本文選題：脊柱結(jié)核(spinal + tuberculosis)　； 參考：《中南大學(xué)》2014年博士論文

【摘要】：第一章椎弓根螺釘系統(tǒng)治療兒童脊柱結(jié)核后凸畸形的效果 目的：探討椎弓根螺釘系統(tǒng)治療兒童脊柱結(jié)核后凸畸形的效果。 方法：2005年4月至2010年8月,本院手術(shù)治療兒童脊柱結(jié)核21例(男12例,女9例),病變部位為T(mén)2-S1,平均累及2.1個(gè)椎體,ASIA分級(jí)C級(jí)4例,D級(jí)12例,E級(jí)5例,后凸畸形角為15.7-71.9°,平均34.2±18.8°,13例采用一期后路病灶清除植骨融合椎弓根螺釘內(nèi)固定術(shù)治療,8例采用一期后路椎弓根螺釘內(nèi)固定前路病灶清除植骨融合術(shù)治療,觀察并比較術(shù)前、術(shù)后及末次隨訪時(shí)患者后凸畸形角以及神經(jīng)功能恢復(fù)情況。 結(jié)果：隨訪時(shí)間36～68月(平均45.3月),所有患者療效明顯且無(wú)神經(jīng)損傷并發(fā)癥發(fā)生,均獲得滿(mǎn)意骨性融合,無(wú)結(jié)核復(fù)發(fā)病例。一期后路手術(shù)平均耗時(shí)142分鐘,低于一期前后路手術(shù)平均耗時(shí)(330分鐘,p0.05),一期后路手術(shù)和一期前后路手術(shù)的手術(shù)出血量分別為497mL和933mL(p0.05)。所有患者術(shù)后3個(gè)月內(nèi)ESR值均恢復(fù)正常；至末次隨訪時(shí),ASIA分級(jí)平均增加1至2級(jí),無(wú)病例發(fā)生神經(jīng)功能惡化；術(shù)后后凸畸形角由術(shù)前34.2±18.8°(15.7-71.9°)下降至14.7±9.0°(3.2-29.3°),較術(shù)前明顯改善(p0.05),末次隨訪時(shí)為17.1±9.3°(6.1-32.8°),矯正丟失1.0-3.9°,平均2.4±0.9°,較術(shù)后無(wú)明顯差異(少0.05)；采用不同手術(shù)方式的患者的術(shù)前、術(shù)后后凸畸形角以及角度改善情況有顯著性差異(p0.05),但隨訪期間矯正角度丟失無(wú)顯著性差異(p0.05)。 結(jié)論：對(duì)于兒童脊柱結(jié)核,后路椎弓根螺釘內(nèi)固定系統(tǒng)對(duì)于脊柱結(jié)核引起的后凸畸形治療效果滿(mǎn)意。 第二章椎弓根螺釘系統(tǒng)對(duì)于兒童結(jié)核患者椎體及椎管發(fā)育的影響 目的：評(píng)價(jià)椎弓根螺釘內(nèi)固定系統(tǒng)對(duì)于兒童脊柱結(jié)核患者椎體及椎管發(fā)育的影響。 方法：回顧性研究21例由于脊柱結(jié)核行病灶清除椎弓根螺釘內(nèi)固定治療的兒童患者,隨訪時(shí)間為24個(gè)月以上。對(duì)椎弓根螺釘固定的節(jié)段和未固定的節(jié)段進(jìn)行影像學(xué)參數(shù)的測(cè)量,并評(píng)價(jià)椎弓根螺釘植入是否會(huì)對(duì)椎體及椎管發(fā)育造成影響。 結(jié)果：手術(shù)時(shí)患者年齡1-13歲,平均7.13歲。21例患者中,一共有142個(gè)節(jié)段納入研究,包括63個(gè)未固定的節(jié)段和79個(gè)至少一側(cè)椎弓根螺釘固定的節(jié)段。術(shù)前和末次隨訪時(shí)的椎體及椎管影像學(xué)參數(shù)之間有明顯的差異(p0.05)。而使用內(nèi)固定植入的節(jié)段和未固定的節(jié)段的椎體及椎管影像學(xué)參數(shù)之間無(wú)明顯差異(p0.05)。固定和未固定的腰椎節(jié)段比胸椎節(jié)段生長(zhǎng)更快(p0.05)。 結(jié)論：椎弓根螺釘植入并不會(huì)明顯影響椎體及椎管的生長(zhǎng)發(fā)育,可以在兒童脊柱結(jié)核患者中使用。
[Abstract]:Chapter 1 the effect of pedicle screw system in the treatment of kyphosis deformity in children with tuberculosis objective: to investigate the effect of pedicle screw system in the treatment of kyphosis deformity in children. Methods: from April 2005 to August 2010, 21 cases (12 males and 9 females) with spinal tuberculosis in our hospital were treated with spinal tuberculosis. The lesion site was T2-S1. The average involvement of ASIA grade C involved 2.1 vertebral bodies in 4 patients with grade D and grade E in 5 patients. The angle of kyphosis was 15.7-71.9 擄, with an average of 34.2 鹵18.8 擄and 13 cases were treated with one stage posterior debridement and fusion with pedicle screw fixation. The angle of kyphosis and the recovery of nerve function were observed after operation and at the last follow-up. Results: the follow-up time was 36 ~ 68 months (mean 45.3 months). All the patients had obvious curative effect and no complication of nerve injury. Satisfactory bone fusion was obtained without recurrence of tuberculosis. The