CAJ | 학술논문

骨关节植入物%脊柱植入物%脊柱病变%胸腰段%内固定%钛网%一期前后路%脊柱结核%后凸畸形%植骨融合%神经功能%后凸角%植入物骨關節植入物%脊柱植入物%脊柱病變%胸腰段%內固定%鈦網%一期前後路%脊柱結覈%後凸畸形%植骨融閤%神經功能%後凸角%植入物
골관절식입물%척주식입물%척주병변%흉요단%내고정%태망%일기전후로%척주결핵%후철기형%식골융합%신경공능%후철각%식입물
bone and joint implants%spinal implants%spinal lesions%thoracolumbar%internal fixation%titanium mesh%one-stage anterior-posterior approach%spinal tuberculosis%kyphosis%interbody fusion%neurological function%kyphosis angle%implants

背景:有学者提出的经前路矫正脊柱结核后凸畸形和解除脊髓压迫的治疗方法,可能会有植骨块塌陷、吸收或断裂的并发症.研究证实,通过一期前后路联合内固定可增加对后凸畸形的矫正力量,避免出现植骨并发症、降低假关节的形成并有助于患者早期下地活动及功能恢复.目的:分析评价2个或多个节段受累伴中重度后凸畸形的脊柱结核患者,一期行前后路病灶清除、植骨融合内固定矫正后凸畸形的临床疗效.方法:回顾性分析20例脊柱胸腰段有2个或更多节段受累的结核患者,一期行后路内固定融合并前路病灶清除钛网融合内固定.所有患者内固定后持续9个月抗结核化疗,最初3个月采用四联抗结核药物,后6个月采用三联抗结核药物.随访时测量后凸角度,评价患者融合情况、神经病变和功能恢复状况.结果与结论:所有患者随访均超过37个月.所有患者均获得牢固节段融合重返工作岗位.内固定治疗后15例(75%)的患者仅残留局部轻度疼痛,3例(15%)活动受限明显.内固定前11例有神经功能障碍,内固定后9例神经功能完全恢复正常.后凸角度平均矫正了35.1°(84.8%)(P <0.001),在随访期间矫正丢失差异无显著性意义(P >0.05),未出现内固定及植骨相应并发症.结果表明,对于2个或更多节段受累伴有中重度后凸畸形的脊柱结核患者,应环形融合,即一期前后路联合内固定融合治疗.可获得更大矫正,有助于患者早期下地活动,稳定病变节段,而且可以长期有效地维持矫正效果.
배경:유학자제출적경전로교정척주결핵후철기형화해제척수압박적치료방법,가능회유식골괴탑함、흡수혹단렬적병발증.연구증실,통과일기전후로연합내고정가증가대후철기형적교정역량,피면출현식골병발증、강저가관절적형성병유조우환자조기하지활동급공능회복.목적:분석평개2개혹다개절단수루반중중도후철기형적척주결핵환자,일기행전후로병조청제、식골융합내고정교정후철기형적림상료효.방법:회고성분석20례척주흉요단유2개혹경다절단수루적결핵환자,일기행후로내고정융합병전로병조청제태망융합내고정.소유환자내고정후지속9개월항결핵화료,최초3개월채용사련항결핵약물,후6개월채용삼련항결핵약물.수방시측량후철각도,평개환자융합정황、신경병변화공능회복상황.결과여결론:소유환자수방균초과37개월.소유환자균획득뢰고절단융합중반공작강위.내고정치료후15례(75%)적환자부잔류국부경도동통,3례(15%)활동수한명현.내고정전11례유신경공능장애,내고정후9례신경공능완전회복정상.후철각도평균교정료35.1°(84.8%)(P <0.001),재수방기간교정주실차이무현저성의의(P >0.05),미출현내고정급식골상응병발증.결과표명,대우2개혹경다절단수루반유중중도후철기형적척주결핵환자,응배형융합,즉일기전후로연합내고정융합치료.가획득경대교정,유조우환자조기하지활동,은정병변절단,이차가이장기유효지유지교정효과.
@@@@BACKGROUND: Scholars have supposed that the treatment of spinal tuberculosis kyphosis with anterior approach and spinal cord decompression may lead to complications such as bone graft col apse, absorption or fracture. Studies have confirmed that one-stage anterior-posterior surgery combined with internal fixation can enhance the corrective effect to kyphosis, avoid bone graft complications, reduce the formation of false joints, help patients with early activities out of bed and promote the functional recovery. OBJECTIVE: To evaluate the clinical outcome for tuberculous spondylitis of thoracolumbar region with two or more affected segments treated with one-stage anterior-posterior debridement, interbody fusion and internal fixation. METHODS: We retrospectively studied 20 cases of tuberculous spondylitis of thoracolumbar region with two or more levels of involvement. Al the patients underwent one-stage posterior fixation fusion and anterior debridement and titanium mesh fusion and internal fixation. Al the patients received antituberculosis chemotherapy for 9 months after internal fixation. For the first 3 months, the patients were treated with quadruple antituberculosis drugs, and then treated with triple antituberculosis drugs in the later 6 months. The kyphosis angles were measured during fol ow-up to evaluate the fusion status, neuropathy and functional recovery. RESULTS AND CONCLUSION: Al the patients were fol owed-up for more than 37 months. Al patients returned to their previous occupation after firmly segment fusion; only 15 cases (75%) felt mild pain or no pain and three cases (15%) with major limitations in activities. There were 11 patients with neurological deficit before internal fixation, and nine cases of these achieved complete neurological recovery. The kyphosis angles were corrected for 35.1° (84.8%) in average (P < 0.001), and there was no significant difference in correction loss during the fol ow-up period (P < 0.05). There were no grafts or fixation-related complications. Tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis should be treated with circumferential fusion, that is one-stage anterior-posterior fusion and fixation, which can obtain greater correction, help the patients with early activities out of bed, stabilize the lesioned segments, and long-term maintain the correction effect.