一期后路经单侧入路病灶清除植骨内固定治疗多节段胸腰椎结核

发布时间：2018-03-21 16:25

本文选题：多节段脊柱结核　切入点：单侧入路病灶清除　出处：《中国修复重建外科杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的探讨一期后路经单侧入路病灶清除植骨内固定治疗多节段胸腰椎结核的疗效。方法回顾分析2012年1月—2015年7月收治并符合选择标准的29例多节段胸腰椎结核患者临床资料。男17例,女12例;年龄21~62岁,平均37.4岁。病变节段3~8个,其中3个节段者6例,4~6个节段者17例,7~8个节段者6例。中心病灶位于胸椎8例,腰椎10例,胸腰段6例,胸、腰椎跳跃性病灶5例。合并椎旁脓肿7例,腰大肌脓肿6例,骶棘肌脓肿7例,髂窝及臀部脓肿1例,椎管内脓肿2例。术前神经功能按美国脊柱损伤协会(ASIA)分级:B级1例,C级3例,D级8例,E级17例。病程6~48个月,平均19.3个月。采用一期后路经单侧椎弓根或关节突入路病灶清除植骨内固定术治疗。比较患者手术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、矢状位Cobb角,采用Bridwell等的分级标准评价植骨融合情况。根据病变节段数目及中心病灶部位分析钛网安置情况。结果术后患者均获随访,随访时间18~30个月,平均24个月。发生脑脊液漏3例、肋间神经痛2例、切口不愈合并窦道形成1例、髂窝脓肿复发1例,均经相应处理后治愈。随访期间未发现内固定物断裂、松动等。按Bridwell等的分级标准,病灶区植骨于术后4~9个月达骨性融合。术后即刻及末次随访时VAS评分、ODI及Cobb角均较术前显著改善(P0.05)。末次随访时患者神经功能均得到明显改善,与术前比较差异有统计学意义(Z= 3.101,P=0.002)。6个节段以上病变者未安置钛网比例(6/6,100%)明显高于6个节段以下病变者(4/23,17.4%)(χ2=14.374,P=0.000);在不同中心病灶部位未安置钛网比例比较,差异无统计学意义(χ~2=0.294,P=0.863)。结论对于多节段胸腰椎结核,采取一期后路单侧入路病灶清除植骨内固定术可减少脊柱后方结构破坏,减少手术创伤,临床效果良好。
[Abstract]:Objective to evaluate the efficacy of one-stage posterior approach in the treatment of multi-level thoracolumbar tuberculosis with unilateral debridement and bone grafting. Methods 29 patients with multilevel thoracolumbar tuberculosis admitted from January 2012 to July 2015 were retrospectively analyzed. Clinical data of the patients. 17 men, There were 12 females, aged 21 to 62 years, with an average age of 37.4 years. The lesion segments ranged from 3 to 8, including 3 segments in 6 cases, 4 ~ 6 segments in 17 cases and 7 ~ 8 segments in 6 cases. The central focus was located in 8 cases of thoracic vertebrae, 10 cases of lumbar vertebra, 6 cases of thoracolumbar segment, 6 cases of thoracolumbar segment, and 6 cases of thoracolumbar segment. There were 7 cases of paraspinal abscess, 6 cases of psoas major abscess, 7 cases of sacral spinalis abscess, 1 case of iliac fossa and hip abscess. There were 2 cases of intraspinal abscess. Preoperative neurological function was classified according to ASIAA of American Spinal injury Association (ASIA): 1 case of grade B, 3 cases of grade C, 8 cases of grade D and 17 cases of grade E. The course of disease was 6 ~ 48 months. The average of 19.3 months was 19.3 months. The patients were treated by unilateral pedicle or articular approach with focal debridement and internal fixation. The visual analogue score of pain before and after operation was compared with that of Oswestry dysfunction index and sagittal Cobb angle. According to the number of lesion segments and the location of the lesion, titanium mesh placement was analyzed. Results all the patients were followed up for 18 ~ 30 months (mean 24 months). Cerebrospinal fluid leakage occurred in 3 cases. There were 2 cases of intercostal neuralgia, 1 case of incision nonunion and sinus formation, 1 case of recurrence of iliac fossa abscess. Bone graft in the focus area reached bone fusion from 4 to 9 months after operation. VAS scores and Cobb angle were significantly improved at immediate and last follow-up compared with those before operation (P 0.05). The neurological function of the patients at the last follow-up was significantly improved. There was significant difference between before and after operation. The proportion of patients without titanium mesh was significantly higher than that of patients with less than 6 segments (P < 6) (P < 0. 000.000). It was significantly higher than that of patients with less than 6 segments (蠂 2 + 14. 374% P 0. 000), and the proportion of titanium mesh not placed in different central lesions was significantly higher than that in patients with less than 6 segments (蠂 2 / 2, 14. 374, P < 0. 000, P < 0. 000). There was no significant difference (蠂 ~ 2 / 2 ~ (294) P ~ (0.863)). Conclusion for multi-level thoracolumbar tuberculosis, one-stage unilateral posterior approach for debridement and internal fixation of bone graft can reduce the damage of posterior spinal structure and surgical trauma, and the clinical effect is good.
【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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