臨床整形外科56巻9号

2021年09月発行

特集 膝周囲骨切り術を成功に導く基礎知識

膝周囲骨切り術における人工骨の役割

著者： 藤間保晶¹

所属機関： ¹さいわい鶴見病院関節外科

ページ範囲：P.1167 - P.1173

　内側楔状開大式高位脛骨骨切り術をはじめとする骨切り部の開大操作を伴う膝周囲骨切り術では開大部の補填材として人工骨が広く使用される．人工骨は骨切り術に適した特性をもつものを選択し，人工骨の果たす役割を理解して使用する．骨切り開大部における荷重伝達能を最大限に発揮できるよう術前作図に基づいて人工骨は採型し，矯正アライメントを維持するべく開大部への挿入方向，設置も正確に行う必要がある．

参考文献

1) Tohma Y, Ohgushi H, Dohi Y, et al. Quantitative analysis of bone formation in the composites of cultured marrow cells and hydroxyapatite by X-ray computed tomography. Key Eng Mater 2003;240-2:615-8.

2) 田中孝昭，熊谷吉夫．骨補填材．日本Knee Osteotomyフォーラム(編)．ゼロからはじめる！Knee Osteotomy アップデート．東京：全日本病院出版会；2018．p.116-9．

3) Takeuchi R, Ishikawa H, Aratake M, et al. Medial opening wedge high tibial osteotomy with early full weight bearing. Arthroscopy 2009;25(1):46-53.

4) Tohma Y, Takeuchi R, Tanaka Y. Advantages of creation holes and removal of air in artificial bone for early bone formation when used artificial bone as a gap filler in open wedge high tibial osteotomy. Eur J Orthop Surg Traumatol 2019;29(1):131-7.

5) 藤間保晶，竹内良平，大澤克成．高位脛骨骨切り術(HTO)．整形外科Surgical Technique 2021;11(4):70-80.

6) 藤間保晶．Hybrid closed wedge high tibial osteotomy．症例から学ぶ膝周囲骨切り術ピットフォール．東京：全日本病院出版会；2021刊行予定．

7) 藤間保晶．高位脛骨骨切り術—Hybrid closed wedge HTO．松田秀一(編)．整形外科手術Knack and Pitfalls　変形性膝関節症　外科的治療の要点と盲点．東京：文光堂；2021．p.118-30．

8) Ogawa H, Matsumoto K, Ogawa T, et al. Effect of wedge insertion angle on posterior tibial slope in medial opening wedge high tibial osteotomy. Orthop J Sports Med 2016;4(2):2325967116630748.

9) Altermatt S, Schwöbel M, Pochon JP. Operative treatment of solitary bone cysts with tricalcium phosphate ceramic. A 1 to 7 year follow-up. Eur J Pediatr Surg 1992;2(3):180-2.

10) Onodera J, Kondo E, Omizu N, et al. Beta-tricalcium phosphate shows superior absorption rate and osteoconductivity compared to hydroxyapatite in open-wedge high tibial osteotomy. Knee Surg Sports Traumatol Arthrosc 2014;22(11):2763-70.

11) Muller ME．骨折手術法マニュアル　AO法の実際．東京：シュプリンガー・フェアラーク東京；1994．p.12-79．

12) Okamoto M, Dohi Y, Ohgushi H, et al. Influence of the porosity of hydroxyapatite ceramics on in vitro and in vivo bone formation by cultured rat bone marrow stromal cells. J Mater Sci Mater Med 2006;17(4):327-36.

13) Liu G, Zhao L, Zhang W, et al. Repair of goat tibial defects with bone marrow stromal cells and beta-tricalcium phosphate. J Mater Sci Mater Med 2008;19(6):2367-76.

14) Eggli PS, Müller W, Schenk RK. Porous hydroxyapatite and tricalcium phosphate cylinders with two different pore size ranges implanted in the cancellous bone of rabbits. A comparative histomorphometric and histologic study of bony ingrowth and implant substitution. Clin Orthop Relat Res 1988;(232):127-38.

15) Murphy CM, Haugh MG, O'Brien FJ. The effect of mean pore size on cell attachment, proliferation and migration in collagen-glycosaminoglycan scaffolds for bone tissue engineering. Biomaterials 2010;31(3):461-6.

16) Torigoe I, Sotome S, Tsuchiya A, et al. Novel cell seeding system into a porous scaffold using a modified low-pressure method to enhance cell seeding efficiency and bone formation. Cell Transplant 2007;16(7):729-39.

17) Masaoka T, Yoshii T, Yuasa M, et al. Bone defect regeneration by a combination of a β-tricalcium phosphate scaffold and bone marrow stromal cells in a non-human primate model. Open Biomed Eng J 2016;10:2-11.

18) Yoshii T, Sotome S, Torigoe I, et al. Fresh bone marrow introduction into porous scaffolds using a simple low-pressure loading method for effective osteogenesis in a rabbit model. J Orthop Res 2009;27(1):1-7.

19) Hasegawa T, Miwa M, Sakai Y, et al. Efficient cell-seeding into scaffolds improves bone formation. J Dent Res 2010;89(8):854-9.

20) Torigoe I, Sotome S, Tsuchiya A, et al. Bone regeneration with autologous plasma, bone marrow stromal cells, and porous beta-tricalcium phosphate in nonhuman primates. Tissue Eng Part A 2009;15(7):1489-99.

21) Takeuchi R, Bito H, Akamatsu Y, et al. In vitro stability of open wedge high tibial osteotomy with synthetic bone graft. Knee 2010;17(3):217-20.

22) Takeuchi R, Aratake M, Bito H, et al. Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise. Knee Surg Sports Traumatol Arthrosc 2008;16(11):1030-7.

23) Takeuchi R, Woon-Hwa J, Ishikawa H, et al. Primary stability of different plate positions and the role of bone substitute in open wedge high tibial osteotomy. Knee 2017;24(6):1299-306.