高齢者骨粗鬆症性椎体骨折に対する手術成績の検討

Results of Surgical Treatment of Osteoporotic Vertebral Fractures in the Elderly

　骨粗鬆症性椎体骨折に対して施行した前方固定術9例(A群)，前方後方合併手術8例(AP群)，後方短縮骨切り術9例(S群)を後ろ向きに比較検討した．再手術例では再手術直前を，再手術なしの症例では最終観察時をend pointと定義し術式間の比較に用いた．AP群が他の2群と比べ有意に手術時間が長く，S群がA群に比べ有意に術直後矯正角が大きかった．統計学的な有意差はなかったものの最大改善時およびend pointの腰背部痛，end pointの移動能力，矯正損失(術直後→end point)においてS群でよい傾向がみられた．end pointの設定により，S群においてよい結果が得られていた．

　The clinical and radiographic results of major surgery for osteoporotic vertebral fractures in an anterior spinal fixation group (A Group, 9 cases), a single-stage combined anterior-posterior procedure group (AP Group, 8 cases), and a posterior closing wedge osteotomy group (S Group, 9 cases) were compared retrospectively.　Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparisons.　The operation time in AP Group was significantly longer than in the other two groups.　The postoperative correction of kyphosis in S Group was significantly larger than in A Group.　Although the differences were not significant, better outcomes in regard to the following were obtained in S Group：1) back pain relief both at the peak back pain relief after surgery and at the end point, 2) ambulatory ability at the end point, 3) average loss of correction.　S Group had better surgical results at the time of the end point.