侧方单钉棒固定联合骨痨汤治疗胸腰椎结核43例  

Effect of lateral single nail rod fixation combined with Gulao decoction in the treatment of 43 cases with thoracolumbar tuberculosis

作　　者：卞恒杰 周宇 王睿[1] 任国飞[1] 李同林[1] 周飞[1] 王中兴 孔晓海[1] BIAN Heng-jie;ZHOU Yu;WANG Rui;REN Guo-fei;LI Tong-lin;ZHOU Fei;WANG Zhong-xing;KONG Xiao-hai(Department of Orthopaedics,Hospital of Integrated Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine,Nanjing,Jiangsu 210014,China)

机构地区：[1]南京中医药大学附属市中西医结合医院骨一科,江苏南京210014

出　　处：《颈腰痛杂志》2022年第5期646-648,652,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：国家青年科学基金项目(编号:81704099)。

摘　　要：目的 对我科胸腰椎结核手术病例的诊治过程及疗效进行分析总结,为胸腰椎结核的治疗提供参考。方法 回顾我科2015年7月~2019年6月行侧前方胸腹外入路病灶清除髂骨植骨单钉棒固定术联合中西药治疗的胸腰椎结核患者43例,对术前、术后1个月及末次随访时的相关资料进行分析,通过VAS评分、Prolo评分、Cobb角、血沉、CRP等指标评估临床疗效。结果 术后18个月治愈率为100%,3例术后窦道形成,经VSD负压引流后痊愈。末次随访VAS评分为(2.62±0.36)分,Cobb角纠正(14.3±2.5)°,Prolo评分明显改善(其中3例截瘫患者术前Prolo评分为2分,末次随访改善至4分、5分、6分),血沉及CRP恢复正常范围,较术前差异有统计学意义(P<0.05)。结论 侧前方胸腹外入路病灶清除髂骨植骨单钉棒固定联合骨痨汤治疗胸腰椎结核,疗效确切,具有创伤小、病灶清除彻底、并发症少、恢复快、有效纠正后凸畸形等优点。Objective To analyze and summarize the diagnosis and treatment of thoracic and lumbar tuberculosis cases in our department,and provide reference for the treatment of thoracolumbar tuberculosis.Methods Form July 2015 to June 2019,43 patients with thoracolumbar tuberculosis treated by lateral anterior thoracoabdominal approach,focus clearance,iliac bone grafting and single pole rod fixation combined with Chinese and western medicine were reviewed in our department.The clinical data of preoperation,postoperative 1 month and the last follow-up were analyzed,and the clinical efficacy was evaluated by VAS score,Prolo score,Cobb angle,erythrocyte sedimentation rate(ESR) and CRP.Results At 18 months after operation,the cure rate was 100%.Three cases of postoperative sinus formation were cured after VSD negative pressure drainage.At the last follow-up,VAS score was(2.62 ± 0.36),Cobb angle corrected(14.3±2.5)°,Prolo score was improved significantly(preoperative Prolo score was 2 points in 3 cases with paraplegia,at the last follow-up improved to 4 points,5 points,6 points),ESR and CRP returned to normal range,the differences were statistically significant compared with before operation.Conclusion The treatment of thoracolumbar tuberculosis by anterior lateral thoracoabdominal approach with iliac bone graft and single screw rod fixation combined with Gulao decoction is effective,with the advantages of small trauma,thorough lesion clearance,less complications,fast recovery,and effective correction of kyphosis.

关 键 词：侧前方入路病灶清除 胸腰椎结核 自体髂骨植骨 单钉棒固定 骨痨汤 

分 类 号：R529.2[医药卫生—内科学]