遊離自家腸骨移植と髄内釘固定により治癒しえたメチシリン耐性黄色ブドウ球菌（MRSA）脛骨骨髄炎の1例

MRSA Osteomyelitis of the Tibia Treated with Autologous Iliac Bone Grafts and Intramedullary Nail Fixation. Case report

　下腿開放骨折治療後に生じた脛骨骨髄炎に対して遊離自家腸骨移植と髄内釘固定術で治癒しえた1例を報告する．症例は63歳の男性，交通事故で右下腿開放骨折を受傷した．前医で創外固定を施行されたが，ピン刺入部にメチシリン耐性黄色ブドウ球菌（MRSA）感染から脛骨骨髄炎を併発した．病巣掻爬を行い広範な軟部組織欠損を生じ，脛骨も15cmに及ぶ掻爬を行ったが連続性は残すことができた．開放創として処置を継続し感染が鎮圧されたため，広背筋皮弁移植を行った．皮弁生着後，最終的に腸骨骨移植と髄内釘固定を施行し，感染の再燃なく骨癒合が得られた．

　We report a case of tibial osteomyelitis treated with autologous iliac bone grafts and intramedullary nail fixation. A 63-year-old man sustained an open fracture of his right leg in a traffic accident. The fracture was initially treated by external fixation, but MRSA osteomyelitis of the tibia developed following pin-tract infection. After extensive debridement, the wound was left open with a 15-cm-long segment of the thin posterior cortex of the tibia exposed. After wet dressing, good granulation tissue was confirmed, and a latissimus dorsi flap was applied. Finally, reconstructive surgery of the tibia with autologous iliac bone grafts and intramedullary nail fixation was performed, and the bone grafts united with no recurrence of the infection.