脊索腫に対する仙骨全摘後の再建術の工夫

Reconstruction Using Schanz-screws after Total Sacrectomy for Sacral Chordoma

　仙骨脊索腫に対する仙骨全摘術後の再建術に独自の工夫を行った．仙骨全体および左腸骨まで及ぶ巨大な脊索腫に対して，仙骨全再建方法はシャンツスクリューをL4・L5椎体に刺入する前方要素の再建および椎弓根スクリューを使用した後方再建を併用した．仙骨全摘術後の再建術において強固な支持性を得るためには前方再建も行うことが望まれるが，シャンツスクリューを使用した脊柱再建術は，良好な前方支持性を獲得できるとともに，手術操作をより簡便に行える方法である．

　We report a case in which the continuity between the spine and the pelvis after total sacrectomy for chordoma was reconstructed by an original instrumentation technique. A 69-year-old woman complained of severe leg pain that was found to have been caused by a sacral chordoma. Total sacrectomy and partial resection of the left side of the pelvis were performed, and during a second operation the continuity between the spine and the pelvis was reconstructed. Both the posterior column and the anterior column of the spine were reconstructed by our method. The anterior instruments consisted of two iliac screws and two Schanz screws inserted into the L4-L5 vertebrae. The patient was able to walk using parallel bars six months later. Both anterior and posterior instrumentations are necessary to obtain great stability. Our method consists of both instrumentations and provides great stability.