一期前路病灶清除植骨椎体钉道强化固定治疗老年胸腰椎结核

Efficacy of one-stage debridement and internal fixation with bone cement strengthening in the treatment of senile osteoporosis thoracolumbar tuberculosis

目的对伴有老年性骨质疏松的胸腰椎结核采用一期前路病灶清除植骨融合椎体钉道骨水泥强化内固定术治疗,评估其临床疗效。方法回顾性分析2012-01-2015-01本院采用一期前路病灶清除植骨融合椎体钉道骨水泥强化内固定术治疗34例年龄大于65岁的老年性骨质疏松胸腰椎结核患者的临床资料、术前准备、手术方法、术后处理、随访结果及疗效评价指标(包括VAS评分、ODI指数、Cobb’s角、C7矢状位铅垂线和红细胞沉降率)。结果手术时间平均为(190±27)min,术中失血量平均(645±137)ml,术后并发症发生率5.8%(2/34),随访平均(26.5±3.9)个月,术后抗结核治疗平均(21.5±4.7)个月,34例患者均达到植骨融合标准,融合时间平均(9.1±3.2)个月。所有患者术后2周及末次随访的VAS评分、ODI指数、Cobb’s角、C7矢状位铅垂线和红细胞沉降率较术前均改善,差异有统计学意义(P<0.05)。术后神经功能ASIA分级提升1~2级,6例达到B^C级,28例达到D^E级。结论严格抗结核并抗骨质疏松治疗下,行一期前路病灶清除植骨融合椎体钉道骨水泥强化内固定术,是治疗老年性骨质疏松胸腰椎结核安全而有效的手术方法。

Objective To analyze the therapeutic effects of one-stage anterior debridement and in- ternal fixation with bone cement strengthening in the treatment of senile osteoporosis thoraeolumhar tuber- culosis. Methods From January 2012 to January 2015, 34 patients with senile osteoporosis thoracolum- bar tuberculosis were treated by one-stage anterior debridement and internal fixation with bone cement strengthening. The clinical data, preoperative preparation, surgical method, postoperative treatment, fol- low-up results and efficacy evaluation index were evaluated before surgery, 2 weeks after surgery and at the last follow-up. Results The average operation time and blood loss were （190 ± 27） rain and （645 ± 137） ml. The average period of follow-up was （26.5 ± 3.9） months. The average period of postoperative an- ti-tuberculosis treatment was （21.5 ± 4.7） months. The average fusion time of intervertebral bone graft was （9.1 ± 3.2） months. The average VAS, ODI index, Cobb angle, C7 sagittal plumb and ESR of the patients were significantly improved after surgery. And compared with preoperation, the differences were statisti-cally significant （P〈O.05）. Conclusion The method of one-stage anterior debridement and internal fixation with bone cement strengthening is a safe and effective treat- ment for senile osteoporosis thoracolumbar tuberculosis.