椎弓根螺钉系统在治疗儿童脊柱结核中的疗效及对生长发育的影响

发布时间：2018-06-14 09:00

本文选题：脊柱结核(spinal + tuberculosis)　；参考：《中南大学》2014年博士论文

【摘要】：第一章椎弓根螺钉系统治疗儿童脊柱结核后凸畸形的效果目的：探讨椎弓根螺钉系统治疗儿童脊柱结核后凸畸形的效果。方法：2005年4月至2010年8月,本院手术治疗儿童脊柱结核21例(男12例,女9例),病变部位为T2-S1,平均累及2.1个椎体,ASIA分级C级4例,D级12例,E级5例,后凸畸形角为15.7-71.9°,平均34.2±18.8°,13例采用一期后路病灶清除植骨融合椎弓根螺钉内固定术治疗,8例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治疗,观察并比较术前、术后及末次随访时患者后凸畸形角以及神经功能恢复情况。结果：随访时间36～68月(平均45.3月),所有患者疗效明显且无神经损伤并发症发生,均获得满意骨性融合,无结核复发病例。一期后路手术平均耗时142分钟,低于一期前后路手术平均耗时(330分钟,p0.05),一期后路手术和一期前后路手术的手术出血量分别为497mL和933mL(p0.05)。所有患者术后3个月内ESR值均恢复正常；至末次随访时,ASIA分级平均增加1至2级,无病例发生神经功能恶化；术后后凸畸形角由术前34.2±18.8°(15.7-71.9°)下降至14.7±9.0°(3.2-29.3°),较术前明显改善(p0.05),末次随访时为17.1±9.3°(6.1-32.8°),矫正丢失1.0-3.9°,平均2.4±0.9°,较术后无明显差异(少0.05)；采用不同手术方式的患者的术前、术后后凸畸形角以及角度改善情况有显著性差异(p0.05),但随访期间矫正角度丢失无显著性差异(p0.05)。结论：对于儿童脊柱结核,后路椎弓根螺钉内固定系统对于脊柱结核引起的后凸畸形治疗效果满意。第二章椎弓根螺钉系统对于儿童结核患者椎体及椎管发育的影响目的：评价椎弓根螺钉内固定系统对于儿童脊柱结核患者椎体及椎管发育的影响。方法：回顾性研究21例由于脊柱结核行病灶清除椎弓根螺钉内固定治疗的儿童患者,随访时间为24个月以上。对椎弓根螺钉固定的节段和未固定的节段进行影像学参数的测量,并评价椎弓根螺钉植入是否会对椎体及椎管发育造成影响。结果：手术时患者年龄1-13岁,平均7.13岁。21例患者中,一共有142个节段纳入研究,包括63个未固定的节段和79个至少一侧椎弓根螺钉固定的节段。术前和末次随访时的椎体及椎管影像学参数之间有明显的差异(p0.05)。而使用内固定植入的节段和未固定的节段的椎体及椎管影像学参数之间无明显差异(p0.05)。固定和未固定的腰椎节段比胸椎节段生长更快(p0.05)。结论：椎弓根螺钉植入并不会明显影响椎体及椎管的生长发育,可以在儿童脊柱结核患者中使用。
[Abstract]:Chapter 1 the effect of pedicle screw system in the treatment of kyphosis deformity in children with tuberculosis objective: to investigate the effect of pedicle screw system in the treatment of kyphosis deformity in children. Methods: from April 2005 to August 2010, 21 cases (12 males and 9 females) with spinal tuberculosis in our hospital were treated with spinal tuberculosis. The lesion site was T2-S1. The average involvement of ASIA grade C involved 2.1 vertebral bodies in 4 patients with grade D and grade E in 5 patients. The angle of kyphosis was 15.7-71.9 掳, with an average of 34.2 卤18.8 掳and 13 cases were treated with one stage posterior debridement and fusion with pedicle screw fixation. The angle of kyphosis and the recovery of nerve function were observed after operation and at the last follow-up. Results: the follow-up time was 36 ~ 68 months (mean 45.3 months). All the patients had obvious curative effect and no complication of nerve injury. Satisfactory bone fusion was obtained without recurrence of tuberculosis. The average time of one stage posterior approach operation was 142 minutes, which was lower than that of one stage anterior and posterior approach operation, the average time was 330 minutes (p 0.05). The blood loss of one stage posterior approach and one stage anterior and posterior approach were 497 mL and 933 mL / ml respectively. The ESR value of all the patients returned to normal within 3 months after operation, and at the last follow-up, the Asia grade increased by 1 to 2 grades on average, and no neurologic deterioration occurred in the patients. The postoperative kyphosis angle decreased from 34.2 卤18.8 掳/ 15.71.9 掳to 14.7 卤9.0 掳/ 3.2-29.3 掳/ L, which was significantly improved than that before operation. At the last follow-up, it was 17.1 卤9.3 掳(6.1-32.8 掳), and the corrected loss was 1.0-3.9 掳(average 2.4 卤0.9 掳). There was no significant difference between the two groups (0.05 掳). There was significant difference in the angle and angle of kyphosis after operation, but there was no significant difference in correction angle loss during follow-up. Conclusion: for children with spinal tuberculosis, the posterior pedicle screw fixation system is effective in the treatment of kyphosis caused by spinal tuberculosis. Chapter 2 the effect of pedicle screw system on the development of vertebral body and spinal canal in children with tuberculosis objective: to evaluate the effect of pedicle screw fixation system on the development of vertebral body and spinal canal in children with spinal tuberculosis. Methods: Twenty-one children with spinal tuberculosis underwent debridement and pedicle screw fixation. The follow-up time was more than 24 months. The imaging parameters of the segmental and unfixed segments of pedicle screw fixation were measured and the effects of pedicle screw implantation on the development of the vertebral body and the spinal canal were evaluated. Results: of the 21 patients aged 1-13 years (mean 7.13 years), 142 segments were included in the study, including 63 unfixed segments and 79 segments with at least one pedicle screw fixation. There was significant difference between the imaging parameters of vertebral body and spinal canal before operation and at the last follow-up (p 0.05). There was no significant difference in the imaging parameters of the vertebral body and the spinal canal between the segments implanted with internal fixation and those without fixation. The fixed and unfixed segments of the lumbar vertebrae grow more rapidly than the thoracic segments. Conclusion: pedicle screw implantation can not significantly affect the growth and development of vertebral body and spinal canal, and can be used in children with spinal tuberculosis.
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R726.8

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