前路一期病灶清除植骨内固定术治疗椎体成形术后术椎结核

发布时间：2018-05-01 22:57

本文选题：胸腰椎椎体成形术后术椎结核 + 前路　；参考：《中国矫形外科杂志》2017年03期

【摘要】：[目的]探讨前路一期病灶清除植骨内固定治疗胸腰椎骨折椎体成形术后术椎结核的疗效。[方法]2010年4月~2014年6月,对36例胸腰椎椎体成形术后术椎结核的患者行一期前路结核病灶清除、椎间植骨内固定治疗。其中胸椎(T_(8~10))17例,胸腰椎(T_11~L_2)15例,腰椎(L_(3~4))4例。病变累及单节段16例,双节段19例,3个节段1例。脊髓功能Frankel分级为C级4例,D级8例。术前后凸畸形Cobb角为(49.98±6.67)°。术前Oswestry功能障碍指数(ODI)75.43%±3.42%,术前疼痛视觉模拟(VAS)评分为(7.61±0.55)分。[结果]所有病例均获随访,随访时间18~72个月,平均46个月。术后切口均Ⅰ期愈合,无感染及窦道形成。末次随访时X线片和CT片均示植骨骨性融合,融合时间5~9个月,平均7个月;未发生内固定松动、脱出等相关并发症。术后7 d、末次随访后凸Cobb角、ODI、VAS评分与术前比较差异有统计学意义(P0.05)。术后7 d的后凸Cobb角、ODI、VAS评分与末次随访比较,差异无统计学意义,P0.05,神经功能:2例由C级恢复为D级,其余10例均恢复至E级。[结论]采用经前方入路病灶清除植骨内固定术治疗胸腰椎经皮椎体成形术后术椎结核,具有病灶清除、减压彻底,骨水泥取出彻底、安全,脊柱稳定性更高,并能满意矫正病变节段的后凸畸形;相较于传统后路手术更加安全可靠,可明显提高生活质量,获得良好的临床疗效。
[Abstract]:Objective: to evaluate the effect of anterior debridement and bone grafting in the treatment of vertebral tuberculosis after thoracolumbar vertebroplasty. [methods] from April 2010 to June 2014, 36 patients with spinal tuberculosis after thoracolumbar vertebroplasty underwent one stage anterior removal of tuberculosis focus and intervertebral bone grafting and internal fixation. There were 17 cases of thoracic tiasis, 2cases of T _ 11 / L _ S, and 4 cases of LT _ T _ T _ 3 / L _ T _ T _ 1 / T _ (11) / L _ (+) / T _ (11) / T _ (11) / L ~ +. The lesions involved single segment in 16 cases, double segment in 19 cases and 3 segments in 1 case. The Frankel grade of spinal cord function was grade C in 4 cases and grade D in 8 cases. The Cobb angle of kyphosis was 49.98 卤6.67 掳. The preoperative Oswestry dysfunction index was 75.43% 卤3.42 and the preoperative pain visual analogue score was 7.61 卤0.55. [results] all cases were followed up for 18 ~ 72 months (mean 46 months). All the incisions healed in the first stage without infection and sinus formation. At the last follow-up, both X-ray and CT films showed bone graft fusion, the fusion time ranged from 5 to 9 months (mean 7 months), and there were no related complications such as loosening of internal fixation and prolapse. On the 7th day after operation, there was a significant difference between the Cobb angle of kyphosis and the preoperative score (P 0.05). Compared with the last follow-up, there was no significant difference in VAS score of Cobb angle of kyphosis 7 days after operation (P 0.05). The neurological function of 2 cases recovered from C grade to D grade, and the other 10 cases recovered to E grade. [conclusion] the treatment of thoracolumbar vertebroplasty with debridement, decompression, complete removal of bone cement, safety and stability of spinal column by anterior approach of debridement and bone grafting and internal fixation for thoracolumbar vertebroplasty. Compared with the traditional posterior approach, the kyphosis is more safe and reliable, and can obviously improve the quality of life and obtain a good clinical effect.
【作者单位】：广西中医药大学第一附属医院骨一科;
【分类号】：R687.3

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