内窥镜下结合自制拉钩经前路治疗单节段腰椎结核  

Endoscopy associated with a novel retractor in treating single segment thoracolumbarlumbar tuberculosis by anterior approach.

作　　者：周强 刘煊文 刘德敏 侯伟光 丁小川 张强 李宁远 罗毅 王戈 陈丹 

机构地区：[1]成都363医院骨科,四川成都610041

出　　处：《四川医学》2013年第8期1087-1089,共3页Sichuan Medical Journal

基　　金：四川省科技厅攻关基金课题(编号:05SGD22-088)

摘　　要：目的探讨自制拉钩系统联合内窥镜技术治疗单节段腰椎结核的可行性及疗效。方法 2007年9月~2010年1月共收治单节段腰椎结核患者34例。均采用自制微创拉钩并联合应用内窥镜技术,经小切口行椎管微创减压,取髂骨植骨,再结合前路钉棒内固定。术后常规抗结核治疗18个月,评估腰椎前路固定术后脊柱畸形矫正度、患者神经功能康复状况、植骨融合、结核有无复发,及术后并发症发生情况。结果术后随访2~4.5年,平均2.7年,无1例因并发症死亡,畸形矫正满意,内固定系统无松动、断裂,脊髓神经功能有不同程度的恢复,植骨融合无结核复发患者。患者术后及随访时的后凸角、侧凸角与术前比较,差异均有统计学意义（P〈0.05）;患者术前、术后的神经功能状况比较,差异有统计学意义（P〈0.05）。结论单节段腰椎结核采用内窥镜下结合自制拉钩经前路手术治疗微创安全可靠,对脊髓减压充分彻底,可矫正畸形,重建脊柱的稳定性,促进神经功能恢复。Objective To discuss on practicability and curative effect of self-made assisto-arm system combining endoscope technology to treat single-segment spinal tuberculosis.Methods From September,2007 to January,2010,34 patients with single-segment spinal tuberculosis were received and treated by using self-made assisto-arm system combining endoscope technology,performing small-incision vertebral canal decompression,taking ilium to graft bone,and combining with anterior screw-rod internal fixation.After operation,these patients had been performed with regular antituberculosis treatment for 18 months.Conditions including spine malformation correction after lumbar anterior fixation,recovery of neural function,bone graft fusion,recurrence of tuberculosis and postoperative complication are assessed.Results Through postoperative follow-up survey in 2 to 4.5 years,2.7 years in average,there is no patient died due to postoperative complication;malformation correction result is satisfactory;the internal fixation system is not flexible or broken;and the patient＇s spinal nerves function is recovered in different extent;there is no patient with tuberculosis recurred after bone graft fusion.Comparing the kyphosis angle and scoliosis angle of patients between post-operation,follow-up survey and pre-operation,the difference is statistically significant（P 0.05）;comparing the neural function between pre-operation and post-operation,the difference is statistically significant（P〈0.05）.Conclusion The single-segment spinal tuberculosis can be treated by self-made assisto-arm system combining endoscope technology and anterior operation incisively,safely and reliably.This method can completely decompress spinal cord,correct malformation,rebuild stability of spine and promote recovery of neural function.

关 键 词：腰椎结核 内窥镜 前路手术 

分 类 号：R687.3[医药卫生—骨科学]