摘要
目的评价一期后路病灶清除植骨融合并钉棒固定治疗L5~S1结核的疗效。方法对23例L5~S1结核患者采用腰椎后路病灶清除植骨融合术治疗。根据疼痛视觉模拟评分(VAS)、血沉、C-反应蛋白、受累区腰骶角及植骨融合情况评价临床疗效。结果所有患者均顺利完成手术,术中出血量100~1 500(227.28±119.25)ml。23例患者均获随访,时间6~18(13.2±4.3)个月。血沉:术前(47.30±15.45)mm/1 h,术后3个月(10.43±4.47)mm/1 h,除5例高于正常值,其余恢复正常。C-反应蛋白:术前(36.01±23.60)mg/L,术后3个月(8.55±7.20)mg/L,有6例高于正常值。末次随访所有患者血沉、C-反应蛋白均正常。VAS:由术前的(4.09±2.45)分降低至末次随访的(0.65±0.71)分。腰骶角:术后30.98°±2.97°较术前23.40°±2.43°恢复7.6°,末次随访30.11°±2.75°,丢失1.0°。以上各项指标术后及末次随访与术前比较差异均有统计学意义(P〈0.05)。结论一期后路病灶清除植骨融合是治疗L5~S1结核的有效方法,术前的明确诊断、正确的适应证选择及术中的精细操作是手术成功重要因素。
Objective To evaluate the clinical efficacy of one-stage posterior debridement graft fusion and pedicle screw fixation in the treatment of L5~ S1 tuberculosis. Methods 23 patients who suffered from L5~ S1 tuberculosis were undergone surgical debridement posterior fusion surgery. The clinical efficacy was evaluated based on the materials Prolo scale,visual analogue scale( VAS),erythrocyte sedimentation rate( ESR),C-reactive protein graft fusion and change of lumbo-sacral angle. Results All patients were successfully operated,and the blood loss was 100 ~1 500(227. 28 ± 119. 25) ml. 23 patients were followed up for 6 ~ 18(13. 2 ± 4. 3) months. The preoperative ESR was(47. 30 ± 15. 45) mm /1 h,the postoperative ESR was(10. 43 ± 4. 47) mm /1 h within 3 months and most patients returned to normal except five cases. Preoperative C-reactive protein was(36. 01 ± 23. 60) mg / L,within 3 months it was changed to(8. 55 ± 7. 20) mg / L,but there was also 6 cases abnormal. Both of them were normal in the last follow-up. The VAS was(0. 65 ± 0. 71) at the last follow-up,decreased from(4. 09 ± 2. 45) preoperatively. The lumbo-sacral angle was 30. 98° ± 2. 97° compared with 23. 40° ± 2. 43° preoperatively,and restored to 7. 6°,the last follow-up was 30. 11° ± 2. 75°,loss of less than 1. 0°. Above indicators were statistically significant different in the postoperative and last follow-up compared with the preoperative( P〈0. 05). Conclusions One-stage posterior debridement and bone graft fusion is an effective treatment method for the treatment of lumbo-sacral tuberculosis. Preoperative diagnosis,proper selection and operative indications are important factors in the success of the operation.
出处
《临床骨科杂志》
2015年第2期129-132,共4页
Journal of Clinical Orthopaedics