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2006.11.24

膝にたまった水と注射

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整形外科の外来に訪れる患者さんの訴えの中で多いものの一つが膝の痛みです。
膝の痛みの原因の多くは関節軟骨の変形によるものです。
これを変形性関節症と言います。
関節軟骨の変形は年を取ることや過去の怪我の影響などにより引き起こされ
特に立ったままでも両膝が閉じることのできないようなO脚変形が強い人に生じます。
膝の痛みは関節軟骨や骨、周囲の靱帯や筋肉に炎症によっておこります。
この炎症は時に関節包つまり関節を取り巻く袋の内面にある滑膜という細胞に及びます。膝の水を関節液といいますがこの関節液がたまるのはこの滑膜の炎症が生じるからです。
ですから何か痛みの原因があってその結果として膝に関節液がたまるのであり、膝に関節液がたまるから痛みがあるのではないということを理解しましょう。
多くの患者さんの質問に「膝の水を抜くと癖になりませんか?」というものがあります。
膝の関節液を抜くことによって関節に害を及ぼすということはまったくありません。
関節液には時に血液が混ざっていたり、軟骨のカケラが混ざっていたり、あるいは膿のように濁っていたりすることがあります。そのため関節液を抜いてその状態や量を確かめることが膝の痛みの診断につながることもあります。変形性膝関節症の治療のために傷ついた関節軟骨を修復するヒアルロン酸という注射薬を関節に入れることがあります。関節液が多くたまっている場合はいったん、たまった関節液を抜いてからこのヒアルロン酸を注射します。このような注射は厳密に滅菌された注射器や針を使用して清潔な消毒のもとに行われることが重要です。重症な糖尿病などの免疫状態の悪い患者さんの場合には化膿性膝関節炎という関節内にばい菌が入ってしまう重大な合併症がごくまれに起こります。痛みが楽になるからといって安易に関節注射は行うべきではありませんが整形外科の専門医のもとで決められた回数を確実に関節内におこなえば初期の変形性膝関節症に対しての治療効果は十分に期待できるものと考えられます。

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