CAJ | 학술논문

目的探讨后路病灶清除、椎间植骨融合内固定治疗复杂性胸、腰椎结核的手术适应证、技术要点及临床疗效,并评价其安全性和有效性.方法回顾性分析2008年6月至2012年8月28例复杂性胸腰椎结核患者的相关资料,男15例,女13例；年龄7～58岁,平均34岁.胸椎12例,胸腰段7例,腰椎9例.单节段受累13例,双节段12例,三节段或以上者3例.7例合并腰大肌脓肿,13例存在不同程度的脊髓神经功能损害,17例合并后凸畸形.均采用后路经椎间孔及椎旁病灶清除,联合椎间植骨融合内固定治疗.术后予标准抗结核化疗.定期随访观察结核治愈、神经功能改善及畸形矫正情况.结果 28例患者均获得随访,随访时间12～57个月,平均20.7个月.26例术后12～18个月获得临床治愈；1例术后结核复发2次,经再手术后治愈；另1例发生内固定移位,但骨质愈合良好.术前存在脊髓神经功能损害者除1例末次随访时ASIA分级为D级外,余均恢复至完全正常.术前后凸畸形平均为37.1°±18.5°,术后矫正至13.6°±9.8°,末次随访时15.8°±10.3°.围手术期发生严重并发症2例,1例为术中大出血,行介入栓塞治疗,再次手术后治愈；另1例为术区感染,经再次手术后治愈.结论后路病灶清除、椎间植骨融合内固定对于复杂性胸、腰椎结核是一种安全、有效的术式,且手术创伤相对较小,但病灶清除技术难度较高,学习曲线较长,并存在损伤前方大血管的潜在风险.
목적 탐토후로병조청제、추간식골융합내고정치료복잡성흉、요추결핵적수술괄응증、기술요점급림상료효,병평개기안전성화유효성.방법 회고성분석2008년6월지2012년8월28례복잡성흉요추결핵환자적상관자료,남15례,녀13례；년령7～58세,평균34세.흉추12례,흉요단7례,요추9례.단절단수루13례,쌍절단12례,삼절단혹이상자3례.7례합병요대기농종,13례존재불동정도적척수신경공능손해,17례합병후철기형.균채용후로경추간공급추방병조청제,연합추간식골융합내고정치료.술후여표준항결핵화료.정기수방관찰결핵치유、신경공능개선급기형교정정황.결과 28례환자균획득수방,수방시간12～57개월,평균20.7개월.26례술후12～18개월획득림상치유；1례술후결핵복발2차,경재수술후치유；령1례발생내고정이위,단골질유합량호.술전존재척수신경공능손해자제1례말차수방시ASIA분급위D급외,여균회복지완전정상.술전후철기형평균위37.1°±18.5°,술후교정지13.6°±9.8°,말차수방시15.8°±10.3°.위수술기발생엄중병발증2례,1례위술중대출혈,행개입전새치료,재차수술후치유；령1례위술구감염,경재차수술후치유.결론 후로병조청제、추간식골융합내고정대우복잡성흉、요추결핵시일충안전、유효적술식,차수술창상상대교소,단병조청제기술난도교고,학습곡선교장,병존재손상전방대혈관적잠재풍험.
Objective To assess the clinical effect,safety,indications and techniques of posterior debridement,bone graft and internal fixation for complicated thoracolumbar tuberculosis.Methods Twenty-eight patients from June 2008 to August 2012 were retrospectively analyzed.15 males and 13 females with an average age of 34 (7 to 58) years old were evaluated.Thoracic,thoracolombar and lumbar lesions were found in 12,7 and 9 cases,repectively.There are 12 cases with single segment,12 cases with two segments and 3 cases with at least three segments.7 cases with psoas abscess,13 with neurological defect and 17 with kyphosis.All patients had undergone posterior debridement transforaminally and paravertebrally,combined with bone graft and internal fixation.Anti-TB treatment was given to all patients.The curative effect of tuberculosis,neurologic function and angle of kyphosis were observed in regular follow-up time.Results All patients were followed up for an average of 20.7 (12 to 57) months.26 cases were cured 12 to 18 months postoperatively.One patient had two recurrence,which were successfully treated with reoperations.Although one child was found with loosening of internal fixation,she got full fusion.Only one case was evaluated to be grade D in ASIA scoring,while others were completely recovered.The average preoperative kyphosis angle was 37.1 °± 18.5°,compared to 13.6°±9.8° postoperatively.At the final follow-up time,the average kyphosis angle was 15.8°± 10.3°.Serious perioperative complications occurred in 2 cases.One with massive hemorrhage was cured after interventional embolization and reoperation,while the other with infection was cured after reoperation.Conclusion The clinical outcomes of posterior debridement,bone graft and internal fixation for complicated thoracolumbar tuberculosis are satisfactory.Effective lesions debridement,canal decompression,kyphosis correction,bone graft and stable fixation can be achieved in this operaion with fewer traumas.However,there's still a problem in debridement and a risk of damaging vascular during this operation,which needs further research.