可滑动椎弓根钉棒内固定系统在治疗胸腰椎结核的疗效分析

发布时间：2018-03-01 13:07

本文关键词： 胸腰椎结核椎弓根钉滑动棒术后临床效果手术节段融合证据等级治疗性研究IV级　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨一种新型可滑动椎弓根钉棒内固定系统在胸腰椎椎体结核中手术治疗的临床效果和安全性。方法:分析2014年11月~2016年6月我院采用椎弓螺根钉滑动棒内固定系统治疗的胸腰椎结核患者21例,其中男14例,女7例,年龄为37岁~71岁,平均55.4岁。手术术式均采用后入路病灶清除减压,椎间植骨融合椎弓根螺钉内固定术,评价指标包括术前与术后的美国脊髓损伤神经学分类国际标准ASIA损伤分级,评价患者术前、术后脊髓损伤和恢复情况。应用日本骨科协会评估治疗分数(Japanese Orthopaedic Association,JOA)胸腰椎评分法,评价患者术前、术后胸腰椎功能改善情况。应用疼痛视觉模拟10分评分法(A 10-point visual analogue scale,VAS),评价患者治疗前后腰背部疼痛及双下肢疼痛麻木的改善情况,通过影像学(主要是术前、术后X线)分析椎间植骨融合情况、椎间高度变化及手术前后Cobb角的纠正及远期丢失角度。结果:21例患者均顺利完成手术,均得到随访,随访时间3-12个月,17例随访时间超过12个月,平均10.7个月。术后患者的神经功能ASIA分级较术前明显改善,只有一例ASIA分级与术前无明显变化,考虑可能由于病椎周围结核冷脓肿及术前脊柱后凸压迫脊髓神经时间较长,造成脊髓神经不可逆性损伤术后患者造成。所有患者的VAS、JOA评分较术前均下降,其中VAS评分由术前的(8.48±1.21)分下降到术后3个月的(1.81±0.60)分,至术后6个月时,进一步下降到(0.90±0.62)分,JOA评分由术前的(8.14±2.056)分,上升到术后3个月的的(24.57±1.63)分,至术后6个月时,进一步上升到(25.52±1.88)分差异均有统计学意义(p0.001)。术后影像学显示术后1周,1月,3月,6月融合椎体之间高度有变化,由术后1周的(12.17±1.67)mm降至术后12个月的(9.86±1.35)mm,差异有统计学意义(p0.001),术后6个月趋于稳定,无一例出现神经损害表现。所有患者术后不同随访时间节点滑动棒固定螺钉和球头钉之间的距离也有不同程度的变化,6个月后基本稳定。Cobb角度术后较术前明显改善,术后1周及术后6个月较术前明显改善,术后17例超过12个月的患者影像学均达到融合指证,3例随访6个月的患者,X线显示基本植骨基本达到融合指证,剩下1例随访3个月的患者X线不能明确是否完全融合,但植骨间隙的透亮区面积明显减少。所有手术患者经正规抗结核、换药、拆线治疗出院后,在随访期间均未出现切口感染及手术节段结核复发,未见内固定装置的松动、断裂及融合椎间隙下沉过大导致后凸畸形等现象发生。结论:可滑动椎弓根钉棒内固定系统治疗胸腰椎结核近期临床效果满意,有益于植骨节段融合,可维持手术矫正的后凸畸形,但其远期效果还需长期、大量样本临床观察。
[Abstract]:Objective: to investigate the clinical effect and safety of a new sliding pedicle screw rod fixation system in the surgical treatment of thoracolumbar vertebral tuberculosis. Methods: from November 2014 to June 2016 in our hospital, we used the pedicle screw slider rod. 21 cases of thoracolumbar tuberculosis treated with internal fixation system, There were 14 males and 7 females, aged from 37 to 71 years (mean 55.4 years). The evaluation indexes included the preoperative and postoperative neurological classification of spinal cord injury (ASIA), the preoperative and postoperative spinal cord injury and recovery. The Japanese Orthopaedic Association was used to evaluate the score of thoracolumbar vertebrae. To evaluate the improvement of thoracolumbar function before and after operation, the pain visual analogue 10-point visual analogue scalescale was used to evaluate the improvement of pain and numbness of lower extremity and waist pain before and after treatment. Postoperative X-ray) analysis of intervertebral bone graft fusion, changes of intervertebral height, correction of Cobb angle before and after operation and long term loss angle. Results all 21 cases were successfully operated and followed up. 17 cases were followed up for more than 12 months with an average of 10.7 months. The neurological function ASIA grade was improved significantly after operation, but only one case had no significant change in ASIA grade. Consider that this may be due to the cold abscess of tuberculosis around the diseased vertebrae and the long time of compression of spinal cord nerve by kyphosis before operation, which may result in irreversible injury of spinal cord after operation. The VASJOA score of all patients is lower than that before operation. The score of VAS decreased from 8.48 卤1.21 before operation to 1.81 卤0.60 at 3 months after operation, and further decreased to 0.90 卤0.62 at 6 months after operation. The score increased from 8.14 卤2.056 before operation to 24.57 卤1.63 at 3 months and 6 months after operation. There were significant differences in the scores of 25. 52 卤1. 88) between the fusion vertebrae and the fusion vertebrae in the first week, January, March and June after operation. From 12. 17 卤1. 67 mm to 9. 86 卤1. 35 mm at 12 months after operation, the difference was statistically significant (p 0. 001), and tended to be stable at 6 months after operation. There was no sign of nerve damage in all patients. The distance between the fixed screw and the ball screw at different follow-up time also changed in different degree. After 6 months, the stability of the. Cobb angle was significantly improved compared with that before operation, and there was no significant change in the distance between the fixed screw and the ball head nail at different follow-up time after operation. 1 week after operation and 6 months after operation, the imaging findings of 17 patients more than 12 months after operation reached fusion index. X-ray examination of 3 patients who were followed up for 6 months showed that the basic bone graft basically reached the fusion index. The X-ray of the remaining 1 patient who had been followed up for 3 months could not confirm whether the fusion was complete or not, but the clear area of the bone graft space was significantly reduced. All the patients underwent regular antituberculous therapy, dressing change, and thread disassembly after discharge from the hospital. During the follow-up period, no incision infection or recurrence of surgical segment tuberculosis was found, and no loosening of internal fixation device was observed. Conclusion: the treatment of thoracolumbar tuberculosis with sliding pedicle screw and rod internal fixation system is satisfactory and beneficial to the fusion of bone graft in the treatment of thoracolumbar tuberculosis. Surgical correction of kyphosis can be maintained, but its long-term effects need long-term, a large number of clinical observations.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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