横突植骨在单节段胸椎结核手术中的疗效观察

发布时间：2018-03-09 06:43

本文选题：胸椎结核　切入点：横突植骨　出处：《中国修复重建外科杂志》2016年07期 　论文类型：期刊论文

【摘要】：目的探讨应用后路彻底病灶清除、横突植骨内固定术治疗单节段胸椎结核的临床效果。方法2014年3月-2015年5月,行后路彻底病灶清除、横突植骨内固定术治疗17例胸椎结核患者。男10例,女7例;年龄18~70岁,平均48.5岁。病程1~9个月,平均4个月。病变累及节段:T_(4、5 )2例,T_(6、7) 5例,T_(7、8) 3例,T_(9、10) 2例,T_(10、11) 4例,T_(11、12) 1例。记录患者手术时间、术中出血量、住院时间;术后即刻常规行胸椎正侧位X线片评估减压及内固定情况,随访期间行胸椎正侧位X线片或CT检查判定融合效果;记录并比较手术前后红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C reactive protein,CRP)、背部疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、后凸Kyphosis角,神经功能采用美国脊柱损伤协会(ASIA)标准进行分级。结果手术时间165~220 min,平均184 min;术中出血量150~800 m L,平均231 m L;住院时间12~26 d,平均18 d。术后均无术区血肿、伤口裂开等早期并发症发生。17例均获随访,随访时间9~22个月,平均17.9个月。均未发生植骨失败、内固定物折断、胸腔积液、脑脊液漏、伤口感染、窦道形成等并发症。患者术后均获满意椎间融合,融合时间3~8个月,平均5.3个月。术后即刻及末次随访时的ESR、CRP、VAS评分、ODI及后凸Kyphosis角均较术前显著改善(P0.05);末次随访时ESR、CRP、VAS评分、ODI较术后即刻进一步改善(P0.05),但后凸Kyphosis角与术后即刻比较差异无统计学意义(P0.05)。末次随访时患者神经功能损害均得到较大改善,术前1例ASIA C级及6例D级患者均恢复至E级。结论横突植骨应用于单节段胸椎结核手术中,是一种安全、可靠、有效的新型植骨方式。
[Abstract]:Objective to investigate the clinical effect of posterior radical debridement and transverse-process bone grafting and internal fixation in the treatment of single segment thoracic vertebra tuberculosis. 17 cases of thoracic vertebral tuberculosis were treated by transverse-process bone grafting and internal fixation. There were 10 males and 7 females, the age was 1870 years (mean 48.5 years), the course of disease was 1 ~ 9 months. An average of 4 months. The lesion involved 2 cases of Tast6 / 7) (5 cases of T / T + 7 / 7)) 3 cases of T / T + 9 / 10) / 2 cases of T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T. During the follow-up period, thoracic X-ray or CT examination was performed to determine the fusion effect, erythrocyte sedimentation rate before and after operation was recorded and compared with that before and after operation. The visual analogue score of back pain was evaluated by visual analogue score (VAS) and Oswestry dysfunction index (Oswestry), and the kyphosis Kyphosis angle was recorded and compared. Results the operative time was 165 ~ 220 min (mean 184 min), intraoperative bleeding volume was 150 ~ 800 mL (average 231 mL), hospitalization time was 12 ~ 26 days (mean 18 d), and no hematoma was found in the operation area. All the 17 cases with early complications such as wound opening were followed up for 9 ~ 22 months (mean 17.9 months). No bone graft failure, fracture of internal fixation, pleural effusion, cerebrospinal fluid leakage, wound infection occurred. Complications such as sinus formation. Satisfactory intervertebral fusion was achieved in all patients after operation, and the fusion time was 3 ~ 8 months. The mean time was 5.3 months. At the immediate and the last follow-up, the scores of Kyphosis and kyphosis Kyphosis were significantly improved compared with those before operation, and at the last follow-up, the scores of Kyphosis were improved further than those immediately after operation, but there was no difference between the kyphosis Kyphosis angle and the immediate postoperative. At the last follow-up, the neurological function of the patients was improved greatly. One case of ASIA C and 6 cases of grade D all recovered to grade E before operation. Conclusion Transverse process graft is a safe, reliable and effective new type of bone graft for single segment thoracic vertebra tuberculosis surgery.
【作者单位】：重庆医科大学附属第一医院骨科;
【分类号】：R687.3

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