Bone transport後に感染が再発し高気圧酸素療法を併用した脛骨感染性偽関節の1例

Bone Transport and Hyperbaric Oxygen Therapy for Treatment of Infectious Non-union of the Tibia after an Open Fracture. Case Report

　症例は21歳の男性で，Gustilo type IIIBの下腿開放骨折後，メチシリン耐性黄色ブドウ球菌(MRSA)による感染性偽関節となった．3回の掻爬と抗菌含有セメントビーズ挿入で感染は沈静化したが，約6cmの骨欠損が生じたため，bone transportを行った．その後，偽関節部分で緑膿菌による感染が再発したため，再掻爬し，創外固定器で固定したうえで，高気圧酸素療法を併用した．再発後1年の現在，骨癒合は得られ，感染徴候はみられない．感染性偽関節のbone transport後の再発例に対して，高気圧酸素療法は有効な治療法であった．

　The treatment of post-traumatic osteomyelitis accompanied by severe soft-tissue injuries and bone defects has continued to be a therapeutic problem for orthopedic surgeons.　The patient was a 21-year-old male who sustained a Gustilo type IIIB open fracture of his left tibia in a traffic accident.　MRSA osteomyelitis of the tibia developed as a complication, and debridement of necrotic tissue and filling with bone cement containing antibiotics was performed three times.　After the infection improved, bone transport was performed with Ilizarov fixators, and temporary bone union was achieved.　However infection caused by Pseudomonas aeruginosa occurred at the same fracture site.　Debridement and fixator application was performed again, but this time they were followed by hyperbaric oxygen therapy.　Thereafter bone union was achieved and the osteomyelitis was cured completely.　Distraction osteogenesis with Ilizarov fixators allowed bone union and compensated for the soft tissue defects.　Hyperbaric oxygen therapy was a useful choice of treatments for recurrence case of osteomyelitis after bone transport.