臨床整形外科48巻5号

2013年05月発行

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脊柱後弯症の手術（第2回）

著者： 竹光義治¹

所属機関： ¹旭川医科大学

ページ範囲：P.474 - P.482

(48巻4号から続く)

円背型重度後弯症に対する矯正手術

2．Smith-Petersen脊椎骨切り術による大動脈の破裂，その他の重篤な合併症について

　1956年，Lichtblauら³¹⁾は強直性脊椎炎の高度後弯例に麻酔下で後弯を徒手的に矯正中，惹起された大動脈断裂による1死亡例について(間接的ではあるが)初めて報告した．症例は35歳の男性で，前に放射線治療(2,000r)が施された既往があった．1回目の麻酔下の矯正操作でかなり矯正されたが，術後強い痛みに耐えられず元の変形に戻ったため，5週後同じく麻酔下に仰臥位で前胸部と骨盤を圧迫して矯正していたところ突然心肺停止となり死亡した．剖検でL1/2間の椎間前方に3cmの離開があり，同部に一致して大動脈後壁に完全横断裂が認められた(図12)．大動脈に石灰化はなかったが，前縦靱帯との間の癒着が原因と考えられた．

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