外傷性脊椎後弯変形に対する手術療法

Surgical Treatment of Post-Traumatic Kyphosis : Review of 7 Cases

　抄録：脊椎外傷により脊椎後弯変形を呈した7例に対して脊椎矯正術を行った．全例胸椎脱臼骨折が原因で，局所の疼痛が強く体幹バランスが不良であった．手術は前後合併手術を4例，後方進入単独の矯正骨切り固定術を3例施行した．全例に骨癒合が得られ，後弯部の疼痛は消失した．脊椎後弯変形の手術療法における問題点として，矯正における整復障害因子（軟部組織の拘縮，大血管の癒着）の除去，罹患椎の再建，矯正位の保持が挙げられる．後弯が高度である場合には椎体前方部の剝離が困難であるため，前後合併手術が安全である．また不全麻痺例では，後方単独では除圧操作が困難なため前後合併手術が安全である．一方，後弯や椎体損傷の程度が比較的軽度であり，完全麻痺例の場合には後方進入単独のみで対処可能であり，症例に応じた術式の選択が必要である．

　We reviewed 7cases of post-traumatic kyphosis with indications for spinal corrective osteotomy and posterior fusion with instrumentation. Each of the 7 cases was secondary to fracture-dislocation of the thoracic spine, and the level of the injuries was at T4/5 in 1 case, T11/12 in 4 cases, and T12/L1 in 2 cases. The patients consisted of 5 men and 2 women. Four patients underwent combined surgery by the anterior and posterior approach, and the other three patients underwent surgery by the single posterior approach. After correction, the kyphotic angle was reduced from an average of 49 degrees to an average of 9 degrees by the combined approach, and from an average of 36 degrees to an average of 13 degrees by the single posterior approach. Selection of the surgical procedure for post-traumatic kyphosis depends on the severity of the kyphosis, vertebral body damage, dislocation, and paralysis. In severe kyphosis, vertebral body damage, or dislocation the combined approach proved safe and useful in releasing the contracture of the paravertebral soft tissue and preventing neurological complications. Even the single posterior approach was useful in correcting mild or moderate kyphosis.