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腰痛下肢痛を主訴とする腰部脊柱管狭窄症(lumbar canal stenosis;LCS)と下肢閉塞性動脈硬化症(peripheral arterial disease;PAD)がともに症状に関与する「合併型」の存在が報告されており,間欠跛行症状を訴える患者を診察する際には整形外科医でもPADの診断が必要となる.研究目的は,①LCSとPADの合併率と有効なPADの検査法,②リマプロストが無効であったLCS患者に対するLipo PGE1の有効性について検討することである.対象としたLCS患者19例中6例(31.6%)にPADの合併を認めた.検査法としては足関節/上腕血圧比(ABI)・足趾/上腕血圧比(TBI)は低侵襲でPAD検出率も高いが,特にTBIの検出率が優れており,ABIが正常でもTBIが異常な症例が多かった.また経口リマプロスト製剤が無効であったLCS患者において,2週間のLipo PGE1点滴静注により腰痛および下肢痛,患者QOLの有意な改善を得た.
Objective:To investigate the prevalence of lumbar canal stenosis (LCS) with peripheral arterial disease (PAD) and identity the optimal method of diagnosing PAD. Background of Data:The number of cases of LCS with PAD has been increasing recently, although its exact prevalence is unknown. Results:PAD was noted in 6 (31.6%) of 19 patients with LCS. ABI and TBI were less invasive examination procedures, and the PAD detection rates were high. TBI was particularly, useful for detecting PAD. Even when the results of ABI were normal, TBI revealed abnormal findings in many patients. In LCS patients who did not respond to an oral limaprost alfadex preparation, a 2-week course of intravenous Lipo PGE1 relieved lumbar/lower limb pain and significantly improved the patients' quality of life. Response to Lipo PGE1 therapy can be evaluated 2 weeks after the start of treatment.
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