CAJ | 학술논문

背景：在彻底病灶清除的基础上，同期前路或分期行后路内固定已成为脊柱结核外科治疗的标准方案。虽然大量文献证实二者均取得良好的效果，但是也存在前路解剖结构复杂，创伤大，并发症相对较多，操作及内固定物置入困难等一系列缺点。目的：观察后路经椎间隙病灶清除及椎间植骨融合内固定治疗后单节段胸腰椎结核患者脊柱稳定性及畸形矫正情况。方法：回顾性分析2008年1月至2012年1月广西玉林市中西医结合骨科医院收治的行一期后路经椎间隙病灶清除植骨融合内固定治疗的单节段胸腰椎结核患者36例，病变节段T11/12节段2例，T12/L1节段4例，L3/4节段6例，L4/5节段22例，L5/S1节段2例；其中24例患者有不同程度的脊髓神经损伤表现。治疗后6，12，24个月对所有患者进行随访，观察植骨融合、后凸畸形矫正、脊髓功能恢复及并发症发生情况。结果与结论：治疗后随访24-38个月。治疗后2年患者后凸Cobb角、椎管狭窄率较治疗前显著改善(P <0.05)。末次随访患者腰椎背部疼痛症状均明显缓解(P <0.05)，椎间融合率为100%。治疗后随访无病灶残留及复发，无矫正丢失，无内固定松动、移位等并发症。提示对于单节段胸腰椎结核患者，后路经椎间隙病灶清除及椎间植骨融合内固定能够有效重建脊柱稳定性，矫正畸形，促进脊髓神经功能恢复。
배경：재철저병조청제적기출상，동기전로혹분기행후로내고정이성위척주결핵외과치료적표준방안。수연대량문헌증실이자균취득량호적효과，단시야존재전로해부결구복잡，창상대，병발증상대교다，조작급내고정물치입곤난등일계렬결점。목적：관찰후로경추간극병조청제급추간식골융합내고정치료후단절단흉요추결핵환자척주은정성급기형교정정황。방법：회고성분석2008년1월지2012년1월엄서옥림시중서의결합골과의원수치적행일기후로경추간극병조청제식골융합내고정치료적단절단흉요추결핵환자36례，병변절단T11/12절단2례，T12/L1절단4례，L3/4절단6례，L4/5절단22례，L5/S1절단2례；기중24례환자유불동정도적척수신경손상표현。치료후6，12，24개월대소유환자진행수방，관찰식골융합、후철기형교정、척수공능회복급병발증발생정황。결과여결론：치료후수방24-38개월。치료후2년환자후철Cobb각、추관협착솔교치료전현저개선(P <0.05)。말차수방환자요추배부동통증상균명현완해(P <0.05)，추간융합솔위100%。치료후수방무병조잔류급복발，무교정주실，무내고정송동、이위등병발증。제시대우단절단흉요추결핵환자，후로경추간극병조청제급추간식골융합내고정능구유효중건척주은정성，교정기형，촉진척수신경공능회복。
BACKGROUND:On the basis of thorough debridement, homochronous anterior or staging posterior fixation has been a standard scheme for spinal tuberculosis. Numerous studies confirmed that above approach has obtained good effects, but the anterior approach has some disadvantages, such as complex anatomic structure, great trauma, relatively more complications, and difficult operation and fixator implantation. OBJECTIVE:To observe spinal stabilization and deformity correction in patients with single-segment thoracic/lumbar spinal tuberculosis after posterior debridement and interbody fusion. METHODS:Clinical data of 36 patients with single-segment thoracic/lumbar spinal tuberculosis undergoing one-stage posterior debridement and interbody fusion in the Guangxi Yulin Orthopedics Hospital of Integrated Traditional Chinese and Western Medicine from January 2008 to January 2012 were retrospectively analyzed. There were 2 cases in single T11/12 segment, 4 in T12/L1 segments, 6 in L3/4 segments, 22 in L4/5segments and 2 in L5/S1 segments. Of them, 24 patients suffered from different degrees of spinal nerve injury. At 6, 12 and 24 months after surgery, al patients were folowed up. Bone graft fusion, kyphosis correction, functional recovery of the spinal cord and complications were observed. RESULTS AND CONCLUSION:Al patients were folowed up for 24-38 months. Cobb angle of kyphosis and spinal stenosis rate were significantly improved at 2 years after treatment (P < 0.05). The lumbar back pain symptoms were significantly improved in final folow-up (P < 0.05), with an intervertebral fusion rate of 100%. No lesion residue and recurrence, correction loss, fixation loosening or displacement was found. These results demonstrated that in patients with single-segment thoracic/lumbar spinal tuberculosis, posterior debridement and interbody fusion can effectively reconstruct spinal stabilization, correct deformity, and promote the functional recovery of spinal nerves.