CAJ | 학술논문

目的：探讨单纯经后路途径病灶清除联合异形钛网植骨融合和椎弓根钉棒系统内固定治疗成人腰椎结核的临床疗效。方法回顾性研究自2010年1月至2011年5月湘雅医院脊柱外科收治的腰椎结核病例，满足纳入条件者23例，均采用单纯后路途径病灶清除联合异形钛网植骨融合椎弓根钉棒系统内固定治疗，术前及术后采用规范抗结核药物。分别于术前、术后14 d、1年随访和末次随访时检测红细胞沉降率（ES R ）、病变节段Cobb′s角、Oswestry 功能障碍指数（ODI），术后1年和末次随访时采用Bridwell分级评价植骨融合情况，同时评价临床疗效。结果所有患者均安全度过围手术期，平均手术时间为（198±52）min ，平均失血量为（388±42）mL。ESR、病变节段Cobb′s角、ODI评分术前分别为57±16、6．5°±3．1°和39．1±12．4，末次随访时分别改善为11±3、3．5°±0．7°和6．8±2．5。术后1年和末次随访时Bridwell Ⅰ和Ⅱ级融合率分别为87％和96％。术后1年和末次随访时临床疗效评价优良率分别为91％和96％。本研究中无螺钉松动、断钉或断棒等发生。至末次随访时未发生手术及药物相关并发症。患者结核中毒症状、腰背痛等消失，伤口愈合可，无慢性感染或窦道形成，无复发者。结论单纯经后路途径可以满足成人腰椎结核手术时病灶清除、脊髓减压、畸形矫正和脊柱270°植骨融合的目的。异形钛网植骨量充足，椎间融合率高，椎间支撑力强，是一种安全有效的治疗方法。
목적：탐토단순경후로도경병조청제연합이형태망식골융합화추궁근정봉계통내고정치료성인요추결핵적림상료효。방법회고성연구자2010년1월지2011년5월상아의원척주외과수치적요추결핵병례，만족납입조건자23례，균채용단순후로도경병조청제연합이형태망식골융합추궁근정봉계통내고정치료，술전급술후채용규범항결핵약물。분별우술전、술후14 d、1년수방화말차수방시검측홍세포침강솔（ES R ）、병변절단Cobb′s각、Oswestry 공능장애지수（ODI），술후1년화말차수방시채용Bridwell분급평개식골융합정황，동시평개림상료효。결과소유환자균안전도과위수술기，평균수술시간위（198±52）min ，평균실혈량위（388±42）mL。ESR、병변절단Cobb′s각、ODI평분술전분별위57±16、6．5°±3．1°화39．1±12．4，말차수방시분별개선위11±3、3．5°±0．7°화6．8±2．5。술후1년화말차수방시Bridwell Ⅰ화Ⅱ급융합솔분별위87％화96％。술후1년화말차수방시림상료효평개우량솔분별위91％화96％。본연구중무라정송동、단정혹단봉등발생。지말차수방시미발생수술급약물상관병발증。환자결핵중독증상、요배통등소실，상구유합가，무만성감염혹두도형성，무복발자。결론단순경후로도경가이만족성인요추결핵수술시병조청제、척수감압、기형교정화척주270°식골융합적목적。이형태망식골량충족，추간융합솔고，추간지탱력강，시일충안전유효적치료방법。
Objective To investigate the efficacy of debridement ,interbody fusion with shaped titanium mesh and instrumentation for lumber tuberculosis by posterior-only approach .Methods A retrospective study for 23 cases of lumber tuberculosis from January 2010 to May 2011 .All cases underwent single posterior approach de-bridement ,interbody fusion with shaped titanium mesh and instrumentation .Standard anti-TB chemotherapy was used at preoperatively and postoperatively .ESR ,Cobb′s angle ,Oswestry disability index (ODI) were detected at preoperative ,at 14th day after surgery ,at the postoperative 1-year follow-up and final follow-up ,respectively . Grafting fusion was evaluated with Bridwell grading criteria ,and the clinical efficacy was observed .Results All patients were safe at perioperative period .The mean operative time was (198 ± 52)minutes ,the average blood loss was (388 ± 42)mL .ESR decreased from (14 ± 9)mm/1 h and (11 ± 3)mm/1 h at postoperative 1-year and final follow-up from preoperative (57 ± 16)mm/1 h ,respectively .The Cobb′s angles improved to 3 .5° ± 0 .7° at final follow-up from preoperative 6 .5° ± 3 .1°;ODI improved from 39 .1 ± 12 .4 preoperatively to 7 .3 ± 3 .1 and 6 .8 ± 2 .5 at postoperative 1-year and final follow-up ,respectively .At postoperative 1-year follow-up ,11 cases spinal graft fusions were Bridwell Ⅰ Grade;9 cases were Bridwell Ⅱ Grade;3 case Bridwell Ⅲ Grade .At final follow-up ,15 cases Bridwell Ⅰ Grade;7 cases were Bridwell Ⅱ Grade and 1 case Bridwell Ⅲ Grade .The final fuse rate was 96% .The clinical efficacy evaluated at postoperative 1-year follow-up ,were excellent in 10 cases ,good in 11 , fair in 2;The result improved at final follow-up ,good rate was 96% .Recurrence were not fund in all cases in this study ;TB symptoms in patients with low back pain disappeared .All cases were not found chronic infection or si-nus formation .None of loose screws ,broken nails or broken rods occurred .Surgical or drug-related complications did not occur at the last follow-up .Conclusion For adult patients with lumber tuberculosis ,surgery by a single posterior approach can enable surgeon to perform debridement ,spinal decompression ,deformity correction and spinal 270° fusion safely and effectively ,as long as a shaped titanium mesh is used for interbody fusion.