腰部脊柱管狭窄の診断における歩行負荷試験の有用性の検討

Diagnostic Value of Gait Loading Test in the Patients with Lumbar Canal Stenosis

　本研究の目的は，腰部脊柱管狭窄の診断における歩行負荷試験の有用性を前向きコホート研究により検証することである．当科で腰部脊柱管狭窄の診断で手術を行った109例(男67例，女42例)を対象とした．術前の歩行負荷試験前後での自覚症状と他覚所見の変化から神経障害型式と責任高位の判定について検討した．その結果，自覚症状の変化を全例に，他覚所見の変化を77例(71％)に認めた．神経障害型式判定が変化した症例が11例(10％)存在した．また，新たな責任高位が判明した症例が11例(10％)存在した．神経障害型式と責任高位がともに変化した症例は1例であった．以上の結果から，歩行負荷試験は腰部脊柱管狭窄の神経障害型式と責任高位の判定に必要な手技の一つであるといえる．

　Neurogenic intermittent claudication (NIC) is the most characteristic symptom in patients with lumbar spinal stenosis (LSS).　Typically the symptom does not exist at rest, and appears with gait.　The aim of this study was to verify the diagnostic value of the gait-loading test in assessment of NIC by prospective cohort study.　One hundred nine surgical cases of LSS, 66 males and 42 females were included.　Patients were subjected to the long distance gait with a doctor and asked to walk as long as possible.　We examined subjective symptoms and objective findings, before and after the gait-loading test.　Changes of symptoms and findings, and diagnostic value of the gait-loading test for types of NIC and responsible-level were assessed.　In all cases, there were some changes in subjective symptoms.　In 77 cases(71%), there were some changes in objective findings.　There were 11 cases(10%) in which the gait-loading test helped determine the truth types of NIC, and 11 cases(10%) in which helped to a new responsible-level.　There was one case in which the gait-loading test helped determine the truth types of NIC and a new responsible-level.　These results suggest that the gait-loading test helps more precise assessment of NIC, and it is one of the important test to assess the responsible-level and types of NIC in patients with LSS.