胸椎结核经前路病灶清除融合单钉棒固定术的疗效观察  

Observation of the Clinical Efficacy of Lesion Clearing, Fusing and Fixation with Single Nail from the Anterior Way for the oracic Vertebra Tuberculosis

作　　者：朱定川[1] 高峰[1] 曾建成[2] 

机构地区：[1]西藏自治区人民政府驻成都办事处医院骨科,成都610041 [2]四川大学华西医院骨科

出　　处：《华西医学》2014年第1期26-29,共4页West China Medical Journal

摘　　要：目的观察胸椎结核经前路病灶清除，减压融合后用单钉棒内固定术的临床疗效。方法纳入2008年1月一2011年9月收治的42例胸椎结核患者，其中男28例，女14例；年龄27～63岁，平均45岁；病程4～12个月，平均8个月。按受累部位和节段分：上胸椎l例，中胸椎20例，下胸椎21例；病灶累及单一节段31例，多节段9例，跳跃结核2例。所有患者术前使用药物正规抗结核治疗2～4周，确认抗结核治疗有效后，均采用一期经前路结核病灶清除，减压，取自体髂骨植骨融合单钉棒固定术。术后定期随访，摄x线片检测融合情况，使用瘫痪Frankel分级评价患者功能恢复情况，视觉模拟疼痛评分（VAS）评估症状缓解情况。结果所有患者切口均一期愈合，结核病灶区域无复发。术后随访40例，时间12～34个月，平均23个月，经过x线片复查植骨区域均骨性融合，融合时间10～16个月，平均13个月。无钉棒系统松动断裂。患者瘫痪Frankel分级：术前A级2例，B级3例，C级9例，D级25例，E级3例。术后末次随访：A级0例，B级1例，C级5例，D级10例，E级26例。局部疼痛VAS评分术前（7．82±1．03）分，术后末次随访（0．52±0.31）分，经比较均有统计学意义（P〈0．05）。结论病灶清除结合植骨单钉棒固定在胸椎结核前路手术中的应用是可靠有效的方法之一，疗效满意。Objective To observe the clinical efficacy of lesion clearing, decompression and fusing, and fixation with single nail from the anterior way for thoracic vertebra tuberculosis. Methods From January 2008 to September 2011, 42 patients with thoracic vertebra tuberculosis were treated in our hospital. There were 28 males and 14 females with the age between 27 and 63 years old, averaging 45. The course of the disease ranged from 4 to 12 months, averaging 8 months. According to the affected parts and segments, there was 1 case of upper thoracic vertebrae involvement, 20 of inner thoracic spine, 21 of lower thoracic vertebrae, 9 of multiple segments, and 2 of multi-level noncontiguous tuberculosis. All patients accepted preoperative normal anti-tuberculosis drugs for 2 to 4 weeks. After confirming that the anti-tuberculosis treatment was effective, we cleared the lesion, fused by decompression at iliac crest bone graft sites and fixed by single nail from the anterior way. Postoperative regular follow-up was carried out. X ray film was used to detect the fusion, paralysis Frankel classification was adopted to evaluate the function recovery of patients, and visual analog pain score （VAS） was used to assess the relief of patients＇ symptoms. Results All incisions of the patients were healed by the first intention. There was no recurrence in the tuberculosis focus area. Follow-up was done in forty cases for 12 to 34 months, averaging 23 months. X-ray review showed that the bone graft area turned into osseous fusion in all patients with the fusion time ranging from 10 to 16 months, averaging 13 months. No nail bar system loose or fracture occurred. Paralyzed patients Frankel classification showed that there were 2 A-level, 3 B-level, 9 C-level, 25 D-level, and 3 E-level cases before operation. During the last follow-up, there were no A-level, 1 B-level, 5 C-level, 10 D-level, and 26 E-level cases. Local pain VAS score results showed that preoperative point was 7.82 ± 1.03, and the final follow-up point was 0.52 ±0.31

关 键 词：胸椎结核 前路 单钉棒固定 疗效 

分 类 号：R687.3[医药卫生—骨科学]