2 0 0 0 OA 三次元CTモデルを用いた変形性股関節症における臼蓋骨嚢胞発生部位の解析
- 著者
- 藤巻 洋 稲葉 裕 小林 直実 雪澤 洋平 鈴木 宙 池 裕之 手塚 太郎 平田 康英 齋藤 知行
- 出版者
- Japanese Society for Joint Diseases
- 雑誌
- 日本関節病学会誌 (ISSN:18832873)
- 巻号頁・発行日
- vol.32, no.1, pp.17-22, 2013 (Released:2014-06-26)
- 参考文献数
- 12
Objective: The aims of the present study were first to investigate the frequency and location of bone cysts in the acetabulum of hip osteoarthritis (OA) patients and second to examine the influence of pelvic tilt on the location of bone cysts in the acetabulum.Methods: A total of 80 patients (65 women and 15 men) with hip OA who underwent primary total hip arthroplasty were included in this study. The mean age at surgery was 65 years (range, 43-83 years). The bilateral hips of these 80 patients were examined; however, 9 contralateral hips that had previously been implanted with prostheses were excluded. We evaluated the minimal joint space width (MJS) on preoperative antero-posterior radiographs of the pelvis in the standing position. We also obtained the digital imaging and communication in medicine (DICOM) data from the preoperative pelvic computed tomography (CT) images, and then three-dimensionally reconstructed the DICOM data using OrthoMap 3D software with reference to the anterior pelvic plane. We divided the acetabulum into six areas and examined the presence of bone cysts in each area. We also examined the degree of pelvic tilt with three-dimensionally reconstructed CT images.Results: The frequency of bone cysts on CT images increased when the MJS of the hip joint on radiographs of the pelvis was less than 2 mm (p < 0.05). In the total of 151 hips, the antero-lateral area of the acetabulum (88 hips, 58%) exhibited the highest frequency of bone cysts. Patients who had bone cysts in the anterior part of the acetabulum tended to have a larger value of pelvic retroversion than those who did not have cysts in the anterior part of the acetabulum; however, the difference was not significant.Conclusion: The antero-lateral area of the acetabulum, which exhibited the highest frequency of bone cysts, is thought to be susceptible to loading stress. We hypothesized that patients who have bone cysts in the anterior part of the acetabulum have larger retroversion of the pelvis than others; however, the difference was not significant. We need to investigate further to reveal the influence of pelvic tilt on the location of bone cysts.
1 0 0 0 OA 人工膝関節全置換術前後の立位下肢アライメント左右差が脚長差に及ぼす影響
- 著者
- 藤巻 洋 中澤 明尋 竹内 剛 門脇 絢弘 草山 喜洋 井出 学 金井 研三 金 由梨 松原 譲二 稲葉 裕
- 出版者
- 日本関節病学会
- 雑誌
- 日本関節病学会誌 (ISSN:18832873)
- 巻号頁・発行日
- vol.40, no.1, pp.14-21, 2021 (Released:2021-03-31)
- 参考文献数
- 12
目的 : 人工膝関節全置換術 (TKA) 前後の立位下肢アライメント左右差が脚長差に及ぼす影響を調査すること。方法 : 調査対象は初回片側TKAを施行した74例で手術時年齢は平均73歳。TKA術前および術後3週に両側の下肢全長立位2方向単純X線像を撮影し, 正面像で下肢機能軸 (大腿骨頭中心と足関節中心を結ぶ線) の長さ (MA長) および下肢機能軸の膝関節面通過点の膝関節中央からの偏移 (MAD) を, 側面像でknee flexion angle (KFA) を計測した。術前後での各計測値の左右差を調査し, さらに術前後それぞれでMADおよびKFA左右差がMA長左右差に及ぼす影響を単変量および多変量で解析した。結果 : 術前にMA長左右差と有意に関連したのは単回帰分析でMAD左右差 (R=−0.31, P=0.003) およびKFA左右差 (R=−0.51, P<0.001), 重回帰分析でもMAD左右差 (P<0.001) およびKFA左右差 (P<0.001) であった (修正R2=0.43)。術後にMA長左右差と有意に関連したのは単回帰分析でMAD左右差 (R=−0.39, P<0.001) およびKFA左右差 (R=−0.58, P<0.001) で, 重回帰分析でもMAD左右差 (P<0.001) およびKFA左右差 (P<0.001) であった (修正R2=0.50)。考察 : TKA前後で冠状面および矢状面の立位下肢アライメントが脚長差に影響しており, 片側TKA後には脚長差が生じる可能性を認識する必要がある。