CAJ | 학술논문

目的探讨一期后路病灶清除、异形钛网椎间植骨内固定治疗胸、腰椎结核的安全性及临床疗效.方法 2009年3月至2010年3月,采用一期后路病灶清除、异形钛网椎间植骨椎弓根钉-棒系统内固定治疗胸、腰椎结核28例,男17例,女11例；年龄33～68岁,平均42.7岁.病灶均为非跳跃型,且累及椎体数目(需行椎体病灶清除)均为单节段或双节段.胸椎13例,胸腰段(T11～LD5例,腰椎10例.所有患者入院时均有胸腰背部局部疼痛,其中12例合并病变节段局部后凸畸形,9例合并神经功能障碍(ASIA分级:C级2例、D级7例).术后每3个月门诊随访1次,评估结核治愈及钛网融合情况.结果 28例均顺利完成手术,手术时间130～210 min,平均150 min；出血量200～1200 ml,平均360 ml.术中无死亡及瘫痪加重的病例.12例术前存在后凸畸形的患者,后凸Cobb角由术前平均22.3°矫正术后平均5.4°.随访39～51个月,平均43个月.术后2周患者疼痛视觉模拟评分(visual analogue scale,VAS)由术前平均6.3分改善至2.1分.术后3个月红细胞沉降率均恢复正常.术后3～9个月(平均6个月)钛网及椎板植骨获得骨性融合.9例神经功能障碍者术后ASIA分级平均提高1级.术后并发切口浅层感染1例、脑脊液漏2例.随访期间未见结核原位复发及矫形角度丢失.结论对于单节段或双节段受累的非跳跃型胸、腰椎结核,一期后路手术是一种安全、有效的治疗方式；应用异形钛网椎间植骨融合技术,可更好地重建病椎前柱稳定性.
목적 탐토일기후로병조청제、이형태망추간식골내고정치료흉、요추결핵적안전성급림상료효.방법 2009년3월지2010년3월,채용일기후로병조청제、이형태망추간식골추궁근정-봉계통내고정치료흉、요추결핵28례,남17례,녀11례；년령33～68세,평균42.7세.병조균위비도약형,차루급추체수목(수행추체병조청제)균위단절단혹쌍절단.흉추13례,흉요단(T11～LD5례,요추10례.소유환자입원시균유흉요배부국부동통,기중12례합병병변절단국부후철기형,9례합병신경공능장애(ASIA분급:C급2례、D급7례).술후매3개월문진수방1차,평고결핵치유급태망융합정황.결과 28례균순리완성수술,수술시간130～210 min,평균150 min；출혈량200～1200 ml,평균360 ml.술중무사망급탄탄가중적병례.12례술전존재후철기형적환자,후철Cobb각유술전평균22.3°교정술후평균5.4°.수방39～51개월,평균43개월.술후2주환자동통시각모의평분(visual analogue scale,VAS)유술전평균6.3분개선지2.1분.술후3개월홍세포침강솔균회복정상.술후3～9개월(평균6개월)태망급추판식골획득골성융합.9례신경공능장애자술후ASIA분급평균제고1급.술후병발절구천층감염1례、뇌척액루2례.수방기간미견결핵원위복발급교형각도주실.결론 대우단절단혹쌍절단수루적비도약형흉、요추결핵,일기후로수술시일충안전、유효적치료방식；응용이형태망추간식골융합기술,가경호지중건병추전주은정성.
Objective To evaluate the safety and clinical efficacy of one-stage posterior surgery alone for thoracic and lumbar spinal tuberculosis by debridement,internal fixation,and interbody fusion using multiple special formed titanium meshes.Methods From March 2009 to March 2010,28 patients with T/L spinal tuberculosis,including 17 males and 11 females,with an average of 42.7 years (range,33 to 68 years),had undergone one-stage posterior debridement,internal fixation,and interbody fusion using multiple special formed titanium meshes.The levels involved were less than two contiguous vertebrae:13 in thoracic vertebrae,5 in thoracolumbar vertebrae and 10 in lumbar vertebrae.All patients suffered from back pain,and there were 12 patients with local kyphosis,and 9 patients with neurologic deficit (2 in class C and 7 in class D according to ASIA score).All patients were followed up every 3 months after surgery.Results Twenty-eight patients underwent surgeries successfully,with average blood loss of 360 ml (range,200 to 1200 ml),and average surgery time of 150 mins (range,130 to 210 mins).There was no case of death or increased paralysis intraoperatively.Kyphosis Cobb angel was corrected from 22.3° preoperatively to 5.4° postoperatively in the 12 patients who were kyphosis.All cases were followed up for an average of 43 months (range,39-51 months),and there were one case with superficial infection and 2 with cerebrospinal fluid leakage.The VAS score were improved from 6.3 preoperatively to 3.1 two weeks postoperatively.ESR returned to normal 3 months postoperatively.Titanium meshes got bone fusion within 3-9 months (mean 6 months) after surgery,with no displacement,correction loss,collapse or tuberculosis recurrence during the follow-up period.9 patients with preoperative neurologic deficit restored by 1 grade at last follow-up.Conclusion One-stage posterior surgery alone may be a safe and effective way for thoracic and lumbar tuberculosis less than two contiguous levels involved,and application of multiple special formed titanium meshes can reconstruct spinal stability better.