手術的に治療した腸骨稜裂離骨折の1例

Surgical Treatment of an Avulsion Fracture of the Iliac Crest. Case Report

　患者は15歳の男性で柔道の試合中に背負い投げを試みて，相手に押しつぶされて受傷した．CT上，骨折部は外後方へ転位していた．整復・骨癒合が困難と考えて吸収性材料で骨接合術を行った．術後3カ月で柔道へ復帰した．術後1年の最終観察時，整復位で骨癒合を得ており，柔道も支障なく続けている．腸骨稜部における裂離骨折は腹筋群の張力により発生するとされてきたが，本例では，殿筋，大腿筋群の張力の影響が大きいと思われた．骨片の転位が大きく，保存的には骨癒合が困難であると判断して手術を行い，早期にスポーツ復帰が可能であった．

　We report a rare case of avulsion fracture of the iliac crest that was treated surgically.　A 15-year-old male judo wrestler was injured during a match.　CT and 3D-CT showed that the avulsed bone fragment was displaced posterolaterally and not continuous with the iliac bone.　Osteosynthesis of the iliac crest was performed with three absorbable cancellous screws.　The patient was allowed to walk 3 days after the operation and to resume judo practice 3 months later.　He is now performing judo pain-free, and diagnostic imaging has shown bone fusion.　The abdominal muscles have been thought to cause indicated avulsion fractures of iliac crest, but our intraoperative findings that strong traction on the tensor muscle of fascia lata and mesogluteus resulted in the avulsion in our patient.　Because the avulsed fragment was not continuous with the iliac bone and spontaneous bone fusion was considered unlikely, we opted to treat the fracture surgically.　As a result, 3 months later the patient was able to resume competitive judo, including powerful contact elements, pain-free.