摘要
目的:分析Ⅰ期经椎弓根入路行结核病灶清除椎弓根固定加RBK混合链霉素填充植骨治疗老年胸腰椎结核患者的临床疗效。方法:对2006年9月至2017年7月采用Ⅰ期经椎弓根病灶清除后路固定和OSTEOSETRRBK混合链霉素植骨术进行治疗的20例老年胸椎或腰椎结核患者进行回顾性分析,其中男12例,女8例,年龄62~83(72.4±6.9)岁。采用视觉模拟评分(visual analogue scale,VAS)和Oswe stry残疾指数(Oswestry Disability Index,ODI)进行临床疗效评估,根据X线观察病变节段脊柱后凸角度(Cobb角)和病灶区骨生长情况。结果:所有患者顺利完成手术,手术时间为(160.9±23.8) min,术中出血量为(317.9±112.7) ml。切口均Ⅰ期愈合,未出现窦道及切口延迟愈合。脊柱结核完全治愈,Frankel分级有1个或多个等级的改善。VAS评分由术前的7.50±1.15下降到术后12个月的1.70±1.39(P<0.05)。ODI由术前的(92.50±1.17)%下降到末次随访时的(12.80±0.89)%(P<0.05)。病变节段的矢状面Cobb角由术前的(24.2±1.6)。下降到术后12个月的(8.3±0.7)。(P<0.05),脊柱后凸畸形得到明显纠正。所有病例填充植骨区达到骨性融合,无骨不连和器械断裂并发症。结论:Ⅰ期经椎弓根病灶清除后路椎弓根固定加RBK混合链霉素填充治疗老年脊柱结核适用于一般情况较好、椎体破坏较轻的患者。
Objective:To evaluate the clinical outcomes of one-stage transpedicular debridement,posterior internal fixation,RBK mixed streptomycin-filled bone grafting for the treatment of elderly patients with thoracolumbar tuberculosis.Methods:The clinical data of 20 elderly patients with thoracolumbar tuberculosis underwent one-stage transpedicular debridement,posterior internal fixation,OSTEOSETO RBK mixed streptomycin-filled bone grafting from September 2006 to July 2017 were retrospectively analyzed.There were 12 males and 8 females,aged from 62 to 83 years with an average of(72.4±6.9) years old.Visual analogue scale(VAS),Oswestry Disability Index(ODI)were used to evaluate the pain and spinal function.The kyphosis angle(Cobb angle) of the lesion segment and the bone growth of the lesion area were observed by the X-ray films.Results:All the operations were successful,the operation time was(160.9±23.8) min,and the intraoperative blood loss was(317.9±112.7) ml.The incisions were healed by first intention,and no sinus and incision were delayed.Spinal tuberculosis was completely cured,Frankel grade has one or more improvements.The VAS score decreased from(7.50±1.15) points before surgery to(1.70±1.39) points at 12 months after surgery(P<0.05).The ODI score decreased from preoperative(92.50±1.17)% to(12.80±0.89)% at the final follow-up(P<0.05).The sagittal Cobb angle of the lesion segment decreased from preoperative(24.2±1.6)° to(8.3±0.7)° at 12 months after surgery(P<0.05),the kyphosis deformity was significantly corrected.In all cases,bone fusion was achieved in bone graft area,without bone nonunion and device fracture complications.Conclusion:Onestage transpedicular debridement,posterior internal fixation,RBK mixed streptomycin-filled bone grafting is suitable for thoracolumbar tuberculosis patients with good general condition and less vertebral destruction.
作者
陈学武
徐宏光
刘平
杨晓明
张玙
李逸峰
CHEN Xue-wu;XU Hong-guang;LIU Ping;YANG Xiao-ming;ZHANG Yu;LI Yi-feng(Department of Spinal Surgery,Yijishan Hospital Affiliated to Wannan Medical College,Wuhu 241001,Anhui,China)
出处
《中国骨伤》
CAS
CSCD
2020年第5期454-458,共5页
China Journal of Orthopaedics and Traumatology
关键词
脊柱结核
清创术
经椎弓根
老年人
Spinal tuberculosis
Debridement
Transpedicular
Elderly
