本文選題：脊柱　切入點(diǎn)：結(jié)核　出處：《重慶醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察單純經(jīng)后路行結(jié)核病灶清除、植骨融合、經(jīng)椎弓根螺釘內(nèi)固定術(shù)治療脊柱結(jié)核的療效。方法：回顧分析2007年2月至2014年9月,我院58例患者行單純經(jīng)后路行結(jié)核病灶清除、植骨融合、經(jīng)椎弓根螺釘內(nèi)固定術(shù)治療的臨床資料。該58例患者中男27例,女31例；年齡23-85歲,平均年齡50.6歲；病史為1月～31個(gè)月,平均7.1月。術(shù)前影像學(xué)資料顯示：發(fā)病部位：胸椎11例,胸腰段8例,下腰椎29例,腰骶部6例,多節(jié)段跳躍病灶4例；受累節(jié)段數(shù)：?jiǎn)喂?jié)段12例,2節(jié)段39例,3節(jié)段7例；各患者均有不同程度的椎旁膿腫：明顯累及硬膜囊3例,病變部位明顯膿腫形成5例,骨質(zhì)不均勻、破壞明顯42例,椎間隙變窄52例,竇道形成3例。術(shù)前給予患者標(biāo)準(zhǔn)化抗結(jié)核治療2-4周,同時(shí)糾正患者電解質(zhì)紊亂,給予患者營(yíng)養(yǎng)支持,待全身結(jié)核中毒癥狀減輕、血紅蛋白含量達(dá)80.0g/L以上、各器官功能無(wú)明顯障礙時(shí),根據(jù)脊柱結(jié)核病灶累及范圍制定在不同入路下行經(jīng)后路結(jié)核病灶清除、植骨融合、經(jīng)椎弓根螺釘內(nèi)固定術(shù)治療方案(當(dāng)患者存在脊髓神經(jīng)受壓癥狀時(shí)可給予患者行急診手術(shù)治療),術(shù)后進(jìn)行標(biāo)準(zhǔn)化藥物抗結(jié)核治療9-18月。結(jié)果：所有患者均獲得定期隨訪(6-95月),平均隨訪30.4個(gè)月。據(jù)影像學(xué)資料顯示：術(shù)前脊柱后凸角測(cè)量為23.6°±10.3°,術(shù)后cobb角為11.20±4.90,末次隨訪cobb角為12.2°±5.3°；所有患者均獲得骨性愈合,愈合時(shí)間為3.5月～8.0月,平均5.2月；術(shù)前VAS評(píng)分為5.7±1.1,術(shù)后1周VAS評(píng)分為2.3±0.7；術(shù)前合并有脊髓損傷患者17例, Frankel分級(jí)[1]C級(jí)3例,D級(jí)14例,末次隨訪C級(jí)患者中仍為C級(jí)1例,E級(jí)2例,末次隨訪D級(jí)患者中仍為D級(jí)3例,E級(jí)11例；術(shù)后復(fù)發(fā)患者2例,復(fù)發(fā)時(shí)間分別為術(shù)后2、3個(gè)月后,均有于院外自行停藥或不規(guī)律服用抗結(jié)核藥病史,經(jīng)再次行病灶清除、加強(qiáng)換藥、嚴(yán)格遵守抗結(jié)核治療后痊愈；術(shù)后恢復(fù)欠佳患者1例,反復(fù)發(fā)作腰背部疼痛不適,工作生活中度限制,其余病人患者無(wú)明顯不適,生活工作不受限制,功能恢復(fù)的優(yōu)良率達(dá)98%。結(jié)論：?jiǎn)渭兘?jīng)后路行結(jié)核病灶清除、植骨融合、經(jīng)椎弓根螺釘內(nèi)固定術(shù)可以有效治療脊柱結(jié)核。
[Abstract]:Objective: to observe the curative effect of tuberculosis focus clearance, bone graft fusion and transpedicular screw fixation in the treatment of spinal tuberculosis through posterior approach. Methods: from February 2007 to September 2014, the treatment of spinal tuberculosis was analyzed retrospectively. The clinical data of 58 patients treated with simple posterior approach for tuberculosis focus clearance, bone graft fusion and transpedicular screw fixation were reviewed. There were 27 males and 31 females, aged 23-85 years, with an average age of 50.6 years. The history ranged from January to 31 months (mean 7.1 months). Preoperative imaging data showed that 11 cases had thoracic vertebrae, 8 thoracolumbar segment, 29 lower lumbar vertebrae, 6 lumbosacral lesions and 4 multiple leaping lesions. The number of involved segments: 12 cases with single segment, 39 cases with 3 segments, 7 cases with paravertebral abscess, 3 cases with obvious involvement of dural sac, 5 cases with obvious abscess, 42 cases with bone inhomogeneity and destruction. 52 cases with narrowing of intervertebral space and 3 cases with sinus formation were treated with standardized antituberculous therapy for 2-4 weeks before operation. The electrolyte disturbance was corrected and nutritional support was given to the patients. The symptoms of systemic tuberculosis poisoning were alleviated and the hemoglobin content was over 80.0 g / L. When there is no obvious disorder in the function of each organ, according to the extent of the involvement of the spinal tuberculosis foci, the posterior approach is used to clear the tuberculosis foci, and the bone grafts are fused. Transpedicular screw fixation (emergency surgical treatment for patients with spinal cord nerve compression symptoms and standardized antituberculous drug therapy for 9 to 18 months after operation. Results: all patients were determined. The imaging data showed that the preoperative kyphosis angle was 23.6 擄鹵10.3 擄, the postoperative cobb angle was 11.20 鹵4.90, and the last follow-up cobb angle was 12.2 擄鹵5.3 擄. The healing time ranged from 3.5 months to 8.0 months with an average of 5.2 months, the preoperative VAS score was 5.7 鹵1.1, and the VAS score was 2.3 鹵0.7.There were 17 patients with spinal cord injury before operation, 3 patients with Frankel grade C and 14 patients with grade D, and 1 patient with grade C with grade E was still in grade C at the last follow-up. In the last follow-up, 11 cases of grade D were still grade D and 11 cases were grade E, and the recurrence time was 2 months and 3 months after operation, all of them had a history of withdrawal or irregular use of antituberculotic drugs outside the hospital, and then removed the lesions again. Strengthen the change of medicine, strictly observe the cure after anti-tuberculosis treatment, 1 patient with poor postoperative recovery, recurrent pain in the back and waist, moderate degree of work and life restriction, other patients have no obvious discomfort, life and work are not restricted, and the rest of the patients have no obvious discomfort, and the life and work of the patients are not restricted. Conclusion: removal of tuberculosis foci, fusion of bone graft and transpedicular screw fixation can be effective in the treatment of spinal tuberculosis.
【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】：2015
【分類號(hào)】：R687.3

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