CAJ | 학술논문

背景：胸腰段为脊柱结核好发部位，干酪样坏死组织及死骨压迫脊髓、神经根易引起神经症状，多数合并轻度、中度脊柱后凸畸形。近年来手术修复脊柱结核报道较多，病灶清除、植骨融合、内固定已成为常规治疗方法。目的：探讨胸腰段脊柱结核不同内固定修复方法的选择原则。方法：2001年1月至2011年12月共收治42例胸腰段脊柱结核患者，所有患者都有腰背部疼痛症状，病程1个月-7年；术前有神经功能损害者4例，Frankel分级C 级1例，D 级3例。脊柱后凸畸形Cobb角为12°-45°，平均27°。治疗前后按照标准方案进行化疗。根据结核病灶部位、椎体破坏程度选择内固定方式，均行切除第11和(或)12肋经胸膜外、腹膜后入路病灶清除椎间植骨，其中一期前路病灶清除植骨融合内固定25例，后路椎弓根钉棒固定+前路病灶清除17例(一期手术7例、二期手术10例)。36例采用肋骨植骨，6例采用取髂骨植骨。治疗后随访17个月-9年，观察后凸畸形矫正、脊柱稳定性及脊髓功能恢复情况。结果与结论：治疗后30例患者获得随访，腰背部疼痛症状消失，X射线片检查示治疗后均获得良好的固定，全部病例植骨呈骨性融合，平均融合时间为5.4个月；无内固定松动、断裂，结核无复发。4例合并脊髓损伤患者，术后Frankel分级均为E级。治疗后12个月脊柱后凸Cobb角为0°-26°，平均14°。提示在规范抗结核治疗的基础上，胸腰段脊柱结核采用胸膜外、腹膜后入路的方法进行病灶清除，根据患者一般情况、结核病灶破坏程度采用不同内固定方法，可取的较好的修复效果。
배경：흉요단위척주결핵호발부위，간락양배사조직급사골압박척수、신경근역인기신경증상，다수합병경도、중도척주후철기형。근년래수술수복척주결핵보도교다，병조청제、식골융합、내고정이성위상규치료방법。목적：탐토흉요단척주결핵불동내고정수복방법적선택원칙。방법：2001년1월지2011년12월공수치42례흉요단척주결핵환자，소유환자도유요배부동통증상，병정1개월-7년；술전유신경공능손해자4례，Frankel분급C 급1례，D 급3례。척주후철기형Cobb각위12°-45°，평균27°。치료전후안조표준방안진행화료。근거결핵병조부위、추체파배정도선택내고정방식，균행절제제11화(혹)12륵경흉막외、복막후입로병조청제추간식골，기중일기전로병조청제식골융합내고정25례，후로추궁근정봉고정+전로병조청제17례(일기수술7례、이기수술10례)。36례채용륵골식골，6례채용취가골식골。치료후수방17개월-9년，관찰후철기형교정、척주은정성급척수공능회복정황。결과여결론：치료후30례환자획득수방，요배부동통증상소실，X사선편검사시치료후균획득량호적고정，전부병례식골정골성융합，평균융합시간위5.4개월；무내고정송동、단렬，결핵무복발。4례합병척수손상환자，술후Frankel분급균위E급。치료후12개월척주후철Cobb각위0°-26°，평균14°。제시재규범항결핵치료적기출상，흉요단척주결핵채용흉막외、복막후입로적방법진행병조청제，근거환자일반정황、결핵병조파배정도채용불동내고정방법，가취적교호적수복효과。
BACKGROUND:Thoracic lumbar segment is prone to spinal tuberculosis, caseous necrosis tissue, dead bone compression of spinal cord and nerve root may cause neurological symptoms, and the majority of them is accompanied with mild and moderate spinal kyphosis deformity. Surgical treatment of spinal tuberculosis has been frequently reported in recent years, the commonly used treatment includes lesion clearance, bone graft fusion and internal fixation. OBJECTIVE:To investigate the principle of choosing different internal fixation treatment for thoracolumbar spinal tuberculosis. METHODS:42 patients with thoracolumbar spinal tuberculosis were involved in this study from January 2001 to December 2011. Al patients suffered from waist and back pains, with the disease course range of 1 month to 7 years. Four cases showed neurological deficit before surgery. According to the Frankel classification, 1 case was graded as Frankel C and 3 cases as Frankel D. The preoperative average Cobb angle of kyphosis was 27° (range 12°-45°). The internal fixation approaches were chosen according to the tuberculose focus and vertebral fracture extent. Thoraco-abdominal approach for thoracolumbar spine via diaphragm with the removal of 11 rib and(or) 12 rib was performed for al patients. Among these protocols, 25 cases underwent anterior focal debridement and bone grafting. 17 cases had anterior focal debridement and posterior pedicle screw internal fixation (one-stage surgery in 7 cases and second-stage surgery in 10 cases). Al patients received anti-tuberculosis chemotherapy before and after operation. 36 cases used rib and 6 cases used iliac bone as bone graft. Al patients were fol owed up from 17 months to 9 years. The correction of spinal deformity, spinal stability and spinal functional recovery were observed. RESULTS AND CONCLUSION:30 patients were fol owed up after operations and the back pains disappeared. X-ray examination showed that, al patients were fixed wel without no loosening and rupture, and achieved bony fusion (the mean time were 5.4 months). No tuberculosis recurred. Four cases complicated with spinal cord injury were E grade according to the Frankel classification. The Cobb angle was 0-26° (mean 14°) at 12 months after operation. On the premise of standard anti-tuberculosis chemotherapy, various internal fixation methods can be determined according to general conditions of patients and tuberculose focus site.