本文選題：胸椎結(jié)核　切入點：橫突植骨　出處：《中國修復(fù)重建外科雜志》2016年07期 　論文類型：期刊論文

【摘要】：目的探討應(yīng)用后路徹底病灶清除、橫突植骨內(nèi)固定術(shù)治療單節(jié)段胸椎結(jié)核的臨床效果。方法2014年3月-2015年5月,行后路徹底病灶清除、橫突植骨內(nèi)固定術(shù)治療17例胸椎結(jié)核患者。男10例,女7例;年齡18~70歲,平均48.5歲。病程1~9個月,平均4個月。病變累及節(jié)段:T_(4、5 )2例,T_(6、7) 5例,T_(7、8) 3例,T_(9、10) 2例,T_(10、11) 4例,T_(11、12) 1例。記錄患者手術(shù)時間、術(shù)中出血量、住院時間;術(shù)后即刻常規(guī)行胸椎正側(cè)位X線片評估減壓及內(nèi)固定情況,隨訪期間行胸椎正側(cè)位X線片或CT檢查判定融合效果;記錄并比較手術(shù)前后紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)、C反應(yīng)蛋白(C reactive protein,CRP)、背部疼痛視覺模擬評分(VAS)、Oswestry功能障礙指數(shù)(ODI)、后凸Kyphosis角,神經(jīng)功能采用美國脊柱損傷協(xié)會(ASIA)標(biāo)準(zhǔn)進(jìn)行分級。結(jié)果手術(shù)時間165~220 min,平均184 min;術(shù)中出血量150~800 m L,平均231 m L;住院時間12~26 d,平均18 d。術(shù)后均無術(shù)區(qū)血腫、傷口裂開等早期并發(fā)癥發(fā)生。17例均獲隨訪,隨訪時間9~22個月,平均17.9個月。均未發(fā)生植骨失敗、內(nèi)固定物折斷、胸腔積液、腦脊液漏、傷口感染、竇道形成等并發(fā)癥�；颊咝g(shù)后均獲滿意椎間融合,融合時間3~8個月,平均5.3個月。術(shù)后即刻及末次隨訪時的ESR、CRP、VAS評分、ODI及后凸Kyphosis角均較術(shù)前顯著改善(P0.05);末次隨訪時ESR、CRP、VAS評分、ODI較術(shù)后即刻進(jìn)一步改善(P0.05),但后凸Kyphosis角與術(shù)后即刻比較差異無統(tǒng)計學(xué)意義(P0.05)。末次隨訪時患者神經(jīng)功能損害均得到較大改善,術(shù)前1例ASIA C級及6例D級患者均恢復(fù)至E級。結(jié)論橫突植骨應(yīng)用于單節(jié)段胸椎結(jié)核手術(shù)中,是一種安全、可靠、有效的新型植骨方式。
[Abstract]:Objective to investigate the clinical effect of posterior radical debridement and transverse-process bone grafting and internal fixation in the treatment of single segment thoracic vertebra tuberculosis. 17 cases of thoracic vertebral tuberculosis were treated by transverse-process bone grafting and internal fixation. There were 10 males and 7 females, the age was 1870 years (mean 48.5 years), the course of disease was 1 ~ 9 months. An average of 4 months. The lesion involved 2 cases of Tast6 / 7) (5 cases of T / T + 7 / 7)) 3 cases of T / T + 9 / 10) / 2 cases of T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T. During the follow-up period, thoracic X-ray or CT examination was performed to determine the fusion effect, erythrocyte sedimentation rate before and after operation was recorded and compared with that before and after operation. The visual analogue score of back pain was evaluated by visual analogue score (VAS) and Oswestry dysfunction index (Oswestry), and the kyphosis Kyphosis angle was recorded and compared. Results the operative time was 165 ~ 220 min (mean 184 min), intraoperative bleeding volume was 150 ~ 800 mL (average 231 mL), hospitalization time was 12 ~ 26 days (mean 18 d), and no hematoma was found in the operation area. All the 17 cases with early complications such as wound opening were followed up for 9 ~ 22 months (mean 17.9 months). No bone graft failure, fracture of internal fixation, pleural effusion, cerebrospinal fluid leakage, wound infection occurred. Complications such as sinus formation. Satisfactory intervertebral fusion was achieved in all patients after operation, and the fusion time was 3 ~ 8 months. The mean time was 5.3 months. At the immediate and the last follow-up, the scores of Kyphosis and kyphosis Kyphosis were significantly improved compared with those before operation, and at the last follow-up, the scores of Kyphosis were improved further than those immediately after operation, but there was no difference between the kyphosis Kyphosis angle and the immediate postoperative. At the last follow-up, the neurological function of the patients was improved greatly. One case of ASIA C and 6 cases of grade D all recovered to grade E before operation. Conclusion Transverse process graft is a safe, reliable and effective new type of bone graft for single segment thoracic vertebra tuberculosis surgery.
【作者單位】： 重慶醫(yī)科大學(xué)附屬第一醫(yī)院骨科;
【分類號】：R687.3

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本文編號：1587439