変形性股関節症における腰椎すべりの検討―Hip-spine syndrome

Association of Hip Osteoarthritis with Lumbar Degenerative Spondyolisthesis. Hip-Spine Syndrome

　変形性股関節症と腰椎すべりの関係について検討した．初回人工股関節置換術（THA）を行った女性の変形性股関節症患者247例を対象とした．調査項目は腰椎すべりの頻度，腰椎すべりと椎間関節の形態との関係とした．腰椎すべりの頻度は31％，L4/5椎間関節の矢状化は41％であり，矢状化例で有意に腰椎すべりの頻度が高かった（p＜0.05）．両疾患の高頻度の合併の要因として，共通する遺伝因子や股関節拘縮などの動的因子の影響が推察された．股関節疾患を診療する際に誤診や見逃しを防ぐためには腰椎病変を念頭に置く必要がある．

　We assessed the coexistence of degenerative spondylolisthesis (DSO) in patients with hip osteoarthritis (OAH). Subjects were 247 women with OAH (aged 40-89). The configuration of the L4 lamina was classified into X and M＋W based on the Oda classification. DSO in OAH was recorded in 31％. The incidence of DSO and the ratio of M＋W type increased with age. DSO at L4/5 was recorded in 8％ in X type and 41％ in M＋W type. Based on the fact that DSO occurs fairly commonly with OAH, a group of patients seems to develop OAH from the spine to the pelvis due to either genetic or hormonal factors. Otherwise, the high incidence of M＋W type in older patients means that some cases with M＋W type have been transformed by remodeling from X type due to dynamic factors related to hip contracture.