CT引导下微创手术治疗上颈椎与腰骶椎结核的临床研究

发布时间：2018-04-23 14:49

本文选题：微创手术 + 局部化疗　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:探讨CT引导下微创手术治疗上颈椎与腰骶椎结核的价值和意义。方法:2002年1月至2013年3月单个医生收治的上颈椎结核患者11例。其中男8例,女3例;年龄2-68岁,平均33.3岁。其中累及双节段9例(C1-2 8例,C2-3 1例),累及3节段2例(C1-3),均为连续椎体破坏病例;1例合并肾结核,2例合并有肺结核,1例脑血栓,1例严重风湿病病史。以及单个医生收治的保守治疗无效的腰骶椎结核患者145例,男84例,女61例。失访2例,其余143例均获得随访,年龄2-81岁,平均年龄42.6岁;内固定术后复发6例,无内固定开放术后复发8例;有32例患者伴有椎旁脓肿。腰骶椎结核治疗方法是144例患者实施CT引导下在病灶和脓肿内置管局部化疗灌注冲洗,1例患者行小开窗手术结合局部化疗治疗。上颈椎结核患者观察治疗前及终末随访时的血沉数值,治疗前及终末随访时视觉模拟评分(Visual Analogue Scale,VAS)评价疼痛程度。腰骶椎结核患者观察治疗前及终末随访时的血沉数值、治疗前及终末随访时的腰椎前凸角度(Lumbar lordosis,LL)、治疗前及终末随访时Oswestry功能障碍指数(Oswestry disability index,ODI)等。结果:本组上颈椎结核11例患者均获得随访,随访时间为28-108个月,平均60个月。所有患者临床症状消失,复查血沉正常,VAS评分0-4,平均2.55;术后1例患者出现管路脱落、1例出现管路堵塞,均给予更换导管。无颈椎结核复发、无窦道及假关节形成;手术患者植骨获得融合。本组患者没有实施前路开放手术。本组腰骶椎结核随访21-149个月,平均随访时间67个月。其中获得五年以上随访73例。所有患者均达临床愈合。治疗前腰椎前凸角平均为36.32°,终末随访时平均为33.35°,两者差异有统计学意义(P=0.000);Oswestry功能障碍指数术前平均为73.01分,终末随访时平均为11.25分,两者相比差异有统计学意义(P=0.000)。结论:正规抗结核治疗是上颈椎与腰骶椎结核最基本的治疗方法。大多数上颈椎结核与保守治疗无效且脊柱畸形和神经症状的程度在可接受的范围内的腰骶椎脊柱结核,选择以全身化疗加局部持续化疗治疗方式可以取得良好的治疗效果。对于微创治疗过程中合并有寰枢椎不稳、脱位的患者,采用前路微创、后路开放固定植骨的方法可获得较好的临床疗效。
[Abstract]:Objective: to evaluate the value and significance of CT-guided minimally invasive surgery in the treatment of upper cervical spine and lumbosacral tuberculosis. Methods: from January 2002 to March 2013, 11 patients with upper cervical tuberculosis were treated by a single doctor. There were 8 males and 3 females, aged 2-68 years, with an average age of 33.3 years. Among them, 9 cases were involved in double segment, 8 cases were involved in C1-2, 1 case was involved in C2-3, 2 cases were involved in 3 segments, 2 cases were continuous vertebral destruction, 1 case was complicated with renal tuberculosis, 2 cases were complicated with pulmonary tuberculosis, 1 case had cerebral thrombosis and 1 case had a history of severe rheumatism. 145 cases of lumbosacral tuberculosis, 84 males and 61 females, were treated by a single doctor. The other 143 cases were followed up, the average age was 42.6 years old, 6 cases recurred after internal fixation, 8 cases recurred after internal fixation, 32 cases had paravertebral abscess. The treatment of lumbosacral tuberculosis was performed in 144 patients under the guidance of CT. One patient underwent small fenestration combined with local chemotherapy under CT guidance. Patients with upper cervical tuberculosis were observed the ESR before and after treatment, visual analogue score (VAS) and visual Analogue scale scale (vas) were used to evaluate the pain. Patients with lumbosacral tuberculosis were observed the ESR before and at the end follow-up, Lumbar lordosis angle and Oswestry dysfunction index (Oswestry disability index) before and at the end follow-up. Results: 11 patients with upper cervical tuberculosis were followed up for 28-108 months (mean 60 months). All the patients' clinical symptoms disappeared, and the VAS score of normal ESR was 0-4 (average 2.55). No recurrence of cervical tuberculosis, no sinus and pseudoarthrosis, and fusion of bone graft in surgical patients. No open anterior approach was performed in this group. Patients with lumbosacral tuberculosis were followed up for 21-149 months with an average follow-up time of 67 months. Among them, 73 cases were followed up for more than 5 years. All patients were clinically healed. The mean lumbar kyphosis angle was 36.32 掳before treatment and 33.35 掳at the end follow-up. The difference between the two groups was statistically significant. The average score of Oswestry dysfunction index was 73.01 before operation and 11.25 at the end follow-up. The difference between the two groups was statistically significant. Conclusion: regular anti-tuberculosis therapy is the most basic treatment for upper cervical vertebra and lumbosacral tuberculosis. Most of the upper cervical tuberculosis and lumbosacral tuberculosis which are ineffective in conservative treatment and whose spinal deformities and neurological symptoms are within an acceptable range can be well treated with systemic chemotherapy plus local continuous chemotherapy. For the patients with atlantoaxial instability and dislocation in the course of minimally invasive treatment, anterior minimally invasive and posterior open fixation can obtain better clinical effect.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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