臨牀透析 Vol.15 No.8(6)


特集名 透析患者の骨折
題名 透析患者の骨折の好発部位と特徴
発刊年月 1999年 07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の好発部位は,過去の報告からは肋骨がもっとも頻度の高い部位と考えられる.しかしそれ以外の骨折の発生頻度に関しては疫学的な報告がなく,推測の域を出ない.しかし大腿骨頚部骨折に関しては,一般人口との比較で明らかに高い発生頻度を示した.透析患者の骨折は病的骨折が多いことが一つの特徴であり,軽微な外力ないしは外力なしに骨折を生じやすい.とくに透析アミロイドーシスによる骨嚢胞は大腿骨頚部に多く,予防的な掻爬,骨移植がすすめられる.また骨癒合は遷延する傾向にあり,続発性副甲状腺機能亢進症が存在する場合,骨折手術時に副甲状腺摘出術を併施することが必要である.
Theme Bone Fracture in Patients with Renal Replacement Therapy
Title Characteristics of the fractures in the hemodialyzed patients
Author Tatsuhiko Tanizawa Department of Orthopedics Surgery, Niigata University School of Medicine
[ Summary ] Rib fractures are considered to be the most frequent type seen in hemodialyzed patients. Since there have been no epidemiological studies conducted to investigate of the incidence fractures, precise of incidence fractures has not been well understood in these patients. Despite this, a study in our area revealed that the hip fracture incidence in these patients is much higher that of the general population in this area.
One of the characteristics of the fractures seen in these patients is that many are non-traumatic pathological fractures. Cystic bone lesions caused by dialysis amyloidosis are frequently observed in the hip joints, and may result in pathological fractures in these patients. Preventive surgical debridement with bone grafting is recommend. Delayed union is another characteristic seen in fractures with these patients, especially in cases with secondary hyperparathyroidism. Simultaneous parathyroidectomy at the time of fracture surgery is preferable in facilitating sound bone union.
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