摘要
目的 探讨后路手术治疗老年人中下胸椎结核的疗效。方法 回顾性分析 2011年 5月至 2014年 6月四川大学华西医院收治的 24例老年中下胸椎结核患者，男10例，女14例；年龄 62～83岁，平均 （75±6） 岁。均采用一期经后路病灶清除椎体间植骨融合内固定术治疗。记录患者的手术时间、术中出血量、术前术后神经功能分级及后凸角度。结果 所有患者均获得随访， 随访时间24～48个月，平均（30±9）个月。手术时间150～220 min，平均（175±26） min，术中失血量300～1500 ml，平均（630±276） ml。所有患者术后均未出现呼吸困难， 10 例患者发现少量胸腔积液，但均不需要放置胸腔闭式引流。无窦道形成、感染性脑脊髓膜炎、 结核复发等情况。植骨融合时间为 3～12个月， 平均 （6.0±2.2） 个月。所有患者内固定位置良好， 无松动、 断裂等并发症发生。末次随访时18例脊髓神经功能损害患者的神经功能改善 1～2级。后凸角度由术前（19.4±7.1） °改善至术后即刻（9.0±4.9） °， 差异具有统计学意义 （t=10.475， P＜0.05）， 末次随访矫正角度平均丢失（1.6±0.5） °。结论 对于老年中下胸椎结核患者， 采用一期经后路病灶清除椎体间植骨融合内固定的手术方式可以达到较满意的治疗效果。
Objectives To evaluate the results of posterior surgery for elderly patients with middle or lower thoracic tuberculosis. Methods Twenty- four elderly patients with middle or lower thoracic tuberculosis were admitted in west China Hospital from May 2011 to June 2014. There were 10 males and14 females, with an average age of(75 ± 6) years(range, 62 to 83 years). All cases underwent one- stage posterior debridement together interbody bone graft and internal fixation. The operation time, blood loss,preoperative and postoperative neurological function and kyphosis angle were reviewed. Results All cases were well followed up for 24 to 48 months, with an average of 30±9 months. The operation time ranged from 150 min to 220 min, with an average of(175±26) min. The blood loss were 300 to 1500 ml, with an average of(630 ± 276) ml. No dyspnea happened in all patients after operation. A small amount of pleural effusion was found in 10 patients but did not need thoracic closed drainage. No sinus tract, cerebrospinal meningitis or recurrence of tuberculosis did not occur. All patients achieved solid fusion within 3 to 12 months after operation, with an average of(6.0±2.2) months. No instrumentation failure was found. At the final follow- up, neurological function score of 18 patients with neurological compromise increased 1 to 2grades. At the final follow- up, the kyphosis angle improved to(9.0 ± 4.9)° from preoperative(19.4 ± 7.1)°with statistical significance(t=10.475,P<0.05), and the average loss of corrective angle was 1.6 ± 0.5°.Conclusion One- stage posterior debridement together interbody bone graft and internal fixation can achieve satisfactory results in elderly patients with middle or lower thoracic tuberculosis.
出处
《中华老年骨科与康复电子杂志》
2016年第4期193-197,共5页
Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)
基金
国家自然科学基金(81401760)
关键词
老年人
胸椎
结核
病灶清除术
植骨
Aged
Thoracic vertebra
Tuberculosis
Debridement
Bone transplantation
