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我々の施設では, 口腔癌に対して機能温存, 形態温存を目的に動注, 放射線同時併用療法を行っている。今回は, 一次治療時で腫瘍が消失し外科療法を行わずに良好な経過が得られている下顎歯肉癌の1例について報告する。患者は65歳女性で, 初診時, 左側下顎歯槽部を中心に38×26mmの腫瘍を認め, X線所見にて下顎管におよぶ骨吸収を認めた。入院後, 浅側頭動脈カニュレーションを行い, PEP (総量48mg) , MTX (総量200mg) およびCDDP (総量100mg) の3剤併用化学療法と放射線療法 (Linac総線量40Gy) を行った。治療後臨床的に腫瘍は縮小, 消失し, positoron emission tomographyによる機能的画像診断による治療効果の評価でもCRと判定した。治療後2年2か月経過した現在, 再発, 転移は認めていない。

A 57-year-old patient with rheumatoid arthritis showed posterolateral impingement after total knee arthroplasty. The radiographs showed bone cement extrusion posterolateral to the tibial tray. Arthrotomy through a posterolateral approach revealed that the impingement was caused not only by cement extrusion against the fibular head but also by proximal tibiofibular joint instability. It was speculated that rheumatoid arthritis had caused proximal tibiofibular instability, active knee motion had caused fibular head shift by tension of biceps femoris and the fibular head had been impinged on the extruded cement. In cementing the tibial tray, especially in a rheumatoid patient, it is of paramount importance to take caution against posterolateral cement extrusion in order to minimize the risk of fibular head impingement during total knee arthroplasty.