びまん性特発性骨増殖症（DISH）を伴う胸腰椎骨折に対する椎体終板を貫通させる新しいスクリュー挿入法（Transdiscal Screw for DISH：TSD）と従来法の比較検討
はじめに：びまん性特発性骨増殖症（DISH）を伴う胸腰椎骨折において2枚の椎体終板を貫通するスクリュー（TSD）を用いた後方固定と従来法の手術成績を比較検討した．対象と方法：TSD併用群17例，経皮的椎弓根スクリュー（PPS）を用いたPPS群13例，open法で椎弓根スクリュー（PS）を用いたOpen PS群8例の3群間で手術成績を比較検討しスクリュー挿入トルク（TSD 33本 vs PPS 15本）も追加調査した．結果：結果をTSD併用群，PPS群，Open PS群の順に示す．固定椎間数は4.5椎間，5.3椎間，7.1椎間，スクリュー使用本数は8.1本，12.1本，12.7本，手術時間は16...
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| Published in | Journal of Spine Research Vol. 12; no. 5; pp. 714 - 722 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.05.2021
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2020-0038 |
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| Abstract | はじめに：びまん性特発性骨増殖症（DISH）を伴う胸腰椎骨折において2枚の椎体終板を貫通するスクリュー（TSD）を用いた後方固定と従来法の手術成績を比較検討した．対象と方法：TSD併用群17例，経皮的椎弓根スクリュー（PPS）を用いたPPS群13例，open法で椎弓根スクリュー（PS）を用いたOpen PS群8例の3群間で手術成績を比較検討しスクリュー挿入トルク（TSD 33本 vs PPS 15本）も追加調査した．結果：結果をTSD併用群，PPS群，Open PS群の順に示す．固定椎間数は4.5椎間，5.3椎間，7.1椎間，スクリュー使用本数は8.1本，12.1本，12.7本，手術時間は165.8分，151.6分，219.7分，術中出血量は72.5 ml，115.4 ml，453.7 mlであった．スクリューの緩みはPPS群1例，PS群1例に認め，骨癒合は最終的に全例で得られていた．スクリュー挿入トルクはTSDが175.3 N・m，PSが141.8 N・mで有意にTSDが高値を示した（P＜0.033）．結語：TSDはDISHを伴う椎体骨折において椎弓根スクリューよりも強いアンカーになり手術侵襲の低減も期待できる． |
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| AbstractList | はじめに：びまん性特発性骨増殖症（DISH）を伴う胸腰椎骨折において2枚の椎体終板を貫通するスクリュー（TSD）を用いた後方固定と従来法の手術成績を比較検討した．対象と方法：TSD併用群17例，経皮的椎弓根スクリュー（PPS）を用いたPPS群13例，open法で椎弓根スクリュー（PS）を用いたOpen PS群8例の3群間で手術成績を比較検討しスクリュー挿入トルク（TSD 33本 vs PPS 15本）も追加調査した．結果：結果をTSD併用群，PPS群，Open PS群の順に示す．固定椎間数は4.5椎間，5.3椎間，7.1椎間，スクリュー使用本数は8.1本，12.1本，12.7本，手術時間は165.8分，151.6分，219.7分，術中出血量は72.5 ml，115.4 ml，453.7 mlであった．スクリューの緩みはPPS群1例，PS群1例に認め，骨癒合は最終的に全例で得られていた．スクリュー挿入トルクはTSDが175.3 N・m，PSが141.8 N・mで有意にTSDが高値を示した（P＜0.033）．結語：TSDはDISHを伴う椎体骨折において椎弓根スクリューよりも強いアンカーになり手術侵襲の低減も期待できる． |
| Author | 廣瀬, 友彦 生熊, 久敬 |
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| References | 16) Katzman WB, Huang MH, Kritz-Silverstein D, et al: Diffuse idiopathic skeletal hyperostosis (DISH) and impaired physical function: the rancho bernardo study. J Am Geriatr Soc. 2017; 65 (7): 1476-1481 10) Okada E, Shiono Y, Nishida M, et al: Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation. J Orthop Surg (Hong Kong). 2019; 27 (2): 2309499019843407 11) Moussallem CD, McCtcheon BA, Clarke MJ, et al: Perioperative complications in open versus percutaneous treatment of spinal fractures in patients with an ankylosed spine. J Clin Neurosci. 2016; 30: 88-92 15) Hou Y, Yuan W: Influences of disc degeneration and bone mineral density on the structural properties of lumbar end plates. Spine J. 2012; 12 (3): 249-256 2) Nishimura S, Nagoshi N, Iwanami A, et al: Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Study. Clin Spine Surg. 2018; 31 (9): E460-E465 5) Burkus JK, Denis F: Hyperextension injuries of the thoracic spine in diffuse idiopathic skeletal hyperostosis. Report of four cases. J Bone Joint Surg Am. 1994; 76 (2): 237-243 6) Westerveld LA, vanBemmel JC, Dhert WJ, et al: Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2014; 14 (5): 729-740 7) Ikuma H, Takao S, Inoue Y, et al: Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results. Asian Spine J. 2020. Online ahead of print 8) Caron T, Bransford R, Nguyen Q, et al: Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010; 35 (11): E458-E464 3) Okada E, Yoshii T, Yamada T, et al: Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis: A nationwide multi-institution survey. J Orthop Sci. 2019; 24 (4): 601-606 14) Xavier F, Jauregui J, Cornish N: Regional Variations in Shear Strength and Density of the Human Thoracic Vertebral Endplate and Trabecular Bone. Int J Spine Surg. 2017; 11 (1): 7 12) Lukas Weiser, Gerd Huber, Kay Sellenschloh, et al: Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength. Eur Spine J. 2017; 26 (11): 2891-2897 4) Westerveld LA, Verlaan JJ, Oner FC: Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009; 18 (2): 145-156 13) Inceoglu S, Ferrara L, McLain R: Pedicle screw fixation strength: pullout versus insertional torque. Spine J. 2004; 4 (5): 513-518 9) Kai K, Ikuta K, Masuda K, et al: Surgical Outcomes of Minimally Invasive Stabilization for Spinal Fractures in Patients with Ankylosing Spinal Disorders. Asian Spine J. 2018; 12 (3): 434-441 1) Orimo H, Nakamura T, Hosoi T, et al: Japanese 2011 guidelines for prevention and treatment of osteoporosis-executive summary. Arch Osteoporosis. 2012; 7 (1-2): 3-20 |
