腎と骨代謝 Vol.29 No.3(8)


特集名 透析アミロイドーシスと関連骨関節疾患
題名 透析股関節疾患の外科治療
発刊年月 2016年 07月
著者 福西 成男 兵庫医科大学整形外科
【 要旨 】 長期透析患者における透析アミロイドーシスとしての股関節障害はさまざまな病態を呈し患者のADLを著しく障害する.おもな病態としては腎性骨異栄養症に伴う大腿骨近位部骨折,大腿骨頸部アミロイド骨囊腫部での病的骨折,関節内アミロイドによる関節破壊などが認められる.骨囊腫部での病的骨折に対しては病巣搔爬,骨移植および内固定術が予防に有効であった.進行した病態には人工股関節置換術が行われるが,周術期合併症および生命予後は一般的な人工関節手術と比較して不良である.
Theme Dialysis related amyloidosis and associated bone and joint disorders
Title Surgical approaches for dialysis related hip arthropathy
Author Shigeo Fukunishi Department of Orthopedic Surgery, Hyogo College of Medicine
[ Summary ] Dialysis hip arthropathy is one of the problematic complications affecting quality of life for long-term hemodialysis patients. Pathological fractures of the femoral neck due to amyloid cysts and substantial joint destruction are associated with this disease. THA is often indicated as well. However, the majority of patients in this population experience complications due to both local and systemic morbidities. As a result, the clinical outcome of THA has been reported to be unsatisfactory. Considering results of previous studies, we performed preventive internal fixation with bone grafts for treatment of amyloid bone cysts.
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