広範なComplete scalp avulsionに続発した頭蓋骨のSpreading osteomyelitisの1例

Spreading Osteomyelitis of the Skull following Complete Scalp Avulsion : Case report

I．はじめに

　1899年Tilley^22）は，前頭洞の手術後に発生した前頭骨全体に及ぶosteomyeli-tisをspreading osteomyelitisとして初めて報告した．それ以後，比較的多数の報告例がみられていたが^22），しかし最近の抗生物質の発達と医学の進歩により，spreading osteomyelitisがわれわれの目にはいることはほとんどなくなった^{2,8，18,20,23）}．

　Woodhall^23）は，1955年から1965年に17例の頭蓋骨のosteomyelihsを経験し，原因を次のように分類した——開頭術後7例，cervical traction tongによるもの4例，頭部外傷後3例，副鼻腔炎に続発するもの2例，frozen bome flapによるもの1例．同様にBullitt and Lehman^2）も18例の頭蓋骨骨髓炎を報告しているが，osteomyelihsは限局性のものばかりである．頭蓋骨全体に及ぶostcomyelitisはWood-hall^23）が1944年のOdomの手術をした1例を引用しているのみである．

A 63-year-old man was involved into a train accident at a crossing on February 21, 1980 and admitted to a local hospital. His scalp, 8× 8 cm in width, was Completely avulsed from the midline frontoparietal skull. The avulsed scalp was simply reimplanted as soon as possible. Before long, however, the flap became necrotic and infected. He was referred to mother local hospital on March 10, 1980, where he had two limited sequestrectomies for intractable osteomyelitis. However, his wound did not tend to hseal and Serratia Marcescens was cultured from the pus. Finally, he was transferred to our hospital on July 18, 1980.