前路病灶清除植骨融合联合后路椎弓根钉内固定对脊柱结核患者神经功能的影响  

Effect of anterior lesion removal combined with bone grafting and posterior pedicle screw fixation on neurological function of patients with spinal tuberculosis

作　　者：金永[1] 王文俊[1] 陶振东[1] 潘海根 JIN Yong;WANG Wen-jun;TAO Zhen-dong;PAN Hai-gen(Department of Orthopaedics,the Third People＇s Hospital of Changzhou,Changzhou,Jiangsu l213000,China)

机构地区：[1]常州市第三人民医院骨科,江苏常州213000

出　　处：《颈腰痛杂志》2018年第4期422-425,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨前路病灶清除术联合植骨融合及后路椎弓根内固定术治疗脊柱结核对患者神经功能的影响。方法选取我院手术治疗的33例胸腰椎脊柱结核患者(2010-01-2016-03)进行回顾性研究,所有患者均采用前路病灶清除术联合植骨融合及后路椎弓根内固定术治疗,对比手术前后不同时间患者的血沉、Frankel神经功能、后凸畸形矫正情况。结果术后1个月、术后3个月,本组患者的ESR、血清CRP水平较术前均显著的降低,差异均具有统计学意义(P<0.05);术前,患者脊髓神经功能B级(9.09%)、C级(33.335)、D级(33.33%)、E级(24.24%),术后患者脊髓神经功能C级(6.06%)、D级(36.36%)、E级(63.64%),术后患者的神经功能显著的改善(P<0.05);其中17例胸椎结核患者术前均存在不同程度的后凸畸形,角度范围7～30°,平均(14.2±6.0)°,术后患者后凸畸形角度范围2～14°,平均(6.1±3.4)°;术后患者的后凸畸形角度较术前显著的降低(t=6.747,P<0.05);33例患者手术后6个月复查,均达到融合标准,患者切口愈合良好,未出现内固定松动等并发症;27例患者术后1年到本院进行复查,神经功能恢复较好,未出复发患者。结论前路病灶清除术联合植骨融合及后路椎弓根内固定术治疗脊柱结核效果肯定,术后患者脊髓神经功能恢复较好。Objective To investigate the effect of anterior fissure removal combined with bone grafting and posterior pedicle screw fixation on neurological function of patients with spinal tuberculosis. Methods From January 2010 to March 2016, 33 patients with thoracolumbar spine tuberculosis were selected for retrospective study. All patients were treated with anterior resection of the lesion combined with bone grafting and posterior pedicle screw fixation. Before and after surgery, the ESR, Frankel nerve function, kyphosis correction were compared. Results The levels of ESR and serum CRP at postoperative 1 month and 3 months were significantly lower than before operation （P〈0.05）. The neurological function of patients after operation[grade C（6.06%）, grade D （36.36%）, grade E （63.34%）] were significantly improved than before operation[grade B（9.09%）, grade C（33.33%）, grade D（33.33%）, grade E （24.24%）] （P〈0.05）. Among them, 17 cases of thoracic tuberculosis had different degree of kyphosis before surgery, the angle range was 7~30°, average of（14.2±6.0）°, postoperative kyphosis angle range was 2°~14°, average of（6.1±3.4）° （t=6.747, P〈0.05）. 6 months after operation, 33 patients underwent examination, and the fusion criteria were achieved. The incision was well healed and no fixation or other complications was found. 1 year after surgery, 27 patients went to the hospital for review, had better recovery of neurological function, no recurrence of patients. Conclusion Anterior lesion surgery combined with bone graft fusion and posterior pedicle screw fixation in the treatment of spinal tuberculosis has affirmative effect, postoperative spinal cord nerve function recovery is better.

关 键 词：前路病灶清除术 植骨融合 后路椎弓根内固定术 脊柱结核 神经功能 

分 类 号：R529.2[医药卫生—内科学]