多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究  

One-stage anterior internal fixation with multidirectional self-locking plate in treatment of lumbosacral tuberculosis: report of 35 cases

作　　者：王成 罗飞[1] 张泽华[1] 侯天勇[1] 汪正东 刘勋[1] 荣志刚 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科,全军矫形外科中心,重庆400038

出　　处：《第三军医大学学报》2017年第21期2093-2098,共6页Journal of Third Military Medical University

基　　金：第三军医大学临床创新基金(SWH2011015)~~

摘　　要：目的探讨采用自主研发的多向自锁钛板内固定行一期前路病灶清除、植骨融合术治疗腰骶段结核的安全性和有效性。方法 2010-2015年我科采用一期前路病灶清除、植骨融合与多向自锁钛板内固定术治疗腰骶段结核共35例。术前常规支持及抗结核治疗,采用CT血管造影技术评估髂血管走行与腰骶段结核病灶的关系及骨质破坏情况。术中采用多向自锁钛板选择骨质结构相对完整的区域进行固定。术后定期随访,评估结核活动、植骨融合、矫形维持、神经功能恢复及并发症等情况。结果 35例患者均获随访,随访时间18~36(26.06±6.16)个月。手术时间(148.57±17.68)min,术中失血量(257.14±29.66)m L。术中无大血管、神经及输尿管损伤。术后腰腿痛症状均获明显缓解,无结核复发、下肢深静脉血栓、逆行射精及勃起功能障碍等并发症,术后12个月椎间植骨均达Ⅰ级骨愈合。术前、末次随访红细胞沉降率分别为(32.14±9.87)、(5.34±2.30)mm/h,术前、末次随访C反应蛋白分别为(23.66±9.98)、(1.26±0.55)mg/L,术前、末次随访平均VAS评分分别为(4.80±1.02)、(0.83±0.71)分,术前、末次随访平均ODI评分分别为(27.47±6.79)%、(4.31±1.49)%,术前、术后及末次随访平均腰骶角分别为(23.09±3.21)°、(29.21±1.16)°和(26.71±1.57)°。结论一期前路结核病灶清除、植骨融合与多向自锁钛板内固定术治疗腰骶段结核安全且有效,多向自锁钛板是适合腰骶段结核前路手术的有效内固定装置。Objective To explore the clinical safety and efficacy of one-stage anterior debridement, bone grafting and internal fixation for the treatment of lumbosacral tuberculosis （TB） with the selfdeveloped multidirectional self-locking plate system. MethodsA total of 35 cases of lumbosacral tuberculosis who were treated with above approach between 2010 and 2015 were enrolled in this study. Preoperative routine support and anti-TB treatment, and CT angiography was used to assess the relationship between iliac vascular access and lumbosacral TB lesions and the bone destruction. During the operation, relatively complete regions of bone structure were chosen to place the multidirectional self-locking plate. Postoperative regular follow-up was carried out for assessment of tuberculosis activities, neurological recovery, bone graft fusion, orthopedic maintenance and complications. Results All patients were followed up for a mean period of 26.06±6.16 （ranging from 18 to 36） months. The average operation time was 148.57±17.68 min, and the average intraoperative blood loss was 257.14±29.66 mL. No injury of blood vessel, cauda equina or ureter occurred during surgery. After surgery, the lumbocrural pain was relieved significantly, and no TB recurrence or complications, such as venous thrombosis, impotence, retrograde ejaculation or recurrence was observed in all of these patients. The intervertebral bone grafts reached grade Ⅰ at 12 months after surgery. The average preoperative erythrocyte sedimentation rate （ESR）, C-reactive protein （CRP）, visual analogue scale （VAS） score, and Oswestry disability index （ODI） were 32.14±9.87 mm/h, 23.66±9.98 mg/L, 4.80±1.02, and （27.47±6.79）%, respectively, while the above indicators were 5.34±2.30 mm/h, 1.26±0.55 mg/L, 0.83±0.71, and （4.31±1.49）% postoperatively. The average lumbosacral angle was （23.09±3.21）°, （29.21±1.16）°, and （26.71°±1.57）°, pre, intra- and post-operatively. Conclusion One-stage anterior deb

关 键 词：腰骶段 结核 前路 内固定 多向自锁钛板 

分 类 号：R529.2[医药卫生—内科学] R681.57[医药卫生—临床医学]