后路经单侧椎弓根入路病灶清除植骨内固定治疗胸腰椎结核的疗效分析

发布时间：2018-12-12 03:34

【摘要】：目的探讨后路经单侧椎弓根入路病灶清除、植骨融合、椎弓根螺钉内固定术治疗胸腰椎结核的临床疗效。方法2010年1月～2014年1月,我科共收治胸腰椎结核患者174例,满足纳入标准者共97例,A组(治疗组,53例)接受经单侧椎弓根入路病灶清除植内固定术治疗,B组(对照组,44例)接受传统后路病灶清除植骨内固定术治疗。通过A、B组的对比分析来评估单侧椎弓入路病灶清除植骨内固定术治疗胸腰椎结核的临床疗效。结果两组患者均安全度过围手术期,随访12～48个月,术后临床症状缓解满意,血沉、CRP恢复正常,术后X线片提示后凸畸形矫正满意,术后3-9个月椎间植骨达骨性融合,末次随访后凸Cobb角较术后无明显丢失,神经功能Frankel分级提高0-2级。A、B组患者组间比较：手术时间、术中出血量、术后住院时间、术后Cobb角丢失、VAS评分无明显差异(P0.05)；A组术后引流量明显少于B组(P0.05)；A组术后第3个月ODI指数明显低于B组(P0.05),两组ODI指数末次随访无统计学差异(P0.05)；A、B组术前及末次随访Frankel分级无明显差异(P0.05)。A组1例患者术后1月出现腰大肌脓肿,经脓肿清除后痊愈,其余无内固定松动、断裂等并发症发生。结论采用经单侧椎弓根入路病灶清除、植骨融合、椎弓根螺钉内固定术治疗胸腰椎结核,临床疗效满意,相比于传统后路手术创伤更小,脊柱的稳定性更强,术后功能恢复更快。
[Abstract]:Objective to investigate the clinical effect of posterior transpedicular approach for the treatment of thoracolumbar tuberculosis. Methods from January 2010 to January 2014, 174 patients with thoracolumbar tuberculosis were treated in our department, 97 of whom met the inclusion criteria. Group A (treatment group, 53 cases) received unilateral pedicle approach, and group B (control group) received unilateral pedicle debridement and internal fixation. 44 cases were treated with traditional posterior debridement, bone grafting and internal fixation. To evaluate the clinical effect of unilateral pedicle debridement, bone grafting and internal fixation for thoracolumbar tuberculosis. Results the patients in both groups survived the perioperative period safely and were followed up for 12 ~ 48 months. The clinical symptoms were satisfactory, the erythrocyte sedimentation rate and CRP returned to normal, the X-ray film showed that the correction of kyphosis was satisfactory, and the intervertebral bone graft reached bone fusion 3-9 months after operation. There was no significant loss of kyphosis Cobb angle after the last follow-up, and the Frankel grade of nerve function was increased by 0-2 grades. The time of operation, the amount of blood lost during operation, the time of hospitalization after operation, the loss of Cobb angle after operation in group A were compared. There was no significant difference in VAS score (P0.05). The postoperative drainage volume in group A was significantly lower than that in group B (P0.05). The ODI index in group); A was significantly lower than that in group B (P0.05). There was no significant difference in ODI index between the two groups at the last follow-up (P0.05). There was no significant difference in Frankel grade before and at the last follow-up in group A (P0.05). One patient in group). A had abscess of psoas major muscle one month after operation, which was cured after abscess removal, and no complications such as loosening of internal fixation and fracture occurred. Conclusion the treatment of thoracolumbar tuberculosis by unilateral pedicle approach with debridement, bone graft fusion and pedicle screw fixation is satisfactory. Compared with the traditional posterior approach, the trauma is less and the spine is more stable. The function recovered more quickly after operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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