CAJ | 학술논문

目的：探讨后路一期病灶清除、椎体间植骨融合内固定治疗脊柱结核的适应证及临床疗效。方法采用单纯后路病灶清除、植骨融合钉棒内固定治疗58例脊柱结核患者,其中单节段胸椎结核22例,多节段胸椎结核6例,单节段腰椎结核24例,多节段腰椎结核6例。分析复发率、并发症发生率,进行JOA评分,随访评估结核活动度、植骨融合和畸形矫正情况。结果手术时间平均(190±15．24) min,术中出血量平均(380±19．88) ml。术中无主要血管、神经损伤,无严重并发症发生。所有患者均安全度过围手术期。 JOA评分：优39例,良11例,可7例,差1例,优良率为86．2%。后凸Cobb角矫正满意。1例术后结核脓肿复发,经再次清创、持续负压引流后治愈。患者均获随访,时间6~48(25．14±6．40)个月。无结核病变复发、内固定松动、断裂及明显矫正度丢失等严重并发症发生,58例植骨全部确定融合。结论对脊柱结核的患者采取一期后路病灶清除、椎体间植骨融合内固定治疗,可同时完成病灶清除、重建脊柱稳定,是治愈结核病灶有效可行的方法。
목적：탐토후로일기병조청제、추체간식골융합내고정치료척주결핵적괄응증급림상료효。방법채용단순후로병조청제、식골융합정봉내고정치료58례척주결핵환자,기중단절단흉추결핵22례,다절단흉추결핵6례,단절단요추결핵24례,다절단요추결핵6례。분석복발솔、병발증발생솔,진행JOA평분,수방평고결핵활동도、식골융합화기형교정정황。결과수술시간평균(190±15．24) min,술중출혈량평균(380±19．88) ml。술중무주요혈관、신경손상,무엄중병발증발생。소유환자균안전도과위수술기。 JOA평분：우39례,량11례,가7례,차1례,우량솔위86．2%。후철Cobb각교정만의。1례술후결핵농종복발,경재차청창、지속부압인류후치유。환자균획수방,시간6~48(25．14±6．40)개월。무결핵병변복발、내고정송동、단렬급명현교정도주실등엄중병발증발생,58례식골전부학정융합。결론대척주결핵적환자채취일기후로병조청제、추체간식골융합내고정치료,가동시완성병조청제、중건척주은정,시치유결핵병조유효가행적방법。
Objective To investigate the clinical effect of posterior debridement, bone fusion and internal fixation for the treatment of spinal tuberculosis, as well as interbody indications and clinical efficacy. Methods Using a simple posterior debridement, bone fusion nail fixation rod, 58 cases of spinal tuberculosis patients were enrolled, including 22 single segment thoracic tuberculosis, 6 multi-segmental thoracic tuberculosis, and 24 single lumbar segment spinal tuberculosis, 6 multi-section lumbar spinal tuberculosis. Analysis of relapse rate, complication rate was conducted. JOA score, tuberculosis activity, fusion and deformity correction was recorded in follow-up. Results The mean op-eration time was (190 ± 15. 24)min, average blood loss was (380 ± 19. 88) ml. There were no major blood vessels, nerve damage and severe complications. Based on JOA score, the results were excellent in 39 cases, good in 11, fair in 7 and poor in 1,the excellent and good rate was 86. 2%. The kyphosis was corrected obviously. Recurrence of tu-berculosis abscess was found in one patient, after debridement and continuous negative pressure drainage, the abscess was cured. All patients were followed up for 6~48(25. 14 ± 6. 40)months. No recurrence of tuberculosis, loosening, fracture and significant loss of correction and other serious complications was found. All 58 cases achieved bone fu-sion. Conclusions Posterior primary debridement, interbody fusion and internal fixation can be performed in all pa-tients with spinal tuberculosis, debridement and reconstruction of spinal stability and cure of tuberculosis can be a-chieved simultaneously. It is an effective and feasible method.