前路经腹膜外入路治疗胸腰段脊柱结核的疗效观察  

The curative effect observation on patients of thoracic-lumbar spinal tuberculosis by the treatment of operation with the former path of extraperitoneal approach

作　　者：张志敏[1] 刘建[1] 黄春霞[1] 

机构地区：[1]临汾市人民医院,山西临汾041000

出　　处：《基层医学论坛》2017年第8期897-899,共3页The Medical Forum

摘　　要：目的探讨胸腰段脊柱结核Ⅰ期病灶清除、植骨融合、钉棒内固定系统治疗脊柱结核的临床效果。方法我院2010年3月—2014年12月收治胸腰段脊柱结核患者13例,术前HRZE联合应用3周,复查红细胞沉降率降低后行手术治疗,采用经腹膜外入路Ⅰ期病灶清除、植骨及钉棒内固定。术前、术后评估Cobb角、红细胞沉降率及CRP变化,通过视觉模拟评分法(VAS)评价疼痛程度。结果 13例患者均获随访,随访时间10个月~24个月,平均(17.01±4.6)个月。Cobb角术前为(4.0±1.0)°,末次随访时为(3.6±0.6)°(P>0.05);红细胞沉降率、CRP及VAS评分由术前的(53.7±8.7)mm/1 h、(35.5±4.8)mg/L及(6.0±1.0)分,降低到末次随访时的(16.9±2.9)mm/1 h、(6.6±1.3)mg/L及(1.4±0.9)分(P<0.05)。13例患者抗结核治疗9个月~12个月后病灶椎体融合,末次随访时13例患者无术中及术后并发症。术前5例患者伴有神经功能损伤,末次随访时神经功能均恢复正常。结论对于胸腰段脊柱结核,术前及术后规律应用抗结核药物,Ⅰ期病灶清除、植骨融合、钉棒内固定恢复脊柱稳定性,可降低结核复发率,获得满意疗效。Objective To study the first phase of the thoracic-lumbar spinal tuberculosis lesion clearance and bone graft fusion, screw rod fixation system for treatment of spinal tuberculosis. Methods In our hospital from March 2010 to December 2014 treated 13 cases of thoracic lumbar spinal tuberculosis, preoperative anti-tb drugs treatment after 3 weeks,external issue to adopt the peritoneal lesion clearance and bone graft and screw rod fixation treatment,5 cases were male,female 8 cases,aged from 25 to 64,average was （46.8 ± 11.6）.13 patients had different degree of thoracic lumbar pain, 3 patients were with saddle area numbness symptoms, 2 cases of patients were with a side lower limb numbness symptoms, 4 cases of patients were with tuberculosis poisoning symptoms. Preoperative HRZE combined use of 3 weeks, blood sedimentation reduced review after surgery. Preoperative and postoperative evaluation Cobb Angle,blood sedimentation and the change of CRP and the evaluation of the visual analogue scale （VAS） pain. Results 13 patients had been followed up,the follow-up time： 10 to 24 months follow-up time average （ 17.01 ± 4.6） months.Cobb Angle for preoperative （4.0 ± 1.0 ）° , for at the time of the last follow-up （3.6 ± 0.6 ）° . （P〉0.05）.Blood sedimentation, CRP and VAS score by preoperative （53.7 ±8.7）mm/1 h, （35.5 ± 4.8）mg/L and （6.0 ± 1.0） points,down to the last follow-up when （ 16.9 ±2.9）mm/1 h, （6.6 ± 1.3）mg/L and （ 1.4 ± 0.9） （P〈0.05）, 13 eases with anti-tuberculosis treatment 9-12 months after lesion vertebral fusion, 13 patients at the time of the last follow-up no intraoperative and postoperative complications.5 patients with preoperative neurologic injury,at the time of the last follow-up neural function back to normal. Conclusion The thoracic lumbar spinal tuberculosis, preoperative and postoperative application of anti-tb drugs regularly, issue of lesion clearance and bone graft fusion and restore spinal stability screw rod fixation, can reduc

关 键 词：脊柱结核 胸腰段 外科手术 前路经腹膜外入路 内固定 

分 类 号：R687.3[医药卫生—骨科学]