelitis included arthrodeiss, tendon shifting and orthosis. Secondary impairments due to the weakened muscular force, articular impairments or the difference of the length of the legs also appeared in a considerable number of cases.
Recently, the authors had the opportunity to participate in an examination of adult diseases for citizens living in the Suginami-ward, in Tokyo, and discovered a female patient with left lower limb paralysis due to poliomyelitis, with muscle testing giving a poor result, genu recurvatum 35° and a 4.5 cm difference in the length of the legs. It was observed that she could walk with a T-cane gait, but secondary impairments occurred due to compensatory actions by the typically abnormal gait causing pain over the anterior region of the right ribs.
For the genu recurvatum of this patient, a polypropylene type double-Klenzak system knee orthosis was attached, and axillary correction was performed by extending the posterior of the femoral cuss upwards. For the lateral motions, the femoral cuff was extended forwards from the support up to the shin bone, together with the correction of the different lengths of legs by wearing boots, and with the prevention of lateral motions by placing wedges in the inside of the shoes and in the outside of the shoe soles.
As a result, the genu recurvatum, lateral motions, and dangle foot were prevented and different leg lengths were corrected, so that a stabilized gait and better appearance on walking were brought about. In addition, the patient was able to ride a bicycle and to drive a car.