一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核

发布时间：2018-05-03 09:01

本文选题：胸腰段脊柱结核 + 一期后路　；参考：《中国矫形外科杂志》2016年11期

【摘要】：[目的]探讨一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核的可行性及临床疗效。[方法]2007年1月~2014年1月收集23例胸腰段脊柱结核并有后突畸形的患者,伴有椎管及椎旁脓肿形成。其中男13例,女10例;年龄30~69岁,平均(46.48±12.01)岁。脊柱病变节段后凸Cobb角为17°~40°,平均(30.43±5.74)°。术前ASIA分级:B级2例,C级10例,D级7例,E级4例。均采用一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗。通过研究患者ASIA分级、脊柱病变节段后凸Cobb角、术后并发症、Oswestry功能障碍指数(ODI)、VAS疼痛评分、植骨融合时间评估手术疗效。[结果]术后随访21~41个月,平均(29.30±4.97)个月,无脊髓损伤加重及脑脊液漏,无窦道形成。1例术后伤口延迟愈合,1例出现皮下局部脓肿。术前有神经症状者均有不同程度恢复。至末次随访,根据ASIA分级,2例由B级恢复至D级,8例由C级恢复至E级,2例由C级恢复至D级,7例由D级恢复至E级。术后测量后凸Cobb角较术前显著改善(P0.001)。末次随访时ODI、VAS疼痛评分均较术前明显改善(P0.001)。本组无内固定失败及假关节形成,所有患者均在术后5~8个月达到植骨融合,疗效满意。[结论]对于有适应证的脊柱结核,一期后路单侧椎板开窗、经椎间隙病灶清除植骨融合内固定治疗胸腰段脊柱结核安全有效且手术创伤小。
[Abstract]:[objective] to investigate the feasibility and clinical effect of one-stage posterior laminectomy and intervertebral space debridement, bone grafting and internal fixation in the treatment of thoracolumbar spinal tuberculosis. [methods] from January 2007 to January 2014, 23 cases of thoracolumbar spinal tuberculosis with posterior deformities were collected, with spinal canal and paraspinal abscess. There were 13 males and 10 females, aged 30 to 69 years (mean 46.48 卤12.01) years old. The Cobb angle of segmental kyphosis was 17 掳and 40 掳(mean 30.43 卤5.74) 掳. Before operation, 2 cases with ASIA grade B and 10 cases with grade C, 7 cases with grade D and 4 cases with grade E. All patients were treated with one-stage posterior unilateral lamina fenestration, debridement, bone grafting and internal fixation through intervertebral space. The patients' ASIA grade, segmental kyphosis Cobb angle, postoperative complications and the pain score of Oswestry dysfunction index were studied. The time of bone grafting fusion was used to evaluate the curative effect of the operation. [results] follow up for 21 ~ 41 months (mean 29.30 卤4.97) months, no severe spinal cord injury and cerebrospinal fluid leakage, no sinus formation, 1 case of delayed wound healing after operation appeared subcutaneous local abscess. All patients with preoperative neurological symptoms recovered to varying degrees. To the last follow-up, according to the ASIA grade, 2 cases recovered from B grade to D grade 8 cases recovered from C grade to E grade 2 cases recovered from C grade to D grade 7 cases recovered from D grade to E grade. The postoperative Cobb angle of kyphosis was significantly improved than that before operation (P 0.001). At the last follow-up, the pain score of ODI VAS was significantly improved than that of preoperation (P 0.001). There was no failure of internal fixation and pseudarthrosis. All the patients achieved bone graft fusion 5 ~ 8 months after operation, and the curative effect was satisfactory. [conclusion] for spinal tuberculosis with indications, unilateral laminar fenestration, debridement, bone grafting and internal fixation via intervertebral space are safe, effective and minimally invasive in the treatment of thoracolumbar spinal tuberculosis.
【作者单位】：中南大学湘雅医院脊柱外科湘雅脊柱外科中心;
【分类号】：R687.3

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