摘要
目的 ：探讨手术治疗胸腰段结核的中期临床疗效。方法 ：自2006年7月至2011年7月,采用Ⅰ期前路病灶清除、植骨融合加后路椎弓根内固定治疗的胸腰段结核28例,男17例,女11例。其中17例合并神经损伤,根据Frankel分级,B级6例,C级5例,D级6例。全程督导抗结核治疗,术后观察结核中毒症状和脊髓功能的改善情况,并对植骨融合和腰椎功能情况进行评估。结果：28例均获随访,时间39~85个月,平均57个月。术后结核症状逐渐得到控制,胸腰痛缓解。17例合并神经损伤患者中,术前6例B级患者,3例恢复至D级,3例恢复至E级;5例C级和6例D级患者神经功能基本恢复正常。腰椎功能按JOA疗效评定方法 ,术后3、6个月及1、3、5年的JOA优良率分别为67.86%、82.14%、85.71%、89.29%和91.30%;术后6个月、1年优良率与术后3个月比较,差异无统计学意义（P〉0.05）;术后3、5年与术后3个月进行比较,差异有统计学意义（P〈0.05）;术后5年与术后3年进行比较,差异无统计学意义（P〉0.05）。根据加州大学洛杉矶分校（Universith of California at Los Angeles,UCLA）评分对邻近节段退变情况进行评价,术后3年退变率为53.57%（15/28）,与术前相比差异有统计学意义（P〈0.05）。23例术后获得5年随访,退变率为86.96%（20/23）,与术前及术后3年比较差异有统计学意义（P〈0.05）。结论 ：手术治疗胸腰段脊柱结核能彻底清除病灶、重建脊柱的稳定性、恢复腰椎功能和促进脊髓神经功能恢复,是一种有效的治疗方法。但中期随访发现术后邻近节段出现较高的退行性改变。
Objective：To investigate the mid term outcome of operation for thoracolumbar tuberculosis. Methods：Twenty eight patiens with thoracolumbar tuberculosis underwent one stage anterior debridement,interbody fusion with bone graft and posterior pedicle screw internal fixation treatment from July 2006 to July 2011. There were 17 males and 11 females. Total 17 patients had nerve injuries,including 6 cases of grade B,5 cases of grade C,6 cases of grade D according to Frankel classification. The poisoning symptoms of tuberculosis and recovery of spinal function were observed. The bone fusion and recovery of lumbar function were evaluated. Results：All the patients were followed up,and the duration ranged from 39 to 85 months（mean 57 months）. The clinical symptoms were controlled gradually,and the thoracolumbar back pain was alleviated after operation. Among the 17 patients with complications of nerve injuries,3 patients were improved from preoperative grade B to postoperative grade D,3 patients were improved from preoperative grade B to postopertive E,5 patients with preoperative grade C and 6 patients with preoperative D were almostly recovered to normal after operation. According to JOA scoring system for curative effect evaluation,the excellent and good rate at the 3rd month,the 1st year,the 3rd year and the 5th year after operation were 67.86%,82.14%,85.71%,89.29% and 91.30% respectively. The results at the 6th month and the 1st year had no statistical differences compared to the results at the 3rd month（P〉0.05）; but the results at the 3rd year and the 5th year were better than that at 3 months after operation（P〈0.05）;and the results between 3 yesrs and 5 years after operation had no statistical differences（P〈0.05）. The degeneration of adjacent segments were evaluated according to the California University（Universith of California at Los Angeles,UCLA） score. The degeneration rate was 53.57%（15 / 28） at the 3rd year after surgery,which was better than that before surgery. Twenty three
出处
《中国骨伤》
CAS
2016年第2期157-161,共5页
China Journal of Orthopaedics and Traumatology
基金
浙江省医药卫生科技计划项目(编号:2014KYB207)~~
关键词
结核
脊柱
胸椎
腰椎
外科手术
Tuberculosis
spinal
Thoracic vertebrae
Lumbar vertebrae
Surgical procedures
operative
