CAJ | 학술논문

目的：探讨胸腰椎前路术后并发切口深部感染的外科治疗措施。方法对12例胸腰椎骨折前路术后感染患者行后路经皮椎弓根螺钉固定联合前路内植物取出、清创、植骨融合手术治疗。通过影像学检查、ODI评分、VAS 评分评价治疗效果。结果患者取出内植物后疼痛均消失，术后摄片提示胸腰椎侧凸角及后凸角均获得纠正，术后体温及血沉、C-反应蛋白均正常，患者均获得随访，时间1~4年，患者术后感染无复发，切口与窦道均愈合。术后3个月摄片复查提示胸腰椎侧弯矫正无丢失，胸腰椎稳定性存在，骨折线模糊；术后12个月复查均已植骨融合。末次随访的 ODI 评分和 VAS 较术前均显著下降(P <0．01)。结论后路经皮椎弓根螺钉固定联合前路内植物取出、清创、植骨融合手术是治疗胸腰椎骨折前路术后并发切口深部感染的有效手段，可以重建脊柱的稳定性，允许患者早期下床负重活动。
목적：탐토흉요추전로술후병발절구심부감염적외과치료조시。방법대12례흉요추골절전로술후감염환자행후로경피추궁근라정고정연합전로내식물취출、청창、식골융합수술치료。통과영상학검사、ODI평분、VAS 평분평개치료효과。결과환자취출내식물후동통균소실，술후섭편제시흉요추측철각급후철각균획득규정，술후체온급혈침、C-반응단백균정상，환자균획득수방，시간1~4년，환자술후감염무복발，절구여두도균유합。술후3개월섭편복사제시흉요추측만교정무주실，흉요추은정성존재，골절선모호；술후12개월복사균이식골융합。말차수방적 ODI 평분화 VAS 교술전균현저하강(P <0．01)。결론후로경피추궁근라정고정연합전로내식물취출、청창、식골융합수술시치료흉요추골절전로술후병발절구심부감염적유효수단，가이중건척주적은정성，윤허환자조기하상부중활동。
Objective To investigate surgical treatment of incision deep infection after anterior approach for thoracic and lumbar fractures. Methods 12 patients got deep infection after spine fusion with implant via anterolateral ap-proach. All cases underwent anterior debridement and posterior minimally invasive pedicle screw fixation. The clini-cal outcomes were assessed using the Oswestry disability index (ODI), visual analog scale (VAS) of pain and lordot-ic angle. Results The symptoms and signs of infection were disappeared in all patients. The scoliosis and kyphosis of thoracolumbar assessed by postoperative X-ray photograph were corrected entirely. The temperature,ESR and CRP indication returned to normal and no infection recurred during follow-up of 1 ~ 4 years. The incision and sinus were healed. Three months after operation, the X-ray photograph prompted that there were no change of stability and no loss correction in thoracolumbar fracture site blurred. 12 months after operation, all cases showed bone fusion by X-ray. The serial changes of functional outcomes of the ODI and VAS of pain in the back and leg showed statistically significant decline after operation. The difference of ODI and VAS scores between preoperation and the last follow-up were significant(P < 0. 01). Conclusions Pedicle screw fixation with minimally invasive technique combined with implant removal via anterolateral approach can cure spinal deep wound infection extensively and restore stability of the spine to avoid the intervertebral height and (or) spinal corrective angle loss, the stability of spine also contribute to early ambulation and reduce hospitalization time and hospitalization expenses.