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多节段胸腰椎脊柱结核外科治疗的回顾性研究
引用本文:张嘉利,李大伟,马远征,杨达宇,王天天. 多节段胸腰椎脊柱结核外科治疗的回顾性研究[J]. 中国防痨杂志, 2013, 35(5): 305-308
作者姓名:张嘉利  李大伟  马远征  杨达宇  王天天
作者单位:北京,解放军第三○九医院 全军骨科中心[张嘉利(山西医科大学研究生院在读研究生)、李大伟、马远征、杨达宇、王天天]
摘    要:
目的 探讨在多节段胸腰椎脊柱结核患者在抗结核治疗的基础上,采用不同入路病灶清除、植骨融合及内固定术的治疗效果。 方法 搜集解放军第三○九医院2009年10月至2011年9月间收治的50例多节段胸腰椎脊柱结核患者,根据各处病灶不同病变特点、部位及椎体破坏程度选择不同的手术术式,按术式不同分为4个组:A组:前路病灶清除、植骨、前路内固定术10例;B组:胸椎或胸腰段侧前方病灶清除植骨、经椎弓根固定术6例;C组:腰椎后路病灶清除植骨、经椎弓根内固定术22例;D组:前路病灶清除植骨、一期后路椎弓根固定术12例。对手术时间及术后恢复情况进行分组整理分析,50例患者治疗前18例合并脊髓功能障碍,Frankel分级D级12例,C级4例,B级2例,E级32例。34例患者伴后凸畸形,Cobb角度10°~20°者16例,>20°者18例;对随访的患者Frankel分级、Cobb角度等进行治疗前后对比研究。 结果 A组手术平均时间(3.6±0.6)h,术中平均出血量(455±54)ml;B组手术平均时间(4.7±0.8)h,术中平均出血量(670±58)ml;C组手术平均时间(4.8±0.9)h,术中平均出血量(630±62)ml;D组手术平均时间(4.1±0.7)h,术中平均出血量(420±46)ml。术后1~3周患者症状均明显减轻。50例患者均获得随访,18例合并脊髓功能障碍的患者末次随访时Frankel分级改善1级者14例,改善2级者4例。50例患者术后后凸畸形矫正率为45.6%±12.3%,末次随访矫正角度丢失率为23.7%±20.4%。 结论 根据患者病变椎体的破坏范围及程度、脓肿的部位及大小,选择不同的手术入路及内固定方式,进行彻底的病灶清除和植骨融合术,可对多节段脊柱结核取得较好的治疗效果。 

关 键 词:结核   脊柱/外科学  胸椎  腰椎  回顾性研究  
收稿时间:2013-02-22

The retrospective study of surgical treatment of multi-segmental thoracolumbar tuberculosis
ZHANG Jia-li,LI Da-wei,MA Yuan-zheng,YANG Da-yu,WANG Tian-tian. The retrospective study of surgical treatment of multi-segmental thoracolumbar tuberculosis[J]. The Journal of The Chinese Antituberculosis Association, 2013, 35(5): 305-308
Authors:ZHANG Jia-li  LI Da-wei  MA Yuan-zheng  YANG Da-yu  WANG Tian-tian
Affiliation:Orthopaedics Center,the 309th Hospital of People’s Libra tion Army,Beijing 100091,China
Abstract:
Objective To investigate the surgical treatment effect of multi-segmental thoracolumbar tuberculosis in patients who underwent debridement, bone grafting and internal fixation combined with anti-tuberculosis chemotherapy. Methods Fifty adult patients with multi-segmental thoracolumbar tuberculosis,admitted in the 309th hospital of the PLA from October 2009 to September 2011, undergone different surgical procedures were reviewed retrospectively. All patients were divided 4 groups as follows according to site and extent of the lesion, Frankel level, the kyphosis Cobb angle, surgical treatment and clinical outcome. Group A included 10 cases who underwent anterior radical debridement, bone grafting and internal fixation. Group B included 6 cases who underwent posterior instrumentation and interlaminar bone graft plus anterior radical debridement and strut graft either by one-stage or two-stage. Group C included 22 cases who underwent front side radical debridment,strut graft and posterior instrumentation in thoracic or thoracolumbar spine. Group D included 12 cases who underwent single-stage posterior debridement and instrumentation. Eighteen patients suffered neurological deficit including 12 cases for Frankel D, 4 cases for Frankel C, 2 cases for Frankel B,32 cases for Frankel E. The kyphosis Cobb angle ranged from 10°to 20°in 16 cases,over 20°in 18 cases. Frankel level and the Cobb angle were compared before and after operation in follow-up patients. Results The average operation time and blood loss were (3.6±0.6)h and (455±54)ml in group A,(4.7±0.8)h and (670±58)ml in group B,(4.8±0.9)h and (630±62)ml in group C, (4.1±0.7)h and (420±46)ml in group D. ESR restored to normal value about 8-12 weeks after operation,and the patient’s symptoms were significantly improved about 1-3 weeks after operation. At the last time of follow-up,14 cases had improved 1 grade, and 4 cases improved with 2 grades in Frankel level. Kyphosis Cobb angle was corrected by 45.6%±12.3%, with loss of correction about 23.7%±20.4% at last time of follow-up in 50 patients. Conclusion The radical debridement and bone grafting can improve satisfactorily the efficacy in patients with multi-segmental thoracolumbar tuberculosis based on the scope of vertebrae damage,the site and size of abscess, and different surgical procedure and internal fixation.
Keywords:Tuberculosis   spinal/surgery   Thoracic vertebrae   Lumbar vertebrae   Retrospective studies
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