MIS-CPO（Naito）における進入時の腸骨骨切りの工夫

Modification of Approach of Minimally Invasive Surgery for Curved Periacetabular Osteotomy (MIS-CPO)

　MIS-CPO(minimum invasive surgery for curved periacetabular osteotomy)では，進入時に大腿筋膜張筋を起始部から剝離して上前腸骨棘を矩形に骨切りするため，閉創の際にこの骨切り部をスクリューで固定し，大腿筋膜張筋を腸骨稜に縫合固定する必要がある．大腿筋膜張筋は下肢伸展挙上(SLR)や膝関節の屈伸運動で緊張するため，術後早期に当該部の疼痛を訴える患者が多い．また骨切り部の固定に用いたスクリューヘッド部の疼痛を訴えることがある．これらを回避するために，腸骨稜から内板に向けて斜めに骨切りし，閉創の際に縫合糸で固定する試みを行って良好な結果を得たので，手術の要点を紹介する．

　Minimally invasive surgery for curved periacetabular osteotomy (MIS-CPO) was developed by Naito and was a revolutional procedure at the time.　However, some patients complained of groin pain during active exercise in early postoperative stage as a result of detaching of tensor fascia lata to perform a rectangular osteotomy.　In addition, in some cases the screws that were used to fix the rectangular osteotomy had to be removed because of irritation pain at the iliac crest.　To overcome these disadvantages, I modified the osteotomy, which was oblique osteotomy approaching to the pelvic cavity.　Good results were achieved by performing modified osteotomy of the iliac crest without detaching tensor fascia lata and fixing the osteotomized iliac crest with non-absorbable sutures.