末期股関節症に対する筋解離術後のX線学的長期経過―自然経過例との比較検討

Long-Term Radiographic Evaluation of Muscle Release Operations for Osteoarthritis of the Hip : Comparison Study between the Results of Muscle Release and the Natural History of Osteoarthritis

　抄録：末期変形性股関節症に対する筋解離術のX線学的な効果を検討するため，本法を施行した30関節と，末期股関節症の自然経過18関節の10年以上のX線経過を比較検討した．その結果，全症例を通じ，骨頭の亜脱臼傾向が強いものほど関節の骨増殖性変化が旺盛であるという有意な相関関係が認められた．筋解離群では自然経過群と比較して骨頭の側方亜脱臼が有意に抑制されており，また，骨増殖性変化は緩徐に進行する傾向を認めた．X線学的にみた筋解離術の効果は，骨頭の求心性を改善して亜脱臼傾向を抑制し，関節に緩徐で安定したリモデリングをもたらすことと考えた．

　To evaluate the long-term outcome of muscle release operations for osteoarthritis of the hip (OA), the radiographic findings over at least 10 years of follow-up were compared in 30 terminal OA hips treated by this procedure and 18 terminal OA hips that had not been treated surgically. The radiographic evaluations showed progression of both femoral head subluxation and hypertrophic OA change in both groups, and a significant correlation was found between the progression of these two lesions. Comparisons showed significantly (p＜0.05) less lateral subluxation of the femoral head and a tendency (p＝0.09) toward less hypertrophic OA change in the muscle release group than in the control group. It was concluded that the long-term radiographic findings after muscle release operations for osteoarthritis of the hip show that releasing tight antero-medial muscles reduces lateral femoral head subluxation and allows gradual and stable remodeling in OA hips.