后入路病灶清除植骨融合内固定治疗胸腰椎结核的临床研究

发布时间：2018-06-30 08:23

本文选题：胸腰椎结核 + 后入路　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：探讨后入路结核病灶清除、植骨融合、椎弓根钉内固定治疗胸腰椎结核的临床疗效,并评价其安全性及有效性。方法：回顾性分析2011年1月一2014年1月期间柳州市人民医院脊柱外科收治的胸腰椎结核病例,患者均采用后入路结核病灶清除植骨融合内固定治疗,术前及术后规范抗结核药物治疗。收集患者术前、术后及随访时红细胞沉降率(ESR)、C反应蛋白(CRP)、疼痛视觉模拟评分(VAS). Oswestry功能障碍指数(ODI)、后凸Cobb角及神经功能情况的相关数据；评价术后1年和末次随访时植骨融合情况及临床疗效,并观察内固定松动情况。数据结果用SPSS218.0进行统计分析。结果：本组研究手术时间110-210(138±48)min,出血量300-1200(423±52)ml。术后1例皮缘坏死,1例并发结核窦道,术中及术后均无死亡及神经功能损伤加重的病例。所有患者均获得随访,无脱落,随访时间15-36(18.7±5.3)个月。术前ESR为(47±10.2)mm/h,术后6个月所有患者ESR均恢复正常,为(8.0±3.1)mm/h,ESR在术前、术后1月、3月及6月间差别有统计学意义(F=125.470,P=0.001)；术前CRP为(38.8±9.1)mg/L,术后3个月所有患者CRP均恢复正常,为(9.7±4.7)mg/L,CRP在术前、术后1月、3月及6月间差别有统计学意义(F=79.050,P=0.000)；术前VAS评分为(6.8±1.6)分,术后1月显著下降为(2.6±1.2)分,VAS评分在术前、术后1月、3月及6月间差别有统计学意义(F=17.664,P=0.016)；ODI评分术前为(39.1±12),至末次随访时改善为(6.8±2.5),改善率为82.6%,较术前改善明显,ODI评分在术前、术后3月、6月及末次随访间差别有统计学意义(F=98.073,P=0.004)；术前后凸Cobb角为(23.3±5.2)°,术后1个月为(8.7±2.1)。,平均矫正14.6°,矫正率为62.6%,术前与术后1月后凸Cobb角比较有统计学意义(t=3.92,P=0.006)；末次随访时为(11.6±3.0)°,平均丢失2.9°,术前与末次随访后凸Cobb角比较有统计学意义(t=2.32,P=0.031),术后1月较末次随访后凸Cobb角比较无统计学差异(t=O.38,P=0.705)；术前17例存在神经功能损伤者(B级2例,C级3例,其余均为D级),至末次随访时除1例ASIA分级恢复为D级外,其余均恢复至E级；所有患者术后8个月内植骨均获得骨性融合,植骨融合时间3-8(5.1±1.4)个月,术后1年和末次随访时Bridwell I和Ⅱ级植骨融合率分别为89%和96%。所有患者术后9-14(11±1.7)个月获得临床治愈,在术后1年和末次随访时临床疗效评价优良率分别为91%和96%。至末次随访均未见螺钉松动移位、钛棒螺钉断裂、植骨块松动脱出或塌陷等并发症发生。结论：后入路病灶清除植骨融合内固定治疗胸腰椎脊柱结核,创伤相对小,出血少,并发症少是相对意义上的脊柱结核“微创”手术,可以满足彻底的结核病清除和有效的脊髓减压,良好的植骨融合以及脊柱后凸畸形矫正后的三柱坚强固定的目的,能有效矫正及预防后凸畸形,改善患者神经功能,是一种既安全又有效的手术方法。
[Abstract]:Objective: to evaluate the efficacy and safety of posterior approach for the treatment of thoracolumbar tuberculosis. Methods: the cases of thoracolumbar vertebrae tuberculosis treated in the Department of Spinal surgery of Liuzhou people's Hospital from January 2011 to January 2014 were retrospectively analyzed. Standard antituberculous drug treatment before and after operation. The erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) and visual analogue pain score (VAS) were collected. Oswestry index of dysfunction (ODI), Cobb angle of kyphosis and related data of nerve function were evaluated, bone graft fusion and clinical effect were evaluated at 1 year and the last follow-up, and internal fixation loosening was observed. The data were analyzed by SPSS 218.0. Results: the operative time was 110-210 (138 卤48) min and the blood loss was 300-1200 (423 卤52) ml. One case was complicated with tuberculous sinus in 1 case. There was no death and serious nerve function injury during and after operation. All the patients were followed up without abscission for 15-36 (18.7 卤5.3) months. The preoperative ESR was (47 卤10.2) mm / h, and the ESR was (8.0 卤3.1) mm / r / h in all patients 6 months after operation. There was a significant difference between preoperative, 1 month, 3 month and 6 months after operation (FF125.470 mg / L), the preoperative CRP was (38.8 卤9.1) mg / L, and 3 months after operation, all patients returned to normal, which was (9.7 卤4.7) mg / L CRP. The VAS score was (6.8 卤1.6) points before operation and (2.6 卤1.2) points at one month after operation. The VAS score was significantly different between the first month, the third month and the sixth month after operation (FF17.664P0.016), and the VAS score was significantly decreased to (2.6 卤1.2) in the first month, the third month and the sixth month after operation (F _ (17.664P0.016), and the VAS score was significantly decreased to (2.6 卤1.2) in the first month after operation (F _ (17.664P0.016). The ODI score was (39.1 卤12) before operation, and improved (6.8 卤2.5) at the last follow-up. The improvement rate was 82.6, which was significantly higher than that before operation. There was a significant difference in ODI score between 3 months, 6 months and the last follow-up (F _ (98.073) P _ (0.004). The Cobb angle of kyphosis was (23.3 卤5.2) 掳before operation and (8.7 卤2.1). The average correction was 14.6 掳, and the correction rate was 62.6 掳. The Cobb angle of kyphosis before and after operation was significantly higher than that at 1 month after operation (t = 3.92, P < 0.006). The mean loss of Cobb angle at the last follow-up was (11.6 卤3.0) 掳, the mean loss was 2.9 掳. There was significant difference between preoperative and posterior Cobb angle (t = 2.32), but there was no significant difference in postoperative 1 month compared with that after the last follow-up (t = 0.38, P = 0.705), and 17 patients with neurological function impairment (grade B, n = 2, n = 3, grade C, n = 3). At the last follow-up, all patients recovered to grade E except one case with Asia grade returning to grade D, and all patients received bone fusion within 8 months after operation, and the fusion time was 3-8 months (5.1 卤1.4) months. The fusion rates of Bridwell I and II were 89% and 96% respectively at one year and the last follow-up. All the patients were cured 9-14 (11 卤1.7) months after operation. The excellent and good rates were 91% and 96% respectively at 1 year and the last follow-up. To the last follow-up, there were no complications such as screw loosening displacement, titanium rod screw breaking, bone graft loosening, or collapse. Conclusion: the treatment of thoracolumbar spinal tuberculosis with debridement, bone grafting, fusion and internal fixation via posterior approach has less trauma, less bleeding and less complications. It can meet the goals of complete tuberculosis clearance, effective decompression of spinal cord, good fusion of bone graft and rigid fixation of three columns after correction of kyphosis. It can effectively correct and prevent kyphosis and improve the nervous function of patients. It is a safe and effective surgical method.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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