摘要
目的探讨经椎间孔入路穿刺引流联合椎旁肌间隙入路治疗腰骶椎结核的手术适应证及其临床疗效。方法回顾性分析陆军军医大学大坪医院脊柱外科自2010年1月至2017年1月收治的69例脊柱结核患者实施侧方经椎间孔入路椎旁脓肿穿刺置管引流、后路椎旁肌间隙椎弓根螺钉内固定手术的临床资料。所有患者术前规范口服异烟肼、利福平、吡嗪酰胺、乙胺丁醇四联抗结核药物治疗2~4周,手术方法采用经侧方椎间孔入路穿刺、椎旁脓肿置管引流,后方经椎旁肌间隙行椎弓根螺钉内固定术,记录手术时间、术中出血量及术后引流量;观察术后脓肿吸收、病灶愈合及Oswestry功能障碍指数改变情况。结果手术时间130~220 min,平均140 min;失血量50~150 mL,平均110 mL;术后总引流量30~180 mL,平均引流量70 mL。术后随访12~21个月,患者均获临床愈合,除1例骶椎结核患者因皮缘坏死积液行清创缝合外,其余病例术后未出现切口感染及愈合不良,无医源性脊髓及神经损伤,未出现内固定物松动。术后12个月内患者脓肿均完全吸收,Oswestry功能障碍指数术前为(68.15±18.36)分,随访末时为(11.64±8.12)分,差异有统计学意义(P<0.05)。结论侧方椎间孔入路穿刺引流联合椎旁肌间隙入路内固定治疗腰骶椎结核是一种安全、有效的手术方式,主要适应证为合并巨大椎旁脓肿、椎体部分破坏伴节段不稳、轻度后凸畸形且不伴有明显脊髓功能障碍者。
Objective To explore the operative indications and efficacy of intervertebral foramen puncture combined with internal fixation via paraspinal approach in the treatment of lumbosacral tuberculosis. Methods A total of 69 patients who treated with intervertebral fo- ramen puncture combined with internal fixation via paraspinal approach in spinal surgery department of Daping hospital affiliated to army medical university from January 2010 to January 2017 were retrospectively analyzed. All patients had preoperative standardized oral isoniazid, rifampiein,pyrazinamide,ethambutol for 2 to 4 weeks. The surgical methods included intervertebral foramen puncture, drainage of paravertebral abscess and posterior paraspinal muscle gap approach fixation. The surgery time,intraoperative blood loss,postoperation drainage, abscess absorption,healing of lesions and Oswestry scores were recorded and observed. Results The operation time was from 130 to 220 minutes, with average of 140 minutes;the blood loss was from 50 to 150 mL,with average of 110 mL;the total volume of drainage was 30 to 180 mix, with average of 70 mL. All patients were followed up for 12 to 21 months. All cases were recovered except 1 patient who suffered from sacral tuberculosis received debridement and suturing caused by cutaneous necrosis. There was no infection, injury of spinal cord and nerve nor looseness or shift of internal fixation. The abscess was completely absorbed after 12 months. The Oswestry scores before surgery was （68.15 ± 18.36 ）, while it was （ 11.64 ± 8.12 ） at final followed-up, the difference was significant （ P 〈 0.05 ）. Conclusion The surgical treatment of intervertebral foranaen puncture combined with internal fixation via paraspinal approach is effective for patients who suffered large paravertebral abscess, parts of vertebral body collapse with segmental instability and mild kyphosis of spine with spinal cord disfunction, which is a safe and effective surgical method.
出处
《局解手术学杂志》
2017年第12期868-872,共5页
Journal of Regional Anatomy and Operative Surgery
基金
国家自然科学基金(81501883)
关键词
脊柱结核
腰骶椎
椎间孔
椎椎旁肌
内固定
spinal tuberculosis
lumbosacral vertebrae
intervertebral foramen
paraspinal muscle
internal fixation
