经后路椎间隙病灶清除植骨内固定对腰骶段脊柱结核的临床疗效评价

发布时间：2018-10-24 16:49

【摘要】：目的探讨经后路椎间隙病灶清除植骨内固定对腰椎段脊柱结核的临床疗效。方法收集2014年1月至2016年1月本院收治的37例腰骶段脊柱结核患者的临床病例资料,其中18例患者采用经后路椎间隙病灶清除植骨内固定,19例患者采用一期后路固定前路病灶清除植骨术,通过分析两组患者的手术时间、出血量、住院时间、结核治愈情况、并发症、畸形矫正程度,综合评价手术的临床疗效,并进行统计学分析。结果所有患者均随访了一年以上,平均随访时间14.3个月,均没有出现大血管、神经损伤等严重并发症的患者,按JOA评分标准评价的临床疗效无统计学差异,后路组Cobb角术后末次随访较术前矫正了16.8°,前路组矫正了11.3°,两者具有统计学差异(P0.05)。结论经后路椎间隙病灶清除植骨内固定术可以显著改善临床症状,有效矫正脊柱后凸畸形,重建脊柱稳定性,降低病残率,且手术时间短、术中出血量少,但是病灶区域暴露不够充分,对于椎体前方的病变无法彻底清除,临床上应该充分考虑该手术方式的优缺点,严格掌握手术指征,根据临床实际情况选择手术方式。
[Abstract]:Objective to investigate the clinical effect of debridement and bone grafting through posterior intervertebral space for lumbar spinal tuberculosis. Methods the clinical data of 37 patients with lumbosacral spinal tuberculosis admitted to our hospital from January 2014 to January 2016 were collected. Among them, 18 cases were treated by posterior vertebral space debridement and bone grafting, 19 cases by one stage posterior fixation anterior approach debridement and bone grafting. The operation time, blood loss, hospital stay and tuberculosis cure were analyzed in the two groups. Complications, correction degree of deformity, comprehensive evaluation of the clinical efficacy of surgery, and statistical analysis. Results all the patients were followed up for more than one year with an average follow-up time of 14.3 months. There was no significant difference in the clinical efficacy according to the JOA score. The Cobb angle was corrected 16.8 掳in the posterior group and 11.3 掳in the anterior group at the last follow-up (P0.05). Conclusion posterior debridement and internal fixation can significantly improve the clinical symptoms, correct kyphosis, reconstruct the stability of the spine, reduce the rate of disability, shorten the operation time, and reduce the amount of intraoperative bleeding. However, the focus area is not fully exposed and the lesions in front of the vertebral body can not be completely cleared. Therefore, the advantages and disadvantages of the operation method should be fully considered in clinical practice, the indications of operation should be strictly grasped, and the operation mode should be selected according to the actual clinical situation.
【作者单位】：海南医学院附属第二医院;
【分类号】：R687.3

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