びまん性特発性骨増殖症（diffuse idiopathic skeletal hyperostosis：DISH）を伴う脊椎骨折患者の臨床経過の特徴と術前管理の重要性について

Characteristics of the Clinical Course and Importance of Preoperative Management of Spinal Fractures Associated with Diffuse Idiopathic Skeletal Hyperostosis (DISH)

　背景：人口の高齢化に伴い，びまん性特発性骨増殖症(diffuse idiopathic skeletal hyperostosis：DISH)を伴う脊椎骨折の症例が増加傾向にある．

　目的：DISHを伴う脊椎骨折患者の臨床経過と術前管理の重要性について調査すること．

　方法：当院で手術を施行した21症例22骨折を対象とし，受傷機転や症状経過，治療成績を検討した．

　結果：低エネルギー外傷によるものが多く，骨折は中下位頚椎と胸腰椎移行部に集中していた．21例中7例が手術までに症状の増悪を認めた．

　まとめ：DISHを伴う脊椎骨折は不安定性が強く，経過中に神経症状の悪化を来しやすいため，多くの症例で手術を要する．

　Background：The number of patients with diffuse idiopathic skeletal hyperostosis (DISH) who experience a spinal fracture has gradually been increasing along with the aging of the Japanese population.

　Purpose：The aim of this study was to investigate the characteristics of the clinical course and the importance of preoperative management of patients with a spinal fracture and DISH.

　Methods：Twenty-one patients (22 fractures) who underwent surgical treatment at our hospital were enrolled in this study.　Their mechanisms of injury, clinical course, and surgical outcomes were investigated.

　Results：Many cases were injured by low energy forces, and most of the fractures were in the mid- to lower cervical spine or at the thoracolumbar junction.　In seven cases there was neurological deterioration before surgery.

　Conclusions:Most of the spinal fractures that occurred in the DISH patients were 3-column injuries and unstable.　Orthopaedic surgeons should be familiar with the surgical indications and difficulty of nonsurgical management in such cases.