連続2椎間後方進入腰椎椎体間固定術の侵襲とリスク

Perioperative Complications of Patients Undergoing Two-level Posterior Lumbar Interbody Fusion for Degenerative Lumbar Diseases

　連続2椎間後方進入腰椎椎体間固定術（PLIF）を施行した37例（男4例，女33例，手術時平均年齢65歳）を対象に手術侵襲，周術期合併症について調査した．手術時間は244±37分，術中出血量は1,174±663mlであった．血液検査は術後徐々に回復したが術後2週を経過してもヘモグロビン，総蛋白，CRPは術前レベルまでは回復していなかった．合併症は17例（46％）で認められ，うち筋力低下は8例（22％）に発生し，6例（16％）では術後1年を超えて遺残した．2椎間PLIFは高いリスクを伴う術式との認識が必要である．

　We retrospectively investigated the perioperative complications of patients undergoing two-level posterior lumbar interbody fusion (PLIF). The subjects consisted of 37 patients (4 men and 33 women) who underwent two-level PLIF, after excluding patients with a history of lumbar surgery or rheumatoid arthritis or who were on hemodialysis. The mean age of the subjects at the time of surgery was 65 years old. Mean operation time was 244±37 minutes and mean estimated intraoperative blood loss was 1,174±663ml. The patients' hemoglobin concentration, blood total protein concentration, and serum C-reactive protein level had not returned to the normal range two weeks after surgery. Perioperative complications occurred in 17 patients (46％), and neurological problems were the most common, consisting of a sensory disturbance in 7 patients (19％) and motor weakness in 8 (22％). The motor weakness persisted for one year or more in 6 patients (16％). Two-level PLIF was associated with a higher rate of complications perioperative morbidy than previously thought.