| References_xml | – reference: 2) Nishimura S, Nagoshi N, Iwanami A, et al: Prevalence and Distribution of Diffuse Idiopathic Skeletal Hyperostosis on Whole-spine Computed Tomography in Patients With Cervical Ossification of the Posterior Longitudinal Ligament: A Multicenter Study. Clin Spine Surg. 2018; 31 (9): E460-E465 – reference: 8) Caron T, Bransford R, Nguyen Q, et al: Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010; 35 (11): E458-E464 – reference: 9) Kai K, Ikuta K, Masuda K, et al: Surgical Outcomes of Minimally Invasive Stabilization for Spinal Fractures in Patients with Ankylosing Spinal Disorders. Asian Spine J. 2018; 12 (3): 434-441 – reference: 15) Hou Y, Yuan W: Influences of disc degeneration and bone mineral density on the structural properties of lumbar end plates. Spine J. 2012; 12 (3): 249-256 – reference: 13) Inceoglu S, Ferrara L, McLain R: Pedicle screw fixation strength: pullout versus insertional torque. Spine J. 2004; 4 (5): 513-518 – reference: 3) Okada E, Yoshii T, Yamada T, et al: Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis: A nationwide multi-institution survey. J Orthop Sci. 2019; 24 (4): 601-606 – reference: 7) Ikuma H, Takao S, Inoue Y, et al: Treatment of Thoracolumbar Spinal Fracture Accompanied by Diffuse Idiopathic Skeletal Hyperostosis Using Transdiscal Screws for Diffuse Idiopathic Skeletal Hyperostosis: Preliminary Results. Asian Spine J. 2020. Online ahead of print – reference: 12) Lukas Weiser, Gerd Huber, Kay Sellenschloh, et al: Insufficient stability of pedicle screws in osteoporotic vertebrae: biomechanical correlation of bone mineral density and pedicle screw fixation strength. Eur Spine J. 2017; 26 (11): 2891-2897 – reference: 6) Westerveld LA, vanBemmel JC, Dhert WJ, et al: Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2014; 14 (5): 729-740 – reference: 4) Westerveld LA, Verlaan JJ, Oner FC: Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications. Eur Spine J. 2009; 18 (2): 145-156 – reference: 1) Orimo H, Nakamura T, Hosoi T, et al: Japanese 2011 guidelines for prevention and treatment of osteoporosis-executive summary. Arch Osteoporosis. 2012; 7 (1-2): 3-20 – reference: 10) Okada E, Shiono Y, Nishida M, et al: Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation. J Orthop Surg (Hong Kong). 2019; 27 (2): 2309499019843407 – reference: 11) Moussallem CD, McCtcheon BA, Clarke MJ, et al: Perioperative complications in open versus percutaneous treatment of spinal fractures in patients with an ankylosed spine. J Clin Neurosci. 2016; 30: 88-92 – reference: 16) Katzman WB, Huang MH, Kritz-Silverstein D, et al: Diffuse idiopathic skeletal hyperostosis (DISH) and impaired physical function: the rancho bernardo study. J Am Geriatr Soc. 2017; 65 (7): 1476-1481 – reference: 5) Burkus JK, Denis F: Hyperextension injuries of the thoracic spine in diffuse idiopathic skeletal hyperostosis. Report of four cases. J Bone Joint Surg Am. 1994; 76 (2): 237-243 – reference: 14) Xavier F, Jauregui J, Cornish N: Regional Variations in Shear Strength and Density of the Human Thoracic Vertebral Endplate and Trabecular Bone. Int J Spine Surg. 2017; 11 (1): 7 |
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| Snippet | はじめに：びまん性特発性骨増殖症（DISH）を伴う胸腰椎骨折において2枚の椎体終板を貫通するスクリュー（TSD）を用いた後方固定と従来法の手術成績を比較検討した．対... |
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| SubjectTerms | びまん性特発性骨増殖症 終板貫通スクリュー 経皮的椎弓根スクリュー |
| Title | びまん性特発性骨増殖症（DISH）を伴う胸腰椎骨折に対する椎体終板を貫通させる新しいスクリュー挿入法（Transdiscal Screw for DISH：TSD）と従来法の比較検討 |
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