单纯经后路治疗胸腰段脊柱结核的疗效观察

发布时间：2018-03-17 19:00

本文选题：脊柱　切入点：结核　出处：《重庆医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：观察单纯经后路行结核病灶清除、植骨融合、经椎弓根螺钉内固定术治疗脊柱结核的疗效。方法：回顾分析2007年2月至2014年9月,我院58例患者行单纯经后路行结核病灶清除、植骨融合、经椎弓根螺钉内固定术治疗的临床资料。该58例患者中男27例,女31例；年龄23-85岁,平均年龄50.6岁；病史为1月～31个月,平均7.1月。术前影像学资料显示：发病部位：胸椎11例,胸腰段8例,下腰椎29例,腰骶部6例,多节段跳跃病灶4例；受累节段数：单节段12例,2节段39例,3节段7例；各患者均有不同程度的椎旁脓肿：明显累及硬膜囊3例,病变部位明显脓肿形成5例,骨质不均匀、破坏明显42例,椎间隙变窄52例,窦道形成3例。术前给予患者标准化抗结核治疗2-4周,同时纠正患者电解质紊乱,给予患者营养支持,待全身结核中毒症状减轻、血红蛋白含量达80.0g/L以上、各器官功能无明显障碍时,根据脊柱结核病灶累及范围制定在不同入路下行经后路结核病灶清除、植骨融合、经椎弓根螺钉内固定术治疗方案(当患者存在脊髓神经受压症状时可给予患者行急诊手术治疗),术后进行标准化药物抗结核治疗9-18月。结果：所有患者均获得定期随访(6-95月),平均随访30.4个月。据影像学资料显示：术前脊柱后凸角测量为23.6°±10.3°,术后cobb角为11.20±4.90,末次随访cobb角为12.2°±5.3°；所有患者均获得骨性愈合,愈合时间为3.5月～8.0月,平均5.2月；术前VAS评分为5.7±1.1,术后1周VAS评分为2.3±0.7；术前合并有脊髓损伤患者17例, Frankel分级[1]C级3例,D级14例,末次随访C级患者中仍为C级1例,E级2例,末次随访D级患者中仍为D级3例,E级11例；术后复发患者2例,复发时间分别为术后2、3个月后,均有于院外自行停药或不规律服用抗结核药病史,经再次行病灶清除、加强换药、严格遵守抗结核治疗后痊愈；术后恢复欠佳患者1例,反复发作腰背部疼痛不适,工作生活中度限制,其余病人患者无明显不适,生活工作不受限制,功能恢复的优良率达98%。结论：单纯经后路行结核病灶清除、植骨融合、经椎弓根螺钉内固定术可以有效治疗脊柱结核。
[Abstract]:Objective: to observe the curative effect of tuberculosis focus clearance, bone graft fusion and transpedicular screw fixation in the treatment of spinal tuberculosis through posterior approach. Methods: from February 2007 to September 2014, the treatment of spinal tuberculosis was analyzed retrospectively. The clinical data of 58 patients treated with simple posterior approach for tuberculosis focus clearance, bone graft fusion and transpedicular screw fixation were reviewed. There were 27 males and 31 females, aged 23-85 years, with an average age of 50.6 years. The history ranged from January to 31 months (mean 7.1 months). Preoperative imaging data showed that 11 cases had thoracic vertebrae, 8 thoracolumbar segment, 29 lower lumbar vertebrae, 6 lumbosacral lesions and 4 multiple leaping lesions. The number of involved segments: 12 cases with single segment, 39 cases with 3 segments, 7 cases with paravertebral abscess, 3 cases with obvious involvement of dural sac, 5 cases with obvious abscess, 42 cases with bone inhomogeneity and destruction. 52 cases with narrowing of intervertebral space and 3 cases with sinus formation were treated with standardized antituberculous therapy for 2-4 weeks before operation. The electrolyte disturbance was corrected and nutritional support was given to the patients. The symptoms of systemic tuberculosis poisoning were alleviated and the hemoglobin content was over 80.0 g / L. When there is no obvious disorder in the function of each organ, according to the extent of the involvement of the spinal tuberculosis foci, the posterior approach is used to clear the tuberculosis foci, and the bone grafts are fused. Transpedicular screw fixation (emergency surgical treatment for patients with spinal cord nerve compression symptoms and standardized antituberculous drug therapy for 9 to 18 months after operation. Results: all patients were determined. The imaging data showed that the preoperative kyphosis angle was 23.6 掳卤10.3 掳, the postoperative cobb angle was 11.20 卤4.90, and the last follow-up cobb angle was 12.2 掳卤5.3 掳. The healing time ranged from 3.5 months to 8.0 months with an average of 5.2 months, the preoperative VAS score was 5.7 卤1.1, and the VAS score was 2.3 卤0.7.There were 17 patients with spinal cord injury before operation, 3 patients with Frankel grade C and 14 patients with grade D, and 1 patient with grade C with grade E was still in grade C at the last follow-up. In the last follow-up, 11 cases of grade D were still grade D and 11 cases were grade E, and the recurrence time was 2 months and 3 months after operation, all of them had a history of withdrawal or irregular use of antituberculotic drugs outside the hospital, and then removed the lesions again. Strengthen the change of medicine, strictly observe the cure after anti-tuberculosis treatment, 1 patient with poor postoperative recovery, recurrent pain in the back and waist, moderate degree of work and life restriction, other patients have no obvious discomfort, life and work are not restricted, and the rest of the patients have no obvious discomfort, and the life and work of the patients are not restricted. Conclusion: removal of tuberculosis foci, fusion of bone graft and transpedicular screw fixation can be effective in the treatment of spinal tuberculosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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