臨床整形外科55巻1号

2020年01月発行

特集 新しい概念　“軟骨下脆弱性骨折”からみえてきたこと

腎移植後にみられる大腿骨頭軟骨下脆弱性骨折

著者： 大鶴任彦¹ 岡崎賢¹

所属機関： ¹東京女子医科大学整形外科

ページ範囲：P.47 - P.53

　腎移植300例におけるMRI前向き調査から大腿骨頭軟骨下脆弱性骨折(SIF)と大腿骨頭壊死症(ONFH)の発生率を調査し，両者の鑑別につき検討した．MRI上大腿骨頭にバンドが認められた場合は，大腿骨頚部軸に平行にスライスした斜水平断(oblique axial像)のT1およびT2 STIR像を追加撮影し確定診断した．その結果，発生率はSIF1.0％，膝骨脆弱性骨折0.3％，ONFH1.0％，膝骨壊死0.3％であった．SIFの病変の局在は全例大腿骨頭荷重部前方であった．SIFとONFHの鑑別が困難な場合，MRI oblique axial像においてバンドより中枢部は，SIFなら出血を反映し高信号，ONFHなら壊死組織のため等信号という原則は確定診断に有用であった．

参考文献

1) Kubo T, Yamazoe S, Sugano N, et al. Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 1997;15(9):1017-23.

2) Marston SB, Gillingham K, Bailey RF, et al. Osteonecrosis of the femoral head after solid organ transplantation:a prospective study. J Bone Joint Surg Am 2002;84(12):2145-51.

3) Lopez-Ben R, Mikuls TR, Moore DS, et al. Incidence of hip osteonecrosis among renal transplantation recipients:a prospective study. Clin Radiol 2004;59(5):431-8.

4) Bangil M, Soubrier M, Dubost JJ, et al. Subchondral insufficiency fracture of the femoral head. Rev Rheum Engl Ed 1996;63(11):859-61.

5) 土井口祐一，岩崎勝郎，山田健治・他．X線学的骨盤腔形態と骨盤傾斜角．整外と災外1992；41(2)：641-5．

6) Takao M, Sakai T, Nishii T, et al. Incidence and predictors of osteonecrosis among cyclosporin -or tacrolimus treated-renal allograft recipients. Rheumatol Int 2011;31(2):165-70.

7) Japan Organ Transplantation Network Donors and Transplants Data. http://www.jotnw.or.jp/english/data.html.(Accessed September 15, 2017)

8) Takahashi S, Fukushima W, Yamamoto T, et al. Temporal trends in characteristics of newly diagnosed nontraumatic osteonecrosis of the femoral head from 1997 to 2011:a hospital-based sentinel monitoring system in Japan. J Epidemiol 2015;25(6):437-44.

9) 金谷幸一，加藤義治，三浦智文・他．腎移植後患者における大腿骨頭・顆部骨壊死のMRIによる経時的変化．日整会誌1999；73(2)：S191．

10) Kumar MS, Heifets M, Moritz MJ, et al. Safety and efficacy of steroid withdrawal 2 days after kidney transplantation:analysis of results at three years. Transplantation 2006;81(6):832-9.

11) Arnol M, de Mattos AM, Chung JS, et al. Late steroid withdrawal and cardiovascular events in kidney transplant recipients. Transplantation 2008;86(12):1844-8.

12) Saito M, Ueshima K, Fujioka M, et al. Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis. Acta Orthop 2014;85(3):266-70.

13) Libório AB, Mendoza TR, Esmeraldo RM, et al. Induction antibody therapy in renal transplantation using early steroid withdrawal:long-term results comparing anti-IL2 receptor and anti-thymocyte globulin. Int Immunopharmacol 2011;11(11):1832-6.

14) Yamamoto T. Subchondral insufficiency fractures of the femoral head. Clin Orthop Surg 2012;4(3):173-80.

15) Yamamoto T, DiCarlo EF, Bullough PG. The prevalence and clinicopathological appearance of extension of osteonecrosis in the femoral head. J Bone Joint Surg Br 1999;81(2):328-332.

16) Yamamoto T, Bullough PG. Subchondral insufficiency fracture of the femoral head:a differential diagnosis in acute onset of coxarthrosis in the elderly. Arthritis Rheum 1999;42(12):2719-23.

17) Yamamoto T, Schneider R, Bullough PG. Subchondral insufficiency fracture of the femoral head:histopathologic correlation with MRI. Skeletal Radiol 2001;30(5):247-54.

18) Yamamoto T, Iwamoto Y, Schneider R, et al. Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis 2008;67(2):150-3.

19) Ikemura S, Yamamoto T, Nakashima Y, et al. Bilateral subchondoral insufficiency fracture of the femoral head after renal transplantation:a case report. Arthritis Rheum 2005;52(4):1293-6.

20) Ohtsuru T, Yamamoto T, Murata Y, et al. Bilateral subchondral insufficiency fractures of the femoral head in patients with living renal transplantation:a report of two cases. J Orthop Sci 2017;22(5):972-5.

21) Ohtsuru T, Yamamoto T, Murata Y, et al. Incidence of osteonecrosis and insufficiency fracture of the hip and knee joints based on MRI in 300 renal transplant patients. Hip Int 2019;29(3):316-21.