臨床整形外科50巻7号

2015年07月発行

論述

氷冷灌流水の使用は椎弓形成術時の術後C5麻痺を有意に減少させる

著者： 武中章太¹ 細野昇¹ 向井克容¹ 立石耕介¹ 冨士武史¹

所属機関： ¹JCHO大阪病院整形外科

ページ範囲：P.629 - P.636

　目的：圧迫性頚髄症の除圧術後の上肢麻痺の原因として，エアードリルの摩擦熱による神経根熱傷害の可能性を考え，氷冷灌流水導入による上肢麻痺の頻度の減少効果を調査した．

　対象と方法：片開き式椎弓形成術に氷冷灌流水(平均12.1℃)を導入した前後で800例(室温群400例，氷冷群400例)を対象とし，術後上肢麻痺(三角筋，上腕二頭筋または上腕三頭筋がMMTで1以上低下)を比較検討した．

　結果：術後上肢麻痺は室温群38例(9.5％)に比し氷冷群16例(4.0％)で有意に減少した(p＝0.003)．腕ごとの多変量解析(1,600肢)では室温灌流水使用(p＝0.007)，椎間孔拡大術併用(p＝0.010)，open側(p＝0.017)が危険因子であった．術後2日以内に有意な減少を認め(p＜0.001，82％減)，術後3日以降では有意差はなかった(p＝0.565)．

　まとめ：エアードリル掘削時の灌流水を保冷剤で冷却することにより，椎弓形成術における術後上肢麻痺を有意に減らせることがわかった．

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