臨牀透析 Vol.20 No.2(8)


特集名 透析アミロイド症 -- 今日の考え方
題名 透析アミロイド症への整形外科的治療 -- 運動器の透析アミロイド症
発刊年月 2004年 02月
著者 今井 亮 京都第一赤十字病院整形外科
著者 大澤 透 京都第一赤十字病院整形外科
著者 岩本 則幸 京都第一赤十字病院泌尿器科
著者 小野 利彦 桃仁会病院泌尿器科
【 要旨 】 透析アミロイド症 (DRA) は全身の諸臓器にみられ,とくに骨,関節,腱・腱鞘に沈着しやすい.DRAは透析年数とともに増加し,長期透析患者のQOLの低下をきたす重要な要因である.運動器のDRAとして,(1) 腱・滑膜へのアミロイド沈着による手根管症候群,ばね指,滑液包炎,(2) 骨・関節 (関節包,滑膜など) への沈着によるアミロイド骨嚢腫,病的骨折,破壊性関節症,(3) 椎間板周辺,椎間関節への沈着による破壊性脊椎関節症などが多発することはよく知られている.これらの疾患は保存療法の効果は一時的であり,放置すると進行して骨・関節破壊,病的骨折,神経・筋肉の非可逆変化をきたすため,早期の積極的な手術療法が必要である.ここでは代表的な疾患の治療方針を中心に述べる.
Theme Dialysis Amyloidosis -- Present State of the Art
Title Orthopaedic treatment for dialysis-related amyloidosis
Author Ryo Imai Department of Orthopaedic Surgery, The First Kyoto Red Cross Hospital
Author Toru Osawa Department of Orthopaedic Surgery, The First Kyoto Red Cross Hospital
Author Noriyuki Iwamoto Department of Urology, The First Kyoto Red Cross Hospital
Author Toshihiko Ono Department of Urology, The Toujinkai Hospital
[ Summary ] Dialysis-related amyloidosis (DRA) has been observed in systemic organs, and is often observed in bones, joints, tendons and the peritendineum. DRA increases with the number of years of dialysis, and it is an important factor in causing degradation of quality of life for long-term dialysis patients. It is well known that (1) carpal tunnel syndrome, trigger finger and bursitis may be caused by amyloid deposition on tendons and the synovium, (2) amyloid bone cysts, pathologic fractures, destructive arthropathy from deposition on bones and joints (capsule, synovium), and (3) destructive spodyloarthropathy from deposition on the intervertebral disc periphery and intervertebral joints, occur frequently as forms of DRA locomotorium. It is necessary to pursue active surgical therapy in the early stages of these disorders so that there may be conservative, temporary treatment. Unattended, irreversable bone and joint destruction, pathological fractures, nerve and muscular alterations may follows. We describe this mainly from the viewpoint of a treatment plan.
戻る