摘要
目的探讨一期后路结核病灶清除、椎体间支撑植骨及矫形加压内固定治疗胸腰椎结核的临床疗效。方法回顾性分析2004年1月至2010年3月广州军区广州总医院采用后路病灶清除、椎体间支撑植骨及矫形加压内固定手术治疗的25例胸腰椎结核患者的临床资料。评价指标包括手术时间、术中出血量、住院时间、术前及末次随访美国脊髓损伤学会（ASIA）分级、手术前后及随访时Cobb角、围手术期并发症、骨性融合及结核复发情况。结果手术时间240～440min，平均手术时间390min；术中出血量200～1600mL,平均术中出血量858mL；住院时间14～25d，平均住院时间18d。患者获得12～62个月随访，平均随访时间25.2个月。1例术后1年半时结核复发、内固定断裂，再次行手术及抗结核治疗后痊愈；其余病例均骨性愈合。术前10例神经功能障碍患者ASIA分级均为D级，末次随访时均恢复至E级；12例后凸畸形患者术前Cobb角（24±13）°，术后1周恢复至（8±5）°，末次随访时达（12±7）°，手术前后比较，差异有统计学意义（P＜0.05）。结论一期后路结核病灶清除、椎体间支撑植骨及矫形加压内固定治疗胸腰椎结核具有病灶清除彻底、术后畸形矫正满意、骨性融合率高等特点，是治疗胸腰椎结核的一种可供选择的术式。
Objective To investigate the clinical outcome of one-stage posterior debridement, interbodygrafting and internal fixation for thoracolumbar tuberculosis. Methods Clinical data of 25 patients withthoracolumbar tuberculosis, treated from January 2004 to March 2010 in Guangzhou General Hospital of Guangzhou Military Command, were analyzed retrospectively. All patients underwent one-stage posteriordebridement, interbody grafting and internal fixation. Operation time, intraoperative estimate blood loss, hospitalstay, American Spinal Injury Association (ASIA) grading and Cobb angle before and after surgery, bony fusion,tuberculosis recurrence and perioperative complications were evaluated. Results The average operation time was390 min (240-440 mL), the average intraoperative estimate blood loss was 858 mL (200-1 600 mL) , the averagehospital stay was 18 d (14-25 d). All patients were followed up for 12 to 62 months with the average of 25.2months. During the follow-up, recurrence of tuberculosis and internal fixation breakage was found in one case,and then was cured by secondary posterior debridement, internal fixation and anti-tuberculosis treatment. Theremains of cases had the evidences of solid bony fusion. For 10 patients with neurological deficit, spinal cordfunction all improved from preoperative ASIA grade D to postoperative ASIA grade E. For 12 patients withkyphosis, Cobb angle decreased from (24 ± 13)° preoperatively to (8 ± 5)° one week after the surgery, and was(12 ± 7)° at the final follow-up, the differences between preoperation and postoperation had statisticalsignificance (P <0.05). Conclusion One-stage posterior debridement, interbody bone grafting and instrumentationis an alternative choice for thoracolumbar tuberculosis because it could obtain satisfactory deformity correctioneffect with thorough debridement and high bony fusion rate.
作者
蒲小兵
康洁
周强
夏虹
PU Xiaobing;KANG Jie;ZHOU Qiang;XIA Hong(Hospital of Orthopaedics, Guangzhou General Hospital of Guangzhou Military Command, Institute of Traumatic Orthopaedics of PLA, Key Laboratory of Trauma & Tissue Repair of Tropical Area of PLA, Guangzhou, Guangdong 510010, China)
出处
《中国骨科临床与基础研究杂志》
2016年第5期281-286,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
关键词
胸椎
腰椎
结核
脊柱
清创术
骨移植
内固定器
脊柱融合术
Thoracic vertebrae
Lumbar vertebrae
Tuberculosis, spinal
Debridement
Bone transplantation
Internal fixators
Spinal fusion
