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Scoliosis Research Society
SRS: Scoliosis Research Society

Scoliosis Research Society

脊柱変形の患者の最適なケアに捧げ

Traumatic Kyphosis

原因
外傷性後弯の多くは、胸腰椎または腰椎に発生します。この種の後弯は、ほとんどの場合、四肢麻痺や対麻痺のような重度の神経障害を持つ患者に生じています。 (図 1A)。
40 yo M, CP, spastic quadriplegia, neuromuscular scoliosis Post traumatic kyphosis can occur due to the failure of the initial management of the injury or unrecognized injury. It may also result from inadequate surgical treatment as shown in the figures to the right. Post traumatic kyphosis can occur due to the failure of the initial management of the injury or unrecognized injury. It may also result from inadequate surgical treatment as shown in the figures to the right. Post traumatic kyphosis can occur due to the failure of the initial management of the injury or unrecognized injury. It may also result from inadequate surgical treatment as shown in the figures to the right.
図 1A-D: 外傷に対する初期治療の失敗や見過ごされ治療されなかった場合に、外傷性後弯は発生します。また、右の図に見られるような不適切な手術治療により、生じることもあります。

症状

後弯により生活に支障を来すレベルの慢性疼痛が生じることがあります。疼痛の原因は以下のごとくです。

  • 傍脊柱筋疲労
  • 慢性炎症と進行性の変性変化
  • 前方からの脊髄または神経根の刺激

身体所見
Progressive kyphosis develops when there is major disruption of the anterior column and all posterior ligaments. In paraplegic patients problems with sitting balance and skin alterations may be due to excessive kyphosis.

治療方法の選択肢
後弯の治療は、変形を矯正すること、変形を安定化させること、疼痛を減じること、神経症状を改善させることなどの目的で行われます。

フレキシブルな変形はインストゥルメンテーションによる後方固定により矯正可能です。リジッドな変形はより複雑な治療が必要となります。

References

  1. Atici T, A. U., Akesen B, Serifoglu R. (2004). "Results of surgical treatment for kyphotic deformity of the spine secondary to trauma or Scheuermann's disease." Acta Orthop Belg 70(4): 344-8.
  2. Been HD, P. R., Ubags LH. (2004). "Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures." Eur Spine J 13(2): 101-7.
  3. Jodoin A, G. P., Dupuis PR, Maurais G. (1989). "Surgical treatment of post-traumatic kyphosis: a report of 16 cases." Can J Surg. 32(1): 36-42.
  4. Klockner C, H. A., Weber U. (2001). "Post-traumatic kyphosis of the truncal vertebrae." Orthopade. 30(12): 947-54.
  5. Kostuik JP, M. H. (1989). "Anterior stabilization, instrumentation, and decompression for post-traumatic kyphosis." Spine. 14(4): 379-86.
  6. Lazennec JY, N. N., Rousseau MA, Boyer P, Pascal-Mousselard H, Saillant G. (2006). "Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels." J Spinal Disord Tech. 19((7):): 487-94.
  7. Vaccaro AR, S. J. (2001). "Post-traumatic spinal deformity." 26 24(S111-8).
  8. Wawro W, B. N., Aebi M. (1992). "Technique of surgical correction of post-traumatic kyphosis." Unfallchirurg 95(1): 41-6.
  9. Wenger M, B. M., Markwalder TM. (2005). "Post-traumatic cervical kyphosis with surgical correction complicated by temporary anterior spinal artery syndrome." J Clin Neurosci 12(2): 193-6.
  10. Wu SS, H. S., Lin LC, Pai WM, Chen PQ, Au MK. (1996). "Management of rigid post-traumatic kyphosis." Spine. 21(19): 2260-7
  11. Zhi., Z. W. K. Z. (2005). "Surgical correction of post-traumatic kyphosis of thoracolumbar spine." 43(4): 201-4.