変形性股関節症に対する筋解離術の長期成績―初期・進行期例と末期例の比較検討

Long-Term Clinical Results of Muscle Release Operations for Osteoarthritis of the Hip : Comparison Study between Early/Advanced and Terminal Stages of Osteoarthritis

　抄録：変形性股関節症に対する筋解離術後平均20年の成績を，手術時病期が初期・進行期の23関節と末期の54関節で比較検討した．術後早期の除痛効果と調査時の股関節機能には両群に明らかな差を認めなかった．THAへの移行を終点とした生存率は末期群でより高い傾向を認め，X線成績では，末期群の多くの症例で関節リモデリングによる適合性の改善を認めた．変形性股関節症に対する筋解離術は，疼痛軽減とTHA回避を目的にいずれの病期にも適応しうるが，その長期経過におけるTHA回避率とX線成績は末期症例でよりよい成績が期待できる．

　Long-term (mean 20 years) clinical results of muscle release operations for osteoarthritis of the hip were evaluated, and the results in the cases in which muscle release was indicated for early/advanced-stage osteoarthritis (23 hips) and those in the cases in which it was indicated for terminal-stage (54 hips) were compared. The differences between the two groups were not significant in terms of either pain relief in the early postoperative stage or hip function at the time of the final follow-up examination. However, ten years after the operation, the survival rate with the end point defined as a conversion to THA was higher in the terminal-stage group (98％) than in the early/advanced-stage group (83％). Radiographs showed progression of the osteoarthritis in the early/advanced-stage group, but improvement of the joint surface in the terminal-stage group. Although muscle release operations may be indicated for both the early/advanced and terminal stages to obtain pain relief and to delay THA, better long-term results in terms of survival rate and radiographic improvement can be expected in terminal-stage osteoarthritis.