CAJ | 학술논문

目的探讨脊柱结核经后路固定加后外侧或前外侧病灶清除手术治疗的疗效.方法回顾性分析2007年4月至2011年6月期间收治的一期经后路固定加病灶清除的38例脊柱结核患者的临床资料,其中胸椎结核19例患者行后路钉棒系统内固定且一期经胸椎后外侧入路行结核病灶清除;腰椎结核15例,腰骶椎结核4例患者行后路钉棒系统内固定后改变体位一期经腰椎前外侧入路行结核病灶清除.手术后继续规范抗结核治疗.随访患者疼痛及畸形以及神经系统改善情况.结果所有患者得到随访.1例背部切口轻度慢性炎症,2例双下肢神经系统功能未完全恢复.所有患者结核中毒症状全部消失,胸部腰背疼痛明显改善,后凸畸形好转.植骨融合,治愈率92.1%(35/38).结论脊柱结核经后路固定,胸椎结核经后外侧腰椎结核经前外侧病灶清除术式安全,疗效确切.术前术后规范抗痨用药及营养支持是保障手术疗效的关键.
목적탐토척주결핵경후로고정가후외측혹전외측병조청제수술치료적료효.방법회고성분석2007년4월지2011년6월기간수치적일기경후로고정가병조청제적38례척주결핵환자적림상자료,기중흉추결핵19례환자행후로정봉계통내고정차일기경흉추후외측입로행결핵병조청제;요추결핵15례,요저추결핵4례환자행후로정봉계통내고정후개변체위일기경요추전외측입로행결핵병조청제.수술후계속규범항결핵치료.수방환자동통급기형이급신경계통개선정황.결과소유환자득도수방.1례배부절구경도만성염증,2례쌍하지신경계통공능미완전회복.소유환자결핵중독증상전부소실,흉부요배동통명현개선,후철기형호전.식골융합,치유솔92.1%(35/38).결론척주결핵경후로고정,흉추결핵경후외측요추결핵경전외측병조청제술식안전,료효학절.술전술후규범항로용약급영양지지시보장수술료효적관건.
Objective To investigate the efficacy of posterior fixation and lesion debridement by posterolateral or anterolateral approach in the treatment of spinal tuberculosis. Methods The clinical data of 38 patients with spinal tuberculosis who were treated by posterior fixation and lesion debridement at first stage from April 2007 to June 2011 were analyzed retrospectively. Among them, 19 patients with thoracic spinal tuberculosis were treated by lesion debridement by thoracic posterolateral approach at first stage after internal fixation by posterior nail bar system. 15 patients with lumbar spinal tuberculosis and 4 patients with lumbosacral spinal tuberculosis were treated by lesion debridement by lumbar anterolateral approach after internal fixation by posterior nail bar system and changed body position. After surgery, the anti-tuberculosis treatment was regulated continuously, and the patients were followed up in 3 aspects:the pain, deformity and improvement of nervous system. Results All patients were followed up. 1 patient had mild chronic inflammation in the back incision and 2 patients did not get completely recovered in the function of the nervous system of both lower limbs. Poisoning symptoms of tuberculosis of all patients disappeared. The pain in the chest and back was improved obviously, and the kyphosis deformity was also improved. The cure rate of bone graft fusion was 92.1%(35/38). Conclusions The efficacy of posterior fixation in the treatment of spinal tuberculosis and lesion debridement in the treatment of thoracic spinal tuberculosis and lumbar spinal tuberculosis by posterolateral or anterolateral approach is safe and satisfactory, and the regulation of anti-tuberculosis medication and nutritional support before and after surgery are the keys to ensure the efficacy.