末期変形性股関節症を合併した大腿骨転子下骨折後の偽関節に対して人工股関節置換術を施行した1例

Total Hip Arthroplasty for Nonunion following Subtrochanteric Fracture in a Patient with Severe Coxarthrosis. Case Report

　末期変形性股関節症を合併した大腿骨転子下骨折後の偽関節に対して，一期的に人工股関節置換術（THA）を施行した1例を経験したので報告する．症例は66歳の女性，変形性股関節症を合併した大腿骨転子下骨折に対して骨接合術が施行されたが骨癒合が得られず，変形性股関節症と偽関節による疼痛のため歩行困難であった．一期的にヘッドネックステムを用いたTHAを施行したところ，痛みの消失と可動域の改善が得られ歩行可能となった．末期変形性股関節症を合併した大腿骨転子部周辺偽関節に対して，ヘッドネックステムを用いたTHAも有用と考える．

　A 66-year-old woman with severe coxarthrosis sustained a subtrochanteric fracture of the ipsilateral femur. The subtrochanteric fracture was treated by open reduction and internal fixation, but the fracture failed to unite, and her walking ability deteriorated as a result of the hip pain caused by both the coxarthrosis and nonunion. Total hip arthroplasty was performed to treat the hip pain and improve the range of motion of hip joint. The pain resolved after replacement surgery, and both the ROM of the hip and her walking ability improved markedly. We concluded that total hip arthroplasty with special apparatus for revision surgery so called “head neck stem” is an effective solution for subtrochanteric nonunion in patients with severe coxarthrosis.