一期后路病灶清除、颗粒植骨及内固定治疗胸腰椎结核的效果分析  

Clinical effect of one-stage posterior debridement,autogenous morselized bone graft and internal fixation in the treatment of thoracolumbar tuberculosis

作　　者：鲁增辉 张会军 岳晓通 闫锦玉 Lu Zenghui;Zhang Huijun;Yue Xiaotong;Yan Jinyu(Department of Orthopaedics,Xi’an Chest Hospital,Xi’an 710000,China)

机构地区：[1]西安市胸科医院骨科,西安710000

出　　处：《中国防痨杂志》2024年第6期707-712,共6页Chinese Journal of Antituberculosis

基　　金：西安市卫生健康委员会(2020yb39)。

摘　　要：目的:探讨一期后路病灶清除、椎体间颗粒植骨及内固定术治疗胸腰椎结核的临床疗效。方法:回顾性分析2020年1月至2022年6月西安市胸科医院骨科收治的31例胸腰椎结核患者,均接受一期后路病灶清除、椎体间骨颗粒植骨及内固定手术,通过分析手术时间、出血量、手术并发症情况,以及比较手术前后视觉模拟评分(VAS)、血红细胞沉降率(ESR)、C反应蛋白(CRP)、脊髓功能Frankel分级、Cobb角及植骨融合情况评价手术疗效。结果:31例患者均完成手术并获得随访,术后随访时间18~36个月,平均随访时间(24.0±8.5)个月。术中无神经根、脊髓损伤发生,未发生术后切口感染。平均手术时间(190.6±64.4)min;平均手术出血量(442.5±114.6)ml。术后3个月的VAS疼痛视觉评分[(2.2±0.7)分]、ESR[(11.9±6.6)mm/1h]及CRP[(7.9±5.5)mg/L]均较术前[(5.5±1.9)分、(49.3±18.1)mm/1h、(34.1±16.7)mg/L]明显下降,差异均有统计学意义(t值分别为10.554、11.683和9.826,P值均<0.001)。椎体间植骨术后均获得融合。末次随访时Cobb角为(9.6±3.3)°,与术前[(18.5±5.8)°]比较,差异有统计学意义(t=11.527,P<0.001)。末次随访Frankel神经功能分级:D级2例,E级29例。结论:单纯后路病灶清除椎体间颗粒植骨及内固定术对于手术指征合适的胸腰椎结核患者是安全有效的方案,手术效果确切。Objective:To assess the clinical outcomes of single-stage posterior debridement,intervertebral autogenous morselized bone grafting,and internal fixation for the treatment of thoracolumbar tuberculosis.Methods:This retrospective analysis encompassed 31 patients with thoracolumbar tuberculosis treated at the Orthopedic Department of Xi’an Chest Hospital from January 2020 to June 2022,all undergoing single-stage posterior lesion clearance,intervertebral autogenous morselized bone grafting,and internal fixation.Surgical metrics analyzed included duration,blood loss,complications,and postoperative improvements in Visual Analogue Scale(VAS)scores,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),spinal cord function(Frankel classification),spinal curvature(Cobb angle),and bone graft fusion.Results:The study followed up 31 patients for a period ranging from 18 to 36 months,averaging(24.0±8.5)months.There were no instances of nerve or spinal cord injuries during surgeries,nor were there cases of postoperative wound infections.Surgical metrics revealed an average duration of(190.6±64.4)minutes and blood loss of(442.5±114.6)ml.Notably,at 3 months postoperatively,significant improvements were observed with the VAS scores decreasing from 5.5±1.9 to 2.2±0.7,ESR from(49.3±18.1)mm/1 h to(11.9±6.6)mm/1 h,and CRP levels from(34.1±16.7)mg/L to(7.9±5.5)mg/L,all demonstrating statistically significant reductions(t-values of 10.554,11.683,and 9.826,respectively;P<0.001).Fusion was achieved after interbody bone grafting surgery.At the last follow-up,the Cobb angle was(9.6±3.3)°,and compared with preoperative((18.5±5.8)°),the difference was statistically significant(t=11.527,P<0.001).The last follow-up Frankel neurological function grading was D grade in 2 cases and E in 29 cases.Conclusion:Single-stage posterior lesion clearance combined with intervertebral autogenous morselized bone grafting and internal fixation proves to be a safe and efficacious strategy for thoracolumbar tuberculosis patients fitting surg

关 键 词：结核 脊柱 颗粒物 治疗 临床研究性 

分 类 号：R52[医药卫生—内科学] R81[医药卫生—临床医学]