中島 祐子, 砂川 融, 越智 光夫

Yuko NAKASHIMA, Toru SUNAGAWA, Mitsuo OCHI

広島大学病院整形外科

Department of Orthopaedic Surgery, Hiroshima University Hospital

キーワード : ultrasonography, hand, tendon, ligament, peripheral nerve

手の画像診断には，従来単純レントゲン，CT，MRIが多く用いられているが，これらの検査には「全て静止画である」という弱点がある．そもそも整形外科は運動器を扱う科であり，動きに伴う病態を知ることは非常に大切と考える．近年の超音波診断装置や画像構築技術の進歩には目覚ましいものがあり，高周波プローブの出現とともに高分解能画像が得られるようになった．リアルタイムに得られる鮮明な運動器の超音波画像は，整形外科診療を変えるといっても過言ではなく，現在，整形外科領域でも急速に超音波診療が広まりつつある．整形外科における手領域疾患は，その関心領域のほとんどが皮下3 cm以内にあり，高周波プローブが1本あれば観察できる．本稿では，外来で比較的よく遭遇する整形外科の手・肘領域疾患について，その超音波画像所見を紹介し，解説する．具体的には，腱鞘炎，腱損傷，靭帯損傷，ガングリオン，腫瘍，骨折，関節リウマチ，肘部管症候群，手根管症候群を紹介する．超音波検査は診断のみならず，術前術後の評価などの経過観察，麻酔や注射，穿刺といった治療にも有用であり，また患者とのコミュニケーションツールとしても役立ち，今後ますます発展していくものと考える．

Plain radiograph, CT, and MRI are still often used to create images of the hand. However, these modalities have the same limitation: their images are all just still images. We, as orthopaedic surgeons, are doctors who examine the motor system such as muscles, bones, tendons, ligaments, and nerves. Therefore, it is very important for us to know about the clinical condition associated with motion. Recent advances in ultrasound devices and digital imaging have been remarkable, and recent high-resolution ultrasound devices have made it possible to create a clear image of superficial structures with a high-frequency probe. It would not be an exaggeration to say that ultrasonography could change the daily orthopaedic medical practice, and it is becoming more and more prevalent in the field of orthopaedics. In the field of hand surgery, most of the region of interest is located within 3 cm under the skin. It means that we could examine most of the region with one high-frequency linear probe. Here, we will present and explain the ultrasonograms from some of the clinical cases we often encounter at our hand clinic. Specifically, we will present cases of tenosynovitis, tendon injury, ligament injury, ganglion cyst, soft tissue tumor, fracture, rheumatoid arthritis, cubital tunnel syndrome, and carpal tunnel syndrome. Ultrasonography is useful not only for diagnosis but also for treatments such as nerve blocks, injections, or punctures. In addition, it is helpful as a communication tool between doctors and patients. In light of this fact, we think it will continue to develop more and more.