一期侧前路及后路手术联合治疗胸腰椎结核的临床疗效分析

发布时间：2018-05-29 07:54

本文选题：胸腰椎结核 + 手术入路　；参考：《西安交通大学学报(医学版)》2017年06期

【摘要】：目的探讨一期侧前路及后路联合病灶清除植骨融合内固定术治疗胸腰椎结核的临床疗效。方法回顾性分析2010年1月到2014年12月胸腰椎结核56例,其中男31例,女25例,年龄18~72岁,平均43.1岁;术前采用标准四联抗结核方案治疗2~4周;采用一期侧前方结核病灶清除,自体髂骨植骨可吸收螺钉固定术,同期经后方多裂肌间隙入路(Wiltse入路)椎弓根螺钉固定。记录手术时间、出血量、植骨融合情况和术后血沉、Cobb角、VAS评分、美国脊髓损伤协会(American Spinal Injury Association,ASIA)等级变化等情况,评估手术效果。结果手术时间175~290min,平均(248±42)min;出血量300~900mL,平均(420±68)mL。平均随访(24±5.2)月,植骨融合率100%,融合时间(4.7±0.5)月;末次随访Cobb角(8.2±3.1)°,VAS评分(2.1±0.8)分,血沉(17±4.2)mm/h,ASIA评分除3例为D级外,均为E级,与术前比较差异均有统计学意义。6例患者发生不同程度并发症,无严重并发症发生。结论一期侧前路病灶清除植骨可吸收螺钉固定及后路Wiltse入路固定治疗胸腰椎结核,可以彻底清除病灶,后凸畸形矫正理想,植骨融合率高,神经减压效果满意;可吸收螺钉可以安全应用于结核病灶清除术后的植骨中。
[Abstract]:Objective to investigate the clinical effect of one-stage anterior and posterior debridement combined with bone grafting and internal fixation for thoracolumbar tuberculosis. Methods from January 2010 to December 2014, 56 patients with thoracolumbar tuberculosis were retrospectively analyzed, including 31 males and 25 females, aged 1872 years with an average of 43.1 years. Autologous iliac bone graft was performed with absorbable screw fixation, and pedicle screw fixation was performed through the posterior polyfissure space approach (Wiltse approach). The operative time, blood loss, bone graft fusion and postoperative ESR Cobb Corner VAS score, American Spinal Injury Association of American Spinal Cord Association (Asci) grade were recorded to evaluate the effect of the operation. Results the operative time was 175 ~ 290 min, the average time was 248 卤42 min, and the blood loss was 300 ~ 900mL, with an average of 420 卤68mL. The average follow-up was 24 卤5.2 months, the fusion rate of bone graft was 100 and the fusion time was 4.7 卤0.5 months. In the last follow-up, the Cobb angle was 8.2 卤3.1 掳and the score was 2.1 卤0.8. The ESR score was 17 卤4.2 mm / h Asia, except 3 cases were D grade, all of them were E grade. The differences were statistically significant in 6 patients with different degree of complications, no serious complications. Conclusion One-stage anterior debridement and bone graft fixation with absorbable screw and posterior Wiltse approach for thoracolumbar tuberculosis can completely remove the lesion, correct kyphosis deformity is ideal, the fusion rate of bone graft is high, and the effect of nerve decompression is satisfactory. Absorbable screws can be safely used in bone grafts after tuberculosis removal.
【作者单位】：西安交通大学第二附属医院骨二科;
【基金】：国家自然科学基金资助项目(No.81571209) 陕西省自然科学基金资助项目(No.2016JM8054)~~
【分类号】：R687.3

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