40年間排膿が持続した結核性脊椎炎に二期的手術が有効であった1例

Tuberculous Spondylitis with Persistent Pus Discharge from Fistulas over a 40 Year Period Successfully Treated by a 2-Stage (posterior-anterior) Surgical Procedure

　症例は57歳の男性で，慢性難治性の結核性脊椎炎で当科に紹介された．背部の瘻孔から40年間排膿が持続し骨破壊による高度の後弯変形および腰下肢痛を認めた．手術は，まず後方固定術を行った．後方固定術を行うことにより強固な固定が得られるとともに除痛と全身状態の改善が得られた．ついで6週後に前方病巣廓清と血管柄付き有茎肋骨移植による前方再建術を施行した．前方廓清術後から排膿は消失，治癒し，術後9年の現在，再燃なく後弯変形の進行も認めていない．

　We report the case of a 57-year-old man with chronic refractory tuberculous spondylitis.　The patient had experienced persistent severe back and lower limb pain and drainage from fistulas on his back for 40 years, and he also had a severe kyphotic deformity.　In the first stage we performed posterior fusion with spinal instrumentation, and in the second stage, 6 weeks later, we performed anterior debridement and a vascularized rib graft.　The patient is well and has remained asymptomatic for 9 years since the operation.