CAJ | 학술논문

目的探讨Ⅰ期后正中切口经肋横突关节入路治疗胸椎单间隙结核的疗效及安全性.方法 2011年7月至2013年10月间共33例患者采用Ⅰ期后路正中切口经肋横突关节行胸椎结核病灶清除、取髂骨植骨融合、椎弓根螺钉内固定术治疗.其中男18例,女15例;年龄17～39岁;病程5 ～11个月,平均病程时间7.3个月;均为胸椎单间隙结核,术前Cobb角19°～42°,平均29.8°;累及上胸椎5例,中胸椎17例,下胸椎11例.脊髓损伤Frankel分级:C级6例,D级11例,E级16例.观察患者术后后凸矫正、神经功能恢复及植骨融合情况.结果 33例手术均完成,平均手术时间183 min(120 ～230 min),术中出血530 ml (480 ～ 700 ml).患者术后随访12 ～ 36个月,Cobb角8°～15°,平均10.2°,矫正率77％;Frankel评分术前11例D级均恢复为E级,6例C级有2例恢复至D级,4例恢复至E级.末次随访时,33例患者的植骨均融合,无内固定松动断裂或植骨块移位,ESR、CRP水平均降至正常范围,结核中毒症状均消失.结论 Ⅰ期后正中切口经肋横突入路治疗胸椎结核可通过同一体位、同一切口一次性完成手术,可行性及安全性高,临床疗效良好.
목적 탐토Ⅰ기후정중절구경륵횡돌관절입로치료흉추단간극결핵적료효급안전성.방법 2011년7월지2013년10월간공33례환자채용Ⅰ기후로정중절구경륵횡돌관절행흉추결핵병조청제、취가골식골융합、추궁근라정내고정술치료.기중남18례,녀15례;년령17～39세;병정5 ～11개월,평균병정시간7.3개월;균위흉추단간극결핵,술전Cobb각19°～42°,평균29.8°;루급상흉추5례,중흉추17례,하흉추11례.척수손상Frankel분급:C급6례,D급11례,E급16례.관찰환자술후후철교정、신경공능회복급식골융합정황.결과 33례수술균완성,평균수술시간183 min(120 ～230 min),술중출혈530 ml (480 ～ 700 ml).환자술후수방12 ～ 36개월,Cobb각8°～15°,평균10.2°,교정솔77％;Frankel평분술전11례D급균회복위E급,6례C급유2례회복지D급,4례회복지E급.말차수방시,33례환자적식골균융합,무내고정송동단렬혹식골괴이위,ESR、CRP수평균강지정상범위,결핵중독증상균소실.결론 Ⅰ기후정중절구경륵횡돌입로치료흉추결핵가통과동일체위、동일절구일차성완성수술,가행성급안전성고,림상료효량호.
Objective To assess the efficacy of one-stage posterior median incision via costotransverse joint in treating thoracic spinal tuberculosis.Methods Thirty three patients with tuberculosis of thoracic spine undergoing one-stage posterior thoracic spine debridement,bone grafting fusion and posterior instrumentation from July 2011 to October 2013 were included in the study.There were 18 males and 15 females.The age was from 17 to 39 years old with an average of 29.5.The course was from 5 to 11 months with an average of 7.3.The Cobb angle was from 19° to 42° with an average of 29.8°.There were 5 in upper thoracic spine,17 in middle thoracic spine and 11 in lower thoracic spine.6 were in Frankel scale grade C,11 were in grade D and 16 were in grade E before surgery.Postoperative kyphosis correction,recovery of neurological function and bone fusion were observed.Results All the surgeries were completed successfully.The operation time was from 120 to 230 min with an average of 183.The blood loss during operation was from 480 to 700 ml with an average of 530.All 33 patients were followed-up for 12-36 months with an average of 22.7 months.The Cobb angle was from 8° to 15° with an average of 10.2°,the correction rate was 77％.The Frankel scale of 11 patients recovered from D to E,2 recovered from C to D and 4 recovered from C to E.The postoperative kyphosis correction and Frankel scale were significantly improved,all patients had a 100％ bone fusion rate and there were no internal fixation loosened or shift of graft bone at the last follow-up.ESR and CRP were returned to the normal range and the tuberculosis symptoms disappeared.Conclusions One-stage posterior median incision via costotransverse joint can complete surgery by the same position and the same incision in treating thoracic spinal tuberculosis with safety and good clinical efficacy.