脊椎骨折に硬膜外血腫を伴った乾癬性関節炎の1例

A Case of Psoriatic Arthropathy Complicated with Spinal Fracture and Epidural Hematoma

I．はじめに

　乾癬性関節炎は強直性脊椎炎，ライター症候群と互いに共通する疾患であり，血清反応陰性脊椎関節炎（seronegative spondyloarthropathy）という呼称で一括されている．これらの疾患は血清リウマトイド因子が陰性で，仙腸関節炎および脊椎炎が存在し，靱帯症を有しHLA B-27陽性率が高いという特徴をもつ．

　これらの疾患に共通する脊椎病変は，靱帯や関節包，腱付着部炎を来し，進行すると椎体間の骨性癒合によりbamboo spineとなる．強直した脊椎は軽微な外傷に対しても容易に損傷し，脊髄や神経根症状を呈する頻度が高いと言われている^8,9）．今回われわれは軽微な外傷によって引き起こされた脊椎骨折に硬膜外血腫を伴った症例を経験したので報告する．

A 78-year-old man with psoriatic arthropathy complicated with traumatic spinal fracture and epidural hematoma is reported. He had fallen down the stairs. On admission one hour after injury, he developed an incomplete C6 quadriparesis. CT revealed a C6-7 fracture and dislocation on sagittal reconstruction. MR imaging disclosed the compression of the spinal cord between the posterior margin of the vertebral body and an epidural hematoma.

The patient had had the skin lesion, psoriasis vulgaris, for about 20 years and been previously treated for uveitis. Serological tests for rheumatoid factor and HLA B-27 were negative.

Emergent laminectomy and evacuation of the epidural hematoma were carried out because of progres-sive neurological deterioration. Osteoporotic laminar bone and ossified yellow ligament were observed to have been fractured. Conservative therapy was selected for spinal instability. Although a respiratory com-plication occurred postoperatively, he was transferred to the rehabilitation facility in an improved neurolo-gical condition.