1 0 0 0 OA 脊髄誘発電位を用いた術中脊髄機能モニタリングの基礎的臨床的研究
- 著者
- 竹光 義治 原田 吉雄 熱田 裕司 今井 充
- 出版者
- West-Japanese Society of Orthopedics & Traumatology
- 雑誌
- 整形外科と災害外科 (ISSN:00371033)
- 巻号頁・発行日
- vol.31, no.3, pp.494-497, 1983-06-25 (Released:2010-02-25)
- 参考文献数
- 4
Spinal cord monitoring during surgery by using SCEP has been shown to be superior to the wake-up test, because it enables the practitioner to determine the induced ischemia of the spinal cord more precisely and promptly before neural deficit develops into permanent. Surgical procedures have to be stopped when peak amplitude of N1 has decreased up to 50% of the control potentials. We have already successfully operated on 72 patients with spine deformity under it. The purpose of this paper is to introduce animal experiments which have given conclusion described above. The study was conducted in three parts. In the first part, injury experiment by distraction force was done. The spinal cord was impaired by longitudinal distraction using a special designed instrument. There was a certain degree of distraction which produced transient augumentation of the N2 amplitude without neural deficit. The N1 deflection always decreased more than 50% with paralysis immediately after continueing 4mm distraction. In the second part, intraspinal potentials were recorded using glass pipet electrodes in order to identify precise location of N1 and N2 in conductive SCEP. The N2 conducted in the dorsal column. N1, however, was compound potentials from the whole spinal cord. In the third part, ascending and descending pathways of N1 and N2 was determined by the collision test. It was strongly suspected that the N1 and N2 of ascending and descending conductive SCEP had common pathways.
1 0 0 0 骨粗鬆症性椎体圧潰後の偽関節と誤診した結核性脊椎炎の一例
- 著者
- 今井 大輔 大田 秀樹 松本 佳之 井口 洋平 巽 政人 柴田 達也 眞田 京一 木田 浩隆 竹光 義治
- 出版者
- 西日本整形・災害外科学会
- 雑誌
- 整形外科と災害外科 (ISSN:00371033)
- 巻号頁・発行日
- vol.69, no.1, pp.210-214, 2020
<p>骨粗鬆症性椎体圧潰後偽関節と診断しBKP施行したが疼痛改善せず,最終的に結核性脊椎炎であった一例を経験した.症例は83歳,女性.重いものを抱えて腰痛出現.近医入院加療したが改善せず当院受診.当院にてL1破裂骨折偽関節と診断しBKPを行った.しかし症状は改善せず,術後一か月目のMRIにてL1周囲腸腰筋に膿瘍が疑われた.術後感染の診断で前方除圧固定と後方PPSを行った.多量の膿が排出されたが,培養にて結核菌が同定された.術後は骨癒合も得られ疼痛は改善した.一般的に結核性脊椎炎は膿瘍形成が強く通常の骨折とは鑑別は容易である.術後に膿瘍形成が認められ,術後感染と紛らわしかったが,結果的には結核性脊椎炎であった.反省点として術前のCRPも1.29であったことである.CRPの異常値を重要視し精査するべきであった.骨粗鬆性椎体圧潰後の偽関節には感染も紛れているので術前の安易な診断には注意が必要である.</p>