不同手术入路治疗多节段胸腰椎椎体结核的疗效分析

发布时间：2018-09-10 09:50

【摘要】：目的探讨多节段胸腰椎椎体结核患者采取不同入路的病灶清除,植骨融合及内固定手术的疗效。方法回顾性分析2010年至2014年间,在新疆医科大学第一附属医院脊柱外科收治的40例多节段胸腰椎椎体结核患者,根据患者结核病灶的病变特点、脓肿的位置、椎体的破坏程度及是否伴有后凸畸形、脊髓压迫等因素选择不同的手术方式,按手术入路的不同可分为三组:A组:前路病灶清除植骨融合内固定术8例;B组:后路病灶清除植骨融合内固定术20例;C组:前路病灶清除植骨、一期后路内固定术12例。40例患者Frankel分级:B级1例,C级6例,D级16例,E级17例。29例患者合并后凸畸形,Cobb角10°-30°者24例,30°者5例。术前所有患者均给予规范口服四联(异烟肼、利福平、吡嗪酰胺和链霉素)抗结核药物治疗2-4周,同时加服肝泰乐保护肝功能。分别记录三组患者的手术时间、术中出血量、结核活动度(血沉、C反应蛋白变化)、术后植骨块、钛网位置及融合情况、神经功能恢复情况以及相关手术术后并发症(包括结核复发、椎弓根螺钉及钛网松动断裂等)cobb角等结果,并对其进行分组整理分析。结果A组的手术时间平均(3.6±0.5)h,出血量平均(431±44)ml;B组的手术时间平均(4.5±0.5)h,出血量平均(496±61)ml;C组的手术时间平均(4.7±0.6)h,出血量平均(557±63)ml。所有患者的结核毒性症状在平均5.5天内得到缓解。cobb角为10-30°的患者术后平均矫正率为53.7±18.3%,cobb角30°的患者术后平均矫正率为54.4±14.6%。术后3-9个月血沉及C-反应蛋白逐渐降低至正常。结论多节段胸腰椎椎体结核患者经由规律的抗结核药物治疗后,根据各节段破坏的范围、脓肿的大小位置、是否伴有后凸畸形和脊髓压迫等因素的不同,选择合理的手术术式,给予彻底的病灶清除和植骨融合,采取合理化、综合化、个体化的治疗方案,会取得满意的临床疗效。
[Abstract]:Objective to evaluate the effect of multiple thoracolumbar vertebrae tuberculosis with different approaches of debridement, bone grafting and internal fixation. Methods from 2010 to 2014, 40 patients with multi-level thoracolumbar vertebral tuberculosis admitted in the first affiliated Hospital of Xinjiang Medical University were analyzed retrospectively. The location of abscess was analyzed according to the pathological changes of the patients' tuberculosis foci. The degree of destruction of the vertebral body and whether it is accompanied by kyphosis, spinal cord compression and other factors choose different surgical methods, According to the different operative approaches, we can divide them into three groups: anterior debridement, bone grafting, fusion and internal fixation, anterior debridement, bone grafting, internal fixation, posterior debridement, bone grafting and internal fixation, and anterior debridement and bone grafting. One stage posterior internal fixation was performed in 12 cases. 40 cases were classified as Frankel grade B, 1 case, grade C, 6 cases, grade D, 16 cases, grade E, 17 cases, 29 cases, with kyphosis angle 10 掳-30 掳, 24 cases with 30 掳, 5 cases. All patients were given routine oral administration of isoniazid, rifampicin, pyrazinamide and streptomycin for 2 to 4 weeks. The time of operation, the amount of blood lost during operation, the activity of tuberculosis (ESR C-reactive protein change), the bone graft, the position of titanium mesh and the fusion were recorded respectively in the three groups. The recovery of nerve function and the cobb angle of postoperative complications (including recurrence of tuberculosis, pedicle screw and titanium mesh loosening and fracture) were analyzed. Results the mean operation time was (3.6 卤0.5) h in group A, (4.5 卤0.5) h in ml;B group, (4.7 卤0.6) h in group A and (557 卤63) ml. in group A. The average correction rate of TB toxic symptoms in all patients was 53.7 卤18.3cobb angle 30 掳and 54.4 卤14.6in patients with cobb angle 10-30 掳relief in an average of 5.5 days. ESR and C-reactive protein gradually decreased to normal 3-9 months after operation. Conclusion after regular treatment with antituberculous drugs in patients with multiple thoracolumbar vertebrae tuberculosis, a reasonable surgical procedure is chosen according to the extent of destruction of each segment, the location of abscess, whether or not kyphosis is associated with spinal cord compression and so on. Complete debridement and bone graft fusion, rational, comprehensive and individualized treatment can achieve satisfactory clinical results.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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