関節リウマチ腰椎病変に対する後方進入腰椎椎体間固定術（PLIF）の治療成績

Posterior Lumbar Interbody Fusion for Rheumatoid Arthritis Patients

　関節リウマチ(RA)患者の腰椎病変に対する手術治療(単椎間後方進入腰椎椎体間固定術)の術後1年短期成績について，RA患者10例(RA群)と非RA患者10例(非RA群)を対象とし，術後合併症，骨癒合率，固定椎矯正損失(椎体高，椎体固定角，椎体すべりの変化)，臨床症状または画像上の固定隣接椎間障害(ASD)，JOAスコア改善率，JOABPEQを後ろ向きに検討した．RA四肢関節機能障害が原因と思われる評価項目を除き臨床成績・骨癒合率ともにRA群と非RA群に有意差を認めなかった．しかし，画像上のASDはRA腰椎病変を認めた6例中2例(33％)と高頻度に認めた．

　The subjects were 20 patients who underwent single-level posterior lumbar interbody fusion (PLIF), and they were divided into a rheumatoid arthritis (RA) group (n＝10) and a non-RA group (n＝10) and retrospectively evaluated.　Postoperative complications and the non-union rate, loss of correction at the fused level, and adjacent segment degeneration (ASD) at the 1-year follow-up examination were reviewed.　Clinical results were evaluated on the basis of the Japanese Orthopaedic Association (JOA) scores and the replies to the Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ).　There were no major complications or non-union in either group, and there were no significant differences between the groups in loss of correction at the fused level or clinical outcomes.　However, there was a high incidence of ASD after PLIF among the patients in the RA group who had rheumatoid lesions, and the presence of lumbar rheumatoid lesions may have played a role in the etiology of the ASD after PLIF.