自體肋骨捆綁移植重建胸椎結(jié)核病灶清除術(shù)后骨缺損
發(fā)布時(shí)間：2018-08-07 10:29
【摘要】：目的探討自體肋骨捆綁移植重建治療胸椎結(jié)核病灶清除術(shù)后骨缺損的療效。方法 2006年1月—2013年12月,采用前路病灶清除、捆綁肋骨椎間植骨融合,前路或后路內(nèi)固定術(shù)治療36例胸椎結(jié)核術(shù)后骨缺損。男20例,女16例;年齡21~60歲,平均50.5歲。病程5~11個(gè)月,平均6.8個(gè)月。胸椎結(jié)核位于T_(4、5) 1例,T_(5、6) 4例,T_(6、7) 4例,T_(7、8) 4例,T_(8、9) 9例,T_(9、10) 8例,T_(10、11) 5例,T_(11、12) 1例。伴神經(jīng)損害34例,根據(jù)Frankel分級(jí)為B級(jí)2例、C級(jí)8例、D級(jí)24例。記錄患者手術(shù)前后紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)、C反應(yīng)蛋白(C reactive protein,CRP)、疼痛視覺模擬評(píng)分(VAS)及胸椎后凸Cobb角;根據(jù)CT三維重建分析植骨融合情況。結(jié)果術(shù)后測(cè)量捆綁肋骨的橫截面積為136.8~231.2 mm~2,平均197.1 mm~2;相鄰上、下位椎體終板表面積為425.0~677.6 mm~2,平均550.6 mm~2;肋骨占終板表面積百分比為29%~50%,平均33.6%。手術(shù)時(shí)間125~160 min,平均125 min;術(shù)中出血量280~850 mL,平均450 mL�；颊呔@隨訪,隨訪時(shí)間2~8年,平均4.4年。術(shù)后出現(xiàn)肋間神經(jīng)痛2例、胸腔積液1例、結(jié)核藥物導(dǎo)致肝功能損害2例,均經(jīng)對(duì)癥治療后治愈。其余患者未發(fā)生任何呼吸道并發(fā)癥及傷口感染,無肋骨支撐體骨折、移位和吸收,無結(jié)核病灶復(fù)發(fā),無內(nèi)固定物松動(dòng)斷裂、脊柱后凸畸形。術(shù)后6個(gè)月三維CT示融合率為86.1%(31/36),術(shù)后12個(gè)月為97.2%(35/36)。術(shù)后3個(gè)月及末次隨訪時(shí)ESR、CRP、VAS評(píng)分及胸椎后凸Cobb角均較術(shù)前顯著改善(P0.05),術(shù)后3個(gè)月及末次隨訪間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)前Frankel分級(jí)B級(jí)2例均恢復(fù)至D級(jí),術(shù)前C級(jí)8例恢復(fù)至D級(jí)1例、E級(jí)7例,術(shù)前D級(jí)24例均恢復(fù)至E級(jí)。結(jié)論對(duì)中下胸椎結(jié)核病灶清除術(shù)后小于2個(gè)椎體和椎間盤的骨缺損,采用自體肋骨捆綁支撐移植是可行的。
[Abstract]:Objective to evaluate the effect of bone defect after thoracic vertebrae tuberculosis removal by bone reconstruction with autologous rib grafting. Methods from January 2006 to December 2013, 36 patients with thoracic spinal tuberculosis were treated with anterior debridement, intervertebral bone fusion and anterior or posterior internal fixation. There were 20 males and 16 females, aged from 21 to 60 years (mean 50.5 years). The course of disease ranged from 5 to 11 months (mean 6.8 months). Thoracic vertebral tuberculosis was located in T _ (4O _ 5), 1 case, T _ (5N _ 6), 4 cases, T _ (6N), 4 cases, T _ (7N), 4 cases, T _ (8O 9), 9 cases, T _ (9O 10), 8 cases, T _ (1010), 5 cases, T _ (1112), 1 case. There were 34 cases with nerve damage and 24 cases with grade D according to Frankel classification. The erythrocyte sedimentation rate (erythrocyte sedimentation rateur) C-reactive protein (C reactive), pain visual analogue score (VAS) and thoracic kyphosis Cobb angle were recorded before and after operation. Results the cross sectional area of the rib was 136.8 / 231.2 mm / 2 (mean 197.1 mm / 2), the surface area of the inferior vertebral endplate was 425.0 / 677.6 mm / 2 (mean 550.6 mm / 2) and the ratio of rib to the end plate was 290.50 mm / 2 (mean 33.6 mm / 2). The operative time was 125 ~ 160 min with an average of 125 min, and the blood loss during operation was 280 ~ 850 mL, with an average of 450 mL. All patients were followed up for 2 ~ 8 years (mean 4.4 years). There were 2 cases of intercostal neuralgia, 1 case of pleural effusion and 2 cases of liver function damage caused by tuberculosis drugs. There were no respiratory complications and wound infection, no rib support fracture, displacement and absorption, no recurrence of tuberculosis, no internal fixation loosening and rupture, kyphosis deformity. The fusion rate was 86.1% (31 / 36) on 3D CT and 97.2% (35 / 36) at 12 months postoperatively. The VAS score and the Cobb angle of thoracic kyphosis were significantly improved 3 months after operation and at the last follow-up (P0.05), but there was no significant difference between the three months after operation and the last follow-up (P0.05). Frankel grade B recovered to grade D in 2 cases, grade C to grade D in 8 cases, grade E to grade E in 7 cases, and grade D to grade E in 24 cases before operation. Conclusion it is feasible to remove the bone defect of less than 2 vertebrae and intervertebral disc in the middle and lower thoracic vertebrae.
