摘要
目的探讨微创手术方式治疗腰椎结核的应用价值,为脊柱结核的临床治疗提供参考。方法回顾性分析我院自2005年1月—2014年12月收治的保守治疗无效、需手术治疗的腰椎结核252例患者资料。在全身应用抗结核药物化疗的基础上,根据病情严重程度分别采取不同微创治疗方式:接受经皮穿刺病灶置管单纯局部化疗(A组)154例;接受经皮灌注冲洗引流局部化疗(B组)48例;接受经皮穿刺病灶清除联合置管局部化疗(C组)32例;经皮病灶清除+内固定联合置管局部化疗(D组)18例。记录患者术前及末次随访时血沉(ESR)、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)并根据改良MacNab标准评价末次随访时患者总体优良率。结果 228例获得随访,4组失访情况分别为:A组15例、B组5例、C组2例、D组2例,总失访率9.52%。患者随访时间25~126个月,平均68(60,76)个月。214例达到临床治愈,治疗期间所有患者均未出现逆行性感染和交叉感染等严重并发症。患者总体术后末次随访时ESR(7.26±3.43)mm/1 h,较术前ESR(44.96±12.42)mm/1 h降低(t=35.06,P=0.023);末次随访时总体VAS评分、ODI分别为1.5(1,3)、30(25,35)%,较术前7.5(7.0,8.0)、60(55,65)%改善明显(Z分别为13.641和6.806,均P<0.05)。根据改良MacNab标准,末次随访时患者总体优良率86.4%(197/228)。结论术前综合评估腰椎结核患者病情,依据阶梯治疗和个性化的治疗原则,通过介入或者微创的治疗方法,大多数患者可获得长期稳定和较好的临床疗效。
Objective To explore the application value of minimally invasive surgery in the treatment of lumbar spinaltuberculosis,and to provide reference for clinical treatment of spinal tuberculosis.Methods Data of252cases of patientswith lumbar spinal tuberculosis treated by conservative treatment in our hospital from January2005to December2014wereretrospectively analyzed.Patients were divided into four groups on the basis of systemic application of antituberculosischemotherapy.A total of154patients were given simple local chemotherapy of percutaneous placement of focus catheter(group A),48patients were received percutaneous perfusion drainage and local chemotherapy(group B),32patientsunderwent percutaneous puncture catheter debridement combined with local chemotherapy(group C),and18patients weregiven percutaneous debridement and internal fixation combined with local chemotherapy catheter(group D).Data oferythrocyte sedimentation rate(ESR),visual analogue scale(VAS),Oswestry disability index(ODI)score and the modifiedMacNab criteria were recorded before operation and at the end of the follow-up in four groups of patients.Results Of the252patients,228were followed up and214patients achieved clinical cure.The lost access were15cases in group A,5casesin group B,2cases in group C and2cases in group D.The total rate of lost visit was9.52%.The follow up duration rangedfrom25-126months.The mean duration of follow-up was68(60,76)months.A total214cases reached the standard of clinical cure.No complications(retrograde infection and cross infection)were found in all patients during treatment.ESRwas statistically decreased to(7.26±3.43)mm/1h at the last follow-up(t=35.06,P=0.023)compared with that(44.96±12.42)mm/1h before operation.The VAS and ODI were1.5(1,3)and30(25,35)%at the last follow-up,which weresignificantly improved than those[7.5(7.0,8.0)and60(55,65)%]before operation(Z=13.641and6.806,P<0.05).According to the improved MacNab criteria,the overall excellent and good rates for patients were86.4%(197/228)at the lastfollow-u
作者
朱何涛
朱博
高天阳
张琳
邓晓磊
张西峰
ZHU He-tao;ZHU Bo;GAO Tian-yang;ZHANG Lin;DENG Xiao-lei;ZHANG Xi-feng(The Second Hospital of Shanxi Medical University, Taiyuan 030001, China;;Department of Orthopedics,General Hospital of PLA;Department of Orthopedics, General Hospital of PLA Hainan Branch;The Affiliated Hospital of Liaoning University of Traditional Chinese Medicine)
出处
《天津医药》
CAS
2017年第6期614-619,共6页
Tianjin Medical Journal
关键词
结核
脊柱
外科手术
微创性
腰椎
抗结核药
治疗结果
局部化疗
tuberculosis, spinal
surgical procedures, minimally invasive
lumbar vertebrae
antitubercular agents
treatment outcome
local chemotherapy
