手术治疗老年轻型GATAⅡ型胸腰椎结核的疗效

Effect of surgical treatment for thoracolumbar spinal tuberculosis of GATA type Ⅱ with elderly patients

目的分析老年轻型GATAⅡ型胸腰椎结核的手术疗效。方法对抗结核药物治疗无效的21例老年轻型GATAⅡ型胸腰椎结核患者采用手术治疗。评估患者患椎后凸Cobb角、病变愈合、神经功能、疼痛及体力状况。结果患者均获得随访,时间9~40个月。患者Cobb角由术前20.6°±2.3°恢复到术后4°±1.6°,差异有统计学意义(P<0.05)。术后3个月ESR恢复正常。VAS评分由术前(8.8±0.9)分下降至术后1个月(1.3±0.2)分,差异有统计学意义(P<0.05)。19例神经损伤的患者术后3个月Frankel分级均提高1~2级。术后6个月体力状况ECOG分级:2级5例全部恢复到1级,3级12例中9例恢复到1级、3例恢复到2级,4级4例中1例恢复到1级、3例恢复到2级。结论一期后路钉棒复位内固定术治疗老年轻型GATAⅡ型胸腰椎结核疗效显著,可矫正或防止后凸畸形,减轻患者疼痛,维持和改善神经功能,提高患者生存质量。

Objective To analyze the surgical efficacy of elderly patients with GATA typeⅡthoracolumbar tuberculosis.Methods Twenty-one elderly patients with GATA typeⅡthoracolumbar tuberculosis who were ineffective in non-surgical treatment were evaluated with Cobb angle,lesion healing,neurological function,pain and physical condition before and after the operation.Results The patients were followed up for 9~40 months.The Cobb angle was restored to 4°±1.6°after surgery from 20.6°±2.3°before surgery(P<0.05).ESR returned to normal at 3 months after operation.The VAS decreased from(8.8±0.9)points to(1.3±0.2)points at 1 month after operation,the difference was statistically significant(P<0.05).The Frankel grade of 19 patients with neurological injury improved 1~2 grades at 3 months after surgery.The ECOG score classfication of physical status at 6 months after operation:5 cases of grade 2 recovered to grade 1;there were 12 patients in grade 3,of which 9 cases recovered to grade 1,3 cases recovered to grade 2;4 cases were in grade 4,of which 1 case recovered to grade 1 and 3 cases recovered to grade 2.Conclusions The one-stage posterior screw rod reduction and internal fixation is effective in treating elderly patients with GATA typeⅡthoracolumbar tuberculosis.It can correct or prevent kyphosis,reduce pain,maintain and improve neurological function,and improve the quality of life of patients.