腸腰筋腱に由来した両側弾発股の1例

Bilateral Snapping Hip Caused by the Iliopsoas Tendons : Case Report

　抄録：腸腰筋腱と腸恥隆起で起こる関節外・内側型の弾発股の報告は少ない．患者は24歳・女性．以前より両股関節に随意性の弾発を自覚していた．2001年7月29日バレーボールでジャンプの遊脚時に右股関節痛を認め，歩行困難となり当科を受診した．初診時右股関節前面に圧痛を認め，疼痛のため右股関節自動運動不能であった．健側股関節では，屈曲・外転・外旋位から伸展する際，約45°屈曲位で弾発を再現できた．腸腰筋腱鞘造影検査にて，右股関節を自動的に屈曲・外転・外旋位から伸展する際，腸腰筋腱が腸恥隆起部で外側から内側へとスキップする像を確認でき，確診にいたった．同年10月24日小転子部での腸腰筋腱切離術を施行した．術直後より，股関節痛は消失し，経過良好である．比較的稀とされている腸腰筋由来の弾発股を手術的に加療し良好な結果を得た．診断には腸腰筋腱鞘造影が有効であった．

　The snapping hip syndrome is a well recognized but sometimes poorly understood entity. Its external etiology attributable to the iliotibial tract moving over the greater trochanter is well-known, but its the internal etiology attributable to the iliopsoas tendon slipping over the iliopectineal eminence is poorly understood. We report a case of bilateral snapping hip in a 24-year-old volley ball player, in which the etiology was slipping of the iliopsoas tendons. Right hip pain occurred suddenly whenever the patient jumped. Fluoroscopic iliopsoas bursography is effective in the diagnosis, and it showed the iliopsoas tendon jerk over the iliopectineal eminence upon extension of the flexed, abducted, and externally rotated femur. Because the patient complained of persistence of the pain despite of conservative management by rest, decreased activity, and steroid injections, we sectioned the iliopsoas tendon at the lesser trochanterr after three months after the onset of the pain. The severity pain decreased dramatically, and 15months post operatively the patient had no hip pain during any activities and had recovered full range of right hip motion. Further follow-up is necessary to assess the adequacy of the surgical treatment.