本文選題：胸腰椎結(jié)核 + 后入路��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：探討后入路結(jié)核病灶清除、植骨融合、椎弓根釘內(nèi)固定治療胸腰椎結(jié)核的臨床療效,并評(píng)價(jià)其安全性及有效性。方法：回顧性分析2011年1月一2014年1月期間柳州市人民醫(yī)院脊柱外科收治的胸腰椎結(jié)核病例,患者均采用后入路結(jié)核病灶清除植骨融合內(nèi)固定治療,術(shù)前及術(shù)后規(guī)范抗結(jié)核藥物治療。收集患者術(shù)前、術(shù)后及隨訪時(shí)紅細(xì)胞沉降率(ESR)、C反應(yīng)蛋白(CRP)、疼痛視覺模擬評(píng)分(VAS). Oswestry功能障礙指數(shù)(ODI)、后凸Cobb角及神經(jīng)功能情況的相關(guān)數(shù)據(jù)；評(píng)價(jià)術(shù)后1年和末次隨訪時(shí)植骨融合情況及臨床療效,并觀察內(nèi)固定松動(dòng)情況。數(shù)據(jù)結(jié)果用SPSS218.0進(jìn)行統(tǒng)計(jì)分析。結(jié)果：本組研究手術(shù)時(shí)間110-210(138±48)min,出血量300-1200(423±52)ml。術(shù)后1例皮緣壞死,1例并發(fā)結(jié)核竇道,術(shù)中及術(shù)后均無(wú)死亡及神經(jīng)功能損傷加重的病例。所有患者均獲得隨訪,無(wú)脫落,隨訪時(shí)間15-36(18.7±5.3)個(gè)月。術(shù)前ESR為(47±10.2)mm/h,術(shù)后6個(gè)月所有患者ESR均恢復(fù)正常,為(8.0±3.1)mm/h,ESR在術(shù)前、術(shù)后1月、3月及6月間差別有統(tǒng)計(jì)學(xué)意義(F=125.470,P=0.001)；術(shù)前CRP為(38.8±9.1)mg/L,術(shù)后3個(gè)月所有患者CRP均恢復(fù)正常,為(9.7±4.7)mg/L,CRP在術(shù)前、術(shù)后1月、3月及6月間差別有統(tǒng)計(jì)學(xué)意義(F=79.050,P=0.000)；術(shù)前VAS評(píng)分為(6.8±1.6)分,術(shù)后1月顯著下降為(2.6±1.2)分,VAS評(píng)分在術(shù)前、術(shù)后1月、3月及6月間差別有統(tǒng)計(jì)學(xué)意義(F=17.664,P=0.016)；ODI評(píng)分術(shù)前為(39.1±12),至末次隨訪時(shí)改善為(6.8±2.5),改善率為82.6%,較術(shù)前改善明顯,ODI評(píng)分在術(shù)前、術(shù)后3月、6月及末次隨訪間差別有統(tǒng)計(jì)學(xué)意義(F=98.073,P=0.004)；術(shù)前后凸Cobb角為(23.3±5.2)°,術(shù)后1個(gè)月為(8.7±2.1)。,平均矯正14.6°,矯正率為62.6%,術(shù)前與術(shù)后1月后凸Cobb角比較有統(tǒng)計(jì)學(xué)意義(t=3.92,P=0.006)；末次隨訪時(shí)為(11.6±3.0)°,平均丟失2.9°,術(shù)前與末次隨訪后凸Cobb角比較有統(tǒng)計(jì)學(xué)意義(t=2.32,P=0.031),術(shù)后1月較末次隨訪后凸Cobb角比較無(wú)統(tǒng)計(jì)學(xué)差異(t=O.38,P=0.705)；術(shù)前17例存在神經(jīng)功能損傷者(B級(jí)2例,C級(jí)3例,其余均為D級(jí)),至末次隨訪時(shí)除1例ASIA分級(jí)恢復(fù)為D級(jí)外,其余均恢復(fù)至E級(jí)；所有患者術(shù)后8個(gè)月內(nèi)植骨均獲得骨性融合,植骨融合時(shí)間3-8(5.1±1.4)個(gè)月,術(shù)后1年和末次隨訪時(shí)Bridwell I和Ⅱ級(jí)植骨融合率分別為89%和96%。所有患者術(shù)后9-14(11±1.7)個(gè)月獲得臨床治愈,在術(shù)后1年和末次隨訪時(shí)臨床療效評(píng)價(jià)優(yōu)良率分別為91%和96%。至末次隨訪均未見螺釘松動(dòng)移位、鈦棒螺釘斷裂、植骨塊松動(dòng)脫出或塌陷等并發(fā)癥發(fā)生。結(jié)論：后入路病灶清除植骨融合內(nèi)固定治療胸腰椎脊柱結(jié)核,創(chuàng)傷相對(duì)小,出血少,并發(fā)癥少是相對(duì)意義上的脊柱結(jié)核“微創(chuàng)”手術(shù),可以滿足徹底的結(jié)核病清除和有效的脊髓減壓,良好的植骨融合以及脊柱后凸畸形矯正后的三柱堅(jiān)強(qiáng)固定的目的,能有效矯正及預(yù)防后凸畸形,改善患者神經(jīng)功能,是一種既安全又有效的手術(shù)方法。
[Abstract]:Objective: to evaluate the efficacy and safety of posterior approach for the treatment of thoracolumbar tuberculosis. Methods: the cases of thoracolumbar vertebrae tuberculosis treated in the Department of Spinal surgery of Liuzhou people's Hospital from January 2011 to January 2014 were retrospectively analyzed. Standard antituberculous drug treatment before and after operation. The erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) and visual analogue pain score (VAS) were collected. Oswestry index of dysfunction (ODI), Cobb angle of kyphosis and related data of nerve function were evaluated, bone graft fusion and clinical effect were evaluated at 1 year and the last follow-up, and internal fixation loosening was observed. The data were analyzed by SPSS 218.0. Results: the operative time was 110-210 (138 鹵48) min and the blood loss was 300-1200 (423 鹵52) ml. One case was complicated with tuberculous sinus in 1 case. There was no death and serious nerve function injury during and after operation. All