臨牀透析 Vol.13 No.9(3-3)


特集名 アミロイド骨・関節症 -- 診断と治療の実際
題名 治療 (3) 透析患者における骨・関節手術 -- 骨折,骨嚢胞に対する手術と関節鏡視下手術
発刊年月 1997年 08月
著者 谷澤 龍彦 新潟大学医学部整形外科
【 要旨 】 透析患者における骨折は,頻度が高く,その治療に難渋することが多い.とくに大腿骨頸部では骨嚢胞の存在がある場合は,予防的な手術も推奨される.近年,関節鏡視下での手根管開放術が行われるようになってきた.皮切が小さく,侵襲は少ないが,再発,合併症例もあり,その得失をわきまえて手術法を決定する必要がある.肩関節の愁訴は,透析患者においてはもっとも頻度が高い.その病態はsubacromial impingement syndromeと考えられるが,直視下ないし関節鏡視下による肩峰下除圧術が有効とされる.
Theme Amyloid-Related Bone and Joint Derangements -- Clinical Diagnosis and Treatment
Title Surgical treatments for osteoarticular lesions in hemodialyzed patients; A new procedure of arthroscopic surgery
Author Tatsuhiko Tanizawa Department of Orthopedics Surgery, Niigata University School of Medicine
[ Summary ] Hip fractures of patients with long term hemodialysis are considered to be more frequent and crucial in treatment. Prophylactic internal fixation surgery is recommended if cystic bone lesions of the femoral neck are present. Although arthroscopic release of the carpal tunnel is a less invasive procedure for carpal tunnel syndrome, adverse effects such as recurrence and soft tissue injury during this procedure should be noted. Shoulder pain is the most frequent osteoarticular complaints among the patients. The thickened bursa seems to cause subacromial impingement which leads to persisting inflammation under the acromion. Open surgery or arthroscopic surgery of subacromial decompression is the most promising surgical strategy.
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