整形１５

【臨床症状】10代　膝蓋骨下端に圧痛　他院で異常なし

【問題】画像所見と診断名、またどのように変化しているか？

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※初回受診時のMRI画像　T2*、プロトン強調、脂肪抑制画像の順に表示

➡ 3か月後のMRI画像
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※初回から3か月後のMRI画像　T2*、プロトン強調、脂肪抑制画像の順に表示

    ▶答えはこちら
    • 膝蓋骨下極の成長軟骨に浮腫性変化あり
    • また膝蓋靭帯や膝蓋下脂肪織にも同様に浮腫性変化あり
    • 上記と臨床症状からSinding-Larsen-Johansson病が疑われる
    ※脂肪抑制の横断像は非提示
    • 3か月後のMRI画像では膝蓋骨下極の浮腫性変化は消失しているのが確認できる
    右側が診断時、左側が3ヶ月後

    シンディング・ラーセン・ヨハンソン（Sinding-Larsen-Johansson）病

    ・10～14歳の男児に多い

    ・大腿四頭筋の伸張性低下や、繰り返す膝蓋腱の引率などにより、膝蓋骨下極に炎症が起きた状態

    ・膝蓋骨下極の疼痛（圧痛）や、運動時の痛みなど

    ・オスグッド・シュラッター病との違いは痛みの部位

    ・治療法は保存的療法がメイン