大腸癌転移による両大腿骨近位部病的骨折に対して髄内釘により骨接合術を施行した1例

Bilateral Pathological Fracture in the Proximal Femur due to Bone Metastasis from Colon Cancer Treated by Intramedullary Nails. Case Report

　症例は再発大腸癌多発骨転移の48歳の女性で，化学療法を施行中であったが，転倒し両大腿骨近位部病的骨折を受傷した．髄内釘による両側同時骨接合術により，車椅子での生活を再獲得し得た．術後約半年で骨癒合を認めたが，大腿骨遠位への転移は認めなかった．化学療法の進歩で大腸癌の生命予後が改善しているため，大腸癌骨転移例の手術適応は拡大するものと思われた．また，大腸癌骨転移の病的骨折において，髄内釘と化学療法により骨癒合が得られる可能性が示唆された．

　A 48-year-old woman with multiple bone metastases from colon cancer who was undergoing chemotherapy suffered bilateral pathological fractures of the proximal femur in a fall.　We performed intramedullary nailing of the fractured bones, and the patient recovered sufficiently to allow her to use a wheelchair again.　At the 6-month follow-up examination bone union was observed at the sites of both fractures, and no metastatic lesions were detected in the distal femurs.　Since advances in chemotherapy for colon cancer have improved life expectancy, the indications for surgical treatment of bone metastases of colon cancer have expanded.　Our experience in the treatment of this case suggests the possibility of using a combination of intramedullary nailing and chemotherapy to achieve bone union in pathological fractures secondary to metastatic colon cancer.