CAJ | 학술논문

目的总结胸、腰椎椎体结核前路一期病灶清除、椎体间植骨融合、病椎置钉短节段内固定的疗效,并探讨其安全性和有效性.方法 2009年6月至2013年11月,行前路一期病灶清除、椎体间植骨融合、病椎置钉短节段内固定治疗胸、腰椎椎体结核患者46例,男25例,女21例;年龄13～69岁,平均39.6岁.病变节段为T6～L4(均≤3个节段).术前Frankel分级:B级3例、C级6例、D级4例、E级33例.术前后凸Cobb角平均为16.34°±3.19°.术前红细胞沉降率为19～81mm/1 h.术前均行胸、腰椎CT平扫及二维重建,测量残余椎体冠状位及矢状位前、中柱最低有效残留高度,当最低残留有效高度＞10 mm时,结合术中测量选择合适的内固定器械行前路病灶清除、植骨融合、病椎置钉内固定.对手术前后Cobb角、视觉模拟评分(visual analogue scale,VAS)、红细胞沉降率、Frankel分级行统计分析,并观察内植物稳定性和植骨融合情况.结果 46例患者随访12～48个月,平均26个月.所有患者结核中毒症状均消失,红细胞沉降率为0～15 mm/1 h.末次随访Frankel分级:D级2例、E级44例.术后1周后凸Cobb角平均为4.16°±2.71°,末次随访平均为4.52°±1.29°;VAS评分由术前(6.85±1.22)分,恢复至术后1周(4.79±0.95)分,末次随访时(2.26±0.93)分;红细胞沉降率由术前(41.25±1.61)mm/1 h,恢复至术后1周(17.36±6.82) mm/1 h,末次随访时(10.67±0.72) mm/1 h.术后6个月植骨融合优44例、良2例.结论胸、腰椎椎体结核残余椎体有效高度＞10 mm时行病椎置钉短节段内固定安全且可靠.
목적 총결흉、요추추체결핵전로일기병조청제、추체간식골융합、병추치정단절단내고정적료효,병탐토기안전성화유효성.방법 2009년6월지2013년11월,행전로일기병조청제、추체간식골융합、병추치정단절단내고정치료흉、요추추체결핵환자46례,남25례,녀21례;년령13～69세,평균39.6세.병변절단위T6～L4(균≤3개절단).술전Frankel분급:B급3례、C급6례、D급4례、E급33례.술전후철Cobb각평균위16.34°±3.19°.술전홍세포침강솔위19～81mm/1 h.술전균행흉、요추CT평소급이유중건,측량잔여추체관상위급시상위전、중주최저유효잔류고도,당최저잔류유효고도＞10 mm시,결합술중측량선택합괄적내고정기계행전로병조청제、식골융합、병추치정내고정.대수술전후Cobb각、시각모의평분(visual analogue scale,VAS)、홍세포침강솔、Frankel분급행통계분석,병관찰내식물은정성화식골융합정황.결과 46례환자수방12～48개월,평균26개월.소유환자결핵중독증상균소실,홍세포침강솔위0～15 mm/1 h.말차수방Frankel분급:D급2례、E급44례.술후1주후철Cobb각평균위4.16°±2.71°,말차수방평균위4.52°±1.29°;VAS평분유술전(6.85±1.22)분,회복지술후1주(4.79±0.95)분,말차수방시(2.26±0.93)분;홍세포침강솔유술전(41.25±1.61)mm/1 h,회복지술후1주(17.36±6.82) mm/1 h,말차수방시(10.67±0.72) mm/1 h.술후6개월식골융합우44례、량2례.결론 흉、요추추체결핵잔여추체유효고도＞10 mm시행병추치정단절단내고정안전차가고.
Objective To explore the effectiveness of short segmental screw fixation and bone graft fusion on the decayed vertebral of thoracolumbar tuberculosis.Methods A total of 46 cases undergone one stage anterior debridement,interbody fusion,screw fixation on the decayed vertebral of thoracolumbar tuberculosis were retrospectively analyzed from June 2009 to November 2013.Including 25 males and 21 females,with the mean age of 39.6 years (range,13-69 years).Lesion segments:T6-L4 (segment lesions ≤ 3 segments); 3 B gradecases,6 C grade cases,4 D grade cases and 33 E grade cases assessmed by Frankel grade.The average Cobb angle of kyphosis was 16.34°±3.19° and ESR:19-81 mm/1 h preopration.CT scan and Two-dimensional reconstruction were done before operation,and the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position were measured before operation,when the minimum effective height was higher than 10 mm,combined the intraoperative visual,the appropriate internal fixation for anterior debridement and interbody bone grafting were choosed.The cobb angle,the Frankel grade,the ESR and VAS value were compared with preoperative and postoperative.The stability and bone graft fusion were also observed.Results Fourty-six cases of patients were received followed up from 12 to 48 months,an average of 26 months.All patients with tuberculosis poisoning symptoms disappeared.The ESR:0-15 mm/1 h.Frankel rating at the end of postoperative follow-up:2 D-class cases,44 E-class cases.The VAS score (6.85± 1.22,4.49±0.95 vs.2.06±0.93) and vertebral Cobb angle (16.34°±3.19°,4.16°±2.71° vs.4.52°±1.29°) at post-operation 7 d and the last follow-up were significant lower than those at pre-operation,while the ESR (41.25±1.61 mm/1 h,17.36±6.82 mm/1 h vs.10.67±0.72 mm/1 h) was reduced to normal levelthan that of pre-operation.The comparative difference was statistically significant between pre-operative and post-operative.The fusion rate at the end of post-operative follow-up:44 excellent cases,2 good cases.Conclusion When the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position in vertebral tuberculosis was higherthan 10mm,reliable stability and treatment efficiency were achieved with anteriorinternal fixation.