一期病灶清除植骨融合内固定治疗跳跃性胸腰椎结核  

One-stage debridement,bone graft and internal fixation for the treatment of skipped thoracolumbar tuberculosis

作　　者：张涛[1] 王世勇[1] 屈涛[1] 蓝旭[1] 

机构地区：[1]兰州军区兰州总医院脊柱外科,甘肃兰州730050

出　　处：《临床骨科杂志》2015年第4期385-389,共5页Journal of Clinical Orthopaedics

摘　　要：目的：探讨一期病灶清除植骨融合内固定术治疗跳跃性胸腰椎结核的疗效。方法对17例跳跃性胸腰椎结核患者一期行结核病灶清除植骨融合内固定术。术后定期随访ESR、CRP、X线片、CT等了解结核治愈情况。结果患者均获随访,时间1．5∽4年,1例伤口不愈合,其余患者切口均一期愈合。结核病复发1例。术后患者神经功能均较术前改善,术后4∽8个月椎间植骨均获骨性融合。末次随访时, ESR由术前（45．6±17．7）mm/1 h降至（12．3±9．2）mm/1 h,CRP由术前（8．8±6．9）mg/L降至（1．6±1．4） mg/L,VAS评分由术前（5．1±1．4）分降至（1．5±1．0）分,ODI由术前57．8%±19．2%降至11．8%±7．6%,后凸角度由术前22．6°±9．7°矫正到8．9°±4．5°,术后各项数据与术前比较差异均有统计学意义（P〈0．05）。结论在常规抗结核药物治疗基础上,一期病灶清除植骨融合内固定术治疗跳跃性胸腰椎结核是安全有效的。Objective To investigate the effect and feasibility of one-stage debridement, bone graft and internal fixa-tion for the treatment of skipped thoracolumbar tuberculosis. Methods 17 cases who suffering from skipped thoraco-lumbar tuberculosis were analyzed retrospectively. All cases underwent one-stage debridement, bone graft and internal fixation. ESR, CRP test, X-ray, CT after operation were recorded. Results The follow-up time was 1. 5∽4 years. 1 case complicated with nonunion of the wound, while the others were primary healing. 1 case had tuberculosis recur-rence. All cases′neurologic function was improved after operation. Solid fusion was achieved within 4∽8 months. At last follow-up, the ESR reduced from （ 45. 6 ± 17. 7 ） mm/1h to （ 12. 3 ± 9. 2 ） mm/1h, the CRP reduced from （8. 8 ± 6. 9）mg/L to （1. 6 ± 1. 4） mg/L, the VAS scores reduced from 5. 1 ± 1. 4 to 1. 5 ± 1. 0, the ODI reduced from 57. 8% ± 19. 2% to 11. 8% ± 7. 6%, the kyphotic angle reduced from 22. 6° ± 9. 7° to 8. 9° ± 4. 5°,the data had significant difference compared with the preoperation （ P〈0. 05 ） . Conclusions On the basis of conventional anti-tuberculosis treatment, one-stage debridement, bone graft and internal fixation for the treatment of skipped thora-columbar tuberculosis is safe and effective.

关 键 词：跳跃性结核 胸腰椎结核 一期病灶清除 植骨 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]