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CT引导下微创手术治疗腰骶椎结核的中远期临床观察 被引量:4

Long-term clinical studies on the treatment of lumbosacral spinal tuberculosis with CT-guided minimally invasive surgery
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摘要 目的 :探讨CT引导下微创手术治疗腰骶椎结核的临床疗效。方法 :对2002年1月至2013年3月收治的保守治疗无效的145例腰骶椎结核患者的临床资料进行回顾性分析,男84例,女61例;其中143例获得随访,年龄2.5-81岁,平均(42.60±17.14)岁。术后复发患者14例(6例有内固定,8例无内固定);椎旁脓肿的患者32例。术前合并左下肢无力浅感觉差1例,肌力减退1例,此2例患者Frankel分级均为D级,其他患者为E级。144例实施CT引导下在病灶和脓肿内置管局部化疗灌注冲洗,1例行小开窗手术结合局部化疗治疗。观察患者治疗前及末次随访时的血沉及腰椎前凸角度(lumbar lordosis,LL)。结果:143例患者获随访,时间为21-149个月,平均67个月,其中73例获得5年以上随访。所有患者达临床愈合。术前血沉(44.96±12.41)mm/h,末次随访时(7.25±3.43)mm/h,两者差异有统计学意义(t=35.06,P=0.000)。治疗前腰椎前凸角为(36.32±8.55)°,末次随访时为(33.35±8.16)°,两者差异有统计学意义(t=13.90,P=0.000)。结论:经保守治疗3个月以上无效,脊柱稳定性较好且神经症状的程度在Frankel分级D级以上的患者,行微创治疗辅以全身抗结核药物化学治疗效果较好。 Objective:To evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis. Methods:From January 2002 to March 2013,145 patients(84 males and 61 females) with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them,143 patients were followed up,aged from 2.5 to 81 years with an average of(42.60±17.14) years. Fourteen cases(6 cases with internal fixation and 8 cases without internal fixation) recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse,1 case with muscle strength decrease,this 2 cases were grade D of Frankle,other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy,144 cases with CT guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up. Results:The mean follow-up time was 67 months(ranged,21 to 149 months) in 143 cases,and 73 cases more than 5 years. All patients obtained clinical healing. ESR was(44.96±12.41) mm / h before operation and(7.25±3.43) mm / h at final follow-up,there was significant difference between preoperative and postoperative(t=35.06,P=0.000). Lumbar lordosis angle was(36.32±8.55)° before operation and(33.35±8.16)° at final follow-up,there was significant difference between preoperative and postoperative(t=13.90,P=0.000). Conclusion:When conservative treatment fails for 3 months or more,the patients have good spinal stabilization,nerve function is more than grade D of Frankel,CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis.
出处 《中国骨伤》 CAS 2016年第3期270-274,共5页 China Journal of Orthopaedics and Traumatology
关键词 结核 脊柱 外科手术 微创性 抗结核药 局部化疗 Tuberculosis spinal Surgical procedures minimally invasive Antitubercular agents Local chemotherapy
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