回復期に生じた股関節周囲の異所性骨化に対して外科手術とリハビリテーション治療で移乗が自立した頚髄損傷の1例

Efficacy of Surgery and Rehabilitation for Cervical Cord Injury with Concomitant Heterotopic Ossification around the Hip Joint on the Acquisition of Transferable Movements

はじめに

　異所性骨化は中枢神経系の損傷，四肢の外傷，人工関節置換術後などの合併症の1つである．脊髄損傷での異所性骨化の発生頻度は18〜86%と報告に差があるが¹⁾，通常臨床で問題となるようなものは10〜20%とされる²⁾．異所性骨化が発生すると，関節可動域制限により基本動作・日常生活動作に障害をきたす可能性がある．異所性骨化の外科的手術の時期としては骨化出現後1〜2年の骨化成熟後が基本とされている^{3, 4)}．

　今回，回復期リハビリテーションにおいて左股関節に生じた異所性骨化により，関節可動域と移乗動作の制限をきたした頚髄損傷患者を担当した．この患者に対し，異所性骨化出現4カ月後に外科手術と術後リハビリテーション治療を行ったことで，関節可動域の改善および移乗動作の自立に至った症例を報告する．

　なお，症例報告として論文投稿することについて，患者様本人・家族から書面にて同意を得ている．

Heterotopic ossification (HO) is one of the complications of a cervical cord injury that results in limited range of motion, which can interfere with basic movements and activities of daily living. We encountered a case of a cervical cord injury patient with limited range of motion and mobility due to HO of the hip joint who experienced improvement in both as a result of early surgery and rehabilitation. A 17-year-old boy was diagnosed with a cervical cord injury due to an anterior fracture of the sixth cervical vertebrae following a fall into a pool. It was classified as bilateral C6BII according to the Zancolli's classification for cervical cord injury. The patient presented with limited range of motion in his left hip and was diagnosed with HO four months after the injury. Eight months after the injury, his hip range of motion deteriorated further；consequently, he required continuous transfer assistance. Therefore, surgical HO removal was performed during this period of convalescent rehabilitation. The patient underwent constant post-operative rehabilitation, and the range of motion in his left hip joint improved；thus, he became independent in transfer activities. A concomitant HO after a cervical cord injury can lead to functional impairment in convalescent rehabilitation. In addition, no practice guidelines have been developed that include recommendations on when to perform surgical procedures for HO. Treatment of HO with a combination of immediate surgery and aggressive rehabilitation can be expected to restore function and maximize activity and participation in patients with cervical cord injury with concomitant HO.