本文選題：手術(shù)時機　切入點：胸椎結(jié)核　出處：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:在胸椎結(jié)核伴截癱患者診療中,分析不同手術(shù)時機對患者術(shù)后疼痛、脊髓損傷恢復(fù)情況、脊柱骨性結(jié)構(gòu)改變、術(shù)后相關(guān)并發(fā)癥的影響,研究活動型胸椎結(jié)核伴截癱臨床療效與手術(shù)時機選擇的關(guān)系。方法:回顧性分析2012年1月至2014年1月我院收治脊柱結(jié)核患者的臨床資料,根據(jù)標(biāo)準(zhǔn)選擇活動型胸椎結(jié)核伴截癱患者28例。依照截癱入院至接受手術(shù)時間長短分成兩組:第I組共12名患者,入院抗結(jié)核治療(HRZES)不到3天(平均2.1天)即接受手術(shù)治療;第II組16名患者入院后接受2至6周四聯(lián)(HRZE)抗結(jié)核治療,每周復(fù)查ESR、CRP至正�；蛎黠@下降,合并癥及貧血糾正后手術(shù)。采用SPSS 16.0軟件分析兩組患者術(shù)前、術(shù)后2周及末次疼痛程度、并發(fā)癥、脊髓功能指數(shù)、脊髓殘障指數(shù)、脊髓神經(jīng)殘損分級,研究活動型胸椎結(jié)核伴截癱臨床療效與手術(shù)時機選擇的關(guān)系。結(jié)果:所有患者術(shù)后無截癱加重,神經(jīng)功能在術(shù)后1天-3月恢復(fù)較快,隨訪時間14-36月(平均18.5月)。第I組7例發(fā)生術(shù)后并發(fā)癥,第II組2例術(shù)后相關(guān)并發(fā)癥。余患者切口均I期愈合、未見復(fù)發(fā)。兩種手術(shù)時機的術(shù)后并發(fā)癥行統(tǒng)計學(xué)檢驗,差別有統(tǒng)計學(xué)意義(P0.05),可以認(rèn)為早期手術(shù)治療組(第I組)并發(fā)癥較多�；颊咝g(shù)前、術(shù)后及末次隨訪Cobb角、MPQ、ODI、ASIA殘損分級(組內(nèi))差別有統(tǒng)計學(xué)意義(P0.05),手術(shù)干預(yù)對患者脊髓功能恢復(fù)有效果;兩種手術(shù)時機對患者功能恢復(fù)(組間)差別無統(tǒng)計學(xué)意義(P0.05),兩種手術(shù)時機對于患者術(shù)后功能恢復(fù)無明確影響。結(jié)論:以規(guī)范抗結(jié)核藥物治療為基礎(chǔ)的活動型胸椎結(jié)核伴截癱,原則上應(yīng)早期手術(shù)。早期接受手術(shù)的活動型胸椎結(jié)核伴截癱患者術(shù)后神經(jīng)功能恢復(fù)良好,術(shù)后短期并發(fā)癥較多,應(yīng)注意密切觀察,及時處理�；顒有托刈到Y(jié)核伴截癱病理機制不同于急性脊髓損傷,病情復(fù)雜的活動型胸椎結(jié)核伴截癱患者在一定時間窗內(nèi)采取合并癥控制后盡早手術(shù)的個體化治療方案,神經(jīng)功能恢復(fù)好,無須急診手術(shù)治療。具體時間窗的制定有待于進一步研究。
[Abstract]:Objective: in the diagnosis and treatment of thoracic spinal tuberculosis with paraplegia, the effects of different operative timing on postoperative pain, recovery of spinal cord injury, changes of spinal bone structure and postoperative complications were analyzed. To study the relationship between the clinical effect of active thoracic vertebral tuberculosis with paraplegia and the choice of surgical timing. Methods: the clinical data of patients with spinal tuberculosis admitted to our hospital from January 2012 to January 2014 were analyzed retrospectively. According to the criteria, 28 patients with active thoracic spinal tuberculosis with paraplegia were selected. According to the length of admission to paraplegia, they were divided into two groups: group I (12 patients) received surgical treatment in less than 3 days (mean 2.1 days); After admission, 16 patients in group II were treated with anti-tuberculosis therapy combined with HRZE for 2 to 6 days. The levels of CRP in group II were reduced to normal or significantly lower every week, complications and anemia were corrected after operation. SPSS 16.0 software was used to analyze the two groups of patients before operation. The degree of pain, complications, spinal cord function index, spinal cord disability index, spinal cord nerve damage grade, 2 weeks and the last time after operation, To study the relationship between the clinical effect of active thoracic vertebra tuberculosis with paraplegia and the choice of surgical timing. Results: all the patients had no exacerbation of paraplegia after operation, and the neurological function recovered more quickly from one day to three months after operation. The follow-up time was 14-36 months (mean 18.5 months). Postoperative complications occurred in 7 cases in group I and 2 cases in group II. The difference was statistically significant (P 0.05), and it could be considered that there were more complications in the early operative treatment group (group I). After operation and at the last follow-up, there was a statistically significant difference in the grade of Asia lesion (P 0.05) between the patients with Cobb's angle and MPQ ODI. The effect of surgical intervention on the recovery of spinal cord function was significant. There was no significant difference in functional recovery between the two groups (P 0.05). The two operative timing had no significant effect on the postoperative functional recovery. Conclusion: the active thoracic spinal tuberculosis with paraplegia based on the standard antituberculous drug therapy. In principle, early operation should be carried out. The patients with active thoracic vertebra tuberculosis and paraplegia who received early operation recovered well after operation, and had more short-term complications after operation, so we should pay close attention to observe closely. The pathological mechanism of active thoracic vertebra tuberculosis with paraplegia is different from that of acute spinal cord injury. The recovery of neural function without emergency surgical treatment. The specific time window needs further study.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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