CAJ | 학술논문

背景:钉棒系统对于老年脊柱结核患者重建和稳定脊柱是一种可优先选择的内固定材料.老年胸腰骶椎结核后路病灶清除、器械内固定治疗、植骨融合与前路手术的选择常有争论. 目的:观察钉棒系统置入内固定结合病灶清除治疗老年胸腰骶椎结核的效果,对比前路与后路手术治疗效果的差异. 方法:选择老年胸腰骶椎结核患者47例,按手术方案分为2组,后路组27例,行后路病灶清除、植骨融合、钉棒系统置入内固定;前路组20例,行前路病灶清除、植骨融合、后路钉棒系统置入内固定.利用 Frankel 分级标准评价患者治疗前后脊髓损伤和恢复情况;应用 X 射线片评价患者治疗前后临床疗效;观察患者治疗前后血沉、Cobb 角变化. 结果与结论:47例患者均获得随访,随访时间10-36个月,所有患者均治愈,术中及住院期间无严重并发症发生.植骨于10-18个月内均获融合,Frankel 分级明显改善.2组患者 Frankel 分级改善情况及 Cobb 角、血沉变化差异均无显著性意义(P >0.05).提示钉棒系统置入内固定结合病灶清除治疗老年胸腰骶椎结核,后路与前路手术均可获得较好的治疗效果,均可重建脊柱稳定性,恢复脊柱正常序列.应根据脊柱结核的类型、破坏程度及手术可能造成的脊柱稳定性改变等选择合理的手术入路.
배경:정봉계통대우노년척주결핵환자중건화은정척주시일충가우선선택적내고정재료.노년흉요저추결핵후로병조청제、기계내고정치료、식골융합여전로수술적선택상유쟁론. 목적:관찰정봉계통치입내고정결합병조청제치료노년흉요저추결핵적효과,대비전로여후로수술치료효과적차이. 방법:선택노년흉요저추결핵환자47례,안수술방안분위2조,후로조27례,행후로병조청제、식골융합、정봉계통치입내고정;전로조20례,행전로병조청제、식골융합、후로정봉계통치입내고정.이용 Frankel 분급표준평개환자치료전후척수손상화회복정황;응용 X 사선편평개환자치료전후림상료효;관찰환자치료전후혈침、Cobb 각변화. 결과여결론:47례환자균획득수방,수방시간10-36개월,소유환자균치유,술중급주원기간무엄중병발증발생.식골우10-18개월내균획융합,Frankel 분급명현개선.2조환자 Frankel 분급개선정황급 Cobb 각、혈침변화차이균무현저성의의(P >0.05).제시정봉계통치입내고정결합병조청제치료노년흉요저추결핵,후로여전로수술균가획득교호적치료효과,균가중건척주은정성,회복척주정상서렬.응근거척주결핵적류형、파배정도급수술가능조성적척주은정성개변등선택합리적수술입로.
@@@@BACKGROUND: Screw and rod system is a priority choice fixation material for the reconstruction and spine stabilization of elderly spinal tuberculosis patients. There are controversies on the debridment, internal fixation, interbody fusion and the selection of anterior approach operation for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients. @@@@OBJECTIVE: To observe the effect of screw and rod system fixation combined with debridement in treating tuberculosis of thoracic, lumbar and sacral spine in elderly patients, and to compare the difference of treatment effect of anterior and posterior surgery. @@@@METHODS: Forty-seven elderly patients with tuberculosis of thoracic, lumbar and sacral spine were selected, and divided into two groups according to the surgery program. There were 27 patients in posterior operation group, and the patients in the posterior group were treated with debridment, bone graft fusion and screw and rod system internal fixation. There were 20 patients in anterior operation group, and the patients were treated with debridment, bone graft fusion and posterior screw and rod system internal fixation. Frankel neurological grade was used to evaluate spinal cord injury and recovery situations before and after treatment. The clinical efficacy was evaluated with X-ray films before and after treatment, and the changes of erythrocyte sedimentation rate and Cobb angle were observed before and after treatment. @@@@RESULTS AND CONCLUSION: Al the 47 patients were fol owed-up for 10-36 months, and al the patients were cured. No severe complications occurred during and after operation. Spinal fusion occurred in al the patients at 10-18 months after operation. Frankel neurological grades were improved significantly. There were no significant differences of the improvement of Frankel neurological grades, Cobb angle and erythrocyte sedimentation rate between two groups (P > 0.05). Both of anterior and posterior screw and rod system fixation combined with debridement for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients can obtain the satisfactory effect, reconstruct the spinal stability and restore normal spine sequence. Reasonable surgical approach should be chosen based on the type of spinal tuberculosis, the extent of the damage and surgery caused spine stability changes.