臨床整形外科50巻5号

2015年05月発行

誌上シンポジウム 股関節鏡の現状と可能性

寛骨臼形成不全股に対する鏡視下手術—適応と限界

著者： 和田孝彦¹² 飯田寛和²

所属機関： ¹医療法人オサダ整形外科クリニック ²関西医科大学整形外科

ページ範囲：P.429 - P.435

　寛骨臼形成不全股では，ほとんどの症例で関節唇損傷や関節軟骨剝離を認められる．近年，股関節内病変に対する鏡視下手術の成績が報告されるが，鏡視下単独手術は多くの報告であまり推奨されず，特に関節唇部分切除は成績不良である．形成不全の程度，関節包靱帯の処置，股関節唇への対応，牽引量，時間，円靱帯の状態，対応，術者の技術などが影響すると考えられる．鏡視下単独手術は，種々の影響因子を検討したうえで一部の症例では適応されるが，現状ではほとんどの場合，避けるべきである．

参考文献

1) Klaue K, Durnin CW, Ganz R:The acetabular rim syndrome.-A clinical presentation of dysplasia of the hip. J Bone Joint Surg Br 73:423-429, 1991

2) Henak CR, Abraham CL, Anderson AE, et al:Patient-specific analysis of cartilage and labrum mechanics in human hips with acetabular dysplasia. Osteoarthritis Cartilage 22:210-217, 2014

3) Leunig M, Podeszwa D, Beck M, et al:Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res 418:74-80, 2004

4) Landa J, Benke M, Feldman DS:The limbus and the neolimbus in developemental dysplasia of the hip. Clin Orthop Relat Res 466:776-781, 2008

5) McCarthy JC, Lee JA:Acetabular dysplasia:a paradigm of arthroscopic examination of chondral injuries. Clin Orthop Relat Res 405:122-128, 2002

6) Ross JR, Zaltz I, Nepple JJ, et al:Arthroscopic disease classification and interventions as an adjunct in the treatment of acetabular dysplasia. Am J Sports Med 39(supple):72s-78, 2011

7) Langlais F, Lambotte JC, Lannou R, et al:Hip pain from impingement and dysplasia in patients aged 20-50 years. Workup and role for reconstruction. Joint Bone Spine 73:614-623, 2006

8) Clohisy JC, Nunley RM, Carlisle JC, et al:Incidence and charasteristics of femoral deformities in the dysplastic hip. Clin Orthop Relat Res 467:128-134, 2009

9) Ida T, Nakamura Y, Hagio T, et al:Prevalence and characteristics of cam-type femoroacetabular deformity in 100 hips with symptomatic acetabular dysplasia:a case control study. J Orthop Surg Res 9:93, 2014

10) Parvizi J, Bican O, Bender B, et al:Arthroscopy for labral tears in patients with developemental dysplasia of the hip:a cautionary note. J Arthroplasty 24:110-113, 2009

11) Byrd JW, Jones KS:Hip arthroscopy in the presence of dysplasia. Arthroscopy 19:1055-1060, 2003

12) Yamamoto Y, Ida T, Nakamura M, et al:Arthroscopic partial limbectomy in hip joints with acetabular hypoplasia. Arthroscopy 21:586-591, 2005

13) Kalore NV, Jirane WA:Save the torn labrum in hips with borderline acetabular coverage. Clin Orthop Relat Res 470:3406-3413, 2012

14) Uchida S, Utsunomiya H, Furuko T, et al:Predictors of poor clinical outcome following hip arthroscopy foe developemental dysplasia of the hip. A.A.O.S., 2014

15) Jackson TJ, Watson J, LaReau JM, et al:Periacetabular osteotomy and arthroscopic labral repair after failed hip arthroscopy due to iatrogenic aggravation of hip dysplasia. Knee Surg Sports Traumatol Arthrosc 22:911-914, 2014

16) Mei-Dan O, McConkey MO, Brick M:Catastrophic failure of hip arthroscopy due to iatrogenic instability:Can partial division of the ligamentum teres and iliofemoral ligament cause subluxation? Arthroscopy 28:440-445, 2012

17) Matsuda D, Khatod M:Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia. Arthroscopy 28:1738-1743, 2012

18) Benali Y, Katthagen BD:Hip subluxation as a complication of arthroscopic debridement. Arthroscopy 25:405-407, 2009

19) Sampson TG:Hip morphology and its relationship to pathology:dysplasia to impingement. Oper Tech Sports Med 13:37-45, 2005

20) Steppacher SD, Tannast M, Ganz R, et al:Mean 20-year followup of Bernese periacetabular osteotomy. Clin Orthop Relat Res 466:1633-1644, 2008

21) Troelsen A:Assessment of adult hip dysplasia and the outcome of surgical treatment. Dan Med J 59:B4450, 2012

22) Kain MS, Novai S, Vallim C, et al:Periacetabular osteotomy after failed hip arthroscopy for labral tears in patients with acetabular dysplasia. J Bone Joint Surg Am 93(Suppl 2):57-61, 2011

23) Hartig-Andreasen C, Sφballe K, Troelsen A:The role of the acetabular labrum in hip dysplasia. A literature overview. Acta Orthopedica 84:60-64, 2013

24) Nishina T, Saito S, Ohzono K, et al:Chiari pelvic osteotomy for osteoarthritis-The influence of the torn and detached acetabular labrum. J Bone Joint Surg Br 72:765-769, 1990

25) Ilizaliturri VM, Chaidez PA, Valero FS, et al:Hip arthroscopy after previous acetabular osteotomy for developemental dysplasia of the hip. Arthroscopy 21:176-181, 2005

26) Girard J, Springer K, Boucquet D, et al:Influence of labral tears on the outcome of acetabular augumentation procedures in adult dysplastic hips. Prospective assessment with a minimum follow-up of 12 years. Acta Orthop Belg 73:38-43, 2007

27) Berton C, Boucquet D, Krantz N et al:Shelf arthroplasties long-term outcome:Influence of labral tears. A prospective study at a minimal 16 years follow-up. Orthop Traum Surg Res 96:753-759, 2010