両側Schanz骨切り術後の変形性股関節症に対してlocking compression plate併用セメント人工関節全置換術を行った1例

Combination of Cement Total Hip Arthroplasty with a Locking Compression Plate (LCP) for Osteoarthritis after Schanz Osteotomy. Case Report

　Schanz骨切り術後の高度変形を呈した変形性股関節症に対して，大腿骨短縮および内反骨切り術を行い，骨切り部をlocking compression plate（LCP）で固定して人工股関節全置換術（THA）を施行した1例を経験したので報告する．大腿骨はCrowe 4型の高位脱臼であり，Schanz骨切り術のため小転子遠位で高度外反変形があった．また大腿骨は低形成で髄腔は非常に狭かった．転子下での大腿骨短縮および内反骨切り術を行った．近位骨片と遠位骨片間での回旋防止と，広い接触面積の獲得のため骨切り部をステップ状とした．またLCPを併用することで骨切り部の安定性が得られ，偽関節の予防と早期荷重が可能となり，本術式は有用な方法と考える．

　We report a case of total hip arthroplasty (THA) in which we performed femur-shortening osteotomy for osteoarthritis of the hip with severe deformity after Schanz osteotomy and reinforced the operated site was with a locking compression plate (LCP). The femur was Crowe type Ⅳ, and there was an advanced valgus deformity of the marrow cavity at a point distal to the lesser trochanter because of the Schanz osteotomy. Performing a femur-shortening osteotomy and step osteotomy below the lesser trochanter level made it possible to check the rotation of the proximal and distal bone fragments and obtain a large contact area. The LCP also made it possible to prevent pseudoarthrosis and to allow early weight bearing. For these reasons this procedure is considered a useful method.