強皮症における脛骨顆部Insufficiency fractureの1例

Insufficiency Fracture of the Tibial Condyle in the Patient with Scleroderma. Case Report

　強皮症における𦙾骨顆部insufficiency fractureの1例を報告する．症例：68歳の女性．既往で強皮症のためステロイドが投与されていた．誘因なく右膝関節痛を生じ，初診時単純X線写真で𦙾骨顆部陥没骨折を認めた．強皮症による難治性の皮膚潰瘍があったため，保存的治療としたが，関節破壊が進行したため，人工膝関節置換術を施行した．術後10カ月現在で疼痛はなく，経過良好であった．結語：ステロイド性骨壊死がみられた𦙾骨顆部にinsufficiency fractureを生じ，診断と治療に難渋した強皮症の1例を経験した．

　We report a case of insufficiency fracture of the tibial condyle in a patient with scleroderma. Case：A 68-year-old woman with scleroderma undergoing treatment with steroids presented with pain in the right knee joint of unknown cause, and an X-ray at the time of the initial examination revealed a tibial plateau fracture. Intractable skin ulcers caused by the scleroderma were present on the lower extremities and made surgical intervention impossible, but total knee arthroplasty was performed because there was advanced destruction of the knee joint. Ten months after the operation, the patient did not complain of any pain in the operated knee, and no progression of the bone destruction was detected on the X-rays. Conclusion：This was a case of scleroderma with an insufficiency fracture of the tibial condyle complicated by steroid-induced osteonecrosis, in which both diagnosis and treatment were difficult.