CAJ | 학술논문

背景:脊柱结核多采用前路病灶清除植骨融合手术,而后路经椎弓根入路行病灶清除的手术疗效少见报道. 目的:探讨经后路椎弓根入路病灶清除和椎弓根固定治疗胸腰椎结核的疗效. 方法:2006年1月至2010年12月采用后路经椎弓根入路病灶清除和椎弓根固定治疗胸腰椎结核16例,男11例,女5例,年龄19~80岁,平均47.2岁.病程6~11个月.根据结核破坏程度及手术对脊柱稳定性的影响,所有患者均采用一期后路椎弓根系统内固定. 结果:16例患者切口均一期愈合,无慢性窦道形成.所有患者均获随访,随访时间11~58个月,平均37.6个月.术后脊柱结核均治愈,未出现复发病例.腰背疼痛VAS评分由术前平均8.0改善到术后2.2(F=17.6,P<0.05).后凸畸形由术前平均18.7°改善到术后12.5°(F=94.5,P<0.05).术后6个月植骨块骨性融合,未出现植骨块脱出、吸收.随访至植骨块融合时,角度丢失0°~8°,平均3.1°. 结论:后路经椎弓根入路病灶清除和椎弓根固定术治疗胸腰椎结核能够达到有效清除病灶并且纠正脊柱畸形的目的.
배경:척주결핵다채용전로병조청제식골융합수술,이후로경추궁근입로행병조청제적수술료효소견보도. 목적:탐토경후로추궁근입로병조청제화추궁근고정치료흉요추결핵적료효. 방법:2006년1월지2010년12월채용후로경추궁근입로병조청제화추궁근고정치료흉요추결핵16례,남11례,녀5례,년령19~80세,평균47.2세.병정6~11개월.근거결핵파배정도급수술대척주은정성적영향,소유환자균채용일기후로추궁근계통내고정. 결과:16례환자절구균일기유합,무만성두도형성.소유환자균획수방,수방시간11~58개월,평균37.6개월.술후척주결핵균치유,미출현복발병례.요배동통VAS평분유술전평균8.0개선도술후2.2(F=17.6,P<0.05).후철기형유술전평균18.7°개선도술후12.5°(F=94.5,P<0.05).술후6개월식골괴골성융합,미출현식골괴탈출、흡수.수방지식골괴융합시,각도주실0°~8°,평균3.1°. 결론:후로경추궁근입로병조청제화추궁근고정술치료흉요추결핵능구체도유효청제병조병차규정척주기형적목적.
@@@@Background: Anterior debridement and fusion surgery has been often used for the treatment of spinal tuberculosis. However, there are few reports on debridement and surgical treatment by transpedicular approach. @@@@Objective: To investigate the clinical results of single-stage posterior transpedicular debridement with transpedicular instru-mentation as an alternative operative method for thoracic and lumbar spinal tuberculosis. @@@@Methods: From January 2006 to December 2010, 16 patients who had less bone destruction or poor medical condition were treated with transpedicular decompression and transpedicular instrumentation that was supplemented with posterolateral bone fusion and chemotherapy. There were 11 males and 5 females with an average age of 47.2 years (range, 19 to 80 years). Spinal tuberculosis lasted for 6 to 11 years. @@@@Results: All patients had been followed up for 37.6 months on average (range, 11 to 58 months). Spinal tuberculosis was completely cured and the grafted bones were fused in all patients. Preoperative and postoperative VAS scores were 8.0 and 2.2, respectively (F=17.6, P<0.05). Preoperative and postoperative Cobb's angle were 18.7°and 12.5°, respectively (F=94.5, P<0.05). No sinus tract and recurrence occurred. Cobb's angle loss range from 0°to 8°(mean, 3.1°). @@@@Conclusions: The transpedicular approach debridement with transpedicular instrumentation can be an alternative treatment for less involved spinal tuberculosis especially for patients in early phase of bone destruction or ones with mild kyphosis.