臨牀透析 Vol.26 No.6(2-7)


特集名 維持透析患者の整形外科的疾患―手術の適応と非適応
題名 [各論]骨関節感染症―血液透析患者における化膿性脊椎炎
発刊年月 2010年 06月
著者 簗瀬 誠 偕行会名古屋共立病院整形外科
著者 成瀬 隆裕 偕行会リハビリテーション病院整形外科
著者 堀江 裕美子 偕行会名古屋共立病院整形外科
著者 高木 英希 偕行会名古屋共立病院整形外科
著者 松山 幸弘 浜松医科大学整形外科
【 要旨 】 化膿性脊椎炎では腰痛などの脊椎局所の疼痛や発熱を生じるが,発症様式は一様ではない.よって本疾患を念頭に疑わなければ診断できないことがある.MRIは発症早期より異常所見を示すことから,診断上もっとも重要な画像検査である.また,透析患者における破壊性脊椎関節症との鑑別にも有用である.脊椎に有痛性病変を疑い,CRP陽性の場合には積極的に当該脊椎のMRI検査を行うのが望ましい.化膿性脊椎炎の起炎菌のうちMRSAが占める割合は増加傾向にある.本稿で提示した透析患者においても高頻度にみられ,その予後は不良であった.
Theme Orthopedic Diseases Seen in Maintenance Dialysis Patients -- Surgical Indication and Non-indication
Title Pyogenic spondylitis in hemodialysed patients
Author Makoto Yanase Department of Orthopaedic Surgery, Kaikoukai Nagoya Kyoritsu Hospital
Author Takahiro Naruse Department of Orthopaedic Surgery, Kaikoukai Rehabilitation Hospital
Author Yumiko Horie Department of Orthopaedic Surgery, Kaikoukai Nagoya Kyoritsu Hospital
Author Hideki Takagi Department of Orthopaedic Surgery, Kaikoukai Nagoya Kyoritsu Hospital
Author Yukihiro Matsuyama Department of Orthopaedic Surgery, Hamamatsu University School of Medicine
[ Summary ] Patients with pyogenic spondylitis (PS) generally present with low back pain and systemic fever. Clinical features of this condition are not uniform, therefore the diagnosis of PS is sometimes difficult. Magnetic resonance imaging (MRI) can detect small changes in the spine in the early stages, which is very useful for diagnosising PS. MRIs are also useful for distinguishing destructive spondyloarthropathy from PS in the hemodialysed patient population. If the patient experiences pain and a high level of C-reactive proteins, MRI studies should be done on the affected spine as soon as possible. There has been a recent increase in PS caused by methicillin-resistant Staphylococcus aureus (MRSA). This study demonstrates that MRSA is frequently associated with PS patients who are receving hemodialysis and that their prognoses are poor.
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