钴合金椎弓根螺钉植入修复脊柱结核重度后凸畸形：自身对照临床试验方案

BACKGROUND: There is evidence that internal fixation through an anterior or posterior approach for treatment of severe kyphotic deformity in spinal tuberculosis exhibits good curative effects. However, few prospective, long-term follow-up case control studies are reported.     

比较不同方式置入椎弓根钉内固定修复胸腰椎爆裂骨折的生物相容性

BACKGROUND: During the repair of thoracolumbar fracture, pedicle screw fixation is a commonly used treatment method. In the process of fixation, the different approaches can be used.  OBJECTIVE: To compare effect and biocompatibility of pedicle screw by percutaneous approach, posterior median approach, and intervertebral space approach for thoracolumbar fracture.  METHODS: 118 cases of thoracolumbar fracture were included after pedicle screw fixation. All patients were divided into three groups according to the approach: posterior median approach group (38 cases), intervertebral space approach group (40 cases) and percutaneous approach group (40 cases). After 12 months of follow-up, perioperative conditions, pain score, vertebral height of anterior border, kyphosis correction effect, adverse events and biological compatibility were compared among three groups. RESULTS AND CONCLUSION: (1) Operation time, intraoperative bleeding and time in bed after surgery were shorter or less in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group. Postoperative drainage was better in percutaneous approach and intervertebral space approach groups than in the posterior median approach group (all P < 0.05). Except drainage in the percutaneous approach and intervertebral space approach groups, no significant difference in other indicators was found. (2) Patients received imaging examination at different time points. The percentage of anterior vertebral height and kyphosis were significantly improved immediately after treatment and in final follow-up (all P < 0.05). No significant difference was detected before treatment, immediately after treatment and in final follow-up. (3) Visual Analogue score was identical before treatment. Visual analogue score was lower in the percutaneous approach and intervertebral space approach groups than in the posterior median approach group at 24 hours and 3 days after treatment and in final follow-up (all P < 0.05). No significant difference was detectable at 24 hours and 3 days after treatment and in final follow-up between the percutaneous approach and intervertebral space approach groups. (4) No rejection or wound non-healing was seen at 12 months after treatment. Some patients suffered from mild low back pain, which was improved by active symptomatic treatment. (5) These findings suggest that intervertebral space approach percutaneous approach obtained satisfactory outcomes compared with posterior median approach for treatment of thoracolumbar spine fractures, and good biocompatibility was found.        

病椎间固定在脊柱结核患者治疗中的应用价值

[目的]探讨病椎固定在脊柱结核患者治疗中的疗效.[方法]回顾性分析本院2009年1月到2014牟12月收治的脊柱结核患者84例,根据患者意愿分为两组.病椎间组:38例,固定在病变累及的单个神经单元中完成;超病椎间组:46例,采用长、短节段内固定,范围超出病灶外2个运动神经单元.比较两组患者的术中出血量、手术时间及术前、术后血沉(ESR)、C反应蛋白(CRP)、视觉模拟(VAS)评分及Frankel分级、Cobb角.[结果]病椎间组术中出血量及手术时间均优于超病椎间组,差异有统计学意义(P＜0.05);两组患者ESR、CRP术后6个月均降低至正常水平,组间比较差异无统计学意义(P＞0.05);病椎间组与超病椎间组末次随访时VAS评分较术前均下降,且低于超病椎间组,差异有统计学意义(P＜0.05);两组患者Frankel功能分级较术前均明显恢复;两组患者末次随访时Cobb角均小于术前Cobb角.但两组间术前、术后、末次随访、矫正度数及丢失度数比较差异无统计学意义.[结论]病椎固定治疗脊柱结核是安全、有效的,能有效保留与病椎相邻正常运动神经单元,并有术中出血少、手术时间短的优势,值得临床推广应用.     

后路病灶清除植骨融合内固定术在脊柱结核患者中的应用效果

目的探讨后路病灶清除植骨融合内固定术在脊柱结核患者中的应用效果。方法回顾性分析2009年1月至2014年1月来保定市第三中心医院就诊的脊柱结核患者共84例,所有患者均接受后路病灶清除植骨融合内固定术。记录治疗前、后患者神经功能ASIA分级、功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、后凸角、红细胞沉降率(ESR);同时记录患者在手术时的手术时间和术中出血量,对数据进行对比分析。结果手术后后凸角、ODI与术前相比明显改善,差异有统计学意义(P0.05);手术后患者VAS评分为和ESR明显改善,差异有统计学意义(P0.05);患者平均手术时间为(198.9±44.3)min,平均出血量(551.2±123.6)mL。术后随访发现无复发及感染发生,且无并发症发生。结论后路病灶清除植骨融合内固定术用以治疗脊柱结核患者具有良好的效果,且安全性较高。