大腿骨外反骨切り術の適応拡大を目的として骨頭部骨棘切除術を追加した1例

Capital Osteophyte Resection to Expand The Indications for Pauwels' Valgus Osteotomy for Osteoarthritis of The Hip. Case Report

　骨頭部骨棘切除により外反骨切り術の適応とした症例について報告する．症例は51歳，女性で，右股部痛を主訴とし，可動域制限とX線上荷重部関節裂隙の消失を認めた．動態撮影，関節造影，CT-MPR像にて大腿骨頭部骨棘が寛骨臼下方骨棘と衝突し十分な内転位とならず，本来では外反骨切り術の適応外となる変形性股関節症に対し，骨棘切除を追加することで比較的良好な適合性が得られると判断し，大腿骨頭部骨棘切除後に外反骨切り術とキアリ骨盤骨切り術を行った．術後，疼痛の消失，可動域制限の改善，荷重部関節裂隙の開大を認め，術後2.4年の現在，経過良好である．本法は外反骨切り術の適応を拡大する一術式と考えられた．

　A 51-year-old woman came to our outpatient clinic complaining of a painful right hip joint. The range of motion (ROM) of the hip was 85° of flexion, -5° of extension, 5° of abduction, 10° of adduction, 30° of external rotation, and 20° of internal rotation, and plain radiographs showed loss of joint space. Stress views of plain radiographs did not provide any indications for femoral osteotomy because of femoral head osteophyte formation. However, we concluded that osteophyte resection of the femoral head would make a congruent joint followed by valgus osteotomy, adding Chiari's pelvic osteotomy to correct acetabular dysplasia, and then, we performed valgus osteotomy additional Chiari's pelvic osteotomy after resection of the femoral osteophyte. Postoperatively there was no hip pain, and ROM of the hip had improved to 90° of flexion and 40° of abduction, and 2.4-year postoperative plain radiographs showed that the joint space had been restored.