抗生剤含浸ハイドロキシアパタイトブロック充塡により鎮静化した慢性骨髄炎再燃例

Treatment of Antibiotic-loaded Porous Hydroxyapatite Block for Osteomyelitis Since 65 Years. Case Report

　抄録：慢性骨髄炎の治療にあたっては，病巣掻爬に加え抗生物質の局所濃度を上昇させることが必要となる．今回われわれは，65年来の慢性骨髄炎症例に対し，一期的に抗生剤含浸ハイドロキシアパタイトブロック（以下HAbと略す）を使用し良好な結果を得たので報告する．症例は，78歳男性．12歳時に他院で骨髄炎の診断にて手術加療．その後左大腿部痛残存するも放置．65歳頃より左大腿内側からの排膿を認め，自宅で瘻孔処置継続．左大腿部からの排膿が持続し，単純X線像にて慢性骨髄炎と診断され，78歳時当科に入院し，病巣掻爬・抗生剤含浸HAb充塡術を行った．術後2年の現在，感染は鎮静化している．今回われわれが行ったHAを基材とした徐放システムは，感染治癒に骨の強度を早期に補強しうる．この他の徐放システムとして封入法が試みられているが，われわれの含浸法はこれに比べ手技が容易である．抗生剤含浸HAb法は，難治例や慢性化例に早期に試みてよい方法と考えられる．

　A 78-year-old male, his clinical findings were only slight pain and slight discharge on the left thigh. Laboratory findings indicated an chronic infections.

　However, on plain X-ray were observed osteosclerotic and osteolytic change in the diaphysis of the left femur. According to the MRI, T1 weighted images showed a low signal in this area. The T2 weighted images showed a remarkably high-signal at this area. The surgical intervention was instigated with a diagnosis of chronic osteomyelitis.

　Cortical bone fenestration was made on the diaphysis of the left femur, a large quantity of pus was drained from a lesion, and 40g HAb including antibiotic (ISP：640mg) were placed into the bone marrows after curettage and irrigation by using pulse irrigater. There is symptom free during 2 years after operation.

　A major problem in treating osteomyelitis is obtaining bactericidal concentrations of antibiotic at the focus of the infection. When an antibiotic is used, it is necessary to maintain a highly effective concentration of the antibiotic in the infected area for sufficient period of time to allow the healing process to begin.

　A new drug delivery system (DDS) was developed for osteomyelitis using porous hydroxyapatite blocks (HAb) that were impregnated with antibiotics by decompressing in vacuum container under from 5 to 10 in. (127mmHg-254mmHg)/20min. to load antibiotics into HAB-pores.

　These new methods are simple, can be performed safely to treat osteomyelitis as a one stage, but we must take care to recur after long term.