本文選題：微創(chuàng)手術(shù) + 局部化療　； 參考：《山西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:探討CT引導(dǎo)下微創(chuàng)手術(shù)治療上頸椎與腰骶椎結(jié)核的價(jià)值和意義。方法:2002年1月至2013年3月單個(gè)醫(yī)生收治的上頸椎結(jié)核患者11例。其中男8例,女3例;年齡2-68歲,平均33.3歲。其中累及雙節(jié)段9例(C1-2 8例,C2-3 1例),累及3節(jié)段2例(C1-3),均為連續(xù)椎體破壞病例;1例合并腎結(jié)核,2例合并有肺結(jié)核,1例腦血栓,1例嚴(yán)重風(fēng)濕病病史。以及單個(gè)醫(yī)生收治的保守治療無效的腰骶椎結(jié)核患者145例,男84例,女61例。失訪2例,其余143例均獲得隨訪,年齡2-81歲,平均年齡42.6歲;內(nèi)固定術(shù)后復(fù)發(fā)6例,無內(nèi)固定開放術(shù)后復(fù)發(fā)8例;有32例患者伴有椎旁膿腫。腰骶椎結(jié)核治療方法是144例患者實(shí)施CT引導(dǎo)下在病灶和膿腫內(nèi)置管局部化療灌注沖洗,1例患者行小開窗手術(shù)結(jié)合局部化療治療。上頸椎結(jié)核患者觀察治療前及終末隨訪時(shí)的血沉數(shù)值,治療前及終末隨訪時(shí)視覺模擬評(píng)分(Visual Analogue Scale,VAS)評(píng)價(jià)疼痛程度。腰骶椎結(jié)核患者觀察治療前及終末隨訪時(shí)的血沉數(shù)值、治療前及終末隨訪時(shí)的腰椎前凸角度(Lumbar lordosis,LL)、治療前及終末隨訪時(shí)Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)等。結(jié)果:本組上頸椎結(jié)核11例患者均獲得隨訪,隨訪時(shí)間為28-108個(gè)月,平均60個(gè)月。所有患者臨床癥狀消失,復(fù)查血沉正常,VAS評(píng)分0-4,平均2.55;術(shù)后1例患者出現(xiàn)管路脫落、1例出現(xiàn)管路堵塞,均給予更換導(dǎo)管。無頸椎結(jié)核復(fù)發(fā)、無竇道及假關(guān)節(jié)形成;手術(shù)患者植骨獲得融合。本組患者沒有實(shí)施前路開放手術(shù)。本組腰骶椎結(jié)核隨訪21-149個(gè)月,平均隨訪時(shí)間67個(gè)月。其中獲得五年以上隨訪73例。所有患者均達(dá)臨床愈合。治療前腰椎前凸角平均為36.32°,終末隨訪時(shí)平均為33.35°,兩者差異有統(tǒng)計(jì)學(xué)意義(P=0.000);Oswestry功能障礙指數(shù)術(shù)前平均為73.01分,終末隨訪時(shí)平均為11.25分,兩者相比差異有統(tǒng)計(jì)學(xué)意義(P=0.000)。結(jié)論:正規(guī)抗結(jié)核治療是上頸椎與腰骶椎結(jié)核最基本的治療方法。大多數(shù)上頸椎結(jié)核與保守治療無效且脊柱畸形和神經(jīng)癥狀的程度在可接受的范圍內(nèi)的腰骶椎脊柱結(jié)核,選擇以全身化療加局部持續(xù)化療治療方式可以取得良好的治療效果。對(duì)于微創(chuàng)治療過程中合并有寰樞椎不穩(wěn)、脫位的患者,采用前路微創(chuàng)、后路開放固定植骨的方法可獲得較好的臨床療效。
[Abstract]:Objective: to evaluate the value and significance of CT-guided minimally invasive surgery in the treatment of upper cervical spine and lumbosacral tuberculosis. Methods: from January 2002 to March 2013, 11 patients with upper cervical tuberculosis were treated by a single doctor. There were 8 males and 3 females, aged 2-68 years, with an average age of 33.3 years. Among them, 9 cases were involved in double segment, 8 cases were involved in C1-2, 1 case was involved in C2-3, 2 cases were involved in 3 segments, 2 cases were continuous vertebral destruction, 1 case was complicated with renal tuberculosis, 2 cases were complicated with pulmonary tuberculosis, 1 case had cerebral thrombosis and 1 case had a history of severe rheumatism. 145 cases of lumbosacral tuberculosis, 84 males and 61 females, were treated by a single doctor. The other 143 cases were followed up, the average age was 42.6 years old, 6 cases recurred after internal fixation, 8 cases recurred after internal fixation, 32 cases had paravertebral abscess. The treatment of lumbosacral tuberculosis was performed in 144 patients under the guidance of CT. One patient underwent small fenestration combined with local chemotherapy under CT guidance. Patients with upper cervical tuberculosis were observed the ESR before and after treatment, visual analogue score (VAS) and visual Analogue scale scale (vas) were used to evaluate the pain. Patients with lumbosacral tuberculosis were observed the ESR before and at the end follow-up, Lumbar lordosis angle and Oswestry dysfunction index (Oswestry disability index) before and at the end follow-up. Results: 11 patients with upper cervical tuberculosis were followed up for 28-108 months (mean 60 months). All the patients' clinical symptoms disappeared, and the VAS score of normal ESR was 0-4 (average 2.55). No recurrence of cervical tuberculosis, no sinus and pseudoarthrosis, and fusion of bone graft in surgical patients. No open anterior approach was performed in this group. Patients with lumbosacral tuberculosis were followed up for 21-149 months with an average follow-up time of 67 months. Among them, 73 cases were followed up for more than 5 years. All patients were clinically healed. The mean lumbar kyphosis angle was 36.32 擄before treatment and 33.35 擄at the end follow-up. The difference between the two groups was statistically significant. The average score of Oswestry dysfunction index was 73.01 before operation and 11.25 at the end follow-up. The difference between the two groups was statistically significant. Conclusion: regular anti-tuberculosis therapy is the most basic treatment for upper cervical vertebra and lumbosacral tuberculosis. Most of the upper cervical tuberculosis and lumbosacral tuberculosis which are ineffective in conservative treatment and whose spinal deformities and neurological symptoms are within an acceptable range can be well treated with systemic chemotherapy plus local continuous chemotherapy. For the patients with atlantoaxial instability and dislocation in the course of minimally invasive treatment, anterior minimally invasive and posterior open fixation can obtain better clinical effect.
【學(xué)位授予單位】：山西醫(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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本文編號(hào)：1792418