全周性自家脛骨移植による前方固定術を施行した結核性脊椎炎の1例

Tuberculous Spondylitis Treated by Anterior Fusion with a Full-thickness Autologous Tibial Graft. Case Report

　症例は62歳，男性，結核性脊椎炎と足関節炎を併発していた．抗結核薬投与後も改善なく，足関節の再建は困難と判断し，左下腿切断術およびT12-L3の病巣掻爬と前方固定術を施行した．脊椎固定の移植骨には，切断肢から採取した全周性の脛骨を用いた．術後1年で骨癒合は確認され，術後5年でも良好な脊椎アライメントが維持されていた．脛骨は，全周性の強固な皮質骨と豊富な海綿骨を有するため，早期の骨癒合が期待でき，また支持性を必要とする脊椎固定の移植骨として極めて稀な症例で使用したところ，良好であった．

　We report a case of tuberculous spondylitis treated by anterior spinal fusion with a full-thickness autologous tibial graft.　The patient was a 62-year-old man with tubercle bacillus infection of his left ankle and lumbar spine.　Although he had been treated by chemotherapy with antitubercular agents, the vertebral destruction was progressive.　Below knee amputation was indicated for the ankle infection, because the severely infected ankle could not be reconstructed.　After the below knee amputation the vertebral lesion was curetted, and anterior spinal fusion from T12 to L3 was performed with a bone graft taken from the amputated tibia.　Solid bone union was confirmed one year after surgery.　Lumbar alignment has been maintained with in the normal range for 5 years.　Full-thickness autologous tibial grafts are considered suitable for vertebral fusion because of the structural stability provided by the circumference of cortical bone and bone induction by the abundant cancellous bone.