病灶清除椎间植骨融合内固定治疗胸椎结核合并脊髓损伤的临床研究

Clinical effect of debridement, interbody fusion and internal fixation in the treatment of thoracic spinal tuberculosis and spinal cord injury

目的探讨病灶清除、椎间植骨融合及内固定术治疗胸椎结核合并脊髓损伤的临床效果。方法选取2013-01-2015-01我院收治的胸椎结核合并脊髓损伤患者60例,所有患者均行病灶清除、椎间植骨融合及内固定治疗,记录手术时间、术后出血量及术后骨融合时间。比较术前、术后3周及术后24个月患者的Cobb角变化、脊柱疼痛情况、神经功能恢复情况,使用CT或X线检查评价Cobb角变化,使用VAS疼痛视觉评分法评价疼痛情况,使用ASIA神经功能分级评价神经功能恢复情况。结果:手术时间105～356 min,平均220.5 min;术中出血量112～1895 ml,平均821.8 ml;术后随访期间所有患者结核均未复发;术后3周及术后24个月患者的Cobb角和VAS评分较术前均显著降低(P<0.05);术后24个月随访患者神经功能评分较术前显著改善(P<0.05)。结论病灶清除、椎间植骨融合及内固定胸椎结核合并脊髓损伤效果良好,可有效缓解患者疼痛,恢复患者神经功能,并重建脊柱稳定性,值得临床推广应用。

Objective To investigate the clinical effect of debridement, interbody fusion andinternal fixation in the treatment of thoracic spinal tuberculosis and spinal cord injury. Methods From January 2013 to January 2015, 60 patients with thoracic spinal tuberculosis and spinal cordinjury were treated in our hospital. All patients were treated with debridement, interbody fusion andinternal fixation. The operation time, the amount of bleeding and the time of bone fusion wererecorded. The changes of Cobb angle, pain and recovery of neurological function were comparedbefore and 3 weeks after operation and at the end of the operation for 24 months. CT and X-rayexamination were used to evaluate the changes of Cobb angle, and the pain was evaluated by VASpain visual score. The neurological function was evaluated by ASIA neural function classification.Results The operation time was 105 -356 min, with an average of 220.5 min. The intraoperativeblood loss was 112 -1895 ml, with an average of 821.8 ml. All patients had no recurrence duringfollow-up. The Cobb angle and VAS score of the patients at postoperative 3 weeks and 24 monthswere significantly lower than before operation （P〈0.05）. After 24 months of follow-up, the neurologicalfunction score was significantly improved （P〈0.05）. Conclusion Debridement, interbody fusion andinternal fixation in the treatment of thoracic spinal tuberculosis complicated with spinal cord injuryhas good effect, can effectively relieve the pain of patients, promote the recovery of neurologicalfunction, and reconstruction of spinal stability, it is worthy of clinical application.