CAJ | 학술논문

目的：探讨椎体间多枚分网的异形钛网植骨技术应用于单纯一期后路手术治疗腰骶段(腰5/骶1)脊柱结核的安全性及临床疗效。方法：自2009年7月至2012年6月，采用多枚分网异形钛网植骨技术一期后路手术治疗的腰骶段结核患者共25例。比较25例患者术前术后ASIA分级、腰骶角度、椎间隙高度、疼痛视觉模拟评分(visual analogue scale，VAS)、红细胞沉降率，并观察手术时间、术中失血量、植骨融合情况。结果：手术时间为90~180(128±24) min，术中失血量100~800(310±125) mL。术后随访24~59(43±7)个月。神经功能障碍的患者术后神经功能均有不同程度的改善；25例患者术后6个月红细胞沉降率均恢复正常；终末随访时腰骶角和椎间隙高度较术前明显增加(P<0.001)。术后2周患者VAS较术前降低；植骨融合时间为4~8(平均6)个月。术后1例患者伤口延迟愈合。无窦道形成和结核复发，亦无感染性脑脊髓膜炎和钛网沉降发生。结论：对于腰骶段结核患者，单纯一期后路病灶清除联合多枚分网异形钛网植骨手术是一种安全、有效的手术方式，且更好地重建脊柱前柱稳定性。
목적：탐토추체간다매분망적이형태망식골기술응용우단순일기후로수술치료요저단(요5/저1)척주결핵적안전성급림상료효。방법：자2009년7월지2012년6월，채용다매분망이형태망식골기술일기후로수술치료적요저단결핵환자공25례。비교25례환자술전술후ASIA분급、요저각도、추간극고도、동통시각모의평분(visual analogue scale，VAS)、홍세포침강솔，병관찰수술시간、술중실혈량、식골융합정황。결과：수술시간위90~180(128±24) min，술중실혈량100~800(310±125) mL。술후수방24~59(43±7)개월。신경공능장애적환자술후신경공능균유불동정도적개선；25례환자술후6개월홍세포침강솔균회복정상；종말수방시요저각화추간극고도교술전명현증가(P<0.001)。술후2주환자VAS교술전강저；식골융합시간위4~8(평균6)개월。술후1례환자상구연지유합。무두도형성화결핵복발，역무감염성뇌척수막염화태망침강발생。결론：대우요저단결핵환자，단순일기후로병조청제연합다매분망이형태망식골수술시일충안전、유효적수술방식，차경호지중건척주전주은정성。
Objective: To determine the clinical efficacy and feasibility of multiple special formed titanium mesh cages (TMCs) to treat lumbo-sacral spinal tuberculosis via posterior approach. Methods: From July, 2007 to June, 2013, 25 patients with lumbo-sacral spinal tuberculosis underwent one-stage posterior debridement, internal if xation, and interbody fusion using multiple special formed titanium meshes. We compared the parameters as follow: the pre- and post-operative American Spinal Injury Association (ASIA) score, lumbo-sacral angle, the height of intervertebral space, visual analogue scale (VAS), and erythrocyte sedimentation rate (ESR), and observedoperation time, intraoperative blood loss, and time of bone gratf fusion. Results: Operation time ranged from 90 to 180 min, (128±24) min in average. Blood loss in the operation ranged from 100 to 800 mL, (310±125) mL in average. hTe patients were followed up for 24 to 59 months, (43±7) months in average. One patient delayed healing of wound. ASIA score was improved in a certain degree in patients with neurological dysfunctions. hTe lumbo-sacral angle and the height of intervertebral space in the post-operation were signiifcantly higher than those in the pre-operation (P<0.001). VAS was reduced obviously atfer 2 weeks of operation. hTe ESR recovered to the normal level 6 months atfer operation in all the patients. Solid fusion was achieved within 4 to 8 months, 6 months in average. No sinus tract, cerebrospinal meningitis, tuberculosis recurrence and titanium mesh subsidence were found. Conclusion: For lumbo-sacral tuberculosis, multiple special formed titanium mesh cages via posterior approach is safe and effective, which is good to the stability in spine reconstruction.