外傷後に遅発性麻痺を生じた強直脊椎の2例

Delayed Paralysis after Trauma in Patients with Spinal Ankylosis. Report of Two Cases

　今回，われわれは外傷後に遅発性麻痺を生じた強直脊椎の2例を経験したため報告する．

　症例1は93歳の女性で，受傷から2週で麻痺が出現し，4週後に当院を受診した．入院後に保存加療を行ったが，受傷9週で肺炎を発症し，敗血症となり死亡した．症例2は86歳の女性で，受傷から1週で麻痺が出現し，3週後に当院を受診した．後方固定術を施行したが，術後1日目に出血性ショックのため死亡した．強直脊椎の患者では，遅発性に骨折部の転位や脱臼を生じやすい．そのため初診時にただちにMRIを施行するなど早期での診断を行い，早期治療を行うことが必要である．

　We report two cases of spinal ankylosis in which the patient developed delayed paralysis after trauma.　The patient in case 1 was a 93-year-old woman who developed paralysis two weeks after trauma and consulted us two weeks later.　We treated her conservatively with a cast brace, but two months later she died of sepsis secondary to pneumonia.　The patient in case 2 was an 86-year-old woman who developed paralysis 1 week after trauma and consulted us three weeks later.　We performed posterior fusion of the vertebral bodies with instrumentation and vertebroplasty, but the patient died of hemorrhagic shock on postoperative day 1 since fractures of a spiral ankylosis tend to cause delayed dislocation and palsy.　Patients must be followed up carefully.　Early diagnosis and treatment of such fractures prevents spinal paralysis.