CAJ | 학술논문

目的回顾性分析81例成人非跳跃性胸椎结核的手术疗效,探讨非跳跃性胸椎结核手术入路、固定方式的选择策略.方法 2001年1月至2010年12月采用5种不同的手术方法治疗胸椎结核患者112例,81例成人非跳跃性胸椎结核患者获得平均39个月(17～75个月)的随访,其中23例合并脊髓功能障碍,Frankel分级A级3例、B级4例、C级7例、D级9例.以双椎体结核多见,尤以T10、T11最多.结果所有患者术后1～3周局部症状均明显减轻,术后8～12周红细胞沉降率恢复正常,无严重的并发症发生.23例伴有脊髓损害的患者脊髓功能Frankel分级至少提高1级.3例患者分别于术后0.5、1和1.5个月出现切口窦道形成,经CT及MR检查无脓肿、死骨形成,经换药治疗1～2个月后治愈.前路固定组脊柱后凸畸形矫正率平均为10.2°±2.1°,后路固定组平均为12.6°±2.7°,差异有统计学意义；末次随访时前路固定组矫正角度丢失平均为6.9°±1.9°,后路固定组为5.8°±1.4°,差异有统计学意义.结论成人非跳跃性胸椎结核的术式选择应根据病变的部位、范围以及患者的一般状态而定,采用正确的手术方式能够达到矫正脊柱后凸畸形、清除病灶、脊髓减压及缓解局部疼痛的目的,后路固定在矫正脊柱后凸畸形及维持矫形方面要优于前路固定.
목적 회고성분석81례성인비도약성흉추결핵적수술료효,탐토비도약성흉추결핵수술입로、고정방식적선택책략.방법 2001년1월지2010년12월채용5충불동적수술방법치료흉추결핵환자112례,81례성인비도약성흉추결핵환자획득평균39개월(17～75개월)적수방,기중23례합병척수공능장애,Frankel분급A급3례、B급4례、C급7례、D급9례.이쌍추체결핵다견,우이T10、T11최다.결과 소유환자술후1～3주국부증상균명현감경,술후8～12주홍세포침강솔회복정상,무엄중적병발증발생.23례반유척수손해적환자척수공능Frankel분급지소제고1급.3례환자분별우술후0.5、1화1.5개월출현절구두도형성,경CT급MR검사무농종、사골형성,경환약치료1～2개월후치유.전로고정조척주후철기형교정솔평균위10.2°±2.1°,후로고정조평균위12.6°±2.7°,차이유통계학의의；말차수방시전로고정조교정각도주실평균위6.9°±1.9°,후로고정조위5.8°±1.4°,차이유통계학의의.결론 성인비도약성흉추결핵적술식선택응근거병변적부위、범위이급환자적일반상태이정,채용정학적수술방식능구체도교정척주후철기형、청제병조、척수감압급완해국부동통적목적,후로고정재교정척주후철기형급유지교형방면요우우전로고정.
Objective To investigate operative approach,immobilization manner,and surgical effect of multiple-level contiguous thoracic spinal tuberculosis.Methods Between January 2001 and December 2010,112 patients with thoracic spinal tuberculosis were treated with 5 different surgical procedures.Among them,81 adults with multiple-level contiguous thoracic spinal tuberculosis were followed up for 17 to 75 months (average,39 months).Twenty three patients suffered from spinal cord dysfunction; according to the Frankel classification,there were 3 cases of type A,4 cases of type B,7 cases of type C,and 9 cases of type D.The double vertebral bodies were commonly affected areas,especially T10 and T11-Results Local symptoms of all patients were relieved significantly 1 to 3 weeks postoperatively.Erythrocyte sedimentation rates (ESR) returned to normal level in all patients 8 to 12 weeks postoperatively.Three sinuses were found 0.5 month,1 month and 1.5 months postoperatively,respectively,which were cured by changing dressing for 1 to 2 months.The average correction of kyphotic deformity was 10.2°±2.1° in anterior fixation group,while 12.6°±2.7° in posterior fixation group.At final follow-up,the average loss of correction was 6.9°±1.9° in anterior fixation group,while 5.8°±1.4° in posterior fixation group.At least one Frankel grade improvement was observed in 23 patients.Conclusion The surgical methods should be chosen according to the location and degree of the lesion.Correct surgical procedures can obtain good results in correction and maintenance of the deformity,clearance of the foci,decompression of the spinal cord and pain relief for thoracic spinal tuberculosis.The posterior fixation is better than the anterior fixation with regard to correction and maintenance of the kyphotic deformity.