腰骶段脊柱结核患者的手术方案分析  

Surgical treatment for patients with lumbosacral spinal tuberculosis

作　　者：李天泉 周恩瑜 张伟 

机构地区：[1]四川甘孜州人民医院神经外科,四川甘孜州626000

出　　处：《中国现代医学杂志》2015年第16期81-85,共5页China Journal of Modern Medicine

摘　　要：目的探讨腰骶段脊柱结核不同手术方案的临床效果。方法回顾性分析该院2007年1月-2011年12月收治的146例腰骶段脊柱结核患者的临床资料及随访结果,根据手术入路分为后路组(n=48)、前路组(n=43)及后路+前路组(n=55),3组分别采取经后路清除病灶+植骨内固定术,经前路清除病灶+植骨内固定术,后路内固定+前路清除病灶及植骨融合术。比较3组患者的手术时间、手术出血量、术后并发症以及临床治疗效果。结果后路组、前路组及后路+前路组的手术时间和手术出血量分别为(160±23)、(150±20)和(180±21)min及(450±42)、(430±53)和(710±34)ml,后路+前路组的手术时间和手术出血量明显高于后路组及前路组,差异有统计学意义(P<0.05),而后路组和前路组比较,差异无统计学意义(P>0.05)。所有患者在术中均未发生神经及输尿管损伤等严重的并发症,3组的术后并发症发生率分别为4.2%、7.0%和7.3%,3组比较差异均无统计学意义(P>0.05)。术后临床症状均有明显改善,血沉(ESR)和C反应蛋白(CRP)均在术后3个月恢复正常。3组的优良率分别为93.8%、93.0%和98.2%,三者比较差异无统计学意义(P>0.05)。3组骨性融合率及平均骨性融合时间比较差异无统计学意义(P>0.05)。3组的腰骶角均显著高于术前(P<0.05),且3组患者术前及末次随访时的腰骶角比较,差异均无统计学意义(P>0.05)。3组患者的神经功能不全的患者比例明显低于术前(P<0.05),且3组患者术前及末次随访时的神经功能不全的患者比较,差异均无统计学意义(P>0.05)。结论对于腰骶段脊柱结核,3种手术均是安全有效的治疗选择,应根据病灶位置及椎体破坏情况选择合适的手术入路,尽可能彻底清除病灶,选择有效的内固定和植骨的方式,均有望获得满意的疗效。[ Objective ] To investigate the clinical effect of different operation procedures on patients with lum- bosacral spinal tuberculosis. [ Methods ] The clinical data and follow-up results of 146 patients with lumbosaeral tu- berculosis from January 2007 to December 2011 were retrospectively analyzed. According to the operative approach, 146 cases were divided into posterior group （n = 48） which underwent posterior pedicle screw instrumentation plus debridement and allograft, anterior group （n = 43） which underwent anterolateral debridement plus allograft and in- ternal fixation, and posterior-anterior group （n = 55） which experienced posterior pedicle screw instrumentation and anterior debridement and allograft. The operative time, operative blood loss, postoperative complications and clinical effect were compared among three groups. [ Results ] The operative time and operative blood loss in posterior group, anterior group and posterior-anterior group were respectively （160±23） min, （150±20） min, （180±21） min and （450±42） ml, （430±53） ml, （710±34） ml. The operative time in posterior-anterior group was significantly longer and the operative blood loss in posterior-anterior group was significantly higher than posterior group and anterior group （P 〈 0.05）, and there was no significant difference in them between posterior group and anterior group （P 〉 0.05）. All cas- es had no serious complication such as nerve and ureteral injury. The rates of postoperative complication in three groups were 4.2%, 7.0%, and 7.3%, in which there was no significant difference （P 〉 0.05）. The clinical symptoms of all cases were significantly improved after operation. The erythrocyte sedimentation rate （ESR） and C-reaction pro- tein （CRP） were recovered to normal after three months. The excellent plus good rates of three groups were 93.7%, 93.0% and 98.2%, in which there was no significant difference （P 〉 0.05）. There was no significant difference in the rate of bon

关 键 词：腰骶段 结核 脊柱 手术 

分 类 号：R529.2[医药卫生—内科学]