|Budget Amount *help
¥2,000,000 (Direct Cost : ¥2,000,000)
Fiscal Year 1995 : ¥500,000 (Direct Cost : ¥500,000)
Fiscal Year 1994 : ¥500,000 (Direct Cost : ¥500,000)
Fiscal Year 1993 : ¥1,000,000 (Direct Cost : ¥1,000,000)
Based on anatomical and clinical studies on the cervical spinal cord and root using 20 Japanese adults and 118 patients, the following facts were elucidated. 1) There were two possible sites for the occurrence of post-decompressive tethering effects on cervical roots, i.e., intradural and extraural. 2) Extradural tethering effect could be induced by exertion of dural traction force on extradural roots which were anchored to the intervertebral foramina by perineural adhesion, resulting in traction injury of extradural roots. 3) Anatomical characteristics of intra-and extradural portions of a root indicated that the extradural tethering effect might be the most probable cause of post-operative palsy and it was verified by a clinical study. 4) As methods of prevention for each of these tethering effects, a longitudinal durotomy was effectivi in reducing extradural tehthering effect and a suppression of posterior enlargement of dural tube to that degree that allowed intradural rootlets rem
ain relaxd was thought to be effective for prevention of intradural tethering effect. In another series of posterior decompression consisting with 43 patients, dural pressures just posterior to C5 root-sleeve were measured using a 2-9 nylon thread with a diameter of 0.3mm. of nine patients with a dural perssure higher than 40 g-weight/mm^2,4patients developed post-operative C5 palsy. Of twenty nine patients with a dural pressure lower than 40 g-weight/mm^2, one patient developed post-operative C5 palsy. There was a difference of statistical significance (X^2=4.35, p<0.05) between those two groups. This result showed that measurement of dural pressure during surgery might be useful to detect a possibility of post-operative palsy. Further studies are required to develop a more accurate method for predicting post-operative palsy and a simpler method of prevention of it than a longitudinal durotomy.
別個に43例の頚髄後方除圧例において術中に2-0 nylon医療用縫合糸を硬膜圧測定糸とし,椎弓拡大状態の硬膜管でC5神経根根襄部背側の硬膜圧を測定したが,高膜圧(40g重/mm^2以上)群の9例中4例(44%),および中硬膜圧群(39-25g重/mm^2)の17例中1例(6%)に術後C5神経根障害が発生し,低硬膜圧群(24g重/mm^2以下、12例)では術後上肢麻痺は発生しなかった.高硬膜圧群で硬膜縦切開を行った5例では術後上肢麻痺は発生しなかった.高硬膜圧・硬膜非切開群(46g重/mm^2以上,9例中4例発生)と中〜低硬膜圧・硬膜非切開群(45g重/mm^2以下,29例中1例発生)の間に統計学的有意差(X^2=4.35,p<0.05)が認められた.この結果から,術中硬膜圧測定が術後麻痺発生にある程度役に立つことが判明した.今後の問題として,術後上肢麻痺発生の可能性をさらに正確に予知する方法の開発,および硬膜縦切開よりさらに侵襲の少ない予防術式の開発が残されている. Less