CAJ | 학술논문

目的：总结一期前路病灶清除钛网植骨融合内固定治疗颈椎结核的临床疗效。方法2008年7月至2011年12月，采用一期前路病灶清除钛网植骨融合内固定治疗下颈椎结核15例，男9例，女6例；年龄32~71岁，平均55岁。病灶累及两个椎体者11例，其中C3~41例，C4~52例，C5~64例，C6~74例；累及3个椎体者4例，均为C5~7。颈椎后凸Cobb角为22°~46°，平均35°。神经功能按Frankel分级，B级2例，C级3例，D级8例，E级2例。术前抗结核药物治疗2周以上，术后继续抗结核治疗12~18个月。随访观察患者临床症状改善和植骨融合情况。结果手术均顺利完成，术中无大血管、脊髓、食道、气管损伤。切口均一期愈合，未发生感染及窦道形成。随访20~60个月，平均30.6个月。患者临床症状及神经功能有不同程度恢复，神经功能1例B级恢复至D级，其余均达E级。术后末次随访后凸Cobb角0°~5°，平均2.6°，较术前明显减少，差异有统计学意义（ P<0.01）。患者植骨均完全融合，融合时间3~5个月，平均3.5个月，无内固定松动、脱落、折断、结核复发等并发症。结论在规范抗结核治疗的基础上，一期前路病灶清除钛网植骨融合内固定是治疗下颈椎结核的有效方法。
목적：총결일기전로병조청제태망식골융합내고정치료경추결핵적림상료효。방법2008년7월지2011년12월，채용일기전로병조청제태망식골융합내고정치료하경추결핵15례，남9례，녀6례；년령32~71세，평균55세。병조루급량개추체자11례，기중C3~41례，C4~52례，C5~64례，C6~74례；루급3개추체자4례，균위C5~7。경추후철Cobb각위22°~46°，평균35°。신경공능안Frankel분급，B급2례，C급3례，D급8례，E급2례。술전항결핵약물치료2주이상，술후계속항결핵치료12~18개월。수방관찰환자림상증상개선화식골융합정황。결과수술균순리완성，술중무대혈관、척수、식도、기관손상。절구균일기유합，미발생감염급두도형성。수방20~60개월，평균30.6개월。환자림상증상급신경공능유불동정도회복，신경공능1례B급회복지D급，기여균체E급。술후말차수방후철Cobb각0°~5°，평균2.6°，교술전명현감소，차이유통계학의의（ P<0.01）。환자식골균완전융합，융합시간3~5개월，평균3.5개월，무내고정송동、탈락、절단、결핵복발등병발증。결론재규범항결핵치료적기출상，일기전로병조청제태망식골융합내고정시치료하경추결핵적유효방법。
Objective To evaluate the clinical efficacy of one-stage surgical management for lower cervical spinal tuber-culosis by anterior debridement,titanium cage fusion with autograft and instrumentation. Methods From July 2008 to Decem-ber 2011,15 patients suffering from lower cervical tuberculosis(9 males and 6 females,aged 32~71 years,mean age 55 years) underwent one-stage anterior debridement,titanium cage fusion with autograft and instrumentation. The defect sites were C3~4 in 1 case,C4~5 in 2 cases,C5~6 in 4 cases,C6~7 in 4 cases,C5~7 in 4 cases. The mean preoperative Cobb angle was 35°( range 22°~46°). The preoperative Frankel grade:2 Frankel B,3 Frankel C,8 Frankel D,2 Frankel E. Preoperative anti-tuberculosis treatment was given for 2 weeks at least,then the treatment lasted for 12~18 months postoperatively. Improvement of clinical symptoms and bone fusion were followed up. Results The operations were successfully completed without injury of blood ves-sels,spinal cord,esophagus and trachea. The incision healed with no complications such as sinus formation and wound infec-tion. The mean follow-up was 30. 6 months ranged from 20 to 60 months. The patients clinical symptoms and the neurological dysfunction had different degrees of improvement of 13 cases with neurological deficit,12 cases improved to Frankel E,1 case improved from Frankel B to Frankel D. The average Cobb angle of cervical spine was 2. 6°(range 0°~5°)at the final follow-up,which was significantly lower than preoperative one(P<0. 01). After 3~5 months postoperatively,all cases were showed signs of bone fusion,and no recurrence or instrument failure was noted. Conclusion One-stage surgical management for lower cervical spinal tuberculosis by anterior debridement,titanium cage fusion with autograft and instrumentation is a safe and effec-tive surgical method on the basis of standard anti-tuberculosis chemotherapy.