臨床整形外科47巻8号

2012年08月発行

誌上シンポジウム 難治性足部スポーツ傷害の治療

扁平足に伴う外脛骨障害の診断と治療

著者： 仁木久照¹

所属機関： ¹聖マリアンナ医科大学整形外科学講座

ページ範囲：P.749 - P.755

　外脛骨のVeitch分類 Ⅱ型では，軟骨結合部に滑膜性関節が存在することや，後脛骨筋腱がいったん外脛骨で停止し，さらに外脛骨を起始部として各足根骨の底側に向かうなどの解剖学的特徴を持つ．舟状骨の後脛骨筋腱付着部にはenthesis organとして強大なストレスが集中するので，軟骨結合部がいったん損傷するとその修復は容易ではなく症候性になりやすい．

　外脛骨障害の手術は，外脛骨および舟状骨底側に付着する後脛骨筋腱をできる限り温存することが重要で，腱と外脛骨の組織学的構造を温存できる骨癒合が力学的に有利である．さらに，合併する扁平足には骨・関節手術を併用してアライメントを矯正し，内側アーチ支持組織や舟状骨の後脛骨筋腱付着部への異常な負荷の軽減を図ることが望ましい．

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