CAJ | 학술논문

背景：医用硫酸钙人工骨用以填充脊柱结核病灶清除后的骨缺损存在争议，长期肌注链霉素抗结核具有患者依从性差等弊端，局部应用可克服这些不足之处。 　　目的：观察在胸腰椎结核后路病灶清除植骨融合内固定中，应用含链霉素的硫酸钙人工骨与自体骨混合植骨的疗效。 　　方法：收集2008年3月至2012年6月收治的18例胸腰椎结核患者，在正规抗结核的基础上采用一期后路病灶清除、含链霉素的硫酸钙人工骨与自体骨混合植骨及内固定治疗，观察患者局部切口情况，有无不良反应及临床症状恢复情况，定期影像学检查对植骨融合和后凸畸形矫正的情况进行分析。 　　结果与结论：所有患者内固定后伤口均一期愈合，临床症状明显缓解，后凸畸形获得不同程度的矫正，矫正角度无明显丢失，无全身不良反应。17例患者一次手术治愈，1例患者于内固定后9个月结核复发再次行前路手术后治愈；胸腰椎X射线检查，内固定后1周硫酸钙人工骨粒显影清楚，内固定后3个月显影不清，内固定后6-9个月植骨部位获骨性愈合。提示在胸腰椎结核手术治疗中应用含链霉素的硫酸钙人工骨不仅可以补充植骨量，而且可以提高局部抗结核药物的浓度，具有可靠的安全性和满意的临床疗效，是一种优良的骨移植替代材料。
배경：의용류산개인공골용이전충척주결핵병조청제후적골결손존재쟁의，장기기주련매소항결핵구유환자의종성차등폐단，국부응용가극복저사불족지처。 　　목적：관찰재흉요추결핵후로병조청제식골융합내고정중，응용함련매소적류산개인공골여자체골혼합식골적료효。 　　방법：수집2008년3월지2012년6월수치적18례흉요추결핵환자，재정규항결핵적기출상채용일기후로병조청제、함련매소적류산개인공골여자체골혼합식골급내고정치료，관찰환자국부절구정황，유무불량반응급림상증상회복정황，정기영상학검사대식골융합화후철기형교정적정황진행분석。 　　결과여결론：소유환자내고정후상구균일기유합，림상증상명현완해，후철기형획득불동정도적교정，교정각도무명현주실，무전신불량반응。17례환자일차수술치유，1례환자우내고정후9개월결핵복발재차행전로수술후치유；흉요추X사선검사，내고정후1주류산개인공골립현영청초，내고정후3개월현영불청，내고정후6-9개월식골부위획골성유합。제시재흉요추결핵수술치료중응용함련매소적류산개인공골불부가이보충식골량，이차가이제고국부항결핵약물적농도，구유가고적안전성화만의적림상료효，시일충우량적골이식체대재료。
BACKGROUND:Medical grade calcium sulfate bone for bone defects after removal of spinal tuberculosis is controversial;however, patients undergoing long-term intramuscular injection of streptomycin for anti-tuberculosis show a poor compliance, and local application can overcome these shortcomings. OBJECTIVE:To study the clinical efficacy and outcome of medical grade calcium sulfate bone incorporated with streptomycin and autogenetic bone graft combined with posterior debridement and instrumentation for thoracolumbar spinal tuberculosis. METHODS:From March 2008 to June 2012, 18 patients with thoracolumbar spinal tuberculosis were treated with one-stage posterior debridement, medical grade calcium sulfate bone incorporated with streptomycin and autogenetic bone graft and instrumentation on the basis of regular anti-tuberculosis. Incision healing, adverse reactions and the change of clinical symptoms were recorded. Bone fusion and deformity correction were analyzed by the regular X-ray examination. RESULTS AND CONCLUSION:Al the patients acquired satisfactory incision healing without obvious general adverse reactions. Clinical symptoms were differently relived. Kyphosis was corrected to some degree and the correction had no loss. Seventeen patients were cured after the first operation. Tuberculosis recurred in one patient 9 months after the first surgery and was cured after the second anterior surgery. X-ray examination showed that the calcium sulfate bone was clear 1 week after surgery and unclear 3 months after surgery. Bone fusion appeared 6 to 9 months after operation. These findings indicate that the application of medical grade calcium sulfate bone incorporated with streptomycin could achieve good effects in the treatment of thoracolumbar spinal tuberculosis, which is an excellent substitute material for bone graft. It not only could repair bone loss but also increase the concentration of anti-tuberculosis drugs.