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Rinsho Seikei Geka Volume 49, Issue 7 （July 2014）

臨床整形外科 49巻7号（2014年7月発行）

Japanese English

論述

セメントレス人工膝関節置換術後のweekly PTH療法は，bone ingrowthを促進させる Treatment with Weekly Parathyroid Hormone Improves Bone Ingrowth after Cementless Total Knee Arthroplasty 金子卓男 ¹ , 大谷崇裕 ¹ , 河野紀彦 ¹ , 望月雄大 ¹ , 南郷脩史 ² , 池上博泰 ¹ , 武者芳朗 ¹ Takao KANEKO ¹ , Takahiro OTANI ¹ , Norihiko KOHNO ¹ , Yuta MOCHIZUKI ¹ , Nobuhito NANGO ² , Hiroyasu IKEGAMI ¹ , Yoshiro MUSHA ¹ ¹東邦大学医学部整形外科学講座（大橋） ²ラトックシステムエンジニアリング ¹Department of Orthopaedics Surgery (Ohashi), School of Medicine, Toho University ²Ratoc System Engineering Co., Ltd. キーワード：副甲状腺ホルモン製剤 , treatment with parathyroid hormone , PTH.1-34 , 骨内形成 , bone ingrowth , セメントレス人工膝関節置換術 , cementless total knee arthroplasty Keyword: 副甲状腺ホルモン製剤 , treatment with parathyroid hormone , PTH.1-34 , 骨内形成 , bone ingrowth , セメントレス人工膝関節置換術 , cementless total knee arthroplasty pp.583-590

発行日 2014年7月25日 Published Date 2014/7/25

DOI https://doi.org/10.11477/mf.1408103090

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Abstract 文献概要
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参考文献 Reference

　背景：今研究ではセメントレス人工膝関節置換術(TKA)術後に，副甲状腺ホルモン製剤(weekly PTH.1-34，56.5μg)療法により人工関節と海綿骨間においてbone ingrowthを促進させるかを検討した．

　対象と方法：セメントレスTKAを施行した20膝に対し，術直後，3，6，9カ月にmulti detector-row CT(以下：MDCT)を撮像し，3D骨形態計測ソフトウェアで海綿骨骨梁構造を3次元的に可視化し骨石灰化度を測定した．Weekly PTH使用群(A群)10膝，非使用群(B群)10膝に分け，経時的に6つのregion of interest(以下，ROI)部位でBMC/TV値(体積あたりの骨石灰化度)，BV/TV値(体積あたりの骨梁の量)を測定し2群間で比較検討した．

　結果：術後，3，6，9カ月の脛骨コンポーネント，ペグ直下の内側部位で，B群よりA群で有意にBMC/TV値の増加を認めた．

　まとめ：セメントレスTKA術後のweekly PTH療法により骨成長を促進できた．

　Background：In this study we investigated whether weekly postoperative subcutaneous injections of teriparatide (56.5 μg) would promote bone ingrowth between the joint prosthesis and cancellous bone after cementless total knee arthroplasty.

　Methods：Cementless total knee arthroplasty with a trabecular metal modular tibia was performed to treat medial gonarthrosis in 20 knees.　Multi-detector-row computed tomography (MDCT) of the knee was performed immediately postoperatively and again at 3, 6, and 9 months postoperatively.　The cancellous trabecular structure of the knee was visualized three-dimensionally by using osteomorphometric software, and ossification density was calculated from the computed structural parameters.　Some patients received a subcutaneous injection of teriparatide once a week (teriparatide group, n＝10), and the other patients did not (control group, n＝10).　The bone mineral content/total volume (BMC/TV) and bone volume/total volume (BV/TV) values of the two groups were compared between over time.

　Results：The mean BMC/TV value and mean BV/TV value of the medial zone under the tibia at 3, 6, and 9 months postoperatively were significantly higher in the teriparatide group.

　Conclusions：Teriparatide treatment increases bone mass by promoting ossification to a rate that exceeds the rate of bone resorption, and our hypothesis that teriparatide promotes bone ingrowth between the joint prosthesis after cementless total knee arthroplasty and medial cancellous bone was verified by the results of this study.