后路病灶清除植骨融合内固定手术治疗跳跃性脊柱结核的疗效分析  

Efficacy of posterior debridement,bone graft fusion and internal fixation in the treatment of noncontiguous spinal tuberculosis

作　　者：麦威拉呢·木合塔尔 高书涛 胡宇坤 依力达尔·塞达合买提 盛伟斌[1] 甫拉提·买买提[1] MAIWEILANI Muhetaer;GAO Shutao;HU Yukun(Department of Spinal Surgery,First Affiliated Hospital of Xinjiang Medical University,Urumqi,830054,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐市830054

出　　处：《中国脊柱脊髓杂志》2024年第2期161-169,共9页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金项目(编号:82360257);新疆维吾尔自治区自然科学基金重点项目(2021D01D18)。

摘　　要：目的:总结跳跃性脊柱结核的临床特点,探讨一期后路病灶清除植骨融合内固定手术治疗跳跃性脊柱结核的疗效。方法:回顾性分析2016年7月~2022年5月我院手术治疗的31例跳跃性脊柱结核患者的临床资料,其中患者男18例,女13例,年龄49.5±27.5岁。其中2处病灶24例,3处病灶7例。对每例患者明确责任椎,确定手术病灶、融合节段、内固定方式,以制定个体化手术方案,随访29.7±14.7个月(15~85个月)。记录患者手术时间、术中出血量,并记录术中及术后并发症情况;术前和术后1个月、3个月、1年及末次随访的红细胞沉降(ESR)和C-反应蛋白(CRP);术前及术后1周、1个月、3个月、1年及末次随访的疼痛视觉模拟评分(VAS);术前及术后1周、末次随访时病灶后凸Cobb角;记录术前及末次随访时美国脊髓损伤协会(ASIA)分级;末次随访时采用Bridwell骨愈合标准分级以评估术后结核活动性、症状改善、畸形矫正及骨愈合。结果:31例患者中20例(65.4%)只有1处病灶出现临床症状,23例(74.2%)以疼痛为主诉入院,15例(48.4%)在病程中只有疼痛症状,而11例(35.5%)只有1处病灶出现疼痛症状,18例(58.1%)患者初诊时至少有1处病灶漏诊。所有患者手术顺利,手术时间280.0±52.2min(165~330min),失血量567.7±332.0mL(150~1000mL)。术后出现脑脊液漏4例,切口感染3例,经对症处理后痊愈;所有结核病灶均治愈,未出现复发。术前及术后1个月、3个月、1年、末次随访时ESR为41.5±26.3mm/h、16.3±13.4mm/h、12.5±6.3mm/h、11.4±5.2mm/h、9.2±3.1mm/h;CRP为32.8±23.2mg/L、7.3±5.6mg/L、6.2±4.1mg/L、5.1±3.7mg/L、2.8±2.3mg/L;术前及术后1周、1个月、3个月、1年、末次随访时VAS评分为6.4±2.4分、2.4±1.7分、2.3±1.3分、1.6±0.9分、0.9±0.7分、0.4±0.3分。术后各个时间点CRP、ESR、VAS评分较术前均有显著改善(P<0.05)。术前Cobb角25.7°±4.9°,术后1周15.4°±2.1°,末次随访时17.1°±2.3°,术�Objectives:To investigate the clinical characteristics of noncontiguous spinal tuberculosis and the efficacy and prognosis of one-stage posterior debridement,bone graft fusion and internal fixation for the treatment of noncontiguous spinal tuberculosis.Methods:The clinical data of 31 patients with noncontiguous spinal tuberculosis treated in our hospital between July 2016 and May 2022 were retrospectively analyzed,including 18 males and 13 females,aged 49.5±27.5 years.There were 24 cases with 2 lesions and 7 cases with 3 lesions.Responsible vertebrae were clarified,and surgical lesions,fusion segments,and internal fixation methods were determined for each patient,so as to develop individualized surgical plans.The patients were followed up for 29.7±14.7 months(15-85 months).The operative time,intraoperative blood loss,and intraoperative and postoperative complications were recorded.Erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were examined and recorded before operation,at 1 month,3 months,and 1 year after operation,and at the last follow-up.Visual analogue scale(VAS)was used to evaluate the pain before operation,at 1 week,1 month,3 months,1 year after operation and at the last follow-up.Cobb angle was measured before operation,at 1 week after operation,and at the last follow-up.The American Spinal Injury Association(ASIA)classification was recorded before operation and at the last follow-up.Bridwell bone healing criteria were used to evaluate postoperative tuberculosis activity,symptom improvement,deformity correction,and bone healing at the last follow-up.Results:Among the 31 patients,20(65.4%)had only one lesion(65.4%),23(74.2%)were admitted to the hospital with pain as the main complaint,15(48.4%)had only pain symptoms during the course of the disease,11 cases(35.5%)had only one lesion with pain symptoms,and 18(58.1%)patients had at least one lesion missed at the initial diagnosis.All the patients were successfully operated.The operative time was 280.0±52.2min(165-330min),and blood loss was

关 键 词：脊柱结核 跳跃性 个体化治疗 植骨融合内固定 手术疗效 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]