本文選題：腰椎結(jié)核　切入點(diǎn)：經(jīng)皮椎間孔鏡　出處：《重慶醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討經(jīng)皮內(nèi)鏡下結(jié)核病灶清除、置管持續(xù)灌洗引流、局部化療治療腰椎結(jié)核的安全性、可行性及臨床療效。 方法選擇15例腰椎結(jié)核患者，采用PESS（Percutaneous endoscopicspine surgery）在靜脈麻醉下清除結(jié)核病灶，放置引流管持續(xù)灌洗引流，局部應(yīng)用異煙肼（INH）注射液，時(shí)間12～18d。術(shù)前及術(shù)后1,3,6,12,18個(gè)月隨訪記錄患者血沉結(jié)果（ESR）及Oswestry功能障礙指數(shù)(OswestryDisability Index，ODI)評(píng)分，術(shù)后1,3,12月行CT或MRI檢查；所收集血沉數(shù)據(jù)及評(píng)分使用SPSS軟件進(jìn)行單因素t檢驗(yàn)分析。 結(jié)果15例患者手術(shù)順利，術(shù)中患者耐受性好，病灶清除及置管放置順利，，有1例術(shù)后8天引流管掉落，再次行置管手術(shù)，所有患者沒(méi)有出現(xiàn)神經(jīng)、血管、硬脊膜損傷等并發(fā)癥。所有患者獲得隨訪15～24個(gè)月，術(shù)后1、3、6、12、18個(gè)月分析血沉結(jié)果及ODI功能評(píng)分均比術(shù)前有顯著下降（P0.05），患者在末次隨訪時(shí)均獲得臨床治愈。 結(jié)論經(jīng)皮內(nèi)鏡下病灶清除灌洗局部化療有創(chuàng)傷小、出血少、費(fèi)用低、術(shù)后恢復(fù)快、臨床療效良好等優(yōu)點(diǎn)，是治療無(wú)嚴(yán)重脊柱后凸畸形和嚴(yán)重的神經(jīng)功能損傷的腰椎結(jié)核可供選擇的方法。
[Abstract]:Objective to investigate the safety, feasibility and clinical effect of percutaneous endoscopic tuberculosis (TB) removal, continuous irrigation and drainage, and local chemotherapy in the treatment of lumbar tuberculosis. Methods Fifteen patients with lumbar spinal tuberculosis were treated with PESS(Percutaneous endoscopicspine surgery.These patients were treated with PESS(Percutaneous endoscopicspine surgery.These patients were treated with isoniazid (isoniazid) injection. The results of ESR and OswestryDisablity Index (Oswestry) were recorded before and after 18 months. Ct or MRI were performed on December. The data of ESR and SPSS were analyzed by single factor t test. Results the operation was successful in 15 patients, the patient was well tolerated during the operation, the focus was cleared and the tube was placed smoothly. The drainage tube dropped 8 days after operation in 1 case, and the tube was placed again. There were no nerves and blood vessels in all the patients. All the patients were followed up for 15 ~ 24 months, and the results of ESR and ODI scores were significantly decreased after 18 months compared with those before operation (P 0.05). All the patients were cured at the last follow-up. Conclusion Local chemotherapeutic therapy with percutaneous endoscopic debridement and lavage has the advantages of less trauma, less bleeding, low cost, quick postoperative recovery and good clinical effect. It is an alternative treatment for lumbar tuberculosis without severe kyphosis and severe neurological impairment.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R687.3

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