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多発性遺伝性外反母趾を有する骨格成熟患者における股関節のX線写真的特徴
Radiographic characteristics of the hip joint in skeletally mature patients with multiple hereditary exostoses.
PMID: 32474654 DOI: 10.1007/s00256-020-03482-0.
抄録
目的:
多発性遺伝性外骨折（MHE）を有する骨格成熟患者の臀部、特に大腿骨近位部の放射線学的特徴を明らかにすること。
OBJECTIVE: To elucidate the radiological characteristics of the hips, especially in proximal femur, of skeletally mature patients with multiple hereditary exostoses (MHE).
材料および方法:
対象となる50名の患者（100股関節）を本研究に含め、MHE群に割り付けた。対照群は年齢と性別をマッチさせた者を対象とし、100 股関節の X 線写真を対照群とした。臼蓋骨と大腿骨近位部の解剖学的特徴を調べ、臼蓋骨深さ幅比（ADR）、シャープ角、大腿骨頸部-シャフト角（NSA）、Wibergの中心端角（CEA）などを調べた。大腿骨頸部軸長（FNAL）、大腿骨頭径（FHD）、大腿骨頸部幅（FNW）、大腿骨軸幅（FSW）、大腿骨頸部-軸角（NSA）、および大腿骨頭-頸部比（FHNR = FHD/FNW）。p値<0.05は有意と考えられた。
MATERIALS AND METHODS: Fifty eligible patients (100 hips) were included in the study and assigned to the MHE group. The control group included age- and sex-matched individuals, and the radiographs of 100 hips were used as controls. We examined the anatomical characteristics of the acetabulum and the proximal femur, including the acetabular depth-width ratio (ADR), Sharp's angle, femoral neck-shaft angle (NSA), Wiberg's centre-edge angle (CEA), femoral neck axis length (FNAL), femoral head diameter, (FHD), femoral neck width (FNW), femoral shaft width (FSW), femoral neck-shaft angle (NSA), and femoral head-neck ratio (FHNR = FHD/FNW). p value < 0.05 was considered significant.
結果:
骨軟骨腫は大腿骨頸部内側（79％）に多く認められたが、大腿骨頭にはほとんど認められなかった（1％）。ADR、シャープ角はMHE群と対照群で有意差はなかった（p=0.2056、p=0.5025）。CEAは両群間で有意差があった（p＜0.0001）。FNWはMHE群の方が対照群よりも有意に大きかった(p<0.0001)。FHNRは両群間で有意差があった(p<0.0001)。NSAはMHE群に比べて有意に大きかった(141.8°±9.7° vs 129.5°±5.6°, p<0.0001)。
RESULTS: Osteochondroma was frequently observed in the medial femoral neck (79%), but it was rarely found in the femoral head (1%). ADR and Sharp's angle were not significantly different between the MHE and control groups (p = 0.2056, p = 0.5025). CEA was significantly different between the two groups (p < 0.0001). FNW was significantly larger in the MHE group than in the control group (p < 0.0001). FHNR was significantly different between the two groups (p < 0.0001). NSA was significantly larger than the MHE group (141.8° ± 9.7° vs 129.5° ± 5.6°, p < 0.0001).
結論:
骨盤側の股関節形成不全は、骨格的に成熟したMHE患者ではあまり見られなかった。しかし、大腿骨頚部の拡がりや骨盤内転位は認められた。大腿骨頚部周囲の骨軟骨腫の発生は、バルガス変形の程度に影響する。これらの事実は、MHE患者を治療する整形外科医にとって有用であると考えられる。
CONCLUSIONS: Hip dysplasia in the pelvic side was not commonly observed in skeletally mature MHE patients. However, they showed femoral neck widening and coxa valga. The occurrence of osteochondroma around the femoral neck affects the degree of valgus deformity. These facts could be useful for orthopaedic surgeons treating MHE patients.