仙腸関節障害，梨状筋症候群，足根管症候群を合併した腰椎変性疾患の治療経験

Assessing the Treatment for Sacroiliac Joint Dysfunction,Piriformis Syndrome and Tarsal Tunnel Syndrome Associated with Lumbar Degenerative Disease

Ⅰ．はじめに

　腰椎変性疾患に対する外科的治療は有効性が確立しており，多種の方法により広く行われている．しかし，さまざまな原因によって手術後に症状が残存する場合があり，治療に難渋する症例が経験される．仙腸関節障害，梨状筋症候群，足根管症候群は，腰椎変性疾患と類似する臨床症状を呈し，腰椎変性疾患に合併した場合には，腰椎変性疾患に対する手術後に症状が残存し得る．そのため，腰椎変性疾患の診療を行う際には，常にこれら疾患の合併を念頭に置くべきである．本稿において，腰椎変性疾患に合併した3疾患に対しての治療成績を検討するとともに，各疾患に対する当科での治療方針および各疾患の臨床的特徴について，文献的考察を加えて報告する．

　OBJECTIVE: Sacroiliac joint (SIJ) dysfunction, piriformis syndrome (PFS) and tarsal tunnel syndrome (TTS) produce symptoms similar to lumbar degenerative disease (LDD). Patients who have these diseases plus LDD sometimes experience residual symptoms after surgery for LDD. We therefore assessed the results of treatment of SIJ dysfunction, PFS and TTS associated with LDD.

　PATIENTS AND METHODS: We assessed 25 patients who underwent surgery for LDD and were affected with SIJ dysfunction (12 patients), PFS (7 patients) or TTS (6 patients). SIJ dysfunction was treated with rest, drugs, pelvic band and sacroiliac joint block. PFS was treated with rest, drugs, physical exercise, injection of local anesthetic into the piriformis muscle, and surgical resection of the piriformis muscle. TTS was treated with drugs and tarsal tunnel opening. We analyzed the improvement score and recovery rate (JOA score) for both LDD surgery and the treatment of SIJ dysfunction, PFS and TTS.

　RESULTS: Symptom improvement was observed in all patients with SIJ dysfunction and PFS and in 4 patients with TTS. The improvement score and recovery rate of treatments for SIJ dysfunction, PFS and TTS were lower than those of surgery for LDD.

　CONCLUSION: The improvement score and recovery rate of treatment for SIJ dysfunction,PFS and TTS were not as high as those for LDD. To enhance patient satisfaction,it is important to consider these complicating diseases when designing treatments for LDD.