一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核  

One-stage posterior uni-vertebral lamina fenestration debridement,bone grafting fusion and instrumentation for thoracolumbar tuberculosis

作　　者：姜力元 胡建中[1] 陈静[1] 刘少华[1] 高琪乐[1] 李平[1] 胥茜[1] 邓展生[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,长沙410008

出　　处：《中国矫形外科杂志》2016年第11期990-994,共5页Orthopedic Journal of China

摘　　要：[目的]探讨一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核的可行性及临床疗效。[方法]2007年1月-2014年1月收集23例胸腰段脊柱结核并有后突畸形的患者,伴有椎管及椎旁脓肿形成。其中男13例,女10例;年龄30-69岁,平均（46.48±12.01）岁。脊柱病变节段后凸Cobb角为17°-40°,平均（30.43±5.74）°。术前ASIA分级：B级2例,C级10例,D级7例,E级4例。均采用一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗。通过研究患者ASIA分级、脊柱病变节段后凸Cobb角、术后并发症、Oswestry功能障碍指数（ODI）、VAS疼痛评分、植骨融合时间评估手术疗效。[结果]术后随访21-41个月,平均（29.30±4.97）个月,无脊髓损伤加重及脑脊液漏,无窦道形成。1例术后伤口延迟愈合,1例出现皮下局部脓肿。术前有神经症状者均有不同程度恢复。至末次随访,根据ASIA分级,2例由B级恢复至D级,8例由C级恢复至E级,2例由C级恢复至D级,7例由D级恢复至E级。术后测量后凸Cobb角较术前显著改善（P〈0.001）。末次随访时ODI、VAS疼痛评分均较术前明显改善（P〈0.001）。本组无内固定失败及假关节形成,所有患者均在术后5-8个月达到植骨融合,疗效满意。[结论]对于有适应证的脊柱结核,一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核安全有效且手术创伤小。[Objective] The aim of this study was to retrospectively evaluate the feasibility and clinical efficacy of one-stage posterioruni- vertebral lamina fenestration debridement,bone grafting fusion and instrumentation for treatment of thoracolumbar tuberculosis. [Methods] Total 23 patients were collected for this study from Jan. 2007 to Dec. 2014. All of them were diagnozed as thoracolumbar tuberculosis and kyphosis deformity associated with spinal canal and paraspinal abscess. There were13 male patients and 10 female patients,with age ranging from 30 to 69 years old（ mean,43. 61 ± 15. 1 years old）. Among all of the enrolled patients,the kyphotic Cobb angle of segmental spinal lesions were 17° - 40°（ mean,30. 43 ± 5. 74°）. According to the American Spinal Injury Association（ ASIA） scoring system,there were 2 level B10 level C,7 level D and 4level E cases. All the patients were treated with the one- stage posterior uni- vertebral lamina fenestration debridement,bone grafting fusion and instrumentation. The ASIA,kyphotic Cobb angle of segmental spinal lesions,postoperative complications,Oswestry Disability Index（ ODI）,Visual Analogue Scale（ VAS） pain score and fusion time of grafted bone were evaluated respectively to assess the feasibility and clinical efficacy of this surgical approach. [Results] Patients were followed up for 21 - 41 months（ mean,29. 30 ± 4. 97 months） after the operation. During this time period,no spinal injury was aggravated. No cerebrospinal fluid leak or sinus tract formation occurred. One wound healing delay occurred and 1 subcutaneous abscess happened. Neurological deficits recovered to different degrees. At the end of follow- up,ASIA grade B improved to D in 2 cases,grade C improved to E in 8 cases,grade C improved to D in 2 cases and in another 7 cases,grade D improved to E. Compared to pre- operation,the postoperative kyphotic Cobb angle of segmental spinal lesions significantly decreased（ P〈0. 001）. Furthermore,both ODI and VAS pain score were significan

关 键 词：胸腰段脊柱结核 一期后路 内固定 

分 类 号：R687.3[医药卫生—骨科学]