一期前后路联合手术治疗胸腰椎结核的临床应用  

Effect of the treatment of thoracic and lumbar spinal tuberculosis by one-stage surgery combined anterior and posterior operation

作　　者：刘青云[1] 刘文和[2] 

机构地区：[1]湘南学院附属医院脊柱外科,湖南郴州423000 [2]湘南学院附属医院骨科,湖南郴州423000

出　　处：《中国民族民间医药》2009年第23期112-113,共2页Chinese Journal of Ethnomedicine and Ethnopharmacy

摘　　要：目的:探讨一期前后路联合手术治疗脊柱胸腰椎结核的疗效。方法:2000年1月至2009年1月收治35例脊柱胸腰椎结核患者,病变均累计2个或2个以上椎体,合并椎旁脓肿32例。患者术前脊髓神经功能损伤20例,Frankel分级:B级4例,C级10例,D级6例,血沉尽可能控制40mm/h以下后手术,手术方式均采用I期后路钉棒系统固定联合前路病灶清除,自体髂骨或肋骨植骨或钛网植骨融合术,随诊观察患者术后神经功能恢复情况及骨愈合情况。结果:平均手术时间(4.5±0.5)h,平均出血量(650±150)m l。术中4例发生胸膜撕裂,行术中缝合,放置引流,术后无并发症发生;2例手术侧大腿前内侧放射痛麻木,经治疗后逐渐消失,1例术后1月余出现复发,伤口不愈合,经再手术后治愈,无大血管、神经损伤,无死亡病例。术后随访3个月-5年(平均17.6个月),骨融合时间平均6.5个月,术后神经功能均恢复至E级,1-2个月后血沉均恢复至正常,末次随访无一例出现明显矫正度丢失。结论:一期前后路联合手术是治疗脊柱胸、腰椎结核一种安全有效的方法。Objective ： To evaluate the curative effect of one - stage combined anterior and posterior approaches in the treatment of thoracic and lumbar spinal tuberculosis. Method： From January 2003 to January 2009, 35 patients with thoracic and lumbar spinal tuberculosis were treated with one - stage combined anterior and posterior approachs. The segments of thoracic and lumbar vertebrae were invalved with two or no less than two, 19 cases had paravertebral abscess. 20 cases had neurolgical dificits （4 eases in Frankel B, 10 cases in Frankel C, 6 cases in Frankel B）. All the caeses underwent one - stage combined anterior debridement with iliae pong fusion or titanium net bony fusion, and posterior pedicle screw - rod. To observe the recovery of neurological deficits and bong fusion. Result ： The operative time was （4. 5 ＋-0. 5） h On an averge and the avergae blood loss was （650 ± 150） ml. 1 case had pleural membrane laceration, it was sutured during operation and no complicaton occurred after operation. 2 patients felt pain and numbness in the left limb, which were relieved with treatment ; 1 case had edema of left limb, the symptoms subsided by raising limb effectively and passive motion of the limb. 1 case was palindromia sign of paravertebral abscess, and the incisions hadn＇ t healed, It healed with another operation. There aere no injuries of large blood vessels and nerves, no death case occurred. All the cases were followed - up from three months to five years （average 17. 6months） , the bony fusion occurred in 6. 5months, the nurological fuction of all cases had recovered to Frankel E and ESR became normal after 1 or 2 months. Conclusion： The combined anterior and posterior approachs in one - stage is a safe and effetive mothod in the treatment of thoracic and lumbar spinal tuberculosis.

关 键 词：脊柱结核 手术治疗 前后路 一期 

分 类 号：R681.53[医药卫生—骨科学]