強直性脊椎骨増殖症に合併した椎体骨折の治療経験

Treatment of Fractures of the Thoracolumbar Vertebral Bodies with Ankylosing Spinal Hyperostosis

　強直性脊椎骨増殖症（以下ASH）は1950年にForestierによって提唱されたが，ASHに合併した椎体骨折の報告は少ない．われわれはASHに伴う胸腰椎移行部椎体骨折の6例を経験したので報告する．手術時年齢は48歳から83歳（平均72歳），骨折高位はT11，L1骨折が各2例，T10，T12骨折が各1例ずつであった．4例に遅発性膀胱直腸障害や両下肢不全麻痺が生じた．3例に後方固定術を行った．残り3例に経椎弓根的に椎体形成術を施行したが，2例は効果なく前方固定術を追加した．本症の骨折は骨折部にストレスがかかり保存治療に抵抗性で，強固な固定術を要することが多かった．

　Ankylosing spinal hyperostosis (ASH) was reported by Forestier in 1950. Reports on fractures of spinal vertebral bodies with ASH are rare. We undertook surgical treatment for 6 patients with fractures of thoracolumbar vertebral bodies with ASH. The age of the patients operated on ranged from 48 to 83 years old (average, 72 yrs). Two patients had a fracture of T11 and L1, and one patient had a fracture of T10 and T12, respectively. Two patients had bladder and bowel disturbance, and incomplete palsy of the bilateral lower extremity later occurred in 2 patients. Posterior fusion of the vertebral bodies with instrumentation was carried out for 3 patients. Trancepedicular vertebroplasty was performed for the other 3 patients, but it was not effective in 2 patients and anterior fusion with instrumentation were added later. The fractures in these cases treated conservatively are difficult to unite because of stress on the fracture vertebral body and are often combined with neurological symptoms. Treatment of this type of fracture this requires hard fusion of the vertebral bodies.