オスグッド・シュラッター病における手術前後の疼痛の経時的変化

A Time-Series Change of Pain for Before and After Surgery for Osgood-Schlatter Disease

はじめに

　オスグッド・シュラッター病（Osgood-Schlatter disease，以下OSD）は，大腿四頭筋の筋収縮により発生する長軸方向への牽引力により，成長期の骨化過程にある脛骨粗面部に疼痛が生じる障害である^1）．一般にOSD発症初期の治療法は，疼痛改善を中心とした保存療法であるが，保存療法で疼痛が改善されなかった場合は手術が行われる．Mitalらは，脛骨粗面から剥離した骨片と滑液包を摘出することにより，疼痛が軽減されるとしている^2）．一方で，手術6カ月後や1年後などの疼痛の変化が報告されている先行研究はあったが，OSD手術前後から競技復帰までの疼痛変化を詳細に調べた研究は我々が渉猟した範囲では見られなかった．

　そこで術後，疼痛の改善の経緯を確かめるため，保存療法で改善せず手術を受ける男子レスリング選手を対象に，術前後での経時的疼痛の変化を調べた．

Abstract : Generally, conservative treatment is performed at the initial stage of Osgood-Schlatter disease (OSD) to decrease pain. When this conservative treatment is no longer effective, surgery will be performed to decrease OSD pain by removing a tibial tuberosity avulsed bone and a synovial capsule. We reported a time-series change of pain before and after the OSD surgery on a wrestling athlete. The present subject was a 20-year-old male wrestler (height 183 cm ; weight 90 kg), who received OSD surgery on the left knee. Numerical rating scale (NRS) was used to determine pain before and after the OSD surgery. NRS was measured by three positions : resting position (RP), sitting with knee extending position (SKEP), squat with knee flexing 90° position (SK90P) and pressure pain (PP). Immediately after the OSD surgery, NRS at the RP, SKEP, SK90P, and PP decreased from NRS3 to NRS0, NRS5 to NRS1, NRS8 to NRS6, and NRS8 to NRS1, respectively. Three weeks after the OSD surgery, pain at the SKEP and PP decreased to NRS0. Eight and eleven weeks after the OSD surgery, pain at the SK90P decreased to NRS2 and NRS1, respectively. The present case study suggests that OSD surgery may progressively decrease pain. Further studies are needed to clarify the effect of OSD surgery on pain.