大腿前内側部にポンプを植込んだバクロフェン髄注療法の1例

A Case Report of Intrathecal Baclofen Therapy with Infusion Pump Implantation into the Antero-medial Thigh

はじめに

　バクロフェン髄注（intrathecal baclofen：ITB）療法における薬液供給ポンプは腹部に植込むのが一般的である．しかし，腹部に対するさまざまな処置や手術の影響により，腹部にポンプを植込むスペースを確保することが困難な症例がある．今回，大腿部にポンプを植込み良好な経過を得た症例を経験したので報告する．

Intrathecal baclofen (ITB) therapy is used to treat patients with spasticity. The pump that delivers baclofen to the intrathecal space of the thoracolumbar spine is generally implanted under the skin or fascia of the anterolateral abdomen. Here we present a case in which the pump was implanted in an alternative site, under the skin of the anteromedial thigh. The patient was a 61-year-old man who was 148 cm tall. He had spastic paraplegia (ASIA Impairment Scale grade B) caused by severe scoliosis related to dystrophic neurofibromatosis. No safety space for pump implantation existed in his abdomen because of a stoma, scars, and adhesions that resulted from surgeries for ileus and abdominal aortic aneurysms. The catheter ran from the lumbar spine to the anteromedial thigh via the point between the iliac crest and the great trochanter. The catheter and pump caused no trouble over 1 year of follow-up. This case demonstrates that the thigh can be an alternative site for ITB pump implantation in some patients with abdominal wall problems. This surgical modification may not be indicated for some patients with ambulators or frequent hip motion, who are at risk of catheter problems or pump migration.