老年人脊椎結核病的外科治療

Surgical Management of Spinal Tuberculosis in the Elderly

簡裕明(Yu-Ming Jian) ； 陳彥宇(Yan-Yu Chen) ； 楊榮森(Rong-Sen Yang)

《台灣老年醫學暨老年學雜誌》 5卷1期 (2010/02) Pp. 13-21

https://doi.org/10.29461/TGG.201002.0002

摘要

脊椎結核病是最常見的骨關節結核病發病部分，老年人因為免疫力較差，且常罹患多種慢性疾病，因此經常成為結核病侵犯的病人。在抗結核藥物出現以前，膿瘡引流或是病灶外後融合手術的效果並不如預期；隨著抗結核藥物的引進，原本嘗試以手術治療的脊椎結核病，轉變成以藥物治療為主的疾病，且在藥物使用之下，不但令手術成功率相對提升，更促使開發新的手術方式，如前側局部清瘡術、前側根治術合併骨移植、後融合植入物固定術、後融合植入物固定術合併前側根治術、前側根治術合併前側融合植入物固定術，甚至是脊椎背凸變形後的變形矯正手術等，各種手術方式，皆得以發展與應用。目前脊椎結核病已是一個以藥物治療為主的疾病，手術治療主要局限於難以利用藥物控制的疾病進展，或出現併發症如背凸變形、神經症狀、甚至癱瘓。但雖有前述諸多手術方式，脊椎手術仍具有相當高的風險，因此對老年病患，儘量考慮以侵襲性較小的方式來處理與治療。

關鍵字

脊椎結核病 ； 老年人 ； 外科治療

並列摘要

Spine is the most common site for skeletal tuberculosis. With a compromised immunity and subsequent comorbidities, elderly people are more vulnerable to tuberculosis. Before the introduction of antituberculosis drugs, incisional drainage or posterior spinal fusion with bone grafting reported no satisfactory effectiveness. The apperance of antituberculosis drugs has brought the treatment of spinal tuberculosis into a new era. With antituberculosis drugs, surgical management of spinal tuberculosis has become increasingly successful and triggered the development and application of a series of new techniques, such as anterior focal debridement, anterior radical surgery with strut graft, posterior fusion and instrumentation, posterior instrumentation and anterior radical surgery, anterior radical surgery with anterior instrumentation, and even surgery for correction of deformity. Nowadays, spinal tuberculosis is a medical condition treated mainly by drugs; surgery becomes more selective, limited mostly to cases of dissatisfactory control of disease and complications. Based on the trend and the fact that the risk of surgery on spine remains high, we should consider a less invasive procedure with a lower risk for aged people with spinal tuberculosis.

並列關鍵字

spinal tuberculosis ； elderly ； surgical management