一期前路病灶清除同种异体骨移植病灶区内固定术治疗脊柱结核的随访观察

发布时间：2018-01-22 06:43

  本文关键词： 同种异体骨 脊柱结核 前路内固定　出处：《第三军医大学学报》2015年12期 　论文类型：期刊论文

【摘要】：目的探讨经前路一期病灶清除椎间植骨融合内固定手术对脊柱结核患者的治疗效果,评价同种异体髂骨块的安全性和有效性。方法回顾性分析2008年1月至2012年12月在我科诊断为脊柱结核患者病例资料,严格按手术指征筛选出适合采用经前路一期病灶清除椎间植骨融合内固定手术的患者共60例,植骨材料选择同种异体髂骨块。术后继续标准化抗结核化疗方案12~18个月,同时佩戴支具3~6个月;随访9~36(22.80±7.71)个月,定期复查CRP、ESR,监测肝肾功;观察X线、CT、MRI等影像学改变。根据手术前后及末次随访影像学资料分析畸形矫正度数和植骨融合情况。结果所有患者均未出现脊髓血管损伤感染等并发症,切口均一期愈合。根据Bridwell标准,骨融合时间9个月至1年,达到Ⅰ级骨性融合标准56例,Ⅱ级骨性融合标准4例。术后半年内血沉逐渐恢复,末次随访ESR均在正常范围(0~20 mm/h);术后融合节段Cobb’s角丢失2.38°±1.86°。结论在有效的抗结核化疗基础上,通过一期前路病灶清除椎间植骨融合内固定手术,应用同种异体髂骨块作为椎间植骨材料,可摆脱供骨区并发症困扰,有效矫正后凸畸形、重建脊柱稳定性。
[Abstract]:Objective to evaluate the effect of anterior debridement and intervertebral fusion and internal fixation in the treatment of spinal tuberculosis. Methods the data of patients with spinal tuberculosis diagnosed in our department from January 2008 to December 2012 were retrospectively analyzed. A total of 60 patients were selected according to the surgical indications who were suitable for anterior debridement, intervertebral fusion and internal fixation. The bone graft materials were selected as allograft iliac bone graft. After operation, standardized anti-tuberculosis chemotherapy regimen was continued for 12 ~ 18 months, and the brace was worn for 3 ~ 6 months. The patients were followed up for a period of 9 months from 36 days to 22.80 卤7.71 months, and the CRP ESRs were checked regularly to monitor the liver and kidney function. X ray CT was observed. MRI and other imaging changes. According to the imaging data before and after operation and the last follow-up, the degree of correction of malformation and bone graft fusion were analyzed. Results none of the patients had complications such as spinal cord vascular injury infection. According to Bridwell standard, bone fusion time was 9 months to 1 year, 56 cases were grade 鈪，

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