人工股関節全置換術術後に非定型大腿骨ステム周囲骨折を生じた1例
Bibliographic record
Abstract
2014年にShaneらが提唱した非定型大腿骨骨折（AFF, atypical femoral fracture）診断基準の5つの大項目とAFFの特徴である大腿骨外側皮質骨肥厚を認めた大腿骨ステム周囲骨折の1例を報告する．症例は81歳女性．66歳の時に右大腿骨頸部骨折に対し人工股関節全置換術を施行し以後，ビスホスホネートを内服していた．79歳の時に右大腿部痛が出現し，両股関節単純X線正面像で，右大腿骨外側に限局する皮質骨肥厚とpedestal formationを認め，ビスホスホネートを中止し，ビタミンDの内服を開始した．81歳の時，立ち上がった際に激しい右大腿部痛があり歩行不能となった．単純X線像で，AFF診断基準の5つの大項目を満たす右大腿骨ステム周囲骨折を右大腿骨外側皮質骨肥厚部に認めた．骨折型はインプラントのゆるみを伴わない骨折（Vancouver分類 type B1）であり，骨接合術を施行した上で，骨癒合促進のために，術後から副甲状腺ホルモン製剤テリパラチドと低出力超音波治療器の使用を開始した．術後4ヶ月で骨癒合を認め，独歩可能となった．大腿骨ステム周囲骨折はAFF診断の除外項目に該当するため，本骨折を非定型大腿骨ステム周囲骨折（PAFF, periprosthetic atypical femoral fracture）と診断をした．PAFFの臨床転帰はAFFと同様に不良であり，PAFFの治療に臨む際には，その病態を考慮した上で方針を決定すべきである．
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".