CAJ | 학술논문

目的：分析一期前路病灶清除、自体肋骨椎间植骨融合前路内固定术治疗胸椎结核的临床效果。方法2003年6月～2008年5月手术治疗胸椎脊柱结核42例，男25例，女17例，均采用一期前路病灶清除、自体肋骨椎间植骨融合前路内固定术。根据术前、术后随访的X线片，分析植骨融合及脊柱后凸畸形矫正效果；采用Frankel分级、红细胞沉降率（ erythrocyte sedimentation rate， ESR）、C反应蛋白（ C-reactionprotein， CRP ）及视觉模拟量表（ visual analog scale， VAS）评分评估临床治疗效果。结果随访1～7年，平均50．8个月，42例患者均获骨性愈合，愈合时间3～7个月，平均4．5个月，无内固定松动、脱出及断裂；术前Cobb角平均19．8°，术后1周为3．7°，末次随访时为4．6°；Frankel分级，术前B级为3例，C级9例，D级20例，E级10例，末次随访时为D级6例，E级36例；VAS评分术前平均为8．2，术后1周为1．8，末次随访时为1．2。除2例患者术后出现疼痛，持续2个月后自行缓解外，无其他并发症。无复发结核感染出现。结论一期行前路病灶清除、自体肋骨椎间融合前路内固定术治疗胸椎结核，可有效矫正脊柱后凸畸形，重建脊柱稳定性，获得较好的临床效果。
목적：분석일기전로병조청제、자체륵골추간식골융합전로내고정술치료흉추결핵적림상효과。방법2003년6월～2008년5월수술치료흉추척주결핵42례，남25례，녀17례，균채용일기전로병조청제、자체륵골추간식골융합전로내고정술。근거술전、술후수방적X선편，분석식골융합급척주후철기형교정효과；채용Frankel분급、홍세포침강솔（ erythrocyte sedimentation rate， ESR）、C반응단백（ C-reactionprotein， CRP ）급시각모의량표（ visual analog scale， VAS）평분평고림상치료효과。결과수방1～7년，평균50．8개월，42례환자균획골성유합，유합시간3～7개월，평균4．5개월，무내고정송동、탈출급단렬；술전Cobb각평균19．8°，술후1주위3．7°，말차수방시위4．6°；Frankel분급，술전B급위3례，C급9례，D급20례，E급10례，말차수방시위D급6례，E급36례；VAS평분술전평균위8．2，술후1주위1．8，말차수방시위1．2。제2례환자술후출현동통，지속2개월후자행완해외，무기타병발증。무복발결핵감염출현。결론일기행전로병조청제、자체륵골추간융합전로내고정술치료흉추결핵，가유효교정척주후철기형，중건척주은정성，획득교호적림상효과。
Objective To assess the clinical efficacy of one-stage surgical management for thoracic tuberculosis by anterior radical debridement, decompression and autogenous rib grafts, and instrumentation.Methods In this retrospective study, 42 patients (25 male and 17 female;average age 47.7 years) with thoracic tuberculosis between June 2003 an May 2008 were eval-uated, who underwent one-stage anterior radical debridement, decompression and autogenous rib grafts, and instrumentation. Kyphotic angle was measured to assess the severity of the thoracic tuberculosis.Neurologic outcome was evaluated using Frankel grade, infection activity using erythrocyte sedimentation rate ( ESR) value and C-reactive protein ( CRP) value, and pain using visual analog scale (VAS) score.Results The average follow-up period was 50.8 months (range, 24-85 months).A solid fusion was achieved in all cases.Of all 42 patients with preoperative kyphosis, the deformity was corrected from an average of 19.8°on admission to an average of 3.7°after surgery, and to an average of 4.6°at the final follow-up.No significant loss of deformitycorrection was noted in these patients.Three patients who had a spinal cord injury with only sensation present ( Grade B) before surgery had improvement by 2 or 3 levels to Grade D or E at the final follow-up.Of the 9 patients with progressive neurologic deficits ( Grade C) before surgery, 6 had complete recovery to Grade E and 3 had improvement by 1 level to Grade D. All 20 patients who had a Grade D recovered completely to normal ( Grade E) .The average VAS 2 score was 8.2 before opera-tion, and decreased to 1.8.At the final follow-up, the average VAS score was 1.2.Only 2 patients had persistent pain for 2 months after surgery, and none of them needed analgesic drugs at the final follow-up.There was no other recurrence of the tuber-culous infection.Conclusion The one-stage anterior autogenous rib grafts with rumentation is safe and effective method in the surgical management of thoracic tuberculosis.