average time of one stage posterior approach operation was 142 minutes, which was lower than that of one stage anterior and posterior approach operation, the average time was 330 minutes (p 0.05). The blood loss of one stage posterior approach and one stage anterior and posterior approach were 497 mL and 933 mL / ml respectively. The ESR value of all the patients returned to normal within 3 months after operation, and at the last follow-up, the Asia grade increased by 1 to 2 grades on average, and no neurologic deterioration occurred in the patients. The postoperative kyphosis angle decreased from 34.2 鹵18.8 擄/ 15.71.9 擄to 14.7 鹵9.0 擄/ 3.2-29.3 擄/ L, which was significantly improved than that before operation. At the last follow-up, it was 17.1 鹵9.3 擄(6.1-32.8 擄), and the corrected loss was 1.0-3.9 擄(average 2.4 鹵0.9 擄). There was no significant difference between the two groups (0.05 擄). There was significant difference in the angle and angle of kyphosis after operation, but there was no significant difference in correction angle loss during follow-up. Conclusion: for children with spinal tuberculosis, the posterior pedicle screw fixation system is effective in the treatment of kyphosis caused by spinal tuberculosis. Chapter 2 the effect of pedicle screw system on the development of vertebral body and spinal canal in children with tuberculosis objective: to evaluate the effect of pedicle screw fixation system on the development of vertebral body and spinal canal in children with spinal tuberculosis. Methods: Twenty-one children with spinal tuberculosis underwent debridement and pedicle screw fixation. The follow-up time was more than 24 months. The imaging parameters of the segmental and unfixed segments of pedicle screw fixation were measured and the effects of pedicle screw implantation on the development of the vertebral body and the spinal canal were evaluated. Results: of the 21 patients aged 1-13 years (mean 7.13 years), 142 segments were included in the study, including 63 unfixed segments and 79 segments with at least one pedicle screw fixation. There was significant difference between the imaging parameters of vertebral body and spinal canal before operation and at the last follow-up (p 0.05). There was no significant difference in the imaging parameters of the vertebral body and the spinal canal between the segments implanted with internal fixation and those without fixation. The fixed and unfixed segments of the lumbar vertebrae grow more rapidly than the thoracic segments. Conclusion: pedicle screw implantation can not significantly affect the growth and development of vertebral body and spinal canal, and can be used in children with spinal tuberculosis.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R726.8

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