一期侧前方入路病灶清除植骨融合内固定联合局部闭式冲洗引流治疗腰椎结核伴椎旁脓肿  被引量:19

One-stage anterolateral debridement, bone graft and internal fixation combined with local closed irrigation drainage for lumbar spinal tuberculosis with abscess

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作  者:黄福立[1] 张明友[1] 刘永恒[1] 周其璋[1] 

机构地区:[1]广州中医药大学附属中山市中医院脊柱专科,广东省中山市528400

出  处:《中国脊柱脊髓杂志》2014年第5期422-426,共5页Chinese Journal of Spine and Spinal Cord

摘  要:目的:探讨一期侧前方入路病灶清除植骨融合内固定联合局部闭式冲洗引流治疗腰椎结核伴椎旁脓肿的有效性。方法:我院自2006年1月~2012年12月收治腰椎结核并椎旁巨大脓肿的患者18例,男8例,女10例;年龄21~65岁,平均44.6岁.病变累及节段:L1~L2 1例,L2~L3 9例,L3~L4 7例,L4~L5 1例。脓肿范围:L1~L3 1例,L2~L4 6例,L2~L5 3例.L3~L5 5例,L3~S1 3例。17例伴神经功能障碍,Frankel分级C级3例,D级14例。术前Barthel指数50~75分,平均65±10分;JOA评分12~23分,平均18±4分.血沉(ESR)57±16.2mm/h;C反应蛋白(CRP)22.4±5.6mg/L.椎管狭窄率(35.0±13.1)%,脊柱后凸Cobb角为25.3°±7.1°,均在全身抗结核药物治疗下行一期侧的方入路病灶清植骨融合内固定,术后应用异烟肼生理盐水持续局部闭式冲洗引流,并继续全身抗结核治疗12~24个月(平均18个月)。比较术前、术后神经功能Frankel分级、Barttlel指数(BI)、腰椎JOA评分以及术前、术后、随访时Cobb角、椎管狭窄率、ESR和CRP水平。结果:手术时间2.5~5.0h(平均3.Oh),术中出血270~750ml(平均450ml),均未发生严重术中或术后并发症;术后异烟肼生理盐水持续局部闭式冲洗引流时间10~16d(平均14d)。随访时间12~30个月,平均20个月。1例C级患者恢复至D级,2例恢复至E级;13例D级患者恢复至E级,1例无变化;1例E级患者术后无神经损害。术后BI为75~90分,平均85±5分,15例达到最效(83.3%);JOA评分17~29分,平均23±5分,17例达到显效(94.4%)。椎管狭窄率纠正至(1.4±3.5)%,脊柱后凸Cobb角为8.7°±2.6°,平均纠正16.6°。ESR及CRP存术后3个月内均恢复至正常,X线显示获得骨性融合时间为4~12个月(平均6个月);术后1年随访期内脊件开凸畸形矫止有1°~4°丢失;所有病�Objectives: To explore the outcome of one-stage anterolateral dehridement, hone graft and internal fixation combined with local closed irrigation drainage for lumbar spinal tuberculosis with ahseess. Methods: From January 2006 to December 2012, 18 patients(8 males and 10 females, aged 21-65 years, mean 44.6 years) suffering from lumbar spinal tuberculosis with abscess were reviewed retrospectively. The vertehral tuberculosis sites included LI-L2 in 1 patients, L2-L3 in 9 patients, L3-1A in 7 patients, IA-L5 in 1 patient. Abscess was noted at LI-L3 in 1 case, L2-1A in 6 cases, L2-L5 in 3 cases, L3-L5 in 5 eases, and L3-SI in 3 cases. Based on Frankel's classification, there were 3 eases of grade C, 14 of grade D, 1 of grade E. The average preoperative Barthel index(Bl) was 65±10(range, 50-75); the average JOA was 18±4 (range, 12-23). The preoperative ESR and CRP was (57±16.2)mm/h and (22.4±5.6)mg/L respectively; stenosis rate was(35.0±13.1)%; kyphosis angle was 25.3°±7.1°. Under systemic and routine antitubereulosis chemotherapy, all patients received one-stage anterolateral debridement, hone graft and internal fixation. Postoperative persistent closed irrigation drainage and local chemotherapy with isoniazid were performed. Systemic antituberculosis therapy continued for 12-24 months (range, 18 months). The preoperative and postoperative Frankel neural function classification, lumbar JOA score, Barthel index as well as the preoperative, postoperative and follow-up Cobb angle, stenosis rate, ESR and CRP level were compared. Results: The average operation time was 3.0h (range, 2.5-5.0h), the average intraoperative blood loss was 450ml (range, 270-750ml), all patients had no serious complications. Postoperative persistent closed irrigation drainage and local chemotherapy with isoniazid lasted for 10 to 16 days (average, 14 days). The mean follow-up was 20 months(range, 12-30 months). Among 18 cases, 1 patients with Frankle C returned to D, 2 increased t

关 键 词:腰椎结核 椎旁脓肿 一期手术 闭式冲洗引流 疗效 

分 类 号:R529.2[医药卫生—内科学]

 

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