亜脱臼性変形性股関節症に対するBombelli外反伸展骨切り術の適応と限界 A Follow-up Study of Bombelli's Valgus Extension Osteomy for Osteoarthrosis og the Hip Joint due to Acetabular Dysplasia
A Follow-up Study of Bombelli's Valgus Extension Osteomy for Osteoarthrosis og the Hip Joint due to Acetabular Dysplasia
学位の種類: 博士（医学）. 報告番号: 乙第1311号. 学位記番号: 新大院博（医）乙第1219号. 学位授与年月日: 平成4年4月23日
新潟医学会雑誌. 1993, 107(1), 40-52.
Bombelli's valgus extension osteotomy was performed on 68 patients, 66 females and 2 males, 74 joints with osteoarthrosis of the hip joint due to acetabular dysplasia. The operation was indicated in patients with radiological evidence of the capital drop, with widening of the lateral joint space on adduction, and with range of motion, more than 60° on flexion and than 15° on adduction. The average postoperative follow-up period was 5 years and 2 months, ranging 2 years to 9 years and 8 months. The results of the operative treatment were evaluated according to the JOA scoring system based on pain, gait, range of motion, ADL and X-ray findings. Also, arthroscopic observation and biopsy were carried out for the articular surface on the weight-bearing area of femoral head. Pain score significantly improved at the follow-up. But gait, range of motion, and ADL were unchanged. Of all the joints operated on, the outcome of the operation was evaluated as "good" in 64 joints (87%) and "poor" for the remaining 10 joints (13%). The mean score for postoperative pain in the patients, more than 6 years after operation, were 35 and 29 at the 2nd and the 6th year respectively. The results were estimated as "good" in patients with the following preoperative X-ray findings: (1) the width of base of the capital drop was more than 5mm, (2) acetabular head index was above 60% and/or the angle of acetabular tilting was 30° or less, or (3) the size of bone cyst within femoral head was less than 20mm. Arthroscopically, articular surface of weight-bearing area was covered with fibrous tissue. Histologically, this tissue was identified as fibrocartilage. However, since such repair of fibrocartilage is thought to be structurally and biomechanically weaker than innate hyaline cartilage. This is the reason why pain relief caused by Bombelli's osteotomy was to be reduced with the passage of time.