病椎置短椎弓根钉治疗多节段胸腰椎结核的临床研究

发布时间：2018-08-29 08:25

【摘要】：目的:观察病椎置短椎弓根钉,病灶清除、植骨融合内固定术治疗多节段胸腰椎结核的临床效果,探讨治疗多节段胸腰椎结核的手术改进方法和疗效。方法:收集2012年2月至2014年2月在青海大学附属医院收治的40例多节段胸腰椎结核患者(术后病检均确诊脊柱结核),其中女性患者15例,男性患者25例,年龄范围26岁至63岁,平均年龄(43.3±2.3)岁,病程6个月~2年,平均12个月。病灶侵袭范围病变部位在胸椎的有14例,腰椎结核有5例,胸椎并腰椎结核有21例。所有患者术前经过CT、X线及MRI确诊,均符合多节段胸腰椎结核的诊断标准。所有患者在术前腰背部位均表现出严重的疼痛症状,活动受到限制,脊椎后凸畸形及神经功能障碍等。其中6例患者Frankel分级为A级,10例患者为B级,12例患者为C级,12例患者为D级。按Frankel分级标准对术前、术后神经功能改善进行评价。术前从影像学上测得Cobb角平均值35.6°±3.7,受损椎体前缘高度(%)平均值40.5%±6.3。常规抗结核化疗至少14天,待患者能耐受手术后行手术治疗,术后继续口服抗结核药物治疗10~12个月,定期复查肝功能、肾功能、血沉、C-反应蛋白,术后分别于3个月、6个月、12个月复查胸腰椎X线片。随访期间观察术后患者症状改善及神经功能恢复情况,观察植骨融合、后凸畸形矫正情况。结果:所有患者手术均顺利完成,术中、后无一例出现严重并发症。40例患者全部随访成功,术后随访时间为12~36个月,平均18个月。术后10-12个月,抗结核药物停用,所有患者结核症状消失,腰背无疼痛,无复发现象出现。末次随访时1例患者Frankel分级为A级,1例患者为B级,8例患者为C级,10例患者为D级,20例患者为E级。后凸畸形矫正良好,后凸角明显改善,末次随访Cobb角平均值为6.8°±2.9,受损椎体前缘高度(%)平均值92.4±5.7。末次随访各项观察指标与术前比较差异均有统计学意义(P㩳0.05)。末次随访时均显示良好的骨性融合,血沉均小于20mm/h。结论:病椎置短椎弓根钉治疗多节段胸腰椎结核,可使病椎后凸畸形和脱位能即刻得到纠正和良好的复位,可取得脊椎即刻稳定,虽固定节段减少,但可充分达到载荷分享均衡,术后角度丢失少。而且有助于防止植骨块脱出、塌陷、不愈合的发生,对恢复脊柱、脊髓的功能有良好的效果。对于脊柱稳定性的生物力学重建奠定基础,提高植骨融合的治愈率,预防和纠正脊柱畸形,减少结核复发,能有效避免二次手术,减少患者的创伤和负担。目前,病椎置短椎弓根钉方法成为一种趋势[1],临床效果显著,安全可靠,是理想的治疗方法,值得推广。
[Abstract]:Objective: to observe the clinical effect of short pedicle screw, focal debridement, bone graft fusion and internal fixation in the treatment of multilevel thoracolumbar tuberculosis, and to explore the surgical improvement and effect of multilevel thoracolumbar tuberculosis. Methods: from February 2012 to February 2014, 40 patients with multi-segmental thoracolumbar tuberculosis (all diagnosed by postoperative examinations) were collected from the affiliated Hospital of Qinghai University, including 15 female patients and 25 male patients, aged from 26 to 63 years old. The mean age was (43.3 卤2.3) years, the course of disease ranged from 6 months to 2 years (mean 12 months). The lesions were located in 14 cases of thoracic vertebra, 5 cases of lumbar tuberculosis and 21 cases of thoracic and lumbar tuberculosis. All the patients were diagnosed by CT,X line and MRI before operation, all of them were in accordance with the diagnostic criteria of multi-level thoracolumbar tuberculosis. All patients showed severe pain, limited movement, kyphosis and neurological dysfunction. The Frankel grade of 6 cases was grade A and 10 cases were grade B, 12 cases were grade C and 12 cases were grade D. The improvement of nerve function before and after operation was evaluated according to Frankel grading standard. The average value of Cobb angle was 35.6 掳卤3.7 掳and the average height of anterior edge of injured vertebral body (%) was 40.5% 卤6.3%. Routine antituberculous chemotherapy was performed for at least 14 days. After operation, patients were treated with antituberculosis drugs for 10 ~ 12 months. Liver function, renal function, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined regularly. Thoracolumbar X-ray examination was performed at 3 months, 6 months and 12 months after operation. During the follow-up period, the improvement of symptoms, the recovery of nerve function, the fusion of bone graft and the correction of kyphosis were observed. Results: all the patients were successfully completed. During the operation, none of the 40 patients were followed up successfully. The follow-up time was 1236 months (mean 18 months). After 10-12 months, antituberculous drugs were stopped, all tuberculosis symptoms disappeared, no pain in the back and back, no recurrence. At the last follow-up, one patient with Frankel grade A, one patient with grade B, 8 patients with grade C, 10 patients with grade D, 20 patients with grade E. Kyphosis was corrected well and kyphosis angle was improved obviously. The average Cobb angle of the last follow-up was 6.8 掳卤2.9, and the average height of the anterior edge of the injured vertebral body (%) was 92.4 卤5.7. There was significant difference between the last follow-up and preoperative observation (P0. 05). At the last follow-up, good bone fusion was observed, and ESR was less than 20 mm / h. Conclusion: the treatment of multilevel thoracolumbar tuberculosis with short pedicle screw can make the kyphosis deformity and dislocation be corrected and well reduced immediately, and the spine can be stabilized immediately, although the fixed segment is reduced. However, load sharing balance can be fully achieved and angle loss is less. It also helps to prevent the bone graft from protruding, collapsing and nonunion, and has good effect on the recovery of spinal and spinal cord function. It lays a foundation for the biomechanical reconstruction of spinal stability, improves the cure rate of bone graft fusion, prevents and corrects spinal deformities, reduces tuberculosis recurrence, effectively avoids secondary surgery, and reduces the trauma and burden of patients. At present, the method of short pedicle screw in diseased vertebrae has become a trend [1]. The clinical effect is remarkable, safe and reliable, and it is an ideal treatment method, which is worth popularizing.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【相似文献】