臨床整形外科55巻7号

2020年07月発行

症例報告

胸椎前側弯症に対し後弯形成を試みた1例

著者： 畠山拓人¹ 渡辺航太¹ 鈴木悟士¹ 辻収彦¹ 名越慈人¹ 岡田英次朗¹ 八木満¹ 中村雅也¹ 松本守雄¹

所属機関： ¹慶應義塾大学医学部整形外科学

ページ範囲：P.881 - P.884

　胸椎前側弯症は，呼吸機能と矢状面アライメントに障害を来すことが多い．しかし保存療法には抵抗性で，手術でも正常な後弯を獲得することは困難である．今回われわれは，35°の胸椎前側弯を伴う14歳の思春期特発性側弯症例に対し，Ponte骨切り術を併用した後方アプローチ単独で30°の胸椎後弯を獲得し，良好な脊椎アライメントと呼吸機能の改善を認めた1例を経験した．

参考文献

1) Winter RB, Lovell WW, Moe JH. Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis. J Bone Joint Surg Am 1975;57(7):972-7.

2) Lowenstein JE, Matsumoto H, Vitale MG, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis:a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007;32(4):448-52.

3) Sidden CR, Katz ME, Swoveland BC, et al. Radiologic considerations in patients undergoing the Nuss procedure for correction of pectus excavatum. Pediatr Radiol 2001;31(6):429-34.

4) Lonner BS, Auerbach JD, Estreicher M, et al, Video-assisted thoracoscopic spinal fusion compared with posterior spinal fusion with thoracic pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg Am 2009;91(2):398-408.

5) Rauzzino MJ, Shaffrey CI, Wagner J, et al. Surgical approaches for the management of idiopathic thoracic scoliosis and the indications for combined anterior-posterior technique. Neurosurg Focus 1999;6(5):Article 6.

6) Watanabe K, Nakamura T, Iwanami A, et al. Vertebral derotation in adolescent idiopathic scoliosis causes hypokyphosis of the thoracic spine. BMC Musculoskelet Disord 2012;13:99.

7) Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg Am 2008;90(11):2509-20.

8) Luo M, Li N, Shen M, et al. Pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis:A systematic review and meta-analysis with emphasis on complications and reoperations. Medicine (Baltimore) 2017;96(27):e7337.