臨床整形外科53巻8号

2018年08月発行

Lecture

股関節鏡手術の適応と限界

著者： 山田和希¹ 内田宗志¹

所属機関： ¹産業医科大学若松病院整形外科スポーツ関節鏡センター

ページ範囲：P.719 - P.726

はじめに

　大腿骨寛骨臼インピンジメント(femoroacetabular impingement：FAI)は，2003年にGanzら¹⁾によってはじめて体系化された概念で，特有の骨形態異常を有する大腿骨近位部と寛骨臼が股関節の運動に伴い繰り返し衝突(インピンジメント)することで，関節唇および寛骨臼軟骨の損傷が生じるとされている．Ganzらは外科的脱臼アプローチにより関節内の処置を行ったが，その後，低侵襲な股関節鏡視下手術が行われるようになり，微細な病変の確認が可能となり，さらに股関節鏡の手術機器と手技が大きく発展した^2,3)．画像診断技術の向上も相まって，股関節鏡視下手術は2000年代以降，欧米を中心に世界的に増加した⁴⁾．股関節鏡手術は低侵襲であるが，良好な手術成績を獲得しかつ合併症を少なくするためには，手術適応を適切に見極めることが重要である．

　現代の股関節鏡手術の適応は，central，peripheral，peritrochanteric，deep glutal spaceの4つのcompartmentに分類されている(表1)⁵⁾．なかでもFAIはcentral compartmentからperipheral compartmentまで多くの病態を含むため，股関節鏡視下手術の最もよい適応疾患であり，短期から長期の良好な成績が報告されている^6-10)．

　一方，股関節鏡手術の普及に伴い，成績不良な病態や因子が明らかになってきた．寛骨臼形成不全(developmental dysplasia of the hip：DDH)は，わが国における股関節痛の原因として最も多い^11,12)ため，股関節痛を有する患者に対し鏡視下手術を検討する際には，極めて慎重な評価が必要である．

　本稿では，FAIとDDHを中心に，病態および診断と鏡視下手術の成績を述べ，股関節鏡手術の適応と限界について考察する．

参考文献

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