病的骨折および脆弱性骨折と鑑別を要した恥骨上下枝疲労骨折の1例

Stress Fracture of the Superior and Inferior Pubic Rami Simulating a Pathological or Insufficiency Fracture. Case Report

　症例は24歳の女性で，主訴は右股関節痛および恥骨部痛であった．特に外傷歴なく左股関節痛が生じ，単純X線，骨シンチグラムで恥骨上下枝骨折を認めた．既往に悪性疾患を有し，かつ骨盤への荷重ストレス，骨盤周囲筋の筋緊張をもたらすスポーツ歴，職業歴を認めた．精査の結果，悪性腫瘍の骨転移による病的骨折および骨粗鬆症による脆弱性骨折は否定的と考えられ，右恥骨上下枝疲労骨折と診断した．骨折型の診断において改めて問診の重要性を再認識した．

　It is sometimes necessary to rule out a secondary pathological fracture and insufficiency fracture in the diagnosis of fatigue fractures.　We report the case of a 24-year-old female with a fatigue fracture of the pubic rami that required ruling out a pathological fracture secondary to a metastatic bone tumor.　The patient had complained of right hip pain coxalgia but had no history of trauma, however, she had a history of surgery for intraepithelial carcinoma of the cervix uteri two years before we first examined her.　In addition, the patient had skipped rope as a sport for one hour every day for six years and had worked as a waitress in a bar where she had often kicked beer barrels weighting 20 kg with her right foot.　We carefully examined the patient, tested her for tumor markers, and had diagnostic imaging examinations performed, including X-ray examinations, bone scintigraphy, and contrast enhanced MRI.　This case illustrates the need for awareness of the patient's history in ruling out a traumatic fracture.