【摘要】：目的:觀察病椎置短椎弓根釘,病灶清除、植骨融合內(nèi)固定術(shù)治療多節(jié)段胸腰椎結(jié)核的臨床效果,探討治療多節(jié)段胸腰椎結(jié)核的手術(shù)改進方法和療效。方法:收集2012年2月至2014年2月在青海大學附屬醫(yī)院收治的40例多節(jié)段胸腰椎結(jié)核患者(術(shù)后病檢均確診脊柱結(jié)核),其中女性患者15例,男性患者25例,年齡范圍26歲至63歲,平均年齡(43.3±2.3)歲,病程6個月~2年,平均12個月。病灶侵襲范圍病變部位在胸椎的有14例,腰椎結(jié)核有5例,胸椎并腰椎結(jié)核有21例。所有患者術(shù)前經(jīng)過CT、X線及MRI確診,均符合多節(jié)段胸腰椎結(jié)核的診斷標準。所有患者在術(shù)前腰背部位均表現(xiàn)出嚴重的疼痛癥狀,活動受到限制,脊椎后凸畸形及神經(jīng)功能障礙等。其中6例患者Frankel分級為A級,10例患者為B級,12例患者為C級,12例患者為D級。按Frankel分級標準對術(shù)前、術(shù)后神經(jīng)功能改善進行評價。術(shù)前從影像學上測得Cobb角平均值35.6°±3.7,受損椎體前緣高度(%)平均值40.5%±6.3。常規(guī)抗結(jié)核化療至少14天,待患者能耐受手術(shù)后行手術(shù)治療,術(shù)后繼續(xù)口服抗結(jié)核藥物治療10~12個月,定期復(fù)查肝功能、腎功能、血沉、C-反應(yīng)蛋白,術(shù)后分別于3個月、6個月、12個月復(fù)查胸腰椎X線片。隨訪期間觀察術(shù)后患者癥狀改善及神經(jīng)功能恢復(fù)情況,觀察植骨融合、后凸畸形矯正情況。結(jié)果:所有患者手術(shù)均順利完成,術(shù)中、后無一例出現(xiàn)嚴重并發(fā)癥。40例患者全部隨訪成功,術(shù)后隨訪時間為12~36個月,平均18個月。術(shù)后10-12個月,抗結(jié)核藥物停用,所有患者結(jié)核癥狀消失,腰背無疼痛,無復(fù)發(fā)現(xiàn)象出現(xiàn)。末次隨訪時1例患者Frankel分級為A級,1例患者為B級,8例患者為C級,10例患者為D級,20例患者為E級。后凸畸形矯正良好,后凸角明顯改善,末次隨訪Cobb角平均值為6.8°±2.9,受損椎體前緣高度(%)平均值92.4±5.7。末次隨訪各項觀察指標與術(shù)前比較差異均有統(tǒng)計學意義(P㩳0.05)。末次隨訪時均顯示良好的骨性融合,血沉均小于20mm/h。結(jié)論:病椎置短椎弓根釘治療多節(jié)段胸腰椎結(jié)核,可使病椎后凸畸形和脫位能即刻得到糾正和良好的復(fù)位,可取得脊椎即刻穩(wěn)定,雖固定節(jié)段減少,但可充分達到載荷分享均衡,術(shù)后角度丟失少。而且有助于防止植骨塊脫出、塌陷、不愈合的發(fā)生,對恢復(fù)脊柱、脊髓的功能有良好的效果。對于脊柱穩(wěn)定性的生物力學重建奠定基礎(chǔ),提高植骨融合的治愈率,預(yù)防和糾正脊柱畸形,減少結(jié)核復(fù)發(fā),能有效避免二次手術(shù),減少患者的創(chuàng)傷和負擔。目前,病椎置短椎弓根釘方法成為一種趨勢[1],臨床效果顯著,安全可靠,是理想的治療方法,值得推廣。
[Abstract]:Objective: to observe the clinical effect of short pedicle screw, focal debridement, bone graft fusion and internal fixation in the treatment of multilevel thoracolumbar tuberculosis, and to explore the surgical improvement and effect of multilevel thoracolumbar tuberculosis. Methods: from February 2012 to February 2014, 40 patients with multi-segmental thoracolumbar tuberculosis (all diagnosed by postoperative examinations) were collected from the affiliated Hospital of Qinghai University, including 15 female patients and 25 male patients, aged from 26 to 63 years old. The mean age was (43.3 鹵2.3) years, the course of disease ranged from 6 months to 2 years (mean 12 months). The lesions were located in 14 cases of thoracic vertebra, 5 cases of lumbar tuberculosis and 21 cases of thoracic and lumbar tuberculosis. All the patients were diagnosed by CT,X line and MRI before operation, all of them were in accordance with the diagnostic criteria of multi-level thoracolumbar tuberculosis. All patients showed severe pain, limited movement, kyphosis and neurological dysfunction. The Frankel grade of 6 cases was grade A and 10 cases were grade B, 12 cases were grade C and 12 cases were grade D. The improvement of nerve function before and after operation was evaluated according to Frankel grading standard. The average value of Cobb angle was 35.6 擄鹵3.7 擄and the average height of anterior edge of injured vertebral body (%) was 40.5% 鹵6.3%. Routine antituberculous chemotherapy was performed for at least 14 days. After operation, patients were treated with antituberculosis drugs for 10 ~ 12 months. Liver function, renal function, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined regularly. Thoracolumbar X-ray examination was performed at 3 months, 6 months and 12 months after operation. During the follow-up period, the improvement of symptoms, the recovery of nerve function, the fusion of bone graft and the correction of kyphosis were observed. Results: all the patients were successfully completed. During the operation, none of the 40 patients were followed up successfully. The follow-up time was 1236 months (mean 18 months). After 10-12 months, antituberculous drugs were stopped, all tuberculosis symptoms disappeared, no pain in the back and back, no recurrence. At the last follow-up, one patient with Frankel grade A, one patient with grade B, 8 patients with grade C, 10 patients with grade D, 20 patients with grade E. Kyphosis was corrected well and kyphosis angle was improved obviously. The average Cobb angle of the last follow-up was 6.8 擄鹵2.9, and the average height of the anterior edge of the injured vertebral body (%) was 92.4 鹵5.7. There was significant difference between the last follow-up and preoperative observation (P0. 05). At the last follow-up, good bone fusion was observed, and ESR was less than 20 mm / h. Conclusion: the treatment of multilevel thoracolumbar tuberculosis with short pedicle screw can make the kyphosis deformity and dislocation be corrected and well reduced immediately, and the spine can be stabilized immediately, although the fixed segment is reduced. However, load sharing balance can be fully achieved and angle loss is less. It also helps to prevent the bone graft from protruding, collapsing and nonunion, and has good effect on the recovery of spinal and spinal cord function. It lays a foundation for the biomechanical reconstruction of spinal stability, improves the cure rate of bone graft fusion, prevents and corrects spinal deformities, reduces tuberculosis recurrence, effectively avoids secondary surgery, and reduces the trauma and burden of patients. At present, the method of short pedicle screw in diseased vertebrae has become a trend [1]. The clinical effect is remarkable, safe and reliable, and it is an ideal treatment method, which is worth popularizing.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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