CAJ | 학술논문

目的比较前路和后路内固定方法治疗胸腰椎结核的疗效.方法 2004年1月至2009年12月解放军第三○九医院骨科采用病灶清除、植骨融合及前路或后路固定方法治疗成年胸腰椎结核患者241例,189例获得平均37个月的随访(22～72个月).其中157例患者术前四联(HRZE)抗结核药物治疗3～6周,其余32例伴有脊髓、神经压迫症状,抗结核药物治疗6～18 h后手术治疗.除8例跳跃性胸腰椎结核患者采用杂交的前路和后路内固定术外,前路固定方法治疗74例(A组),后路固定方法治疗107例(B组).结果术后3～6周两组患者的局部症状明显减轻.A组14例术前伴有脊髓神经损伤症状,术后10例(71％)恢复良好(ODI功能障碍指数＞50％)；B组19例伴有脊髓神经损伤症状,术后14例(74％)恢复良好(P＞0.05).两组患者术前红细胞沉降率分别为43.6 mm/h和42.4 mm/h,术后8～12周恢复正常.术后脊柱后凸畸形矫正角度A组为11.5°,B组为12.6° (P ＜0.01).末次随访时,A组矫正角度丢失为6.8°,B组为6.1 °(P＜0.01)；A组融合率为92.5％,B组为91.8％(P＞0.05).两组患者均没有严重的手术并发症发生.结论只要手术适应证选择正确,胸腰椎结核在不同手术方式下采用前路或后路内固定治疗,都能获得较好疗效.但后路固定在矫正后凸畸形并维持矫正角度方面要优于前路固定.
목적 비교전로화후로내고정방법치료흉요추결핵적료효.방법 2004년1월지2009년12월해방군제삼○구의원골과채용병조청제、식골융합급전로혹후로고정방법치료성년흉요추결핵환자241례,189례획득평균37개월적수방(22～72개월).기중157례환자술전사련(HRZE)항결핵약물치료3～6주,기여32례반유척수、신경압박증상,항결핵약물치료6～18 h후수술치료.제8례도약성흉요추결핵환자채용잡교적전로화후로내고정술외,전로고정방법치료74례(A조),후로고정방법치료107례(B조).결과 술후3～6주량조환자적국부증상명현감경.A조14례술전반유척수신경손상증상,술후10례(71％)회복량호(ODI공능장애지수＞50％)；B조19례반유척수신경손상증상,술후14례(74％)회복량호(P＞0.05).량조환자술전홍세포침강솔분별위43.6 mm/h화42.4 mm/h,술후8～12주회복정상.술후척주후철기형교정각도A조위11.5°,B조위12.6° (P ＜0.01).말차수방시,A조교정각도주실위6.8°,B조위6.1 °(P＜0.01)；A조융합솔위92.5％,B조위91.8％(P＞0.05).량조환자균몰유엄중적수술병발증발생.결론 지요수술괄응증선택정학,흉요추결핵재불동수술방식하채용전로혹후로내고정치료,도능획득교호료효.단후로고정재교정후철기형병유지교정각도방면요우우전로고정.
Objective To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis (TB).Methods Between January 2004 and December 2009,241 adult patients with thoracolunbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages.The mean age was 39 years (range:16 -67).The mean follow-up period for 189 patients was 37 months (range:22 -72 ).Among them,157 cases underwent ＞ 3 weeks of chemotherapeutic regimen of isoniazid,rifampin,pyrazinamide and ethamburol and the remaining 32 were operated for neurological impairment after 6 - 18 h with the same chemotherapeutic regimen.Except for 8 patients with skip lesions undergoing hybrid anterioposterior instrumentation,anterior instrumentation was utilized in 74 patients (Group A) and posterior instrumentation in 107 patients (Group B).Results In both groups,local symptoms of all patients were relieved significantly 1 -3 weeks postoperatively.And 10/14 cases (71％) in Group A and 14/19 cases (74％) in Group B with neurological deficits had excellent or good clinical outcomes ( P ＞ 0.05 ).The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8 - 12 weeks postoperatively.Kyphosis degrees were corrected by a mean of 11.5 ° in Group A and 12.6° in Group B ( P ＜ 0.01 ).The correction loss was 6.8 ° in Group A and 6.1° in Group B at the last follow-up ( P ＜0.01 ).Fusion rates of the grafting bone were 92.5％ and 91.8％respectively at the final follow-up ( P ＞ 0.05 ).Severe complications did not occur.Conclusion Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity,clearance of foci,decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected.Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.