CAJ | 학술논문

目的:探讨一期后路病灶清除椎体钉内固定治疗中上胸椎结核的临床效果.方法:2006年4月～2009年11月,采用一期后路病灶清除椎体钉内固定治疗中上胸椎结核患者19例,其中T2～T3 2例, T3～T5 6例,T5～T8 11例.17例存在明显的脊髓神经功能损害,按Frankel分级,B级3例,C级6例,D级8例,E级2例.术前后凸畸形Cobb角为24°～53°,平均32.4°.根据患者手术时间、Frankel分级、后凸Cobb角、骨融合、内固定物失效、血沉变化及结核复发等情况评价手术治疗结果.结果:19例患者平均手术时间为225.4±26.7min,全部病例随访1.5～3年(平均20.7个月).9例术前合并有神经功能损害患者神经功能有不同程度的恢复.无肋间神经损伤病例.术后脊柱后凸畸形Cobb角矫正至5°～17°,平均12°.术后6～12个月(平均6.8个月)椎间植骨达到骨性融合,未发现假关节形成.无一例内固定物出现断裂、松动、脱落.血沉均在2周后明显下降,在2～3个月内基本恢复正常.1例患者颈前结核脓肿复发,后另行颈前结核脓肿切除术后痊愈.结论:一期后路病灶清除椎体钉内固定可彻底清除病灶,椎体钉置钉安全性高,固定切实可靠,适合大部分中上胸椎结核的治疗.
목적:탐토일기후로병조청제추체정내고정치료중상흉추결핵적림상효과.방법:2006년4월～2009년11월,채용일기후로병조청제추체정내고정치료중상흉추결핵환자19례,기중T2～T3 2례, T3～T5 6례,T5～T8 11례.17례존재명현적척수신경공능손해,안Frankel분급,B급3례,C급6례,D급8례,E급2례.술전후철기형Cobb각위24°～53°,평균32.4°.근거환자수술시간、Frankel분급、후철Cobb각、골융합、내고정물실효、혈침변화급결핵복발등정황평개수술치료결과.결과:19례환자평균수술시간위225.4±26.7min,전부병례수방1.5～3년(평균20.7개월).9례술전합병유신경공능손해환자신경공능유불동정도적회복.무륵간신경손상병례.술후척주후철기형Cobb각교정지5°～17°,평균12°.술후6～12개월(평균6.8개월)추간식골체도골성융합,미발현가관절형성.무일례내고정물출현단렬、송동、탈락.혈침균재2주후명현하강,재2～3개월내기본회복정상.1례환자경전결핵농종복발,후령행경전결핵농종절제술후전유.결론:일기후로병조청제추체정내고정가철저청제병조,추체정치정안전성고,고정절실가고,괄합대부분중상흉추결핵적치료.
Objective:To investingate the surgical efficacy of one-stage posterior debridement and transvertebra screw instrumentation for middle-upper thoracic spinal tuberculosis.Method:From April 2006 to November 2009,19 patients with middle-upper thoracic spinal tuberculosis were treated by posterior debridement and transvertebra screw instrumentation.Of these,2 cases had lesion at T2-T3,6 at T3-T5 and 11 at T5-T8.17 cases were complicated with neurological deficit.According to the Frankel scale system,3 were in grade B,6 in grade C,8 in grade D and 2 in grade E.The average preoperative kyphosis Cobb angle was 32.4°(range,24°-53°).The operation time,Frankel grade,kyphosis Cobb angle,bony union,hardware failure,ESR value and tuberculosis recurrence were evaluated.Result:The average operation time was 225.4±26.7min.All 19 patients were followed up for 1.5-3 years.9 cases with neurological deficit recovered to different extent.No case was complicated with intercostal nerve injury.The average kyphosis Cobb angle was corrected to 12°(range,5°-17°) after surgery.Satisfactory intervertebral bony fusion was evidenced in all cases with no pseudoarticulation formation and hardware failure.Erythrocyte sedimentation rate(ESR) started to decrease at 2 weeks after operation,and to become nearly normal two or three months later.One case was complicated with tuberculosis recurrence at anterior side of cervical spine,which was cured by additional excision of abscess.Conclusion:One-stage posterior debridement and transvertebra screw instrumentation is effective and reliable for most of the middle-upper thoracic spinal tuberculosis,which can secure complete debridement and safe screw placement.