股関節穿刺が有効であった一過性大腿骨頭萎縮症の1例

Transient Osteoporosis of the Hip Treated by Arthrocentesis. Case Report

　症例は51歳，女性．主訴は左股関節痛．初診時の理学所見，X線像，CT，MRIの結果，一過性大腿骨頭萎縮症と診断した．治療は股関節液貯留を認めたため関節穿刺と免荷歩行を行った．穿刺直後から疼痛は軽減し，発症3カ月後には症状が消失，5カ月後には画像所見も正常化した．本症例の臨床経過は諸家の報告と比較し短期間であり，穿刺後から症状が急速に改善していることから，関節内圧の上昇が病態の1つと推測された．関節穿刺は疼痛を速やかに軽減させ早期治癒が期待でき，また患者の満足度も高い有用な治療法の1つである．

　A 51-year-old woman complaining of left coxalgia was diagnosed as having transient osteoporosis of the hip based on her clinical status and X-ray, computed tomography and magnetic resonance imaging findings. Synovial fluid was recognized on the MRI images, so we performed an arthrocentesis of the hip and prescribed relief walking. The sharp pain lessened dramatically immediately after the procedure, and the patient's symptom disappeared three months after onset, normalized MRI evidence was obtained five months after onset. This clinical course was shorter than those mentioned in many previous reports. Because her symptom improved rapidly after arthrocentesis of the hip, we suspected that the elevated joint pressure had been caused by the transient osteoporosis. Arthrocentesis of the hip immediately reduced the pain and enabled an early cure. This procedure may be very useful for treating patients with transient osteoporosis of the hip.