单纯后路经皮内固定术对胸腰椎结核的临床疗效  

Efficacy of isolated posterior percutaneous screw fixation for patients with thoracic and lumbar spinal tuberculosis

作　　者：胡舟扬 李新华[1] 姜倍 赵卫东[1] 谭军[1] 李立钧[1] HU Zhou yang;LI Xin hua;JIANG Bei;ZHAO Wei dong;TAN Jun;LI Li jun(Dep.of Spine Surgery,East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院脊柱外科,上海200120

出　　处：《同济大学学报（医学版）》2018年第5期99-104,共6页Journal of Tongji University(Medical Science)

基　　金：上海市卫生与计划委员会科研项目(201640063);江西省自然科学基金项目(20171BAB205034);上海市浦东新区卫生系统重点学科建设项目(PWZxk2017-08)

摘　　要：目的探讨一期后路单纯经皮内固定术治疗胸腰椎结核的可行性及早期疗效。方法回顾性分析2012年4月至2016年7月同济大学附属东方医院脊柱外科选择收治的64例胸腰椎结核患者的临床资料。其中男28例,女36例,年龄32～66岁,平均49. 2岁。病灶累及范围:胸椎结核12例,胸腰段结核28例,腰椎结核24例。美国脊髓损伤协会(ASIA)分级:D级40例,E级24例。对于有神经症状的患者进行局部的病灶清除、脓肿引流并行后路单纯经皮内固定。对于无神经症状的患者不进行病灶清除和植骨融合,仅行后路单纯经皮内固定。观察术后疗效,定期随访。统计记录手术时间、术中失血量、红细胞沉降率(ESR)、疼痛视觉模拟评分(VAS)、后凸畸形角、ASIA评分及并发症。结果平均手术时间115. 8 min(81～135 min),平均手术出血量为125. 4 mL(90～163 mL)。患者术后均获随访,平均19. 4个月(12～39个月)。末次随访,ESR改善至10. 50 mm/h(4～18 mm/h),VAS评分改善至0. 9分(0～2分)。术后后凸Cobb角平均6. 6°(3°～10°),末次随访为平均8. 7°(5°～12°),患者神经功能恢复良好。术后2例患者出现尿路感染,2例出现切口浅表感染。无严重神经、血管损伤,内固定松动、移位等并发症。结论采用一期后路单纯经皮内固定术治疗胸腰椎结核临床效果显著,患者可获得满意的矫形效果、脊柱稳定性。Objective To evaluate the feasibility and early efficacy of isolated posterior percutaneous screw fixation in patients with thoracic and lumbar spinal tuberculosis （TB）.Methods From April 2012 to July 2016, 64 patients with thoracic or lumbar TB were included in this study, among whom there were 28 males and 36 females, with a mean age of 49.2 years（32 66 years）. The involved levels were thoracic vertebra in 12 cases, thoracolumbar vertebra in 28 cases and lumbar vertebra in 24 cases. Forty patients were categorized as American Spinal Injury Association（ASIA） grade D and 24 as grade E. For patients with ASIA grade D, local debridement and abscess drainage and posterior percutaneous screw fixation surgery were performed. Isolated posterior percutaneous screw fixation operation was performed in patients with ASIA grade E without focal debridement and bone graft. The operative time, intraoperative blood loss, erythrocyte sedimentation rate（ESR）, visual analogue score（VAS）, kyphosis angle, ASIA grade and complications were documented.Results The mean operative time was 115.8 min（81 135 min）; the mean blood loss was 125.4 mL（90 163 mL）. Patients were followed up for a mean time of 19.4 months（12 39 months）. At the last follow-up, the ASIA grade was improved from D to E in 12 patients. The mean kyphosis angle was 6.6°（3° 10°） after the operation. At the last follow-up, the mean ESR was reduced to 10.50 mm/h（4 18 mm/h） and mean VAS scores decreased to 0.86 （0 2）. The kyphosis angle was slightly increased to 8.7°（5° 12°） at latest follow-up, but a satisfactory recovery of neurological function was obtained. Two cases had urinary tract infection and two had superficial wound infection, postoperatively. Serious complications such as neurovascular injury and pedicle screw loosening were not observed.Conclusion Isolated posterior percutaneous screw fixation without debridement and bone graft is a safe and effective treatment for managing selected patients with thoraci

关 键 词：脊柱结核 胸腰段 经皮内固定 后入路手术 

分 类 号：R681.5[医药卫生—骨科学]