脊髄空洞症患者に生じた尺骨偽関節の1例

Ulnar Fracture Nonunion in a Patient with Syringomyelia. Case Report

　痛覚障害患者は外傷の自覚がなく治療が遅れることが示唆されている．われわれは，脊髄空洞症患者に生じた尺骨偽関節の1例を報告する．症例は39歳の女性で，転倒して手をついた際に轢音を自覚したが，疼痛なく放置していた．1カ月後に尺骨骨幹部骨折と診断され，この骨折を契機に脊髄空洞症であることが判明した．保存的治療を行ったが偽関節となり，橈骨頭亜脱臼を併発したため，受傷後3年で尺骨偽関節手術(腸骨骨移植)を施行した．痛覚障害患者においては痛みがないために診断や治療が不確実になりやすく，この症例においても早期に手術治療を検討すべきであった．

　Patients with nociceptive disorders have been reported to sustain injuries without realizing it, thereby leading to delays in medical treatment.　We report a case of ulnar fracture nonunion in a patient with syringomyelia.　The patient was a 39-year-old woman who noticed a crack in her hand after a fall and was diagnosed with an ulnar shaft fracture one month later, when the diagnosis of syringomyelia was also made. Conservative therapy was ineffective, and the result was ulnar nonunion and radius head dislocation.　Plate osteosynthesis with autologous bone grafting was performed 3 years after the injury.　We concluded that it is necessary to be aware of nociceptive disorders when diagnosing and treating bone fractures in patients with syringomyelia.　Early surgical treatment should have been considered in our patient.