有頭骨骨内ガングリオンの1例

Intraosseous Ganglion of the Capitate : Case Report

　抄録：症例は13歳，女性，バスケットボール県代表選手．主訴は右手関節痛である．単純X線およびCT検査にて有頭骨内に辺縁硬化像を伴う円形の囊腫様透明巣を認め，MRI像ではT1強調像で低信号，T2強調像で高信号を呈していた．病巣掻爬および自家骨移植術を施行した．術中，病巣部の硬化した壁を切除するとゼリー状の物質を認め，病理所見からも一部粘液腫様変化のある線維性の組織を認めた．手根骨骨内ガングリオンはしばしば報告例をみるが，有頭骨発生例は自験例を含めても12例と非常に稀である．また，本症例は13歳と若年であり，今後長く高いレベルのスポーツ活動（バスケットボール）を行っていくことを考慮し，できるだけ健常組織を温存する目的で背側よりアプローチした．掌側の病巣も十分掻爬可能であり，術後経過は極めて良好であった．

　A rare case of interosseous ganglion of the capitate in a 13-year-old female member of a semi-professional basketball team is reported. The patient complained of persistent wrist pain that made it difficult to catch the basketball. A radiolucent spot was found in the capitate on Xp radiographs and CT scans that was visualized as a low (T1-weighted) and a high (T2-weighted) signal intensity area by MRI. When conservative treatment for three months failed to relieve the pain, curettage of the bone ganglion and bone grafting were performed. The wrist was immobilized in a cast for 2 weeks, and the patient was able return to sports activities 10 weeks postoperatively. Histological examination of the surgical specimen confirmed an interosseous ganglion. Reports of interosseous ganglion of the capitate are rare, and conservative treatment is usually recommended, however, the surgical approach is effective method of diagnosis and shortens the duration of treatment, especially in young patients who need to return to sports activities as soon as possible.