摘要
目的初步探讨一期前路椎管减压彻底病灶清除植骨内固定治疗胸椎结核伴神经损伤的临床效果及其可行性。方法选择脊柱结核并发截瘫患者157例,均实施一期前路病灶清除椎管减压植骨融合内固定手术。术前强化抗结核治疗3~4周。术后继续全程强化抗结核治疗12~18个月。对患者病灶愈合情况、神经功能恢复状况,后凸畸形改善和丢失情况进行评价。结果患者均顺利完成手术,手术时间(5.2±0.5)h,出血量(800±150)mL。出现胸膜损伤2例、肋间神经疼痛13例、脑脊液漏1例。157例患者成功随访147例,随访率93.6%,随访3~36个月,平均23个月。其中136例手术切口一期愈合;7例手术切口感染,经抗生素、清洁换药治疗后二期愈合;1例胸部切口形成窦道,经切口换药5个月后愈合;3例原病灶结核复发,行二次翻修病灶清除手术。术后1年骨病灶愈合,76例获得Ⅰ级骨性愈合,40例获得Ⅱ级骨性愈合,24例获得Ⅲ级骨性愈合,5例获得Ⅳ级骨性愈合,2例椎间隙植骨无融合并出现钉棒系统松动而行翻修手术。术后神经损伤开始恢复时间5d^2个月。末次随访Cobb角和VAS评分均低于术前1d,ASIA分级较术前1d比较明显改善,差异有统计学意义(P<0.05)。结论在有效抗结核治疗基础上,实施一期前路病灶清除植骨减压内固定治疗胸椎结核伴神经损伤,有利于神经功能恢复、矫正后凸畸形、恢复脊柱生物力学稳定性,其可作为胸椎结核伴神经损伤患者的有效选择。
Objective To investigate the clinic efficacy and feasibility of treating thoracic tuberculosis complicated with nerve injury by anterior thorough debridement of Ⅰ period,decompression of the spinal canal and bone grafting and internal fixation.Methods The surgery of debridement of Ⅰperiod,decompression of the spinal canal and bone grafting and internal fixation were carried out on 157 patients.The patients were applied with anti-tuberculosis treatment strengthened for 3-4weeks regularly before surgery,and then performed an operation until they had no surgical contraindications.They would be continuous received intensive antituberculosis treatment for 12-18 months postoperative.The situations of lesions healing,neurological function recovery,as well as the improvement and loss of the kyphosis deformity were evaluated.Results Patients were successfully operated,the average operation time was（5.2±0.5）h and the average bleeding amount was（800±150）ml.There were 2cases for pleural injury,13 cases for inter costal nerve pain,and 1case for cerebrospinal fluid leakage.One hundred and fifty-seven cases were followed up for 147 cases,and the follow-up rate was 93.6%.The average follow-up was 36 months,from 3months to 36 months.The surgical incisions were healing in 136 cases,infective in 7cases but healing by second intention through therapy with antibiotics and dressing.One case developed fistulas,but was healed after dressing for 5months.Primary lesions of tuberculosis were recurrence in 3cases,and the patients were performed lesion removal surgery and revision twice.For one years after the healing of bone metastases,76 cases of patients were with grade I bone healing,Grade Ⅱ bone union was obtained in 40 cases.Ⅲgrade bone healing was obtained in 24 cases.Ⅳ grade bone healing was obtained in 5cases.Incomplete fusion of graft bone and internal fixation fracture were occurred in 2cases.They were followed to receive revision surgery,and 5d-2 months later nerves began to recover.Last follow-up Cobb angle a
出处
《河北医科大学学报》
CAS
2016年第9期1018-1022,共5页
Journal of Hebei Medical University
基金
河北省医学科学研究重点课题(20160501)
关键词
结核
脊柱
周围神经损伤
减压术
外科
tuberculosis
spinal
peripheral nerve injuries
decompression
surgical
