長時間の胡坐を契機に急性傍脊柱筋コンパートメント症候群，クラッシュ症候群を来した1例(A case of crush syndrome with acute paraspinal compartment syndrome caused by prolonged sitting in a cross–legged position)

• Published in: Nihon Kyūkyū Igakkai zasshi 2016-12, Vol.27 (12), p.782-788
• Main Authors: (Shota Kikuta), 菊田 正太, (Yukihisa Yagata), 矢形 幸久, (Noriaki Mizuta), 水田 宜良, (Akihiko Inoue), 井上 明彦, (Shigenari Matsuyama), 松山 重成, (Satoshi Ishihara), 石原 諭, (Shinichi Nakayama), 中山 伸一
• Format: Article
• Language: English
• Subjects: acute kidney injury; hemodialysis; multifidus muscle; 多裂筋; 急性腎傷害; 血液透析
• ISSN: 1883-3772; 1883-3772
• DOI: 10.1002/jja2.12132

要旨 長時間の胡坐という静的な機序により急性傍脊柱筋コンパートメント症候群とクラッシュ症候群を発症した初めての症例を経験したので報告する。症例は27歳の男性で，基礎疾患に双極性障害と不眠症がある。新規に処方された向精神薬を服用後に胡坐での前傾姿勢で入眠し，13時間後に腰背部の激痛により同一姿勢のまま覚醒して当院へ搬送された。来院時ショック状態であり，下肢，鼠径部外側にそれぞれ発赤，腫脹を認め，腰背部の傍脊柱筋は両側ともに硬直がみられた。また，両下肢は完全麻痺であった。検査所見では横紋筋融解症，急性腎傷害，高カリウム血症，代謝性アシドーシス，ミオグロビン尿を認めた。単純CTでは下肢，臀部に加えて両側の多裂筋に低吸収域を呈し，MRI T2強調像でも同部位に高信号像を認めた。各筋区画内圧は下肢，多裂筋で上昇していたため，下腿，大腿に対する減張切開術後にICUへ入院した。第2病日に臀部への減張切開術を，第19病日に感染制御困難となったため右下腿切断術をそれぞれ施行し，転院時には両下肢は完全麻痺のままであった。 ABSTRACT We report the first case of acute paraspinal compartment syndrome with crush syndrome caused by static mechanism, prolonged sitting in a cross–legged position. A 27–year–old man with bipolar disorder and insomnia fell asleep for 13 h, while sitting cross–legged position in a forward–leaning posture after taking a newly prescribed psychotropic medication. The man presented with symptoms of shock and severe low–back pain. Physical examination revealed redness and swelling of his lower extremities and waist region. His paraspinal muscles were firm on palpation, and his lower extremities were paralyzed bilaterally. Laboratory test results showed rhabdomyolysis, acute kidney injury, hyperkalemia, metabolic acidosis, and myoglobinuria. Plain computed tomography revealed an area of low density on the lower extremities, gluteal muscles, and bilateral multifidus muscles. A T2–weighted magnetic resonance imaging scan showed a high–intensity area in the multifidus muscles. Compartment pressure measurement revealed increased values in the lower extremities, and the multifidus muscles. Thus, we performed a fasciotomy on the lower extremities, following which we admitted him to ICU. On day 2, we performed a fasciotomy on the gluteal muscles. On day 19, he subsequently underwent an amputation of his right lower leg. At the time of his transfer, his lower extremities remained paralyzed bilaterally.