CAJ | 학술논문

目的：探讨单纯经后路途径病灶清除、植骨融合和椎弓根钉棒系统内固定治疗胸腰段结核的临床疗效。方法回顾性研究2010年1月至2012年1月我科收治的82例胸腰段脊柱结核伴脊柱畸形的病例，其中男性47例，女性35例；年龄19～68岁，平均（45±15）岁。均采用单纯后路途径病灶清除内固定的方法进行手术治疗。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（ESR）、C反应蛋白（CRP）、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。结果用SPSS 17．0进行统计分析。结果所有患者均安全度过围手术期，平均手术时间为（168±41）min ，平均失血量为（346±37）mL。ESR由术前的（57±16）mm/1 h ，末次随访时下降为（11±3）mm/1 h。术前椎体Cobb′s角平均（20±4）°，术后1年随访时和末次随访时分别改善为（2．8±2．0）°和（2．8±2．3）°。ODI评分由术前的（39±14），术后1年和末次随访时分别改善为（7±3）和（7±3）。Bridwell Ⅰ级和Ⅱ级植骨融合率于术后1年和末次随访时分别为82％和90％，无Bridw ell Ⅳ级病例。临床疗效评价于术后1年和末次随访时优良率分别为89％和94％。结论单纯后路途径手术治疗成人单节段胸腰段脊柱结核，是相对意义上的脊柱结核“微创”手术，可以满足清除病灶、脊髓减压、畸形矫正和脊柱270°融合的目的，安全有效。
목적：탐토단순경후로도경병조청제、식골융합화추궁근정봉계통내고정치료흉요단결핵적림상료효。방법회고성연구2010년1월지2012년1월아과수치적82례흉요단척주결핵반척주기형적병례，기중남성47례，녀성35례；년령19～68세，평균（45±15）세。균채용단순후로도경병조청제내고정적방법진행수술치료。분별우술전、술후14 d、1년수방화말차수방시검측홍세포침강솔（ESR）、C반응단백（CRP）、병변절단Cobb′s각、Oswestry 공능장애지수（ODI），술후1년화말차수방시채용Bridwell분급평개식골융합정황，동시평개림상료효。결과용SPSS 17．0진행통계분석。결과소유환자균안전도과위수술기，평균수술시간위（168±41）min ，평균실혈량위（346±37）mL。ESR유술전적（57±16）mm/1 h ，말차수방시하강위（11±3）mm/1 h。술전추체Cobb′s각평균（20±4）°，술후1년수방시화말차수방시분별개선위（2．8±2．0）°화（2．8±2．3）°。ODI평분유술전적（39±14），술후1년화말차수방시분별개선위（7±3）화（7±3）。Bridwell Ⅰ급화Ⅱ급식골융합솔우술후1년화말차수방시분별위82％화90％，무Bridw ell Ⅳ급병례。림상료효평개우술후1년화말차수방시우량솔분별위89％화94％。결론단순후로도경수술치료성인단절단흉요단척주결핵，시상대의의상적척주결핵“미창”수술，가이만족청제병조、척수감압、기형교정화척주270°융합적목적，안전유효。
Objective To investigate the efficacy of debridement ,interbody fusion and internalfixation for thoracolumbar tuberculosis with spinal deformity by posterior only approach .Methods A retrospective study was performed ,which included 82 cases of thoracolumbar tuberculosis with spinal deformity admitted to our depart-ment from January 2010 to January 2012 ,including 47 males ,35 females;aged 19 to 68 years ,an average of (45 ± 15)years old .All cases underwent debridement ,interbody fusion and internal fixation by posterior only ap-proach .ESR ,CRP ,Cobb′s angle and Oswestry Disability Index (ODI) were detected at 14th day before and after surgery ,and at the postoperative 1-year follow-up and final follow-up ,respectively .Bone graft fusion was evalua-ted with Bridwell grading criteria ,and the clinical efficacy was observed as well .Results were statistically ana-lyzed with SPSS17 .0 .Results The mean operative time was 168 ± 41 min ,and the average blood loss was (346 ± 37)mL .ESR decreased to (11 ± 3)mm/1 h at posteroperative final follow-up from preoperative (57 ± 16)mm/1 h . For the cases with spinal kyphosis ,the Cobb′s angles changed from preoperative average (20 ± 4)° to(2 .8 ± 2 .0)° and (2 .8 ± 2 .3)°at posteroperative 1-year and final follow-up ,respectively .ODI ,lumbar dysfunction index ,im-proved from preoperative (39 ± 14)to(7 ± 3) and (7 ± 3)at posteroperative 1-year and final follow-up ,respective-ly .At posteroperative 1-year follow-up ,the rate of spinal graft fusion at Bridwell Ⅰ and Bridwell Ⅱ Grade were 82% and 90% ,respectively .The clinical efficacy was evaluated at posteroperative 1-year and final follow-up ,the rate of excellence and goodness was 89% and 94% ,respectively .Conclusion Single posterior approach is in a sense a“minimally invasive surgery”for treatment of the adult thoracolumbar spinal tuberculosis with spinal defor-mity ,and can enable surgeon to remove the lesion ,decompress the spinal cord ,correct spinal deformity and a-chieve 270° spinal fusion safely and effectively.