一期经前路病灶清除钛网植骨固定融合术治疗胸腰椎结核的临床研究  

Clinical study on the treatment of thoracic and lumbar tuberculosis by one-stage anterior debridement and fusion

作　　者：商振国[1,2] 李永民[2] 李颉[2] 周进国[2] 赵泉勇[2] 孙来卿[2] SHANG Zhen-guo LI Yong-min LI Jie ZHOU Jin-guo ZHAO Quan-yong SUN Lai-qing(Graduate School of North China University of Science and Technology, Tangshan, HebeL 063000, PR)

机构地区：[1]华北理工大学研究生学院,唐山063000 [2]唐山市第二医院脊柱一科,063000

出　　处：《中国骨与关节杂志》2016年第11期823-827,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨一期经前路病灶清除钛网植骨固定融合术治疗胸腰椎结核的临床疗效。方法2006年1月至2011年12月,我科对47例胸腰椎结核患者行一期经前路病灶清除钛网植骨固定融合术治疗。其中男22例,女25例;年龄21-68岁,平均45.9岁。累及节段：胸椎（T（6-10））6例,胸腰段（T（11）-L1）32例;腰椎（L（1-2））9例。Gulhane Askeri Tip Akademisi分型,Ⅱ型28例,Ⅲ型19例。病程3-15个月,平均8.7个月。术后采用Cobb’s角纠正度、疼痛视觉模拟评分（visual analogue scale,VAS）及神经功能Frankel分级评价临床疗效。结果术后切口均I期愈合。所有患者均获得有效随访,随访时间36-57个月,平均（45.6±6.3）个月。钛网植骨均获骨性融合,融合时间9-18个月,平均（14.2±3.4）个月。所有患者均无局部结核复发,未发生内固定松动或断裂。术后3个月Cobb’s角、VAS评分（t=20.967,P=0.000;t=59.671,P=0.000）及末次随访Cobb’s角、VAS评分（t=19.746,P=0.000;t=80.113,P=0.000）均较术前明显改善。Frankel分级除10例由D级恢复为E级、4例由C级恢复为D级外,其余患者术前、术后均为E级。结论一期经前路病灶清除钛网植骨固定融合术治疗胸腰椎结核可以充分减压,同时实现固定、融合以及维持脊柱稳定性的目的,从而取得良好的治疗效果。Objective To investigate the clinical results of one-stage anterior focus debridement and titanium cage fusion in the treatment of thoracic and lumbar tuberculosis. Methods From January 2006 to December 2011, 47 patients with thoracic and lumbar tuberculosis underwent one-stage anterior focus debridement and titanium cage fusion. There were 25 females and 22 males with the mean age of 45.9 years（ range： 21- 68 years）. The distribution of thoracic and lumbar segments involved were as follows： thoracic tuberculosis（ T（6-10）） in 6 cases, lumbar tuberculosis（ L（1-2）） in 9 cases and thoracolumbar tuberculosis（ T（11）- L1） in 32 cases. According to the Gulhane Askeri Tip Akademisi grading system for spinal tuberculosis, there were 28 cases of grade Ⅱ and 19 cases of grade Ⅲ. The mean symptom duration before the surgery was 8.7 months（ range： 3- 15 months）. The visual analogue scale（ VAS） scores, Coronary Cobb＇s angles and Frankel＇s grading of neurological deficits were used to evaluate the clinical results. Results All the incisions primarily healed without infections and no revision surgery was conducted. All the cases were followed up for an average of（ 45.6 ± 6.3） months（ range： 36- 57 months）. No such complications as tuberculous peritonitis or intestinal obstruction occurred. All the patients achieved bony fusion at（ 14.2 ± 3.4） months after the operation on average（ range： 9- 18 months） without the occurrence of breakage or loosening of titanium plates and screws. The Coronary Cobb＇s angles and VAS scores were significantly improved at 3 months after the operation（ t = 20.967, P = 0.000; t = 59.671, P = 0.000） and at the final follow-up（ t = 19.746, P = 0.000; t = 80.113, P = 0.000） when compared with the preoperative values. Fourteen patients had the improvement of 1 grade, including 10 patients from grade D to grade E and 4 patients from grade C to grade D according to the Frankel＇s grading system. The other patients remained the

关 键 词：结核 脊柱 胸椎 腰椎 外科手术 病灶清除 

分 类 号：R687.3[医药卫生—骨科学]