血管柄付き肋骨移植を行った骨粗鬆症性椎体圧壊の3例

Osteoporotic Vertebral Collapse Treated by Vascularized Rib Grafting : Report of Three Cases

　抄録：骨粗鬆症性椎体圧壊は時に強い疼痛や麻痺などを惹起し，高齢者のQOLを著しく損なう．今回，ハイドロキシアパタイト（HA）ブロックを併用した血管柄付き肋骨移植を行った椎体圧壊の3例を経験した．症例1，2は63歳女性，症例3は51歳女性であり，それぞれ関節リウマチ（RA），慢性気管支炎による低酸素血症，血小板減少性紫斑病などの基礎疾患を有するcompromised hostであった．罹患高位はT12，L1，T11であり，全例強度の腰背部痛を有し，脊髄・神経根症状のため歩行障害を呈していた．手術はMini-ALIFの開窓器を用いた少切開で進入し，椎体を掻爬後，前方にHA緻密体ブロック，後方に血管柄付き肋骨を移植した．全例で骨癒合および疼痛，麻痺の改善が得られた．本法は比較的低侵襲で行い得る椎体修復術であり，特に神経症状を呈するcompromised hostには有用な方法であると思われた．

　Three patients, all females, age 63, 63, and 51 years, respectively, with osteoporotic vertebral collapse and late neurological complications were treated by vertebroplasty with a composite graft consisting of a hydroxyapatite block and vascularized rib. All three patients had severe back pain and neurological deficits including sensory and gait disturbances secondary to compression of neural structures by the collapsed posterior vertebral body. One patient had rheumatoid arthritis and was on steroid therapy；another patients had chronic bronchitis and hypoxemia；and the third patient had thrombopenic purpura. Thus, all three patient's general condition was compromised. Surgery was performed in a minimally invasive manner with a Mini-ALIF retractor. All patients improved after surgery and regained walking ability with no peri-or post-operative complications. This method is an effective and minimally invasive means of treating patients with osteoporotic vertebral collapse and neurological deficits, and patients whose general condition is compromised may be the best candidates.