【作者單位】： 西南醫(yī)科大學(xué)附屬醫(yī)院脊柱外科;西南醫(yī)科大學(xué)附屬醫(yī)院影像科;
【基金】：四川省科技廳-瀘州市科技局課題(Z1411) 西南醫(yī)科大學(xué)附屬醫(yī)院支撐項(xiàng)目(16024)~~
【分類號(hào)】：R687.3
[Abstract]:Objective to evaluate the effect of bone defect after thoracic vertebrae tuberculosis removal by bone reconstruction with autologous rib grafting. Methods from January 2006 to December 2013, 36 patients with thoracic spinal tuberculosis were treated with anterior debridement, intervertebral bone fusion and anterior or posterior internal fixation. There were 20 males and 16 females, aged from 21 to 60 years (mean 50.5 years). The course of disease ranged from 5 to 11 months (mean 6.8 months). Thoracic vertebral tuberculosis was located in T _ (4O _ 5), 1 case, T _ (5N _ 6), 4 cases, T _ (6N), 4 cases, T _ (7N), 4 cases, T _ (8O 9), 9 cases, T _ (9O 10), 8 cases, T _ (1010), 5 cases, T _ (1112), 1 case. There were 34 cases with nerve damage and 24 cases with grade D according to Frankel classification. The erythrocyte sedimentation rate (erythrocyte sedimentation rateur) C-reactive protein (C reactive), pain visual analogue score (VAS) and thoracic kyphosis Cobb angle were recorded before and after operation. Results the cross sectional area of the rib was 136.8 / 231.2 mm / 2 (mean 197.1 mm / 2), the surface area of the inferior vertebral endplate was 425.0 / 677.6 mm / 2 (mean 550.6 mm / 2) and the ratio of rib to the end plate was 290.50 mm / 2 (mean 33.6 mm / 2). The operative time was 125 ~ 160 min with an average of 125 min, and the blood loss during operation was 280 ~ 850 mL, with an average of 450 mL. All patients were followed up for 2 ~ 8 years (mean 4.4 years). There were 2 cases of intercostal neuralgia, 1 case of pleural effusion and 2 cases of liver function damage caused by tuberculosis drugs. There were no respiratory complications and wound infection, no rib support fracture, displacement and absorption, no recurrence of tuberculosis, no internal fixation loosening and rupture, kyphosis deformity. The fusion rate was 86.1% (31 / 36) on 3D CT and 97.2% (35 / 36) at 12 months postoperatively. The VAS score and the Cobb angle of thoracic kyphosis were significantly improved 3 months after operation and at the last follow-up (P0.05), but there was no significant difference between the three months after operation and the last follow-up (P0.05). Frankel grade B recovered to grade D in 2 cases, grade C to grade D in 8 cases, grade E to grade E in 7 cases, and grade D to grade E in 24 cases before operation. Conclusion it is feasible to remove the bone defect of less than 2 vertebrae and intervertebral disc in the middle and lower thoracic vertebrae.
【作者單位】： 西南醫(yī)科大學(xué)附屬醫(yī)院脊柱外科;西南醫(yī)科大學(xué)附屬醫(yī)院影像科;
【基金】：四川省科技廳-瀘州市科技局課題(Z1411) 西南醫(yī)科大學(xué)附屬醫(yī)院支撐項(xiàng)目(16024)~~
【分類號(hào)】：R687.3
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