鈴江 直人

Naoto SUZUE

徳島大学大学院運動機能外科学

Department of Orthopedics, University of Tokushima Graduate School

キーワード : ultrasonography, screening, musculoskeletal disorder, osteochondritis dissecans

超音波エコーを用いた運動器検診は，発育期の股関節脱臼や成長期スポーツ障害に対して施行されている．股関節脱臼検診ではGrafにより確立されたスクリーニング法とその分類が世界的に用いられており，骨化が進んでいない時期における超音波検査の有用性は高い．スポーツ障害検診については，徳島県が全国に先駆けて1980年代から小学生の野球選手，サッカー選手に対して現場検診を行ってきた．従来はスタッフが可動域，圧痛，ストレス痛などの理学所見から障害を予測していたが，近年，超音波検査を導入することで現場での画像検査が可能となった．結果として野球選手の検診では，重症度が高い割に初期の症状に乏しい上腕骨小頭離断性骨軟骨炎の検出率が向上した．さらに，現場で保護者や指導者に直接画像をみせることで疾患への認識も高まっている．一方で，現場検診においては機種によるみえ方の差や，屋外環境への対応，またＸ線写真など他の画像検査との対比など，検討すべき課題も挙げられる．

Screening with ultrasonography for musculoskeletal disorders such as developmental dysplasia of the hip (DDH) or sports injuries has been done because of its many benefits. For DDH, ultrasonography is useful because it can show the cartilaginous femoral head before ossification, which cannot be shown by X-ray film. Osteochondritis dissecans of the capitellum (OCD) is one of the severest disorders for young baseball players. Screening of OCD has been done for about 30 years in Tokushima. Conventionally, only physical examinations had been performed at the venue by the staff, and the players who had abnormal findings were recommended to consult a doctor. Recently, players undergo ultrasonography in addition to a physical examination. The detection rate of OCD has increased since the start of screening with ultrasonography because OCD shows few abnormal findings in physical examination at the early stage. On the other hand, some problems have been pointed out. The first problem is a difference in image quality between ultrasound devices, the second is how to deal with performing the screening outdoors, and the third is comparison with other radiographic images.