后路病灶清除椎弓根内固定术治疗胸腰椎结核的疗效分析

发布时间：2018-02-13 22:40

本文关键词： 胸腰椎结核骨水泥椎弓根内固定　出处：《皖南医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的探讨一期后路病灶清除、生物骨水泥复合抗结核药物填充联合后路经椎弓根内固定术治疗胸腰椎结核的临床处理方法和疗效,为临床应用提供依据。方法总结2011年6月至2014年10月30例采用一期后路病灶清除、生物骨水泥复合抗结核药物填充联合后路经椎弓根内固定术治疗胸腰椎结核患者资料,男20例,女10例;年龄25~75岁,平均45.5岁。病灶部位:T9结核2例,T10结核2例,T11结核2例,T12结核5例,L1结核8例,L2结核5例,L3结核2例,L4结核4例。14例存在不同程度的脊髓神经功能障碍,脊髓损伤按Frankle分级,B级1例,C级4例,D级6例,E级3例。记录患者手术时间、神经功能(Frankel分级)、后凸Cobb角、脊柱生活质量量表评分、疼痛视觉模拟评分、Oswestry功能障碍指数、血沉、C反应蛋白及结核复发等情况来进行疗效评价。结果术后1例患者出现手术切口延迟愈合,其余患者手术切口愈合良好,未见切口感染,均获得骨性融合。所有患者均获得随访,随访时间12-30个月,平均20.5个月。患者术后日常生活质量明显改善。14例术前存在神经功能障碍的患者神经功能有不同程度的改善。与术前比较,术后疼痛视觉模拟评分、Oswestry功能障碍指数及脊柱后凸Cobb角明显改善(P0.05)。血沉、C反应蛋白在术后约2周明显下降,在2-4个月内基本恢复正常。术后未发现一例患者出现结核复发情况。结论采用一期后路病灶清除、生物骨水泥复合抗结核药物填充联合后路经椎弓根内固定术治疗胸腰椎结核疗效良好,它能够有效矫正脊柱后凸畸形,改善神经功能以及维持脊柱的稳定性。在严格掌握相关手术适应证的条件下,后路病灶清除、生物骨水泥复合抗结核药物填充联合后路经椎弓根内固定术是治疗胸腰椎结核的一个较好选择。
[Abstract]:Objective to investigate the clinical treatment of thoracolumbar tuberculosis with posterior debridement, bone cement and antituberculous drug implantation combined with posterior transpedicular internal fixation in the treatment of thoracolumbar tuberculosis. Methods from June 2011 to October 30th 2014, the clinical data of patients with thoracolumbar tuberculosis treated by posterior debridement, biomedical bone cement combined with antituberculous drugs and posterior transpedicular internal fixation were summarized. There were 20 males and 10 females, aged 2575, The mean age was 45.5 years old. The lesion site was divided into T9 tuberculosis (n = 2), T10 (n = 2), T11 (n = 2), T12 (n = 5), L1 (n = 8), L2 (n = 5), L3 (n = 2), L4 (n = 4), and L4 (n = 14). Spinal cord injury was classified according to Frankle grade B (n = 1), C (n = 4), D (n = 6) and E (n = 3). The time of operation, nerve function Frankel grade, kyphosis Cobb angle, spinal quality of life scale, visual analogue of pain and visual analogue score were recorded. Results one patient had delayed wound healing, the other patients had good wound healing and no wound infection. All patients were followed up for 12-30 months. The average time was 20.5 months. The quality of daily life was significantly improved after operation. 14 patients with neurological dysfunction had different degrees of improvement compared with those before operation. Postoperative pain visual analogue score, Oswestry dysfunction index and Cobb angle of kyphosis were significantly improved (P 0.05). ESR C reactive protein decreased significantly about 2 weeks after operation. No recurrence of tuberculosis was found in one patient after operation. Conclusion one stage posterior debridement is used. The treatment of thoracolumbar tuberculosis with biological bone cement combined with antituberculous drugs and posterior transpedicular internal fixation is effective in correcting kyphosis deformity. Improve neurological function and maintain spinal stability. Under the condition of strict operation indication, the posterior approach focus is cleared. Biological bone cement combined with antituberculous drugs combined with posterior transpedicular internal fixation is a good choice for the treatment of thoracolumbar tuberculosis.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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