摘要
目的探讨一期后路病灶清除植骨融合治疗腰骶段脊柱结核的临床疗效。方法回顾性分析2005年1月～2010年2月收治的49例腰骶段结核患者,采用一期后路病灶清除植骨融合内固定术。分析所有结核患者术前、术后3月以及末次随访时ASIA损伤分级、腰骶角、椎间隙高度及血沉、C反应蛋白变化情况。结果所有病例随访9～27月,平均15.7月。无明显并发症发生,其中2例结核脓肿复发,1例规范化用药后治愈,1例经前路手术治愈。末次随访时,所有植骨均获得骨性融合,无内固定松动断裂出现。神经功能ASIA分级:术前有神经障碍者41例,术后3月29例改善;末次随访时39例改善。术后3月、末次随访腰骶角分别为(27.13±3.78)°、(25.93±3.75)°,高于术前(19.08±4.32)°(P<0.001)。术后3月、末次随访椎间隙高度分别为(10.40±0.50)mm、(9.90±0.48)mm,高于术前的(7.92±0.45)mm(P<0.001)。血沉由术前(49.6±14.8)mm/h减小至末次随访(5.2±2.1)mm/h,C反应蛋白由术前(18.3±7.5)mg/L降至末次随访(1.8±0.7)mg/L改善明显(P<0.05)。结论一期后路病灶清除植骨融合内固定治疗腰骶段脊柱结核可获得较好的疗效。
【Objective】To investigate the clinical efficacy and outcome of one-stage posterior debridement bone graft and instrumentation for lumbosacral tuberculosis.【Method】A total of 49 cases with lumbosacral tuberculosis（TB） between January 2005 and February 2010 underwent one-stage posterior debridement bone graft and instrumentation.The ASIA,lumbosacral angel,intervertebral height,ESR and C-reactive protein（CRP） preoperative and posteroperative 3 months and last follow-up were reviewed and compared,respectively.【Results】All cases were followed up for 9～27 months（average 15.7 months）.During final follow-up,no severe complication was found in all cases,2 cases were found tuberculosis of psoas adscess recurrence,and one of them was cured by standardized anti-TB,another one was cured by the anterior focus clearance.At final follow-up,all cases had evidence of solid bony fusion without any instrument failure.29/41 cases with preoperative neurological deficit improved significantly after 3 months;39/41 cases with preoperative neurological deficit improved significantly at final follow-up.The lumbosacral angle was（27.13±3.78）° at 3 moths after and（25.93±3.75）° at final follow-up,higher than the preoperative（19.08±4.32）°（P 0.001）.The interverterbal space altitude was（10.40±0.50） mm at 3 months after postoperative,and（9.90±0.48） mm,higher than the preoperative（7.92±0.45） mm（P 0.001）.The value of ESR decreased from（49.6±14.8） mm/h preoperative to the last follow-up（5.2±2.1） mm/h.The value of CRP decreased from（18.3±7.5） mg/L preoperative to the last follow-up（1.8±0.7） mg/L significantly improved（P 0.05）.【Conclusion】One-stage poster debridement,bone graft and instrumentation can ensure good clinical outcome for lumbosacral tuberculosis.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2011年第28期3527-3531,共5页
China Journal of Modern Medicine
基金
湖南省自然科学基金(No:08JJ5013)
关键词
腰骶段
脊柱结核
一期后路
植骨
内固定
lumbosacral
spine tuberculosis
one-stage posterior
bone graft
internal fixation
