胸腰椎结核前路术后复发的原因分析及再手术治疗

发布时间：2018-05-05 13:54

本文选题：脊柱结核 + 复发　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:探讨胸腰椎结核一期前路病灶清除、植骨融合及内固定术后复发的原因,并分析再手术的疗效及策略。方法:对收治的15例胸腰椎结核前路术后复发合并窦道形成并经过保守治疗无效患者的相关资料进行回顾性分析。15例均采取一期后路植骨内固定、前路内固定取出、病灶清除、植骨支撑即前后联合的翻修术治疗。结果:初次手术病灶清除不彻底10例,使用异体骨块、人工骨、填装异体骨粒的钛笼植骨支撑9例,内固定松动13例。15例翻修术后均获得随访,时间12~48个月。术后结核杆菌培养阳性5例,其中3例存在不同程度的耐药(2例耐异烟肼、利福平,1例耐异烟肼、利福平、对氨基水杨酸钠)。神经功能Frankel分级:1例C级恢复到D级;8例D级恢复到E级6例,2例无恢复;6例E级仍为E级。术后14例获得治愈,影像学显示植骨融合,未发现内固定物松动断裂;1例再次复发,再次复发率为6.67%(1/15),经过抗结核及换药4个月后治愈。术后1周后凸Cobb角为2°~3°(4.3°±2.5°),矫正率80.7%±8.0%,与术前比较差异有统计学意义(P0.001);末次随访为2°~3°(4.5°±2.6°),矫正率为79.6%±9.3%,与术后1周比较无统计学意义(P0.05)。结论:胸腰椎结核一期前路术后复发的主要原因与病灶清除不彻底、耐药性结核菌株出现、非活性异物过多放置、内固定松动失效、长期营养不良及不正规化疗有关;前路病灶的彻底清除及良好的植骨支撑、后路坚强的内固定结合有效的化疗可明显减少翻修术后结核的复发率。
[Abstract]:Objective: to investigate the causes of recurrence of thoracolumbar tuberculosis after primary anterior debridement, bone graft fusion and internal fixation, and to analyze the effect and strategy of reoperation. Methods: the data of 15 patients with anterior recurrence of thoracolumbar tuberculosis complicated with sinus formation after conservative treatment were retrospectively analyzed. 15 cases were treated with one stage posterior bone graft fixation, anterior internal fixation and debridement. Bone graft support is the combined anterior and posterior revision of the treatment. Results: in the first operation, 10 cases had incomplete debridement, 9 cases were supported by allograft bone, artificial bone, titanium cage with allogeneic bone grafts, 13 cases were loosened with internal fixation and 15 cases were followed up after revision, the time was 12 ~ 48 months. After operation, 5 cases were positive for mycobacterium tuberculosis culture, among which 3 cases were resistant to isoniazid in 2 cases, and 1 case to isoniazid, rifampicin and sodium aminosalicylate in 1 case. The neurological function was recovered from grade C to grade D in 1 case with Frankel's grade 1, from grade D to grade E in 8 cases, from grade D to grade E in 2 cases without recovery, and in 6 cases from grade E to grade E. After operation, 14 cases were cured, bone graft fusion was shown on imaging, and no recurrence of internal fixation loosening and fracture was found in 1 case. The recurrence rate was 6.67 / 1 / 15, and was cured after anti-tuberculosis and dressing change for 4 months. 1 week after operation, the Cobb angle of kyphosis was 2 掳/ 3 掳/ 4. 3 掳卤2. 5 掳/ m, and the correction rate was 80.7% 卤8.0%, which was significantly higher than that before operation (P 0.001), and the last follow-up was 2 掳3 掳(4.5 掳卤2.6 掳), the correction rate was 79. 6% 卤9. 3%, and there was no significant difference between the two groups at 1 week after operation (P 0. 05). Conclusion: the main causes of recurrence of thoracolumbar tuberculosis after primary anterior approach are related to incomplete debridement, emergence of drug-resistant tuberculous bacilli, excessive placement of inactive foreign bodies, loosening of internal fixation, long-term malnutrition and irregular chemotherapy. Complete removal of anterior lesions and good bone graft support, strong posterior internal fixation combined with effective chemotherapy can significantly reduce the recurrence rate of tuberculosis after revision.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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