单侧双通道内镜技术联合药物化疗在胸腰椎结核中的初步应用效果  

Preliminary application effect of unilateral biportal endoscopy technique combined with drug chemotherapy in thoracic and lumbar tuberculosis

作　　者：王湘斌 王翀[1] Wang Xiangbin;Wang Chong(Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院骨科,乌鲁木齐830054

出　　处：《中华医学杂志》2023年第15期1148-1153,共6页National Medical Journal of China

摘　　要：目的探讨单侧双通道内镜(UBE)下清创、减压、椎间融合和经皮螺钉内固定术联合药物化疗治疗胸腰椎结核的效果。方法随访研究。回顾性分析2021年9月至2022年2月因胸腰椎结核在新疆医科大学第一附属医院行UBE下清创、减压、椎间融合和经皮螺钉内固定术联合药物化疗治疗的9例患者的临床资料。其中男4例,女5例,年龄(52.4±13.5)岁(27~71岁)。所有患者术前均予四联(异烟肼+利福平+吡嗪酰胺+乙胺丁醇)抗结核药物化疗2~4周。记录患者的手术时间、术中出血量、术后引流量、术后下地时间、术后住院时间及并发症情况。比较手术前后的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、红细胞沉降率(ESR)和C反应蛋白(CRP)。根据美国脊髓损伤协会(ASIA)神经系统分级评估手术前后脊髓损伤程度及改善情况。测量手术前后Cobb角评估脊柱后凸畸形及矫正情况。术后6个月和末次随访时分别复查X线片或CT,并采用Bridwell分级标准评估手术节段融合情况。结果患者均顺利完成手术,均获得随访,随访时间(14.6±1.9)个月。手术时间(182.2±27.5)min,术中出血量(222.2±66.7)ml,术后引流量(43.3±17.0)ml,术后下地时间(1.9±0.8)d,术后住院时间(5.9±1.5)d。共2例(2/9)发生并发症,其中与手术相关并发症1例(1/9)。术后6个月随访时,ESR和CRP均恢复正常。术后各随访时间点VAS评分及ODI均较术前明显改善,差异有统计学意义(均P<0.05)。所有患者末次随访时ASIA分级均为E级。术后Cobb角由术前14.44°±2.07°降至9.00°±2.29°,末次随访时无明显角度丢失。术后6个月随访时,Bridwell分级Ⅰ级5例(5/9),Ⅱ级2例(2/9),Ⅲ级1例(1/9),Ⅳ级1例(1/9),末次随访时均为Ⅰ级(9/9)。结论UBE下清创、减压、椎间融合和经皮螺钉内固定术联合药物化疗是胸腰椎结核的一种安全可行、有效的治疗方法。Objective To investigate the efficacy of debridement,decompression,interbody fusion and percutaneous screw internal fixation under the unilateral biportal endoscopy(UBE)combined with drug chemotherapy for thoracic and lumbar tuberculosis.Methods A follow-up study.The clinical data of 9 patients who underwent UBE debridement,decompression,interbody fusion and percutaneous screw internal fixation combined with drug chemotherapy for thoracic and lumbar tuberculosis at the First Affiliated Hospital of Xinjiang Medical University from September 2021 to February 2022 were retrospectively analyzed.There were 4 males and 5 females,aged(52.4±13.5)years(ranged 27-71 years).All patients were given quadruple(isoniazid+rifampicin+pyrazinamide+ethambutol)anti-tuberculosis drugs chemotherapy for 2 to 4 weeks before surgery.The operation time,intraoperative blood loss,postoperative drainage volume,ambulation time,postoperative hospital stay and complications were recorded.The visual analog scale(VAS)of pain,Oswestry disability index(ODI),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in the patients were compared before and after the surgery.The degree and improvement of spinal cord injury before and after surgery were assessed according to the American Spinal Injury Association(ASIA)neurological classification;and the Cobb angle was measured before and after surgery to assess kyphotic deformity and correction.X-ray or CT was reviewed at 6 months postoperatively and at the final follow-up,and surgical segmental fusion was evaluated using Bridwell grading criteria.Results All patients completed the surgery successfully and were followed up for(14.6±1.9)months.The operation time was(182.2±27.5)minutes,the intraoperative blood loss was(222.2±66.7)ml,postoperative drainage volume was(43.3±17.0)ml,the ambulation time was(1.9±0.8)days,postoperative hospital stay was(5.9±1.5)days.Complications occurred in 2 patients(2/9),including 1 case of procedure-related complication.ESR and CRP returned to normal level at the

关 键 词：结核 脊柱 单侧双通道内镜技术 清创术 经皮螺钉内固定术 微创脊柱手术 

分 类 号：R687.3[医药卫生—骨科学]