CAJ | 학술논문

目的：探讨经后路全脊椎切除术治疗结核治愈型胸腰椎角状后凸畸形的有效性和安全性。方法：2008年1月~2012年1月，采用后路全脊椎切除手术治疗17例结核治愈型胸腰椎角状后凸畸形患者，男5例，女12例，年龄9～40岁，平均23.6岁。病程16～122个月，平均37.5个月，其中2例病例既往有经肋横突入路结核病灶清除手术史。病灶累及1～2个椎体8例，≥3个椎体9例。后凸畸形顶椎位于胸椎（T5～T10）5例，胸腰段（T11～L1）10例，腰椎2例。术前Cobb角60°～90°者13例，＞90°者4例，最大为102°，平均81.3°±12.8°。所有患者均可见驼背畸形，无低热、盗汗等结核中毒症状。术前、术后和末次随访时分别测量患者后凸Cobb角，并评估神经功能ASIA 分级。结果：本组病例手术均顺利完成，手术时间330～450min，平均364min；术中出血量1600～2500ml，平均2218ml；术中输血1000～2000ml，平均1863ml。术中2例患者出现胸膜破裂，及时予以修补，经观察未发现气胸或血气胸。所有病例术后伤口均一期愈合，无窦道形成，内固定未见松动，未见神经功能加重者。术后Cobb角矫正至10°～28°，平均17.3°±3.6°，较术前明显改善（P<0.01），后凸畸形矫正率平均为（68.7±6.5）%；术后随访13～34个月，平均18.7个月，末次随访时后凸Cobb角10°～32°，平均20.6°±3.9°，较术后平均丢失3.3°（P>0.05），但与术前相比仍有明显改善（P<0.01）；植骨融合时间5～9个月，平均6.5个月；术前神经功能为D级的5例患者，4例恢复到E级，另1例仍为D级，但后凸畸形及局部疼痛已明显好转。结论：经后路全脊椎切除可安全有效地用于结核治愈型胸腰椎角状后凸畸形的矫形手术。
목적：탐토경후로전척추절제술치료결핵치유형흉요추각상후철기형적유효성화안전성。방법：2008년1월~2012년1월，채용후로전척추절제수술치료17례결핵치유형흉요추각상후철기형환자，남5례，녀12례，년령9～40세，평균23.6세。병정16～122개월，평균37.5개월，기중2례병례기왕유경륵횡돌입로결핵병조청제수술사。병조루급1～2개추체8례，≥3개추체9례。후철기형정추위우흉추（T5～T10）5례，흉요단（T11～L1）10례，요추2례。술전Cobb각60°～90°자13례，＞90°자4례，최대위102°，평균81.3°±12.8°。소유환자균가견타배기형，무저열、도한등결핵중독증상。술전、술후화말차수방시분별측량환자후철Cobb각，병평고신경공능ASIA 분급。결과：본조병례수술균순리완성，수술시간330～450min，평균364min；술중출혈량1600～2500ml，평균2218ml；술중수혈1000～2000ml，평균1863ml。술중2례환자출현흉막파렬，급시여이수보，경관찰미발현기흉혹혈기흉。소유병례술후상구균일기유합，무두도형성，내고정미견송동，미견신경공능가중자。술후Cobb각교정지10°～28°，평균17.3°±3.6°，교술전명현개선（P<0.01），후철기형교정솔평균위（68.7±6.5）%；술후수방13～34개월，평균18.7개월，말차수방시후철Cobb각10°～32°，평균20.6°±3.9°，교술후평균주실3.3°（P>0.05），단여술전상비잉유명현개선（P<0.01）；식골융합시간5～9개월，평균6.5개월；술전신경공능위D급적5례환자，4례회복도E급，령1례잉위D급，단후철기형급국부동통이명현호전。결론：경후로전척추절제가안전유효지용우결핵치유형흉요추각상후철기형적교형수술。
Objectives: To evaluate the safety and efficacy of posterior vertebral column resection in treat-ment for severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine. Methods: From Jan-uary 2008 to January 2012, 17 patients with severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine underwent posterior vertebral column resection (PVCR) in our institute. They were 5 males and 12 females, with an average age of 23.6 years old(range, 9 to 40 years). The disease duration ranged from 16 to 122 months(average 37.5 months), two of them underwent debridement through rib-processus transverse ap-proach. One or two vertebral bodies were involved in 8 cases and more than two vertebral bodies were in-volved in 9 cases. The location of apical vertebrae of angular kyphosis was thoracal spine(T5-T10) in 5 cas-es, thoracolumbar spine(T11-L1) in 10 cases and lumbar spine in 2 cases. The kyphotic Cobb angle was e-qual to or larger than 60°, among them 13 cases had Cobb angle betweem 60° to 90°, 4 cases had angle over 90°, with the biggest angle of 102°. All patients had a humpback appearance, no other tuberculosis clinical symptom such as fever or night sweatening was noted. In these cases, kyphotic Cobb angle and ASIA grade were measured before operation, after operation and at final follow-up. Results: All operations were performed successfully. The operation time ranged from 330 to 450min(average, 364min); blood loss during the operation ranged from 1600 to 2500ml (average, 2218ml), and blood transfusion ranged from 1000 to 2000ml (average, 1863ml). Pleura rupture occurred in two cases, and no pneumothorax or hemopneumothorax occurred after repairment. All incisions healed perfectly without sinus formation. No instrument failure or neurological deterioration was noted. The preoperative kyphosis ranged from 60° to 102°(average, 81.3°±12.8°), and postop-erative kyphosis ranged from 10° to 28°(average, 17.3°±3.6°), which showed significant difference(P<0.01). The average kyphosis correction rate was (68.7±6.5)%. The follow-up ranged from 13 to 34 months(average, 18.7 months) and kyphosis at final follow-up ranged from 10° to 32°(average, 20.6°±3.9°), with a loss of correction of 3.3°. Compared with preoperation, these parameters showed significant differences(P<0.01). Bony union oc-curred at an average of 6.5 months (range, 4 to 9 months). Among the 5 patients with preoperative ASIA grade D, 4 cases improved to grade E, the other 1 case remained unchanged, but the kyphosis improved and the local back pain relieved very well. Conclusions: Posterior vertebral column resection is an effective and safe way to treat severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine.