摘要
目的观察一期后路清除下腰椎结核病灶椎间植骨内固定的可行性及临床疗效。方法对纳入研究的9例下腰椎结核患者采用一期后路椎弓根螺钉固定,清除结核病灶和椎间、关节突及横突间植骨融合。对比患者术前、术后、术后3月及末次随访的椎体后凸的Cobb角及红细胞沉降率。结果手术时间为（162.78±25.26）min,术中出血为（350.00±90.14）mL。术中无重要血管神经损伤及脑脊液漏。术后切口均甲级愈合,无窦道及瘘管形成,椎体高度、后凸畸形矫正满意。随访24-31月,结核均治愈,植骨块无滑移,植骨骨性融合时间5-7月,无结核复发。术前、术后、术后3月及末次随访的椎体Cobb角及红细胞沉降率分别为（14.40±5.21）、（2.40±1.71）、（2.40±1.90）、（2.70±2.00）°;（42.00±10.91）、（29.10±5.80）、（14.90±2.13）、（13.50±1.78）mm/h。结论一期后路清除结核病灶椎间植骨内固定治疗下腰椎结核安全、有效,能解除神经压迫,满意地清除结核病灶,矫正脊柱后凸畸形和维持畸形矫正效果,对少数特定情况的下腰椎结核是一种较好的术式选择。
Objective To investigate the feasibility and clinical effect of one-stage posterior debridement,bone graft,and internal fixation for lower lumbar vertebrae tuberculosis. Methods Nine patients of lower lumbar vertebrae tuberculosis met the inclusion criteria were treated with the one-stage posterior pedicle screw fixation, scavenging tuberculous lesions, and bone graft fusion between interbody, processus articularis and intertransverse process. At preoperation,postoperation, 3 months of postoperation, and the final follow-up, the ESR（mm/h） and vertebral kyphosis Cobb angle were examined and compared. Results Operative time and intraoperative hemorrhage was （162.78±25.26） min and（350.00±90.14） mL,respectively. There was no overt vascular or nerve injury and no cerebrospinal fluid leakage during operation. After surgery all operative incisions were first-rate healing,there was no formation of sinus tract and fistula, and the recovery of centrum height and vertebral kyphosis correction was satisfied. The period of follow-up was 24 to 31 months, all tuberculosis focus were healed and there was no recurrence of tuberculosis,and there were no cases of bone block displacement and all the patients had solid bony fusion after 5 to 7 months. The vertebral kyphosis Cobb angle of preoperation, postoperation, postoperative 3 months,and the final follow-up were （14. 40±5. 211）, （2.40±1.71）, （2.40±1.90）, （2.70±2.00）°,respectively; andESR（42.00±10.91）,（29. 10±5.80）,（14.90±2. 13）,（13.50±1.78）mm/h,respectively. Conclusion It is feasible and effective to treat lower lumbar tuberculosis by the means of one-stage posterior debridement,bone graft and internal fixation and it is a better operation mode for the rare lower lumbar tuberculosis. It can fully decompress spinal cord and can effectively correct kyphosis deformity and maintain the operative effect.
出处
《成都医学院学报》
CAS
2015年第2期208-212,共5页
Journal of Chengdu Medical College
关键词
下腰椎结核
后路
一期
椎弓根螺钉
Lower lumbar tuberculosis
Posterior approach
One-Stage
Pedicle screw
