病椎间固定在脊柱结核患者治疗中的应用价值  

Clinical Effects of Diseased Segment Fixation in Treatment of Patients with Spinal Tuberculosis

作　　者：杨帆[1] 韩翠玉[3] 杨雯[2] 侯煜[3] 孙博[3] 梁志兴[3] 申志坤[3] 

机构地区：[1]河北省保定市第三中心医院骨科,河北保定071000 [2]河北省保定市第三中心医院中西医结合,河北保定071000 [3]河北大学附属医院骨科,河北保定071000

出　　处：《医学临床研究》2016年第12期2335-2338,共4页Journal of Clinical Research

摘　　要：【目的】探讨病椎固定在脊柱结核患者治疗中的疗效。【方法】回顾性分析本院2009年1月到2014年12月收治的脊柱结核患者84例，根据患者意愿分为两组。病椎间组：38例，固定在病变累及的单个神经单元中完成；超病椎间组：46例，采用长、短节段内固定，范围超出病灶外2个运动神经单元。比较两组患者的术中出血量、手术时间及术前、术后血沉（ESR）、C反应蛋白（CRP）、视觉模拟（VAS）评分及Frankel分级、Cobb角。【结果】病椎间组术中出血量及手术时间均优于超病椎间组，差异有统计学意义（P〈0．05）；两组患者ESR、CRP术后6个月均降低至正常水平，组间比较差异无统计学意义（P〉0．05）；病椎间组与超病椎间组末次随访时VAS评分较术前均下降，且低于超病椎间组，差异有统计学意义（P〈0．05）；两组患者Frankel功能分级较术前均明显恢复；两组患者末次随访时Cobb角均小于术前Cobb角。但两组间术前、术后、末次随访、矫正度数及丢失度数比较差异无统计学意义。【结论】病椎固定治疗脊柱结核是安全、有效的，能有效保留与病椎相邻正常运动神经单元，并有术中出血少、手术时间短的优势，值得临床推广应用。[Objective]To explore the clinical effects of diseased segment fixation in the treatment of patients with spinal tuberculosis. [Methods]Retrospectively 84 cases with spinal tuberculosis in our hospital from January 2009 to December 2014 were analyzed according to different operation methods , and they were divided into diseased segment fixation group （fixed in lesions involving individual neurons, 38 cases） and non-diseased segment fixation group （using long and short segmental fixation, 46 cases）. The intraoperative blood loss, operative time during the surgery, the ESR and preoperative and postoperative CRP level , CRP , VAS score, Franke 1 classification and Cobb Angle of the two groups were observed and analyzed.[Results]Blood loss and operation time of diseased segment fixation group were superior than diseased non-segment fixation group, the difference was statistical significance （ P 〈0.05）; ESR and CRP of two groups reduced to normal levels 6 months after surgery, but there was no statistical difference between two groups（ P 〈0.05）.VAS score at the last follow-up of the two groups were decreased ,and VAS score of the diseased segment fixation group was lower than that of the non-diseased segment fixation group （ P 〈0.05）;The Frankel function classification of the two groups were obviously recovered ;Cobb angle at the last follow-Up of the two groups were less than that before surgery, but the correction of Cobb＇s angle and angle loss of preoperative and postoperative and the last follow-up of two groups were not statistically different. [Conclusion]Diseased segment fixation in the treatment of patients with spinal tuberculosis is a safe and effective therapy, which can effectively preserve normal vertebral motion nerve unit adjacent to diseased segment with its advantage of less intraoperative bleeding and shorter operation time.

关 键 词：骨折固定术 内 结核 脊柱/外科学 回顾性研究 

分 类 号：R529.23[医药卫生—内科学]