Open wedge高位脛骨骨切り術後感染の1例

Infection after Open-Wedge High Tibial Osteotomy. Case Report

　Open wedge高位脛骨骨切り術(以下，HTO)では骨切り部を開大させるため，感染した場合にその鎮静化は困難である．58歳男性の変形性膝関節症に対しopen wedge HTOを施行し，術後3週でメチシリン耐性コアグラーゼ陰性ブドウ球菌による感染後，菌交代現象により緑膿菌感染を発症した症例を経験した．デブリドマン，抜釘，抗生剤含有セメント充塡，膝関節創外固定に引き続き，抗生剤含有リン酸カルシウム骨ペースト充塡と脛骨ハイブリッド型創外固定など計5回手術を施行した．感染の鎮静化には抗生剤含有セメント充塡と膝関節固定が，また感染再発予防と外反アライメントの維持には抗生剤含有リン酸カルシウム骨ペーストと脛骨ハイブリッド型創外固定が有用であった．

　Infections after open-wedge high tibial osteotomy are difficult to cure, because a huge dead space is created at the osteotomy site.　Open-wedge high tibial osteotomy was performed on the osteoarthritic knee of a 58-year-old male.　Postoperatively the osteotomy site became infected by methicillin-resistant coagulase-negative Staphylococcus epidermidis and then by Pseudomonas aeruginosa.　A total of five surgical procedures, consisting of debridement, removal of the plate, irrigation, insertion of antibiotic-containing bone cement, and extraskeletal knee fixation, were required to overcome the infection.　Ultimately, the osteotomy site was filled with antibiotic-containing calcium phosphate bone paste and non-bridge hybrid extraskeletal fixation was performed, and complete resolution of the infection was confirmed.　Filling the osteotomy site with antibiotic-containing bone cement in addition to extraskeletal knee fixation first and non-bridge type extraskeletal fixation with antibiotic-containing bone paste subsequently were effective in eradicating the postoperative infection after open-wedge high tibial osteotomy.