CAJ | 학술논문

目的总结老年脊柱结核患者的临床特点,探讨老年脊柱结核患者手术方式的选择策略.方法 2005年10月至2010年10月采用6种手术方式治疗老年脊柱结核患者151例,69例患者纳入研究,男36例,女33例；年龄60～83岁,平均68.3岁.62例(171例次)合并有其他疾病.记录患者的临床表现、发病部位及影像学表现.统计误诊、误治的发生情况.在治疗前、术后l周及末次随访时采用疼痛视觉模拟评分(visual analog scale,VAS)进行对比分析,对伴有脊髓神经损害患者采用Frankel分级评价术后脊髓神经功能改善情况.结核临床治愈判定采用脊柱结核治愈标准.结果所有患者均有不同程度的局部疼痛,VAS评分平均为(8.2±1.4)分,严重疼痛者(VAS评分7分以上)42例(60.9％).72.5％的患者无明显结核中毒症状,68.1％的患者有脊髓神经损害表现,43.5％的患者无椎旁脓肿或腰大肌脓肿.腰椎结核发病率最高(78.3％,54/69),双椎体结核最常见(59.4％,41/69).均有轻、中度的后凸畸形,Cobb角平均为20.4°±4.3°.误诊率为30.4％(21/69),误治率为13.0％(9/69).获得平均27个月随访,结核临床治愈67例,2例窦道形成,迁延未愈.融合节段(4.1±0.6)个,骨融合时间(5.9±1.7)个月.术后后凸畸形矫正9.5°±3.6°,末次随访时矫正角度丢失7.2°±2.3°.5例伴有脊髓神经损害者术后Frankel分级至少提高了1级.术后肺部感染5例(其中死亡1例),心功能不全5例,脑梗死2例,内固定松动2例,窦道形成5例,药物性肝损害5例,药物性皮疹6例,术后神经功能损害加重1例.结论老年脊柱结核患者起病隐匿,多合并其他疾病,易导致误诊、误治.手术方式的选择应遵循个体化及微创的原则,术中固定节段应适当延长.
목적 총결노년척주결핵환자적림상특점,탐토노년척주결핵환자수술방식적선택책략.방법 2005년10월지2010년10월채용6충수술방식치료노년척주결핵환자151례,69례환자납입연구,남36례,녀33례；년령60～83세,평균68.3세.62례(171례차)합병유기타질병.기록환자적림상표현、발병부위급영상학표현.통계오진、오치적발생정황.재치료전、술후l주급말차수방시채용동통시각모의평분(visual analog scale,VAS)진행대비분석,대반유척수신경손해환자채용Frankel분급평개술후척수신경공능개선정황.결핵림상치유판정채용척주결핵치유표준.결과 소유환자균유불동정도적국부동통,VAS평분평균위(8.2±1.4)분,엄중동통자(VAS평분7분이상)42례(60.9％).72.5％적환자무명현결핵중독증상,68.1％적환자유척수신경손해표현,43.5％적환자무추방농종혹요대기농종.요추결핵발병솔최고(78.3％,54/69),쌍추체결핵최상견(59.4％,41/69).균유경、중도적후철기형,Cobb각평균위20.4°±4.3°.오진솔위30.4％(21/69),오치솔위13.0％(9/69).획득평균27개월수방,결핵림상치유67례,2례두도형성,천연미유.융합절단(4.1±0.6)개,골융합시간(5.9±1.7)개월.술후후철기형교정9.5°±3.6°,말차수방시교정각도주실7.2°±2.3°.5례반유척수신경손해자술후Frankel분급지소제고료1급.술후폐부감염5례(기중사망1례),심공능불전5례,뇌경사2례,내고정송동2례,두도형성5례,약물성간손해5례,약물성피진6례,술후신경공능손해가중1례.결론 노년척주결핵환자기병은닉,다합병기타질병,역도치오진、오치.수술방식적선택응준순개체화급미창적원칙,술중고정절단응괄당연장.
Objective To summarize clinical characteristics and explore operative strategy of elderly patients with spinal tuberculosis.Methods From December 2005 to December 2010,151 aged patients with spinal tuberculosis were treated with six different surgical procedures.Among 69 patients were followed,including 36 males and 33 females,with the average age of 68.3 (60 to 83) years.62 patients were complicated by other diseases.The clinical manifestations,locations and images of these patients were analyzed.The occurrence of misdiagnosis and mistreatment was counted.The visual analogue scale (VAS) scoring was applied to evaluate the local pain,and the Frankel classification was used to evaluate the improvement of neurological function.The criterion of cure of spinal tuberculosis was used to assess the clinical cure of these patients.Results All patients had different levels of local pain.The preoperative VAS was 8.2±1.4,with 42 (60.9) cases of more than 7.72.5％ patients didn't have obvious toxic symptoms and 43.5％ didn't have paravertebral or psoas abscess,while 68.1％ had spinal nerve damage.Lumbar spine was the most commonly affected area and 2 vertebrae TB got the highest incidence.The Cobb's angle was 20.4°±4.3° preoperatively.The misdiagnose rate was 30.4％ (21/69) and the mistreatment rate was 13.0％ (9/69).The average follow-up period was 27 months.Sixty-seven patients were clinically cured.The average union segments were 4.1 ±0.6 and the average time of union was 5.9± 1.7 months.The correction of kyphosis was 9.5°±3.6° after surgery but lost 7.2°±2.3° at the last follow-up time.5 patients with neurological deficits were clinically improved at least one grade after surgery,according to the Frankel grading system.One patient died from pulmonary infection.Other complications included cardiac dysfunction in 5 patients,pulmonary infection in 4 patients,cerebral infarction in 2 patients,internal fixation loosening in 2 patients,sinus formation in 5 patients,drug-induced liver dysfunction in 5 patients,drug rash in 6 patients and aggravation of neurological function in 1 patient.Conclusion Spinal tuberculosis in elderly patients usually concealed onset and combined with other diseases,which could lead to misdiagnosis and mistreatment.Surgical procedures should be chosen individually and in minimal-invasive way.The segments should be fixed longer to avoid loosening.