異所性骨化の研究(主に脳卒中片麻痺症例について)
スポンサーリンク
概要
- 論文の詳細を見る
X-ray and biochemical examination as well as bone scintigraphy were performed especially in 21 cases of ectopic ossification occurred in hemiplegic patients and also blood flow curve was carried out in hemiplegic patients without ectopic ossification. The following results have been obtained.<BR>1) In hemiplegia, serum calcium (Ca) generally shows tendency to indicate low levels within normal range and serum inorganic phosphorus tends to indicate higher values than normal range. These findings are considered due to decrease of parathyroid function. Especially this tendency seems to appear markedly in ectopic ossification group within one year after occurrence of the disease and in this group, serum Ca shows higher values than other group (p<0.05), which is considered to be caused by stronger bone resorption than in other groups.<BR>2) According to blood flow curve by <SUP>99m</SUP>Tc-albumin in the knee of hemiplegia, there are many cases which show more blood flow in paralyzed side of the patients who are within one year after occurrence of the disease. Including the result of serum Ca mesurement, it may be said that within one year after occurrence of the disease, there is a state where ectopic ossification is liable to be produced.<BR>3) The production of many ectopic ossifications by complete paralysis due to spinal injury is considered to be related with strong bone resorption due to immobilization. Decalcification due to bone resorption, rise in serum Ca and increase in local blood flow are important factors in mechanism to produce ectopic ossification. Also trauma cannot be neglected as an inducing cause of the ossification.<BR>4) The joint where ectopic ossification occurs and the site of the occurrence of ossification are almost constant, hence local diathesis liable to provoke it is supposed.<BR>5) Variation in X-ray pictures on ectopic ossification in hemiplegia presents firstly faint cloud-like shadow, which becomes gradually to have distinct division from the surrounding area. Afterwards the size of the ossification does not change markedly in many cases. Thus, bone-like structure appears and it becomes gradually clear. It takes 3-4 months from the occurrence of ossification until attaining to this picture.<BR>6) According to bone scintigraphy by <SUP>99m</SUP>Tc-EHDP, accumulation begins to decrease 3-4 months after the occurrence of ossification when bone like structure begins to appear in X-ray film, and marked decrease of accumulation is observed about one year after occurrence of ossification in many cases. This fact indicates that, for about one year after the occurrence of ossification, there is possibility that ectopic ossification is enhanced by some stimulation. Accordingly, excessive degree of range of motion exercise or some surgical treatments shoud be avoided.<BR>7) Serum alkaline phosphatase (Al-p) showed elevated values in cases where large ectopic ossification was produced in hip joint. Al-p value decreases with decreased accumulation in bone scintigram, however, in relatively small ectopic ossification, Al-p does not show high values and in such cases, bone scintigraphy is useful for judgment of the activity of ossification.<BR>8) Serum creatinine showed significantly low levels (p<0.05) in ectopic ossification group within one year after occurrence of hemiplegia.<BR>9) I have experienced a case where ectopic ossification disappeared with proceeding of recovery from paralysis caused by spinal injury.
- 学校法人 昭和大学・昭和医学会の論文