CAJ | 학술논문

目的：探讨后路内固定、1期或2期前路病灶清除术在治疗重度脊柱结核中的作用。方法：2006年1月～2012年6月收治了重度脊柱结核18例。年龄14岁～65岁，平均年龄41岁。男8例；女10例。病变部位：胸椎4例，胸腰椎段9例，腰椎5例。入院前病史1个月～12个月。病变仅累及单节段的3例，累及2个节段的10例，累及3个节段的5例。18例中合并冷脓肿形成者14例，伴有双下肢不全瘫者3例。脊柱后突畸形8例， Cobb ’ s角10°～40°。结果：随访6个月～2年半。按骨愈合的Bridwell判断标准：Ⅰ级，11例；Ⅱ级，5例；Ⅲ级，2例。伴有双下肢不全瘫3例，术前Frankel分级D级2例，E级1例，术后均恢复正常。18例中，1例术后7个月内固定松动、脱落、异体骨塌陷。1例胸10～12椎体结核患者术后10个月出现轻度后突， Cobb ’ s角约15°。结论：对于破坏严重、多节段、后凸畸形的重度脊柱结核患者，后路椎弓根螺钉内固定、1期或2期前路病灶清除植骨术为适合选择。
목적：탐토후로내고정、1기혹2기전로병조청제술재치료중도척주결핵중적작용。방법：2006년1월～2012년6월수치료중도척주결핵18례。년령14세～65세，평균년령41세。남8례；녀10례。병변부위：흉추4례，흉요추단9례，요추5례。입원전병사1개월～12개월。병변부루급단절단적3례，루급2개절단적10례，루급3개절단적5례。18례중합병랭농종형성자14례，반유쌍하지불전탄자3례。척주후돌기형8례， Cobb ’ s각10°～40°。결과：수방6개월～2년반。안골유합적Bridwell판단표준：Ⅰ급，11례；Ⅱ급，5례；Ⅲ급，2례。반유쌍하지불전탄3례，술전Frankel분급D급2례，E급1례，술후균회복정상。18례중，1례술후7개월내고정송동、탈락、이체골탑함。1례흉10～12추체결핵환자술후10개월출현경도후돌， Cobb ’ s각약15°。결론：대우파배엄중、다절단、후철기형적중도척주결핵환자，후로추궁근라정내고정、1기혹2기전로병조청제식골술위괄합선택。
To investigate the One or two -stage combined anterio -posterior surgery used in Severe spinal tuberculosis . Methods:18 cases of spinal tuberculosis were collected from January 2006 to June2012, aged 14 years to 65 years old.While ,the average age was 41 years,among them 8 cases were men and 10 was women, 4 in thoracic, 9 in Thoracolumbar and 5 in lumbar spine.In the 18 cases in children, accompanied by the formation of cold abscess were 14 cases, associated with incomplete paralysis of both lower extremi-ties were 3 cases, and combined with kyphosis deformity whose Cobb's angle was 10 °~40 °were 3 cases.Results:All of the subjects were followed up for 6 months to 2?years, bone the degree of fusion by Bridwell criteria:Ⅰgrade, 11 cases;Ⅱgrade, 5;Ⅲgrade, 2, preoperative Frankel grade D had 2 cases and E had 1 case among the 3 cases of incomplete paralysis of both lower extremities ,which all returned to normal after operation ."Debridement surgery"and "Fixation removal and allogeneic bone graft surgery"were respectively implemented in 7 months after operation on one case because of sinus formation 、fixation fall of and allogeneic bone collapse .There was 1 case of thoracic vertebral tuberculosis 10-12 which showed up mild Kyphotic deformity in 10 months after surgeon and the Cobb's angle was about 15 °.Conclusion:It might be safe and feasible to carry out On or two -stage combined anterio -posterior surgery used in Se-vere spinal tuberculosis .