一期后路360度环脊髓减压病灶清除植骨内固定治疗胸腰椎结核并后凸畸形  

One stage posterior and 360 degrees spinal cord decompression debridement bone grafting and internal fixation in the treatment of thoracolumbar tuberculosis

作　　者：郁有来[1] 赵德勇[1] 李强[1] 陈向阳[1] 袁峰[1] 郭开今[1] 

机构地区：[1]徐州医学院附属医院骨科,221002

出　　处：《齐齐哈尔医学院学报》2016年第9期1148-1150,共3页Journal of Qiqihar Medical University

摘　　要：目的观察并探讨一期后路360度环脊髓周围椎管减压、病灶清除植骨融合内固定治疗胸腰椎结核并后凸畸形的临床疗效。方法 2011年1月至2015年6月,一期后路360度环脊髓周围椎管减压、病灶清除植骨融合椎弓根钉内固定治疗胸腰椎结核合并后凸畸形18例,其中男10例,女8例,平均年龄(49.16±15.57)岁。病变节段:胸椎6例,胸腰段7例,腰椎5例,均伴有椎旁脓肿和不同程度的椎管内压迫。患者术前术后抗结核药物治疗,随访观察患者疼痛改善程度(VAS评分),植骨融合时间,畸形矫正程度(Cobb角)以及神经功能恢复情况(ASIA分级)等指标。结果 18例患者均获得随访,术后患者VAS评分和后凸畸形(Cobb角)均较术前明显改善(P<0.05),术后植骨均融合,神经功能恢复良好,随访期间无内固定松动、断裂及脱落,无结核复发。结论在规范化抗结核治疗基础上一期后路360度环脊髓周围椎管减压、病灶清除植骨融合内固定治疗合并后凸畸形的胸腰椎结核能有效达到椎管内减压、矫正畸形、重建脊柱稳定的目的,临床效果满意。Objective To analyze the efficacy of one stage posterior and 360 degrees spinal cord decompression debridement bone grafting and internal fixation in the treatment of thoracolumbar tuberculosis.Methods Eighteen adult patients with thoracolumbar tuberculosis were treated by posterior surgical procedure between January 2011 and June 2015. There were 10 males and 8 females,with an average age of 49. 16 ± 15. 57 years. There were 6 cases of thoracic tuberculosis,7 of thoracolumbar tuberculosis and 5 of lumbar tuberculosis.Data evaluation included visual analogue scale（ VAS）,fusion time,Cobb angle and American Spinal Injury Association grading（ ASIA）. All patients received standard course of chemotherapy with triple or quadruple anti-TB drugs before and after operation. Results All patients were evaluated and followed up. VAS score and Cobb angle improved obviously after the treatment（ P 0. 05）. All cases were fused with autogenous bone,nerve function recovered well,without fixed loosening,breaking and falling,and there was no persistence or recurrence of tuberculosis. Conclusions On the basis of standardized anti tuberculosis treatment,one stage posterior and360 degrees spinal cord decompression debridement bone grafting and internal fixation in the treatment of thoracolumbar tuberculosis can achieve spinal decompression,deformity correction,fusion and spinal stability restoration in single operation through single incision.

关 键 词：胸腰椎结核 后路手术 病灶清除 内固定 

分 类 号：R529.2[医药卫生—内科学]