仙腸関節結核7例の治療経験

Sacroiliac Joint Tuberculosis : Cases Report of 7 Cases

　抄録：仙腸関節結核は骨関節結核全体の中でも比較的稀な病態で，腰仙部痛診断での鑑別対象として考慮されないことが多く，診断が遅れることも少なくない．今回われわれは7例8関節の仙腸関節結核を経験し，その臨床の問題点と術後長期成績について検討した．発症から診断確定までに6カ月以上経過した症例が5症例あった．腰痛，殿部痛，下肢痛を有する患者では仙腸関節疾患を念頭におき，仙腸関節の診察をルーチンとして加えるべきである．画像診断では，単純および造影CT/MRIが有用であった．今回7関節に関節固定術を行ったが，結核の再発は認められず長期成績も安定していた．

　The authors treated 7 patients with sacroiliac joint tuberculosis. The clinical symptoms were buttock, inguinal, low back, and lower limbs pain, and the fact that they were all nonspecific made diagnosis difficult. These symptoms suggested that tuberculosis of the sacroiliac joint should be included in the differential diagnosis. The authors suggest that patients with those symptoms may have sacroiliac joint tuberculosis. Of the 7 patients, one had associated tuberculous spondylitis. The diagnoses were confirmed by the pathology findings, laboratory data, and radiologic findings. The plain and enhanced CT and MRI findings were especially helpful in making the diagnoses. All patients were treated surgically by sacroiliac arthrodesis. They are symptom-free and have had no recurrence of the tuberculosis during long-term follow up.