骨粗鬆症性椎体偽関節に対する広範囲後方固定併用手術の成績―前方支柱骨移植とハイドロキシアパタイトブロックを用いた椎体形成術の比較

Anterior Column Reconstruction Combined with Posterior Spinal Fusion for Pseudoarthrosis after Osteoporotic Vertebral Fractures : Anterior Strut Bone Graft Versus Vertebroplasty with Hydroxyapatite Blocks

　背景：骨粗鬆症性椎体偽関節の手術においては前方支持機構再建が重要であるが，報告により術式は様々であり，これらを単純には比較できない．

　対象と方法：4～6椎間の後方固定術を併用した27例を対象とし，前方支柱骨移植術を施行した12例と，ハイドロキシアパタイトブロックを用いた椎体形成術を施行した15例を比較した．

　結果：手術時間や出血量といった手術侵襲は前者で有意に大きく，矯正損失や臨床成績には有意差を認めなかった．

　まとめ：広範囲後方固定併用時の前方支持機構の再建方法は椎体形成術で十分と考えられた．

　Background：The purpose of this study was to compare the results of anterior strut bone graft and vertebroplasty with hydroxyapatite blocks as a means of anterior spinal column reconstruction in patients with pseudoarthrosis after an osteoporotic vertebral fracture at the thoracolumbar junction.

　Methods：There were 27 subjects, and they were divided into two groups：a group treated with an anterior strut bone graft and posterior spinal fusion (PSF) (AP group, n＝12) and a group treated by vertebroplasty with PSF (VP group, n＝15).　The number of fused segments ranged from 4 to 6 (average 4.8).　We measured the local kyphotic angle on preoperative, postoperative, and final plain radiographs.

　Results：The average angles were 25°, 10.5° and 14.2°, respectively in the AP group and 19.3°, 11.6° and 14.7°, in the VP group.　There were no significant differences between the 2 groups in local kyphotic angles or loss of angular correction.　Operation time and blood loss were significantly greater in the AP group than in the VP group.　The clinical outcome measures, including JOA score, recovery of neurological deficits, incidence of instruments failure, and new vertebral body fractures, were not significantly different in the 2 groups.

　Conclusion：Comparison with anterior strut bone grafts with PSF showed that vertebroplasty with PSF was a less invasive and equally effective procedure that provided pain relief and spinal stabilization.