糖尿病を合併した圧迫性頚髄症例に対する脊柱管拡大術の成績

Clinical Result of Expansive Laminoplasty for Compressive Cervical Myelopathy in Diabetic Patients

　糖尿病（以下DM）を合併症に持つ圧迫性脊髄症患者14例に対する脊柱管拡大術の治療成績について27例の非合併例と比較検討した．JOA改善率に両者間で有意差はなかったが，経過観察時のJOAスコア平均値はDM群で有意に低かった．DM群では下肢知覚障害の改善が悪く，特に下肢反射の低下，消失症例で劣っており，原因としてDM神経障害の合併が推察された．罹病期間，術前HbA1c値は臨床経過に影響していなかった．

　The therapeutic effect of open-door expansive laminoplasty was clinically evaluated in 14 cases of cervical myelopathy with diabetes mellitus (DM), and the outcome was compared to that of 27 non-diabetic cases. The recovery rate, as determined by comparing the JOA scores did not show any significant difference between the groups at the time of the follow-up. The average JOA score of the DM group was significantly lower at the follow-up, in particular, the average sensory score of the lower extremities was poorer than that of the control group. Among the DM cases whose Achilles reflexes decreased, the average sensory score was significantly lower than that of the cases whose reflex did not decrease. Diabetic neuropathy was suspected as the cause of the reduction in the Achilles reflex in the DM patients, and affected the clinical results. The improvement rate was not correlated with either the period of DM or the HbA1c value.