后路病灶清除植骨融合内固定术治疗单节段胸腰椎结核的疗效  

Posterior-Only Approach Decompression,Debridement,Posterior Instrumentation,and Fusion for Single-Segment Thoracic and Lumbar Tuberculosis

作　　者：金祺[1] 阮文峰[1] 赵欣宇[1] 平安松[1] 王文达[1] 刘辉[1] 

机构地区：[1]武汉大学中南医院骨科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2016年第3期476-480,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨后路病灶清除、植骨融合内固定术治疗单节段胸腰椎结核的适应证及短期疗效。方法:回顾分析我院2012年1月-2014年12月收治的28例单节段、病灶局限、椎前无大的脓肿流注的胸腰椎结核患者。所有患者均行经后路病灶清除、植骨融合内固定术。记录手术时间,术中出血量,评价术前及术后的神经功能ASIA分级、Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、后凸角、红细胞沉降率(ESR)变化情况,并进行对比分析。结果:手术时间(199.0±42.1)min,出血量(550.0±133.2)ml,所有患者获得随访,平均(19.6±6.9)个月(11-34个月)。术前存在神经功能障碍者17例,术后12例改善1级,5例改善2级;后凸角由术前的(21.9±15.0)°矫正至术后3月的(9.1±8.7)°,末次随访时后凸角为(10.6±9.9)°,平均矫正角度丢失(1.9±1.7)°。ODI由术前的(60.0±13.3)%下降至术后的(12.9±10.8)%。VAS评分由术前的6.7±0.9减小到术后的1.2±1.0;ESR由术前的(56.3±34.7)mm/h下降至术后(11.9±2.1)mm/h。术前及术后的后凸角、ODI、VAS变化有明显差异(P<0.05)。术后随访无结核复发及感染性脑脊膜炎发生,无内固定松动及断裂等并发症。结论:对于病灶局限的单节段胸腰椎结核,后路病灶清除、植骨融合内固定术是一种安全、有效的治疗方法。Objective：To investigate the effectiveness and feasibility of posterior-only approach decompression,debridement,posterior instrumentation,and fusion for single-segment thoracic and lumbar tuberculosis（TB）.Methods：Twenty-eight cases with single-segment thoracic and lumbar tuberculosis between January 2012 and December 2014 were reviewed retrospectively.There were16 males and 12 females included,with an average age of（46.4±17.2）years（range,10 to 69years）.There were 19 thoracic TB and 9lumbar TB.The defects were limited in local,no abscess was noted in all cases.All cases underwent posterior-only approach decompression,debridement,posterior instrumentation,and fusion.The operation time,intraoperative blood loss were recorded.The ASIA grade and the kyphosis Cobb angle of diseased segments,VAS,ESR before and after surgery were reviewed and compared respectively.Results：The average opera-tion time was（199.0±42.1）min.The average blood loss was（550.0±133.2）ml.All cases were followed up for average（19.6±6.9）months（range,11 to 34months）.17 cases with preoperative neurological deficit improved significantly,including 12 cases improved 1grade and 5cases improved 2grades.The mean kyphosis Cobb angle was（21.9±15.0）°preoperatively,and（9.1±8.7）°at the end of 3months after operation.At last follow-up,the kyphosis Cobb angle was（10.6±9.9）°,the average loss of correction was（1.9±1.7）°.The average ODI were decreased from（60.0±13.3）% preoperatively to（12.9±10.8）% postoperatively.The average VAS decreased from 6.7±0.9preoperatively to 1.2±1.0postoperatively.The value of ESR recovered to normal after operation in all patients,which decreased from（56.3±34.7）mm/h to（11.9±2.1）mm/h.Significant difference was noted with respect to kyphosis Cobb angle,ODI and VAS between preoperation and postoperation（P〈0.05）.Cerebrospinal meningitis,any instrument failure and recurrence of tuberculosis were not noted.Conclusion：Posterior-only approach decompression,d

关 键 词：脊柱结核 胸腰椎 后路 病灶清除 植骨 内固定 

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