后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核的疗效分析  

Efficacy of Posterior Instrumentation Combined with Anterior Debridement and Grafting for Children with Spinal Tuberculosis

作　　者：阿布都艾尼.米吉提 

机构地区：[1]新疆喀什地区第二人民医院,新疆喀什844000

出　　处：《新疆医学》2017年第8期896-899,共4页Xinjiang Medical Journal

摘　　要：目的探讨后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核的临床疗效分析。方法 2011年6月-2015年10月期间于本院采用后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核患者18例,男性11例、女7例,年龄3~11岁,平均5.8岁。对所有患者术后进行定期随访,现对其临床数据进行回顾性分析。根据后凸畸形Cobb角及脊髓功能Frankle分级评价临床疗效。结果手术时间150~240 min,平均196 min。术中出血量200~480 mL,平均328 mL。随访时间1~3年,平均2.18年。Cobb角由术前48.4°矫正至术后10.8°,矫正率为78%(P<0.05)。1例患者出现植骨块骨折,返修术后治愈。末次随访,根据Frankle分级,所有患者神经功能均恢复正常(P<0.05)。Cobb角平均丢失3.4°。随访中未发现结核复发及内固定失败。结论后路内固定联合前路病灶清除植骨融合是治疗小儿脊柱结核有效、安全的手术方式,该技术能够较理想地维持后凸畸形的矫正率。Objective To investigate the clinical outcomes of one-stage posterior instrumentation combined with anterior debridement and grafting for children with spinal tuberculosis. Methods From June 2011 to October 2015,18 children with spinal tuberculosis treated by one-stage posterior instrumentation combined with anterior debridement and grafting in our institution,including11 males,7 females,aged between 3-11 years,average age is 5.8 years. All of the patients were terminally followed up,as now the collected date were retrospectively analyzed. Clinical outcomes were evaluated based on Cobb angle and the Frankel motor score system.Results The mean operation time was 196 min（range 150-240 ml）. The mean blood loss was 328 ml（range 200-480 ml）. All cases were followed up for 1-3 years,average was 2.18 years. The mean Cobb angle was corrected from preoperative 48.4° to postoperative10.8°with a accurate rate of 78%（P0.05）. One case suffered from graft bone displacement,and was undergo revision surgery. At the last follow up,according to the Frankle grade,neurological deficits were back to normal（P0.05）. The mean loss of correction was 3.4°.There was no cases experienced with instrumentation failure and recurrence of the disease. Conclusion For young children with spinal tuberculosis,one-stage posterior instrumentation combined with anterior debridement and grafting is a safe and simple procedure,and it is more effective in long-term maintenance of the surgical correction.

关 键 词：脊柱结核 儿童 后路内固定 前路病灶清除 植骨融合 

分 类 号：R540.45[医药卫生—心血管疾病]