麻痺を伴った胸腰椎破裂骨折に対する後方進入除圧固定術の成績

Surgical Results of Decompression and Fusion through a Posterior Approach for Thoracolumbar Burst Fractures with Paralysis

　抄録：麻痺を伴った胸腰椎破裂骨折に対し後方進入で除圧と2椎間固定を行い，1年以上経過観察した16例17破裂椎体を対象として骨癒合，合併症，麻痺の改善，固定部の矢状面アライメントの変化を調べた．全例で骨癒合が得られた．合併症はインストゥルメントの破損が3例にみられた．2例がスクリューの折損，1例がスクリューキャップの脱転であった．いずれも骨癒合完成後に生じたもので，症状およびアライメントに影響しなかった．神経障害，感染あるいは血管損傷はなかった．麻痺の改善は12例にmodified Frankel分類で1段階以上の改善が得られた．胸腰椎移行部，下位腰椎部を合わせた矯正損失は12.6°となっていた．本骨折に対する後方進入除圧・固定術は麻痺の改善が良好で合併症も少なく，術後の矯正損失はあるものの侵襲の少ない有用な術式と考える．

　We reviewed the surgical results of 17 thoracolumbar burst fractures in 16 patients treated by decompression and two segmental fusions through a posterior approach who had been followed-up for more than one year. Good spinal fusion had been achieved in all patients. Instrumentation failure occurred in 3 patients：pedicle screw breakage in 2 and dislodgement of a screw cap in 1. There were no complaints in these 3 cases, because complete had been achieved fusion in all of them. There was no neurological deterioration, infection, or vessel injuries related to surgery. Neurological recovery of more than one grade according to the modified Frankel classification was found in 12 patients. All the most recent follow-up, kyphotic correction had failed from 10 to 28° (mean：12.6°). Despite the large postoperative correction loss in kyphotic deformity, this surgical procedure yielded satisfactory results.