一期后前路手术治疗儿童胸腰椎结核的临床疗效

发布时间：2018-03-16 15:30

本文选题：胸腰椎结核　切入点：一期手术　出处：《实用医学杂志》2017年19期 　论文类型：期刊论文

【摘要】：目的探讨一期后路椎弓根螺钉内固定、前路病灶清除植骨融合术治疗儿童胸腰椎结核的临床疗效。方法回顾性分析2006年1月至2014年12月我科收治的儿童胸腰椎结核资料,观察组(A组)采用一期后前路手术治疗25例,对照组(B组)采用分期后前路手术治疗16例。统计分析两组手术时间、出血量、术中及术后并发症。用疼痛VAS评分、后凸角度、神经功能ASIA分级、骨融合情况来评估临床疗效。结果所有患者手术顺利完成,手术时间A组(202±50)min,B组(254±46)min;出血量A组(332±126)m L,B组(432±106)m L,两组比较,差异有统计学意义。随访12~60个月,两组患者愈合良好,无结核复发、内固定松动断裂等,两组均达到骨性融合。神经功能障碍者ASIA分级均有1~2级恢复。VAS评分、后凸角度术后较术前有明显改善。疗效比较,两组差异无统计学意义。结论儿童胸腰椎结核采用一期后路椎弓根螺钉内固定、前路病灶清除植骨融合术可以即刻稳定脊柱,手术安全有效,可以达到分期手术相似的临床疗效,且手术时间短,出血少。
[Abstract]:Objective to investigate the clinical effect of posterior pedicle screw fixation and anterior debridement and fusion in the treatment of children with thoracolumbar tuberculosis. Methods the data of children with thoracolumbar tuberculosis from January 2006 to December 2014 were retrospectively analyzed. Group A (n = 25) were treated by one stage anterior approach, and group B (n = 16) were treated by staging anterior approach. The operative time, blood loss, intraoperative and postoperative complications were statistically analyzed. VAS score of pain and kyphotic angle were used. Results all the patients were operated successfully, the operative time was 202 卤50 min in group B (254 卤46 min), and the amount of bleeding in group A was 432 卤106 mL / L (432 卤106 min / L). There was a significant difference between the two groups, and the follow-up was 12 ~ 60 months. The patients in the two groups had good healing, no recurrence of tuberculosis, loose fracture of internal fixation and so on. The ASIA grade of the patients with neurological dysfunction was 1 / 2 recovery. The kyphosis angle after operation was significantly improved than that before operation. Conclusion Thoracolumbar tuberculosis in children is treated with one stage posterior pedicle screw fixation, anterior debridement and fusion can stabilize the spine immediately, and the operation is safe and effective. Similar clinical effect can be achieved by stage surgery, and the operation time is short and bleeding is less.
【作者单位】：西南医科大学附属医院脊柱外科;
【基金】：四川省医学会科研课题(编号:2015GK005) 泸州-川医大联合课题(编号:2015LZCYD-S05)
【分类号】：R726.8

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