后柱缩短钛网植骨治疗活动期胸腰段结核成角后凸  

Posterior column shortening and instrumented fusion with titanium mesh bone grafting for active thoracolumbar tuberculosis accompanied with angular kyphosis

作　　者：李昱 张宏其[1,2] 王昱翔[1,2] 郭超峰[1,2] 刘少华[1,2] 邓盎[1,2] 高琪乐[1,2] 徐鹏 LI Yu;ZHANG Hong-qi;WANG Yu-xiang;GUO Chao-feng;LIU Shao-hua;DENG Ang;GAO Qi-le;XU Peng(Department of Spinal Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科脊柱外科 [2]中南大学湘雅医院国家老年疾病临床医学研究中心,湖南长沙410008

出　　处：《中国矫形外科杂志》2020年第13期1191-1194,共4页Orthopedic Journal of China

摘　　要：[目的]探讨后柱缩短钛网植骨治疗活动期胸腰段结核成角后凸的临床疗效。[方法]2010年1月~2016年12月,共对25例活动期胸腰段结核成角后凸患者行病灶清除后柱缩短钛网植骨术,总结分析围手术期、随访与影像资料。[结果]所有患者术中未出现严重并发症,均安全度过围术期。手术切口均达一期愈合。病例均获得随访,平均(36.25±6.32)月。末次随访时,25例患者VAS、ODI及JOA评分均显著改善(P<0.01)。影像方面,与术前相比,术后即刻局部后凸Cobb角、胸椎后凸角(TK)、腰椎前凸角(LL)、矢状面偏移(SVA)及骨盆倾斜角(PT)显著减小(P<0.05),而骨盆入射角(PI)和骶骨倾斜角(SS)显著增加(P<0.05)。与术后即刻相比,末次随访时上述指标无显著变化(P>0.05)。至末次随访时,25例患者无断钉断棒、拔钉等内固定失败情况,无钛网断裂、移位、沉降;所有患者结核病灶静止,达到骨性融合,无假关节形成。[结论]后柱缩短病灶清除钛网植骨技术是一种治疗活动期胸腰段结核成角后凸安全有效的方法。[Objective]To evaluate the clinical outcomes of debridement,posterior column shortening and instrumented fusion with titanium mesh bone grafting for active thoracolumbar tuberculosis accompanied with angular kyphosis.[Methods]From January 2010 to December 2016,25 patients underwent debridement,posterior column shortening and instrumented fusion with titanium mesh bone grafting for active thoracolumbar tuberculosis accompanied with angular kyphosis in our department.The perioperative,follow-up and radiographic documentations were summarized.[Results]All patients had no serious complications amid operation,passed through the perioperative period safely,and got primary incision healing.The follow-up period lasted for 20~60 months with a mean of(36.25±6.32)months.The VAS and ODI scores significantly declined,while the Frankel index for neurological function significantly improved at the latest follow up compared with those before operation(P<0.05).In term of radiographic assessment,the Cobbs angle of local kyphosis,thoracolumbar kyphosis(TLK),pelvic incidence(PI),and pelvic tilt(PT)significantly decreased(P<0.05),while the lumbar lordosis(LL)and sacral slope(SS)significantly increased(P<0.05),and the deviation in sagittal vertical axis(SVA)remained unchanged(P>0.05)at the latest follow-up compared with those before operation.All the 25 patients had no implants loosening,collapsing or breaking,whereas got the tuberculotic lesion subsided with bony fusion to the latest follow up.[Conclusion]The posterior column shortening and instrumented fusion with titanium mesh bone grafting are effective treatment for active thoracolumbar tuberculosis accompanied with angular kyphosis.

关 键 词：脊柱结核 后凸 胸腰段 截骨术 

分 类 号：R529.2[医药卫生—内科学]