本文選題：胸腰椎結(jié)核 + 多階段及跳躍性　； 參考：《中國(guó)矯形外科雜志》2017年17期

【摘要】：[目的]探討不同術(shù)式治療多節(jié)段及跳躍性胸腰椎結(jié)核的療效。[方法]2008年5月~2015年3月,本科共收住25例患者,男17例,女8例,年齡11~59歲,平均27歲。術(shù)前常規(guī)攝全脊柱正側(cè)位X線片、CT平掃加3D重建和MRI。病變節(jié)段:胸椎11例,胸腰段9例,腰椎5例,累及4個(gè)椎體10例,5個(gè)椎體7例,6個(gè)椎體5例,7個(gè)椎體3例。手術(shù)方式:7例行開胸"前路"手術(shù),4例行開胸"前后"入路手術(shù),9例行胸膜外腹膜后"前后"入路手術(shù),5例行腹膜外"前后"入路手術(shù)。出院后正規(guī)抗結(jié)核治療6~12個(gè)月,定期隨訪觀察植骨融合時(shí)間,后凸畸形矯正度、椎間隙高度和神經(jīng)功能恢復(fù)程度,血沉、C反應(yīng)蛋白變化情況。[結(jié)果]本組患者均順利接受手術(shù),無(wú)嚴(yán)重并發(fā)癥。至術(shù)后第3 d,后凸畸形平均糾正至27°,與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。椎間隙高度平均增加4.2 mm,與術(shù)前相比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1周,ESR和CRP分別下降至15 mm/h,16mg/L,其變化均具有統(tǒng)計(jì)學(xué)意義(P0.05),至術(shù)后3個(gè)月,所有合并脊髓神經(jīng)損傷患者神經(jīng)功能均恢復(fù)至E級(jí)。所有病例均得到隨訪,隨訪時(shí)間1~3.5年,平均植骨融合時(shí)間為7個(gè)月,融合率100%。至末次隨訪,所有患者ESR和CRP在正常范圍內(nèi),且均無(wú)明顯波動(dòng),無(wú)矯形角度丟失。[結(jié)論]個(gè)體化選擇前路或前后聯(lián)合的術(shù)式不僅可以根治結(jié)核,同時(shí)可以恢復(fù)胸腰椎正常生理曲度,重建脊柱穩(wěn)定性,使患者回歸正常生活。
[Abstract]:[objective] to evaluate the efficacy of different surgical methods in the treatment of multi-segmental and jumping thoracolumbar tuberculosis. [methods] from May 2008 to March 2015, a total of 25 patients, 17 males and 8 females, aged 1159 years with an average of 27 years, were enrolled in this study. Ct plain scan and 3D reconstruction and MRI were performed before operation. There were 11 cases of thoracic vertebrae, 9 cases of thoracolumbar segment, 5 cases of lumbar vertebrae, 10 cases of involving 4 vertebrae, 7 cases of 5 vertebrae, 5 cases of 6 vertebrae and 3 cases of 7 vertebrae. 7 cases underwent thoracotomy "anterior approach" and 4 cases underwent thoracotomy before and after thoracotomy. 9 cases underwent extrapleural retroperitoneal surgery and 5 cases underwent extraperitoneal approach. Regular antituberculous therapy was performed for 6 ~ 12 months after discharge. Bone graft fusion time, correction degree of kyphosis, height of intervertebral space and recovery of nerve function, and changes of erythrocyte sedimentation rate (ESR) C-reactive protein were observed. [results] all patients were successfully operated without serious complications. By the third day after operation, the kyphosis was corrected to 27 擄on average, and the difference was statistically significant compared with that before operation (P 0.05). The height of intervertebral space increased by 4.2 mm on average, which was significantly higher than that before operation (P 0.05). At 1 week after operation, CRP and ESR decreased to 15 mm / h and 16 mg / L, respectively, and the changes were statistically significant (P 0.05). By 3 months after operation, the neurological function of all patients with spinal cord nerve injury recovered to E grade. All the cases were followed up for 1 ~ 3.5 years. The average time of bone graft fusion was 7 months, and the fusion rate was 100. To the last follow-up, ESR and CRP in all patients were within normal range, and there was no significant fluctuation and no loss of orthopedic angle. [conclusion] individualized anterior or anterior combined operation can not only cure tuberculosis, but also restore normal physiological curvature of thoracolumbar vertebrae, reconstruct spinal stability and make patients return to normal life.
【作者單位】： 新疆維吾爾自治區(qū)人民醫(yī)院骨科中心;
【分類號(hào)】：R687.3

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