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筆者らはDuchenne型筋ジストロフィー(DMD)に伴う脊柱変形に対し,脊柱変形および骨盤傾斜の大きさに関わりなく,胸椎から骨盤を固定せずにL5までの後方矯正固定術を18症例に行い検討を行った.側弯は術前平均75°が術後平均24°,後弯は62°が32°となり,脊柱変形の矯正は良好であった.術後,全例において,骨盤傾斜の十分な改善と,座位バランスの改善を認め,腰痛を認めた症例も痛みは消失した.DMDの生命的予後は決して良好ではないが,この手術方法によってADLとQOLの向上を得ることが可能であった.
Duchenne muscular dystrophy (DMD) is often accompanied by spinal deformity. Spinal instrumentation and fusion to L5, rather than to the sacrum, is recommended for selected patients with scoliosis secondary to DMD. Most reports have recommended instrumentation and fusion to the sacrum or pelvis (sacropelvis), however, instrumentation to the sacropelvis is technically difficult, and there are many complications. The authors have performed instrumentation and fusion to L5 without regard to curve magnitude or pelvic obliquity and evaluated the clinical results. Mean scoliotic curvature was 75° preoperatively and 24° postoperatively. Mean kyphotic curvature was 62°, preoperatively, and 32° postoperatively. Scoliosis and kyphosis were relatively well corrected after surgery, and the corrections were well maintained. Treatment of patients with spinal deformity secondary to DMD by this surgical method resulted in good improvement of ADL and QOL.
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