个体化术式治疗多节段及跳跃性胸腰椎结核

发布时间：2018-04-20 14:40

本文选题：胸腰椎结核 + 多阶段及跳跃性　；参考：《中国矫形外科杂志》2017年17期

【摘要】：[目的]探讨不同术式治疗多节段及跳跃性胸腰椎结核的疗效。[方法]2008年5月~2015年3月,本科共收住25例患者,男17例,女8例,年龄11~59岁,平均27岁。术前常规摄全脊柱正侧位X线片、CT平扫加3D重建和MRI。病变节段:胸椎11例,胸腰段9例,腰椎5例,累及4个椎体10例,5个椎体7例,6个椎体5例,7个椎体3例。手术方式:7例行开胸"前路"手术,4例行开胸"前后"入路手术,9例行胸膜外腹膜后"前后"入路手术,5例行腹膜外"前后"入路手术。出院后正规抗结核治疗6~12个月,定期随访观察植骨融合时间,后凸畸形矫正度、椎间隙高度和神经功能恢复程度,血沉、C反应蛋白变化情况。[结果]本组患者均顺利接受手术,无严重并发症。至术后第3 d,后凸畸形平均纠正至27°,与术前相比差异有统计学意义(P0.05)。椎间隙高度平均增加4.2 mm,与术前相比差异有统计学意义(P0.05)。术后1周,ESR和CRP分别下降至15 mm/h,16mg/L,其变化均具有统计学意义(P0.05),至术后3个月,所有合并脊髓神经损伤患者神经功能均恢复至E级。所有病例均得到随访,随访时间1~3.5年,平均植骨融合时间为7个月,融合率100%。至末次随访,所有患者ESR和CRP在正常范围内,且均无明显波动,无矫形角度丢失。[结论]个体化选择前路或前后联合的术式不仅可以根治结核,同时可以恢复胸腰椎正常生理曲度,重建脊柱稳定性,使患者回归正常生活。
[Abstract]:[objective] to evaluate the efficacy of different surgical methods in the treatment of multi-segmental and jumping thoracolumbar tuberculosis. [methods] from May 2008 to March 2015, a total of 25 patients, 17 males and 8 females, aged 1159 years with an average of 27 years, were enrolled in this study. Ct plain scan and 3D reconstruction and MRI were performed before operation. There were 11 cases of thoracic vertebrae, 9 cases of thoracolumbar segment, 5 cases of lumbar vertebrae, 10 cases of involving 4 vertebrae, 7 cases of 5 vertebrae, 5 cases of 6 vertebrae and 3 cases of 7 vertebrae. 7 cases underwent thoracotomy "anterior approach" and 4 cases underwent thoracotomy before and after thoracotomy. 9 cases underwent extrapleural retroperitoneal surgery and 5 cases underwent extraperitoneal approach. Regular antituberculous therapy was performed for 6 ~ 12 months after discharge. Bone graft fusion time, correction degree of kyphosis, height of intervertebral space and recovery of nerve function, and changes of erythrocyte sedimentation rate (ESR) C-reactive protein were observed. [results] all patients were successfully operated without serious complications. By the third day after operation, the kyphosis was corrected to 27 掳on average, and the difference was statistically significant compared with that before operation (P 0.05). The height of intervertebral space increased by 4.2 mm on average, which was significantly higher than that before operation (P 0.05). At 1 week after operation, CRP and ESR decreased to 15 mm / h and 16 mg / L, respectively, and the changes were statistically significant (P 0.05). By 3 months after operation, the neurological function of all patients with spinal cord nerve injury recovered to E grade. All the cases were followed up for 1 ~ 3.5 years. The average time of bone graft fusion was 7 months, and the fusion rate was 100. To the last follow-up, ESR and CRP in all patients were within normal range, and there was no significant fluctuation and no loss of orthopedic angle. [conclusion] individualized anterior or anterior combined operation can not only cure tuberculosis, but also restore normal physiological curvature of thoracolumbar vertebrae, reconstruct spinal stability and make patients return to normal life.
【作者单位】：新疆维吾尔自治区人民医院骨科中心;
【分类号】：R687.3

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