摘要
目的探讨一期后路椎弓根螺钉内固定、前路病灶清除植骨融合术治疗儿童胸腰椎结核的临床疗效。方法回顾性分析2006年1月至2014年12月我科收治的儿童胸腰椎结核资料,观察组(A组)采用一期后前路手术治疗25例,对照组(B组)采用分期后前路手术治疗16例。统计分析两组手术时间、出血量、术中及术后并发症。用疼痛VAS评分、后凸角度、神经功能ASIA分级、骨融合情况来评估临床疗效。结果所有患者手术顺利完成,手术时间A组(202±50)min,B组(254±46)min;出血量A组(332±126)m L,B组(432±106)m L,两组比较,差异有统计学意义。随访12~60个月,两组患者愈合良好,无结核复发、内固定松动断裂等,两组均达到骨性融合。神经功能障碍者ASIA分级均有1~2级恢复。VAS评分、后凸角度术后较术前有明显改善。疗效比较,两组差异无统计学意义。结论儿童胸腰椎结核采用一期后路椎弓根螺钉内固定、前路病灶清除植骨融合术可以即刻稳定脊柱,手术安全有效,可以达到分期手术相似的临床疗效,且手术时间短,出血少。
Objective To explore the clinical application of one-stage surgery combined posterior inter-fix- ation and anterior debridement for thoracolumbar tuberculosis in children. Methods The clinical data of thoraco- lumbar tuberculosis in children treated by combined surgery of posterior and anterior approach from January 2006 to December 2014 was reviewed retrospectively. The enrolled patients were divided into group A （25 patients under- went one-stage surgery） and group B （16 patients underwent two-stage surgery）. Operation time, blood loss and complications were compared. The clinical effectiveness was evaluated by using visual analogue scale （VAS） , kyphotic angle, neurological function （ASIA）and bone fusion. Results All operations completed successfully. There was statistically significance between two groups regarding to operation time [ （202 ± 50）min vs. （254 ± 46）mini and blood loss [ （332±162）mL vs. （432 ± 106）mL]. The follow-up of 12 - 60 months indicated that bone grafts were fused without instrumentation failure. For patients with spinal cord injury, there was 1 or 2 grades improvement by ASIA grading. VAS and the kyphotic angle were improved after operation, but there was no statisti- cally significance between two groups regarding to the efficiency. Condusions One-stage surgery combined pos- terior and anterior approach is a safe and effective method for thoraeolumbar tuberculosis in children for immediate stability of spine, less blood loss and shorter operation time.
出处
《实用医学杂志》
CAS
北大核心
2017年第19期3224-3227,共4页
The Journal of Practical Medicine
基金
四川省医学会科研课题(编号:2015GK005)
泸州-川医大联合课题(编号:2015LZCYD-S05)
关键词
胸腰椎结核
一期手术
后手术
前路手术
儿童
thoracolumbar tuberculosis
one-stage surgery
posterior approach
anterior approach
children
