后路短节段固定联合前路病灶清除治疗腰椎结核  

Brachy segament posterior fixation combined with anterior debridement used in the treatment of lumbar tuberculosis

作　　者：丁文元[1] 贺延雷[1] 李宝俊[1] 申勇[1] 张为[1] 董玉昌[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,河北石家庄050051

出　　处：《颈腰痛杂志》2010年第2期116-120,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨后路短节段椎弓根钉系统内固定联合一期前路病灶清除植骨融合术治疗腰椎结核的临床效果。方法2005年6月-2008年9月我科共收治腰椎结核患者42例,随机分为两组。其中A组23例,采用后路短节段椎弓根钉棒系统内固定联合一期前路病灶清除植骨融合术进行治疗;B组19例采用前路钉棒系统固定联合前路病灶清除植骨融合内固定术进行治疗。分别观察两组手术时间、出血量、手术并发症、脊髓神经恢复情况,植骨融合率以及临床满意率等临床指标。结果A组平均手术时间257min,出血量726ml。B组平均手术时间211min,出血量537mL。两组在手术时间及出血量等指标上具有统计学差异(P<0.05)。术中无脊髓、神经、血管损伤等严重并发症。术后随访时间6～42个月,平均18个月。两组术前脊髓神经功能受损患者术后皆有不同程度恢复。植骨融合率A组为91.3%,B组为89.5%,两组比较无显著性差异(P>0.05)。临床满意率A组为95.7%,B组为68.4%,两组比较有显著性差异(P<0.05)。结论后路短节段椎弓根钉系统内固定联合1期前路病灶清除植骨融合治疗腰椎结核效果良好。Objective To discuss the clinical efficiency in treatment of the lumbar tuberculosis with anterior debridement and posterior pedicle screw fixation systems. Methods 42 cases from June 2005 to September 2008 with lumbar tuberculosis were treated in our department were enrolled. 23 patients（group A） were treated with anterior debridement with autograft bone fusion and posterior fixation,while the other 19 patients （group B） were treated with anterior debridement with autograft bone fusion and fixation. Compare the operation time,blood lost as well as the complication rates in both groups. Results There was significant difference between the mean time and blood loss of the operation （P0.05） between the two groups. The operation time were 257minutes （group A） VS 211 minutes（group B）,mean blood loss was 726ml VS 537ml. There was no injury of nerves and blood vessels in both groups. The follow up time ranged from 6 months to 42 months （mean 18 months）. The patients with symptoms of spinal cord injury recovered in different degreeafter the operation. The bone-fusion rates were 91.3% VS 89.5%（P0.05）,The patients in group A had a higher satisfaction rate 95.7% VS 68.4% in group B（P0.05）. Conclusion Brachy segament posterior fixation and anterior debridement with autograft bone fusion appears to be effective in the treatment in lumbar tuberculosis.

关 键 词：腰椎结核 病灶清除 后路手术 内固定 

分 类 号：R529.2[医药卫生—内科学]