the patients were followed up without abscission for 15-36 (18.7 鹵5.3) months. The preoperative ESR was (47 鹵10.2) mm / h, and the ESR was (8.0 鹵3.1) mm / r / h in all patients 6 months after operation. There was a significant difference between preoperative, 1 month, 3 month and 6 months after operation (FF125.470 mg / L), the preoperative CRP was (38.8 鹵9.1) mg / L, and 3 months after operation, all patients returned to normal, which was (9.7 鹵4.7) mg / L CRP. The VAS score was (6.8 鹵1.6) points before operation and (2.6 鹵1.2) points at one month after operation. The VAS score was significantly different between the first month, the third month and the sixth month after operation (FF17.664P0.016), and the VAS score was significantly decreased to (2.6 鹵1.2) in the first month, the third month and the sixth month after operation (F _ (17.664P0.016), and the VAS score was significantly decreased to (2.6 鹵1.2) in the first month after operation (F _ (17.664P0.016). The ODI score was (39.1 鹵12) before operation, and improved (6.8 鹵2.5) at the last follow-up. The improvement rate was 82.6, which was significantly higher than that before operation. There was a significant difference in ODI score between 3 months, 6 months and the last follow-up (F _ (98.073) P _ (0.004). The Cobb angle of kyphosis was (23.3 鹵5.2) 擄before operation and (8.7 鹵2.1). The average correction was 14.6 擄, and the correction rate was 62.6 擄. The Cobb angle of kyphosis before and after operation was significantly higher than that at 1 month after operation (t = 3.92, P < 0.006). The mean loss of Cobb angle at the last follow-up was (11.6 鹵3.0) 擄, the mean loss was 2.9 擄. There was significant difference between preoperative and posterior Cobb angle (t = 2.32), but there was no significant difference in postoperative 1 month compared with that after the last follow-up (t = 0.38, P = 0.705), and 17 patients with neurological function impairment (grade B, n = 2, n = 3, grade C, n = 3). At the last follow-up, all patients recovered to grade E except one case with Asia grade returning to grade D, and all patients received bone fusion within 8 months after operation, and the fusion time was 3-8 months (5.1 鹵1.4) months. The fusion rates of Bridwell I and II were 89% and 96% respectively at one year and the last follow-up. All the patients were cured 9-14 (11 鹵1.7) months after operation. The excellent and good rates were 91% and 96% respectively at 1 year and the last follow-up. To the last follow-up, there were no complications such as screw loosening displacement, titanium rod screw breaking, bone graft loosening, or collapse. Conclusion: the treatment of thoracolumbar spinal tuberculosis with debridement, bone grafting, fusion and internal fixation via posterior approach has less trauma, less bleeding and less complications. It can meet the goals of complete tuberculosis clearance, effective decompression of spinal cord, good fusion of bone graft and rigid fixation of three columns after correction of kyphosis. It can effectively correct and prevent kyphosis and improve the nervous function of patients. It is a safe and effective surgical method.
【學(xué)位授予單位】：廣西醫(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)：2085641