發(fā)布時間：2018-03-01 13:07

  本文關鍵詞： 胸腰椎結核 椎弓根釘滑動棒 術后臨床效果 手術節(jié)段融合證據(jù)等級 治療性研究IV級　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討一種新型可滑動椎弓根釘棒內(nèi)固定系統(tǒng)在胸腰椎椎體結核中手術治療的臨床效果和安全性。方法:分析2014年11月~2016年6月我院采用椎弓螺根釘滑動棒內(nèi)固定系統(tǒng)治療的胸腰椎結核患者21例,其中男14例,女7例,年齡為37歲~71歲,平均55.4歲。手術術式均采用后入路病灶清除減壓,椎間植骨融合椎弓根螺釘內(nèi)固定術,評價指標包括術前與術后的美國脊髓損傷神經(jīng)學分類國際標準ASIA損傷分級,評價患者術前、術后脊髓損傷和恢復情況。應用日本骨科協(xié)會評估治療分數(shù)(Japanese Orthopaedic Association,JOA)胸腰椎評分法,評價患者術前、術后胸腰椎功能改善情況。應用疼痛視覺模擬10分評分法(A 10-point visual analogue scale,VAS),評價患者治療前后腰背部疼痛及雙下肢疼痛麻木的改善情況,通過影像學(主要是術前、術后X線)分析椎間植骨融合情況、椎間高度變化及手術前后Cobb角的糾正及遠期丟失角度。結果:21例患者均順利完成手術,均得到隨訪,隨訪時間3-12個月,17例隨訪時間超過12個月,平均10.7個月。術后患者的神經(jīng)功能ASIA分級較術前明顯改善,只有一例ASIA分級與術前無明顯變化,考慮可能由于病椎周圍結核冷膿腫及術前脊柱后凸壓迫脊髓神經(jīng)時間較長,造成脊髓神經(jīng)不可逆性損傷術后患者造成。所有患者的VAS、JOA評分較術前均下降,其中VAS評分由術前的(8.48±1.21)分下降到術后3個月的(1.81±0.60)分,至術后6個月時,進一步下降到(0.90±0.62)分,JOA評分由術前的(8.14±2.056)分,上升到術后3個月的的(24.57±1.63)分,至術后6個月時,進一步上升到(25.52±1.88)分差異均有統(tǒng)計學意義(p0.001)。術后影像學顯示術后1周,1月,3月,6月融合椎體之間高度有變化,由術后1周的(12.17±1.67)mm降至術后12個月的(9.86±1.35)mm,差異有統(tǒng)計學意義(p0.001),術后6個月趨于穩(wěn)定,無一例出現(xiàn)神經(jīng)損害表現(xiàn)。所有患者術后不同隨訪時間節(jié)點滑動棒固定螺釘和球頭釘之間的距離也有不同程度的變化,6個月后基本穩(wěn)定。Cobb角度術后較術前明顯改善,術后1周及術后6個月較術前明顯改善,術后17例超過12個月的患者影像學均達到融合指證,3例隨訪6個月的患者,X線顯示基本植骨基本達到融合指證,剩下1例隨訪3個月的患者X線不能明確是否完全融合,但植骨間隙的透亮區(qū)面積明顯減少。所有手術患者經(jīng)正規(guī)抗結核、換藥、拆線治療出院后,在隨訪期間均未出現(xiàn)切口感染及手術節(jié)段結核復發(fā),未見內(nèi)固定裝置的松動、斷裂及融合椎間隙下沉過大導致后凸畸形等現(xiàn)象發(fā)生。結論:可滑動椎弓根釘棒內(nèi)固定系統(tǒng)治療胸腰椎結核近期臨床效果滿意,有益于植骨節(jié)段融合,可維持手術矯正的后凸畸形,但其遠期效果還需長期、大量樣本臨床觀察。
[Abstract]:Objective: to investigate the clinical effect and safety of a new sliding pedicle screw rod fixation system in the surgical treatment of thoracolumbar vertebral tuberculosis. Methods: from November 2014 to June 2016 in our hospital, we used the pedicle screw slider rod. 21 cases of thoracolumbar tuberculosis treated with internal fixation system, There were 14 males and 7 females, aged from 37 to 71 years (mean 55.4 years). The evaluation indexes included the preoperative and postoperative neurological classification of spinal cord injury (ASIA), the preoperative and postoperative spinal cord injury and recovery. The Japanese Orthopaedic Association was used to evaluate the score of thoracolumbar vertebrae. To evaluate the improvement of thoracolumbar function before and after operation, the pain visual analogue 10-point visual analogue scalescale was used to evaluate the improvement of pain and numbness of lower extremity and waist pain before and after treatment. Postoperative X-ray) analysis of intervertebral bone graft fusion, changes of intervertebral height, correction of Cobb angle before and after operation and long term loss angle. Results all 21 cases were successfully operated and followed up. 17 cases were followed up for more than 12 months with an average of 10.7 months. The neurological function ASIA grade was improved significantly after operation, but only one case had no significant change in ASIA grade. Consider that this may be due to the cold abscess of tuberculosis around the diseased vertebrae and the long time of compression of spinal cord nerve by kyphosis before operation, which may result in irreversible injury of spinal cord after operation. The VASJOA score of all patients is lower than that before operation. The score of VAS decreased from 8.48 鹵1.21 before operation to 1.81 鹵0.60 at 3 months after operation, and further decreased to 0.90 鹵0.62 at 6 months after operation. The score increased from 8.14 鹵2.056 before operation to 24.57 鹵1.63 at 3 months and 6 months after operation. There were significant differences in the scores of 25. 52 鹵1. 88) between the fusion vertebrae and the fusion vertebrae in the first week, January, March and June after operation. From 12. 17 鹵1. 67 mm to 9. 86 鹵1. 35 mm at 12 months after operation, the difference was statistically significant (p 0. 001), and tended to be stable at 6 months after operation. There was no sign of nerve damage in all patients. The distance between the fixed screw and the ball screw at different follow-up time also changed in different degree. After 6 months, the stability of the. Cobb angle was significantly improved compared with that before operation, and there was no significant change in the distance between the fixed screw and the ball head nail at different follow-up time after operation. 1 week after operation and 6 months after operation, the imaging findings of 17 patients more than 12 months after operation reached fusion index. X-ray examination of 3 patients who were followed up for 6 months showed that the basic bone graft basically reached the fusion index. The X-ray of the remaining 1 patient who had been followed up for 3 months could not confirm whether the fusion was complete or not, but the clear area of the bone graft space was significantly reduced. All the patients underwent regular antituberculous therapy, dressing change, and thread disassembly after discharge from the hospital. During the follow-up period, no incision infection or recurrence of surgical segment tuberculosis was found, and no loosening of internal fixation device was observed. Conclusion: the treatment of thoracolumbar tuberculosis with sliding pedicle screw and rod internal fixation system is satisfactory and beneficial to the fusion of bone graft in the treatment of thoracolumbar tuberculosis. Surgical correction of kyphosis can be maintained, but its long-term effects need long-term, a large number of clinical observations.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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