腰骶椎结核治疗的方法选择(附65例分析)  

Evaluation of therapeutics for lumbar tuberculosis(analysis of 65 clinical cases)

作　　者：周焯家[1] 简月奎[1] 李波[1] 张美心[1] 

机构地区：[1]贵州省人民医院骨科,贵阳550002

出　　处：《中国矫形外科杂志》2008年第15期1141-1143,共3页Orthopedic Journal of China

摘　　要：[目的]探讨腰椎结核治疗的方法选择。[方法]回顾分析65例腰椎结核患者采用五种不同治疗方法的疗效：A组（14例）单纯病灶清除术;B组（15例）病灶清除并植骨融合术;C组（9例）后路病灶清除植骨融合＋内固定术;D组（12例）后路内固定＋前路病灶清除植骨融合术;E组（15例）前路病灶清除植骨融合＋前路内固定术。术前、术后常规支持和抗结核治疗,并定期随访,观察血沉变化,摄X线平片,CT三维重建评估结核活动、骨块融合和畸形矫正情况。[结果]65例腰椎结核患者术中无大血管、神经、输尿管损伤,随访12～16个月,平均13个月,结核病变无复发,植骨全部融合,愈合时间4～6个月,平均3.8个月。后凸畸形矫正角度无明显丢失,内固定无松动、断裂等并发症。[结论]有效的抗痨是治疗结核的前提,彻底清除病灶是治疗的关键,融合、内固定与否,根据结核破坏的程度、部位而定,合理的选择能提高腰椎结核的治疗效果。[Objective] To evaluate therapeutics for lumbar tuberculosis. [ Method] Data from 65 patients treated with five different therapeutics were retrospectively reviewed. Group A （n = 14） was treated with focal debridement, Group B （n = 15 ） with focal debridement and bone grafting fusion. Group C （n = 9 ） with posterior focal debridement plus bone grafting fusion and internal fixation, Group D （ n = 12） with posterior fixation and anterior focal debridement plus, bone grafting fhsioll. Group E （n = 15 ） with anterior focal debridement plus bone grafting fusion and anterior internal fixation. Patients all received routine support and anti - tuberculosis therapy before and after operation. Follow - up, erythrocyte sedimentation rate was studied, and bone fusion and kyphosis correction with X - ray plain film and 3D - CT reconstruction were evaluated. [ Result] There were not damages occurring in the great vessels, nerves or ureters. No recurrence was found during the follow - up of 12 - 16 months （average 13 months ） . Grafting bone were all fused after 4 -6 months with an average time of 3.8 months. There was no missing of angel of kyphosis correction, complications of looseness or break of internal fixation. [ Conclusion ] Efficient anti - tuberculosis therapy and the debridement is the key for treatment of tuberculosis. The selection of fusion or internal fixation is depended on the severity of tuberculosis. Reasonable selection may improve the therapeutic effect of lumbar tuberculosis.

关 键 词：腰椎 结核 治疗 

分 类 号：R687.3[医药卫生—骨科学]