病的骨吸収　　特に慢性腎不全にみられる腎性骨異栄養症（ＲＯＤ）の顎骨Ｘ線写真の評価に関する研究

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  • Studies on the pathologic absorption of mandibula. Especially, radiographic evaluation on the renal osteodystrophy.

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Renal osteodystrophy (ROD) was first reported by Virchow in 1855 and Lucas in 1883, but in the field of the oral and maxillofacial regions were reported for the first time in 1945 by Weinmann. ROD is one of the pathologic bone resorption' as in inflammatory bone resorption and tumor bone resorption. This study is carried out for purpose of finding a method by which bone lesions shown on mandibular roentgenogram can be evaluated objectively. There are very few methods that permit quantitative evaluation of the lesions. Therefore, this study is performed for objective and quantitative evaluation by correlating changes on the dental/mandibular roentgenogram with the duration of haemodialysis and clinical laboratory tests. Subjects consisted of 80 patients (54 male and 26 female patients) on haemodialysis 3 times weekly but without bone lesions in the measured region. Their age ranged between 24 and 65 years (average 45, 5 years). The patients were assigned to subgroups according to haemodialysis duration. Abnormal findings obtained in the study are summarized below.<BR>1) In clinical laboratory tests, abnormal levels of P, PTH, Al, Mg and HCO-3 weredetected, showing the condition in which ROD could occur.<BR>2) According to the interpretation of radiogram, lesions tend to increase in lamina dura, trabecula, mandibular canal and maxillary sinus floor line with the increase in duration of haemodialysis.<BR>3) Significant difference in metacarpal index (MCI) were observed from 4 years after initiation of haemodialysis. As compared with control group, mandibular lower cortical thickness (MLCT) value of molar region decreased significantly from 2 years after initiation of haemodialysis, indicating that MLCT values can reveal ROD induced bone lesions earlier than MCI.<BR>4) As compared with control group, mandibular trabecular width (MTW) values in the patients became more significant from 1 year after initiation of haemodialysis, showing that trabecular structure is affected earlier than cortical bone. It was thus suggested that the changes in trabecular structure occur at 2 year intervals after initiation of haemodial-ysis.

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