ＨＴＬＶ‐１脊髄症に伴う高度両下肢拘縮に対する手術治療 １例報告

Abstract

Patients with HTLV-1 associated myelopathy (HAM) have gradual onset and slowly progressive course of spastic paraparesis with pyramidal signs and bladder dysfunction. In late stages, severe spastic contractures in the lower extremities can disturb walking and even sitting ability. We report a case of HAM, whose deformities were corrected operatively with functional improvement. A 45-year-old woman was referred to us about her disability on October 3, 1996. she first noted gait disturbance in 1986 five years after receiving a blood transfusion, with gradual deterioration. She was diagnosed as HAM in 1987, and a treatment with oral corticosteroids (40mg of prednisolone daily) was started next year. Although her gait ability improved, her spastic paraparesis took a turn for the worse when she stopped the medication. In 1993, she was unable to walk alone, and two years later, her sitting ability was lost because of adduction-flexion deformities of both hips and flexion contractures of bilateral knees. She underwent an operation on February 24, 1997, involving 1) bilateral adductor-gracilis-iliopsoas tenotomy and obturator neurectomy, 2) release of the right sartorius tendon, and 3) bilateral release of hamstrings. Postoperatively, her ability to sit on a chair improved, and she was discharged home on March 15, 1997. The improvement has been maintained for three years since discharge. In a patient with HAM with severe contractures, operative treatment should be considered as an alternative to improve functional abilities.