整形１８

【臨床症状】80代　Xpで離断性骨軟骨炎疑い

【問題】画像所見と診断名は？

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※T2*、プロトン強調、脂肪抑制画像の順に表示

➡ 冠状断
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※T2*、脂肪抑制画像の順に表示

    ▶答えはこちら
    • 大腿骨内顆の荷重面の軟骨下に欠損像あり
    • また関節軟骨も欠損し、変形性変化も認める事から骨壊死の状態と診断できる
    • 骨壊死周囲の大腿骨、脛骨には骨髄浮腫を認めるのと、内側半月板中節は挫滅しているのが確認できる
    • 上記より大腿骨内顆骨壊死疑い
    左からT2*、プロトン強調、脂肪抑制画像

    【大腿骨顆部骨壊死】

    65歳前後に発症のピークがあり、女性に多い

    原因が不明なのを特発性（一次性）、原因が特定できるものを二次性としている

    特発性の場合、内顆に好発すると言われ、骨粗鬆症に伴う軟骨下脆弱性骨折が前駆病変とも言われている

    半月板断裂を合併する事が多く、長期に経過したものは変形性膝関節症を合併する

    突然発症で内側関節裂隙の疼痛、夜間痛が特徴的な症状

    病期分類に腰野分類があるが、これはX線画像での分類方法

    • Stage1（発症期）：X線画像上所見を認めない
    • Stage2（吸収期）：骨吸収像が確認できる
    • Stage3（完成期）：石灰板の形成や荷重面の陥没など
    • Stage4（変性期）：関節裂隙狭小化、骨棘形成