踵骨骨折術後骨髄炎に対する鏡視下手術の1例

Endoscopic Treatment of Postoperative Osteomyelitis of a Calcaneal Fracture. Case Report

　症例は75歳の男性で，転倒により左踵骨骨折を受傷して経皮ピンニングを施行し，術後15日目に踵骨MRSA骨髄炎，距骨下関節化膿性関節炎を発症した．関節鏡視下に距骨下関節内および踵骨骨髄内のデブリドマンを施行し，術後1年で感染の再発は認めていない．一般に骨・関節に達するsurgical site infection(以下SSI)においては徹底的なデブリドマンにより骨欠損が広汎となり，骨組織の脆弱化が危惧される．しかし自験例のように関節鏡を骨髄内視鏡として使用することで，骨髄内病巣の評価と処置を最小限の侵襲で行うことが可能であり，今後選択肢の一つとして検討に値する．

　A case of calcaneal fracture with surgical site infection (SSI) treated by endoscopic debridement is reported. On postoperative day 15, the patient developed calcaneal osteomyelitis and septic arthritis of the subtalar joint as a result of infection by MRSA. We debrided the calcaneus and subtalar joint arthroscopically, and no recurrence of the infection has been detected as of 1 year after the operation. The treatment of acute SSI involving bone, requires thorough, open debridement, which may result in destabilization of the bone. Endoscopic debridement, on the other hand, enables both evaluation and treatment of the infected bone with minimal invasion. Thus, an endoscopic approach to the SSI involving bone (medulloscopy) is a useful option, since arthroscopy is frequently used in the treatment of pyogenic arthritis.