CAJ | 학술논문

目的评价单纯后路经椎板或经椎间孔病灶清除植骨内固定术在腰骶段结核治疗中的应用及疗效.方法 2004年1月至2009年l0月,共32例腰骶段结核患者选择单纯后路病灶清除植骨内固定术.男21例,女11例;年龄32～65岁,平均46岁.L3,4节段3例,L4,5节段19例,L5S1节段10例.20例采用经椎板间病灶清除,12例采用经椎间孔病灶清除.临床疗效评价包括改良Prolo功能评分、疼痛视觉模拟评分(visual analogue scale,VAS),影像学评价包括腰骶段受累区的后凸角、椎体高度的丢失.结果 32例患者均获得12～24个月随访,平均16个月.经椎板入路者术前后凸角平均为-24.3°,术后为-34.8°,终未随访时为-32.4°;经椎间孔入路者术前后凸角平均为-25.4°,术后为-35.2°,终未随访时为-33.6°,术后较术前有显著改善.根据改良Prolo功能评分,术后疗效优良率达93.8%.VAS评分显示,术前平均7.6分,术后平均2.9°,术后比术前有显著降低.结论单纯后路经椎板或经椎间孔病灶清除植骨内固定术是治疗腰骶段结核的有效方法.正确的适应证选择、仔细的影像学评价和彻底的病灶清除是手术成功的关键.
목적 평개단순후로경추판혹경추간공병조청제식골내고정술재요저단결핵치료중적응용급료효.방법 2004년1월지2009년l0월,공32례요저단결핵환자선택단순후로병조청제식골내고정술.남21례,녀11례;년령32～65세,평균46세.L3,4절단3례,L4,5절단19례,L5S1절단10례.20례채용경추판간병조청제,12례채용경추간공병조청제.림상료효평개포괄개량Prolo공능평분、동통시각모의평분(visual analogue scale,VAS),영상학평개포괄요저단수루구적후철각、추체고도적주실.결과 32례환자균획득12～24개월수방,평균16개월.경추판입로자술전후철각평균위-24.3°,술후위-34.8°,종미수방시위-32.4°;경추간공입로자술전후철각평균위-25.4°,술후위-35.2°,종미수방시위-33.6°,술후교술전유현저개선.근거개량Prolo공능평분,술후료효우량솔체93.8%.VAS평분현시,술전평균7.6분,술후평균2.9°,술후비술전유현저강저.결론 단순후로경추판혹경추간공병조청제식골내고정술시치료요저단결핵적유효방법.정학적괄응증선택、자세적영상학평개화철저적병조청제시수술성공적관건.
Objective To evaluate the clinical effects of a single posterior translaminal or transforaminal debridement and internal fixation with bone graft for the treatment of lumbosacral regional spinal tuberculosis. Methods From January 2004 to October 2009, 32 patients with lumbosacral regional spinal tuberculosis were treated by a single posterior debridement and internal fixation with bone graft, including 21 males and 11 females with the mean age of 46 years (range, 32-65). The lesions located: 3 in L3,4, 19 in L4,5, 10 in L5S1. 20 cases were pedormed operation via translaminal approach, 12 via transforaminal approach. The modified Prolo scale, visual analogue scale (VAS), kyphosis angle and the vertebral body loss were measured before and after surgery, and in the final follow-up. Results All the patients were followed up for average 16 months (range, 12-24). The pre-, postoperative and final follow-up mean kyphosis angle were -24.3°,-34.8°, and -32.4° in the translaminal group, -25.4°, -35.2°, and 33.6° in the transforaminal group,respectively. According to the modified Prolo scale, the excellent and good result was 93.8%. VAS decreased significantly from 7.6 points to 2.9 after surgery. Conclusion Debridement and internal fixation with bone graft via a single posterior approach for the treatment of lumbosacral regional spinal tuberculosis was an easy and effective technique. The appropriate selection of indications, careful imaging evaluation and thorough surgical debridement played an important role in the treatment of lumbosacral regional spinal tuberculosis.