病灶清除椎体重建内固定治疗颈椎结核并后凸畸形  

Debridement and reconstruction with internal fixation in the treatment of cervical spinal tuberculosis combined with kyphosis

作　　者：王辉[1] 薛睿[1] 吴璐梅[1] 宋艳丽[1] 丁文元[1] WANG Hui;XUE Rui;WU Lumei;SONG Yanli;and DING Wenyuan(Department of Spine,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中华灾害救援医学》2018年第6期324-328,共5页Chinese Journal of Disaster Medicine

基　　金：河北省2018年度医学科学研究重点课题(20180449)

摘　　要：目的探讨病灶清除椎体重建内固定治疗颈椎结核并后凸畸形的手术疗效,为今后该类患者的临床治疗提供参考。方法回顾性分析2011-02至2016-05在河北医科大学第三医院接受手术治疗的17例颈椎结核并后凸畸形患者的临床及影像学资料,15例接受单纯前路手术,2例接受分期后-前路联合手术。临床评估指标包括:手术时间、术中出血量、神经功能改善、疼痛缓解程度、术后并发症、血沉变化、体重变化、患者满意度指数(modified patient satisfaction index,m-PSI)。影像学指标包括:C_2~C_7矢状垂直轴(sagittal vertical axis,SVA)、C_7倾斜角、C_2~C_7角度、局部后凸角度。随访期间评估内固定物位置、植骨融合情况。结果 (1)17例患者均安全接受手术,平均手术时间(139.4±48.8)min,术中出血(268.7±51.2)ml,术后伤口均甲级愈合。术后随访(15.6±4.3)个月,末次随访椎间植骨均骨性融合,未发生内固定物失败。(2)与术前相比,末次随访时患者神经功能显著改善(t=-3.714,P=0.002)、颈部疼痛明显缓解(t=15.907,P<0.001)、血沉降低(t=9.523,P<0.001)、体重增加(t=-7.933,P<0.001);C_2~C_7 SVA减小(t=-10.442,P<0.001)、C_7倾斜角增大(t=10.052,P<0.001)、C_2~C_7角度减小(t=-15.855,P<0.001)、局部后凸角减小(t=11.044,P<0.001),差异均有统计学意义。(3)患者满意度:m-PSI 1级10例(58.8%)、m-PSI 2级5例(29.4%)、m-PSI 3级2例(11.8%)。结论对于颈椎结核并后凸畸形患者,病灶清除和椎体重建可有效改善其神经功能、缓解颈痛、矫正后凸畸形,临床疗效满意。Objective The objective of this study was to investigate the effect of debridement and reconstruction with internal fixation in the treatment of cervical spinal tuberculosis combined with kyphosis, and to provide reference for future treatment of such patients. Methods The clinical and imaging data of 17 cases of cervical spinal tuberculosis combined with kyphosis from February 2011 to May 2016 in the Third Hospital of Hebei Medical University were retrospectively analyzed, among which 15 cases received anterior surgery and 2 cases were treated by staging posterior-anterior combined operation. The clinical evaluation indexes included： operation length, intraoperative bleeding volume, nerve function, degree of pain relief, postoperative complications, erythrocyte sedimentation rate（ESR）, body weight, and modified patient satisfaction index（m-PSI）. Imaging indexes included： C2-C7 sagittal vertical axis（SVA）, C7 tilt angle, C2-C7 Cobb angle and local kyphosis angle. The internal fixation position and fusion of bone graft were evaluated during the followup period. Results（1） All the patients underwent operations safely. The mean operative time was（139.4±48.8） min, the intraoperative bleeding was（268.7±51.2） ml, and all the wounds healed（grade A）. All patients were followed up for（15.6±4.3） months. At the last followup, all the intervertebral bone grafts were fused without internal fixation failure.（2） Compared with pre-operation, the nerve function in the last follow-up was significantly improved（t=-3.714, P=0.002）, the neck pain was obviously relieved（t=15.907, P〈0.001）, the ESR was significantly reduced（t=9.523, P〈0.001）, and body weight increased（t=-7.933, P〈0.001）, the C2-C7 SVA decreased（t=-10.442, P〈0.001）,the C7 tilt angle increased（t=10.052,P〈0.001）, the C2-C7 Cobb angle decreased（t=-15.855, P〈0.001）, and the local kyphosis decreased（t=11.044, P〈0.001）, and the differences were all statistically significant.（3） Patien

关 键 词：病灶清除 椎体重建 颈椎结核 后凸畸形 

分 类 号：R529.2[医药卫生—内科学] R682.3[医药卫生—临床医学]