单运动节段胸、腰、骶椎结核稳定性评估及手术方式选择

发布时间：2018-11-08 07:59

【摘要】：目的:回顾性研究我院45例单运动节段胸、腰、骶椎结核对脊柱稳定性的影响,探讨病灶清除、单节段固定的方法、适应证及优缺点。方法:回顾分析我院2011年6月~2014年8月共收治并获定期随访的单运动节段胸、腰、骶椎结核45例患者的临床资料,男21例,女24例,年龄:17-69岁,平均38.5岁;病史3-36个月,平均14.5个月,术前“四联”抗痨2-4周。根据后凸畸形、椎体塌陷及移位等影响脊柱稳定性的潜在因素并结合Denis的三柱理论(损伤2柱或以上为脊柱失稳),分为A组7例(稳定组),B组38例(不稳定组);稳定组采取前路病灶清除术;不稳定组根据术前椎体破坏程度、后凸畸形及术中残椎高度分别对17例(B1组)行前路病灶清除并植骨融合+单节段内固定术、13例(B2组)采用前路病灶清除植骨融合+后路单节段内固定术、8例(B3组)采用后路病灶清除植骨融合并单节段椎弓根内固定;本组植骨均采取自体骨。术后常规抗痨治疗12-18个月,随访测量Cobb角矫正水平、评估植骨融合情况,检测C-反应蛋白(CRP)及血沉(ESR)的变化,结合神经功能恢复情况(Frankel分级)进行综合评价。结果:1.单纯前柱破坏未发现脊柱失稳;累及前、中柱的破坏均对脊柱的稳定性造成破坏;2.本组45例后凸角平均矫正17.5°,随访期内丢失3-5°;B组植骨融合(自体肋骨或髂骨)患者在7-9个月植骨融合,平均8个月;31例合并脊髓神经功能障碍者术后按Frankel分级评估,均获不同程度改善,平均改善约1级。结论:1.单纯前柱破坏对脊柱稳定性无明显影响;累及前、中柱破坏的脊柱结核,可认为脊柱失稳;2.行病灶清除、单节段植骨融合内固定可重建前、中柱的稳定性,对单运动节段脊柱结核有确切的临床疗效。
[Abstract]:Objective: to study retrospectively the effects of single segmental thoracic, lumbar and sacral tuberculosis on spinal stability in 45 patients in our hospital, and to explore the methods of debridement, single segment fixation, indications, advantages and disadvantages. Methods: the clinical data of 45 patients with single segmental thoracic, lumbar and sacral tuberculosis admitted in our hospital from June 2011 to August 2014 were retrospectively analyzed. The clinical data were 21 males and 24 females, aged 17-69 years with an average of 38.5 years. The history ranged from 3 to 36 months (mean 14.5 months). According to the underlying factors such as kyphosis, collapse and displacement of vertebral body, and combined with Denis's three-column theory (injury 2 column or above is spinal instability), 7 cases were divided into group A (stable group), B group 38 cases (unstable group). The patients in the stable group were treated with anterior approach debridement. According to the degree of destruction of vertebral body before operation, kyphosis and the height of residual vertebrae in unstable group, 17 cases (group B1) underwent anterior debridement and single segment internal fixation with bone graft fusion, respectively. 13 cases (B2 group) were treated with anterior debridement, bone grafting, posterior single-segment internal fixation, and 8 cases (B3 group) were treated with posterior debridement and fusion with single pedicle fixation. Autogenous bone was used in all cases. Postoperative routine antituberculosis therapy for 12 to 18 months was followed up to measure the level of Cobb angle correction, to evaluate the fusion of bone graft, to detect the changes of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (ESR), and to evaluate the neurological function recovery (Frankel grade). The result is 1: 1. No instability of spine was found in simple destruction of anterior column, destruction of middle column before involvement caused damage to the stability of spine; 2. The mean correction of kyphosis angle in 45 cases was 17.5 掳, and the loss was 3-5 掳during the follow-up period, while in group B, bone graft fusion (autogenous rib or iliac bone) was performed in 7-9 months (mean 8 months). According to the Frankel grading, 31 patients with spinal cord neurological dysfunction improved in different degree, the average improvement was about 1 grade. Conclusion: 1. Simple anterior column destruction had no obvious effect on spinal stability, spinal tuberculosis with anterior and middle column destruction could be considered as spinal instability, and 2. The stability of the middle column can be reconstructed before single segment bone graft fusion and internal fixation. It has definite clinical effect on single segment spinal tuberculosis.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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