【摘要】：目的探討多節(jié)段胸腰椎椎體結(jié)核患者采取不同入路的病灶清除,植骨融合及內(nèi)固定手術(shù)的療效。方法回顧性分析2010年至2014年間,在新疆醫(yī)科大學(xué)第一附屬醫(yī)院脊柱外科收治的40例多節(jié)段胸腰椎椎體結(jié)核患者,根據(jù)患者結(jié)核病灶的病變特點(diǎn)、膿腫的位置、椎體的破壞程度及是否伴有后凸畸形、脊髓壓迫等因素選擇不同的手術(shù)方式,按手術(shù)入路的不同可分為三組:A組:前路病灶清除植骨融合內(nèi)固定術(shù)8例;B組:后路病灶清除植骨融合內(nèi)固定術(shù)20例;C組:前路病灶清除植骨、一期后路內(nèi)固定術(shù)12例。40例患者Frankel分級:B級1例,C級6例,D級16例,E級17例。29例患者合并后凸畸形,Cobb角10°-30°者24例,30°者5例。術(shù)前所有患者均給予規(guī)范口服四聯(lián)(異煙肼、利福平、吡嗪酰胺和鏈霉素)抗結(jié)核藥物治療2-4周,同時(shí)加服肝泰樂保護(hù)肝功能。分別記錄三組患者的手術(shù)時(shí)間、術(shù)中出血量、結(jié)核活動(dòng)度(血沉、C反應(yīng)蛋白變化)、術(shù)后植骨塊、鈦網(wǎng)位置及融合情況、神經(jīng)功能恢復(fù)情況以及相關(guān)手術(shù)術(shù)后并發(fā)癥(包括結(jié)核復(fù)發(fā)、椎弓根螺釘及鈦網(wǎng)松動(dòng)斷裂等)cobb角等結(jié)果,并對其進(jìn)行分組整理分析。結(jié)果A組的手術(shù)時(shí)間平均(3.6±0.5)h,出血量平均(431±44)ml;B組的手術(shù)時(shí)間平均(4.5±0.5)h,出血量平均(496±61)ml;C組的手術(shù)時(shí)間平均(4.7±0.6)h,出血量平均(557±63)ml。所有患者的結(jié)核毒性癥狀在平均5.5天內(nèi)得到緩解。cobb角為10-30°的患者術(shù)后平均矯正率為53.7±18.3%,cobb角30°的患者術(shù)后平均矯正率為54.4±14.6%。術(shù)后3-9個(gè)月血沉及C-反應(yīng)蛋白逐漸降低至正常。結(jié)論多節(jié)段胸腰椎椎體結(jié)核患者經(jīng)由規(guī)律的抗結(jié)核藥物治療后,根據(jù)各節(jié)段破壞的范圍、膿腫的大小位置、是否伴有后凸畸形和脊髓壓迫等因素的不同,選擇合理的手術(shù)術(shù)式,給予徹底的病灶清除和植骨融合,采取合理化、綜合化、個(gè)體化的治療方案,會(huì)取得滿意的臨床療效。
[Abstract]:Objective to evaluate the effect of multiple thoracolumbar vertebrae tuberculosis with different approaches of debridement, bone grafting and internal fixation. Methods from 2010 to 2014, 40 patients with multi-level thoracolumbar vertebral tuberculosis admitted in the first affiliated Hospital of Xinjiang Medical University were analyzed retrospectively. The location of abscess was analyzed according to the pathological changes of the patients' tuberculosis foci. The degree of destruction of the vertebral body and whether it is accompanied by kyphosis, spinal cord compression and other factors choose different surgical methods, According to the different operative approaches, we can divide them into three groups: anterior debridement, bone grafting, fusion and internal fixation, anterior debridement, bone grafting, internal fixation, posterior debridement, bone grafting and internal fixation, and anterior debridement and bone grafting. One stage posterior internal fixation was performed in 12 cases. 40 cases were classified as Frankel grade B, 1 case, grade C, 6 cases, grade D, 16 cases, grade E, 17 cases, 29 cases, with kyphosis angle 10 擄-30 擄, 24 cases with 30 擄, 5 cases. All patients were given routine oral administration of isoniazid, rifampicin, pyrazinamide and streptomycin for 2 to 4 weeks. The time of operation, the amount of blood lost during operation, the activity of tuberculosis (ESR C-reactive protein change), the bone graft, the position of titanium mesh and the fusion were recorded respectively in the three groups. The recovery of nerve function and the cobb angle of postoperative complications (including recurrence of tuberculosis, pedicle screw and titanium mesh loosening and fracture) were analyzed. Results the mean operation time was (3.6 鹵0.5) h in group A, (4.5 鹵0.5) h in ml;B group, (4.7 鹵0.6) h in group A and (557 鹵63) ml. in group A. The average correction rate of TB toxic symptoms in all patients was 53.7 鹵18.3cobb angle 30 擄and 54.4 鹵14.6in patients with cobb angle 10-30 擄relief in an average of 5.5 days. ESR and C-reactive protein gradually decreased to normal 3-9 months after operation. Conclusion after regular treatment with antituberculous drugs in patients with multiple thoracolumbar vertebrae tuberculosis, a reasonable surgical procedure is chosen according to the extent of destruction of each segment, the location of abscess, whether or not kyphosis is associated with spinal cord compression and so on. Complete debridement and bone graft fusion, rational, comprehensive and individualized treatment can achieve satisfactory clinical results.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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