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.

Clinical Effects of Diseased Segment Fixation in Treatment of Patients with Spinal Tuberculosis

[Objective]To explore the clinical effects of diseased segment fixation in the treatment of patients with spinal tuberculosis.[Methods]Retrospectively 84 cases with spinal tuberculosis in our hospital from January 2009 to December 2014 were analyzed according to different operation methods,and they were divided into diseased segment fixation group (fixed in lesions involving individual neurons,38 cases) and non-diseased segment fixation group (using long and short segmental fixation,46 cases).The intraoperative blood loss,operative time during the surgery,the ESR and preoperative and postoperative CRP level,CRP,VAS score,Franke 1 classification and Cobb Angle of the two groups were observed and analyzed.[Results]Blood loss and operation time of diseased segment fixation group were superior than diseased non-segment fixation group,the difference was statistical significance (P ＜0.05);ESR and CRP of two groups reduced to normal levels 6 months after surgery,but there was no statistical difference between two groups(P ＜0.05).VAS score at the last follow-up of the two groups were decreased,and VAS score of the diseased segment fixation group was lower than that of the non-diseased segment fixation group (P ＜0.05);The Frankel function classification of the two groups were obviously recovered;Cobb angle at the last follow-up of the two groups were less than that before surgery,but the correction of Cobb's angle and angle loss of preoperative and postoperative and the last follow-up of two groups were not statistically different.[Conclusion]Diseased segment fixation in the treatment of patients with spinal tuberculosis is a safe and effective therapy,which can effectively preserve normal vertebral motion nerve unit adjacent to diseased segment with its advantage of less intraoperative bleeding and shorter operation time.