摘要
目的:观察一期经后路环脊髓周围病灶清除植骨融合椎弓根钉固定治疗不同发病节段的胸腰椎结核性后凸畸形并截瘫的疗效。方法2008年5月至2014年3月,新疆维吾尔自治区人民医院骨一科共收住胸腰椎结核性后凸畸形并截瘫的患者30例,男21例,女9例,平均年龄27(11~65)岁。病变节段:T3~54例、T6~1010例,胸腰段12例,腰椎4例,累计2个椎体6例,3个椎体14例,4个椎体10例。所有病例均选择一期经后路环脊髓周围结核病灶清除钛网支撑植骨融合并椎弓根钉固定术。术后正规服用抗结核药物6~12个月,随访观察植骨融合时间,后凸畸形矫正度和截瘫恢复情况,血浆沉降率(ESR)、C-反应蛋白(CRP)变化情况。结果所有病例得到随访,植骨融合时间为8个月,融合率100%。后凸畸形由术前的(77±12)°矫正为术后的(9.7±1.6)°,平均纠正57°(P <0.05)。随访时矫正度丢失<1°。 ESR 由术前的(64±44) mm/h 下降为术后的(15±7)mm/h (P <0.05);CRP 由术前的(72±40)mg/L 下降为术后的(13±5)mg/L(P <0.05)。所有患者神经功能都完全恢复,最长的8个月时间内 Frankel 神经功能达到 E 级。本组脊柱结核均治愈,无严重手术并发症。结论根据胸腰椎结核性后凸畸形和截瘫严重程度,选择一期经后路手术治疗方式能获得有效的根治,可行彻底的病灶清除、植骨融合并畸形矫正后内固定获得脊柱前后方的稳定性,能完全恢复脊髓神经功能,改善患者的生活质量。
Objective To evaluate the clinical results of the patients with severe kyphosis and paraplegia in different spine segment due to tuberculosis of thoracic and lumbar had been treated by one stage posterior surgical procedure to debriment of lesion and titian mesh bone fusion with internal fixation by pedicle screw system.Method From May 2008 to March 2014, there were total 30 patients with severe kyphosis and paraplegia in different spine segment due to tuberculosis of thoracic and lumbar in Department of Orthopaedics,the People′s Hospital of Xinjiang Uygur Autonoumy Region.The average age was 27 years, ranging from 11 -65 years old, 21 male and 9 female.Tuberculosis lesion were located in differental spine segment:T3-54 four cases,T6-10 ten cases,T11-L2 twelve cases, L3-L5 four cases,two vertebral bodies were involved in 6 cases,three vertebralbodies were involved in 12 cases,and four vertebral bodies were involved in 10 cases.All patients were treated by one stage posterior surgical procedure to debriment of lesion and titian mesh bone fusion with internal fixation of pedicle screw system .There were investigated the period of bone grafting fusion,kyphosis deformity correction degree ,ESR,CRP preoperatively and postoperatively were compared before and after operation, and neurological function recovery record postoperatively, and neurological function recovery record postoperatively.Result In the final follew-up,all patients got solid fusion in a average of eight months.The kyphosis deformity was corrected from(77 ±12)°preoperatively to(9.7 ±1.6)°postoperatively,in a average of 57°,the result is significant( P 〈0.05).The value of ESR degraded from(64 ±44) mm/h preoperatively to(15 ±7) mm/h,through statistic analyzing,the change of ESR value between postoperative and preoperative is significant( P 〈0.05) .The value of CRP degraded from(72 ±40) mg/L preoperatively to(13 ±5) mg/L postoperatively,via statistic analyzing,the change of CRP value between postoperative and preoperative is significant ( P 〈0.05) .All Patients neurological function deficiency achieved complete recovery,the longest time being within 8 months.All patients were cured thoroughly and there was no seroius complication.Conclusion The one stage debriment of lesion and threaded fusion cage with internal fixation of vertebral pedicle surgical procedure,according to the extent of severe kyphosis and paraplegir due to tuberculosis of thoracic and lumbar vertebrae can achieve thoroughly debridement of tuberculosis,solid interbody fusion,good correction of deformity and forever stability of spine with posterior internal fixation,it get successfully rehablitation for neurological function and improve the life quality.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第37期2993-2997,共5页
National Medical Journal of China
关键词
结核性后凸畸形
内固定
截瘫
Tuberculosis of thoracic and lumbar
Kyphosis and paraplegia
Internal fixation