一期后路病灶清除植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的临床初步报告  

One-stage posterior debridment,bone grafting and internal fixation for the treatment of thoracolumbar tuberculosis with kyphosis in children:a preliminary report

作　　者：张宏其[1] 王昱翔[1] 郭超峰[1] 唐明星[1] 刘少华[1] 邓盎[1] 刘金洋[1] 吴建煌[1] 王锡阳[1] 陈静[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,长沙410008

出　　处：《中国矫形外科杂志》2011年第1期31-35,共5页Orthopedic Journal of China

基　　金：湖南省科技厅科技计划一般项目资助(项目编号:2009JT4011)

摘　　要：[目的]探讨经后路一期病灶清除、植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的可行性及疗效。[方法]7例胸腰段脊柱结核患儿,均伴有后凸畸形。其中男5例,女2例;年龄9~12岁。术前脊柱后凸角为35°~45,°平均37.9°。Frankel分级：B级2例,C级3例,D级2例。采用经后路一期病灶清除、植骨融合加钉棒系统矫形固定治疗。[结果]术后随访27~42个月,平均34个月。切口均一期愈合,无1例结核复发。Frankel分级：4例恢复2级,3例恢复1级。术后后凸角为2°~9,°较术前明显改善,最后随访时后凸角为2°~12°,较术后无明显丢失。术后3个月血沉均恢复正常;所有患儿均获得满意的植骨融合。[结论]一期后路病灶清除、后方植骨内固定矫形手术治疗伴后凸畸形的儿童胸腰段脊柱结核是矫正后凸畸形和预防晚期后凸畸形发生的有效方法。[Objective]To investigate the effectiveness and feasibility of surgical management of thoracolumbar tuberculosis with kyphosis in children using one-stage posterior debridment,bone grafting and instrumentation. [Methods]Seven children with thoracolumbar tuberculosis complicated with kyphosis were admitted to our hospital,with 5 males and 2 females.The age ranged from 9 to 12 years.The kyphotic angle ranged from 35°to 45°before operation,with 37.9 °on average.Frankel grade system was used to evaluate the neurological deficits.The results showed that there were 2 cases in grade B,3 cases in grade C and 2 cases in grade D.All cases were treated with debridement,decompression,bone grafting and instrumentation by one-stage posterior approach.[Results]The mean follow-up was 34 months（range,27~42 months）.All incisions were healed perfectly without recurrence.Frankel grade system： 4 cases improved by 2 grades,3 cases improved by 1 grade.The postoperative kyphotic angle was 2 to 9 degrees and there was no significant loss of the correction at the latest follow up.The ESR decreased to normal level 3 months postoperatively.[Conclusion]One-stage posterior debridment,bone grafting and instrumentation is an effective method to treat children thoracolumbar tuberculosis with kyphosis.It not only corrects the kyphosis but also prevents the late kyphosis progress.

关 键 词：儿童 胸腰段 脊柱结核 后路 

分 类 号：R726.8[医药卫生—儿科]