單運(yùn)動(dòng)節(jié)段胸、腰、骶椎結(jié)核穩(wěn)定性評(píng)估及手術(shù)方式選擇
發(fā)布時(shí)間：2018-11-08 07:59
【摘要】：目的:回顧性研究我院45例單運(yùn)動(dòng)節(jié)段胸、腰、骶椎結(jié)核對(duì)脊柱穩(wěn)定性的影響,探討病灶清除、單節(jié)段固定的方法、適應(yīng)證及優(yōu)缺點(diǎn)。方法:回顧分析我院2011年6月~2014年8月共收治并獲定期隨訪的單運(yùn)動(dòng)節(jié)段胸、腰、骶椎結(jié)核45例患者的臨床資料,男21例,女24例,年齡:17-69歲,平均38.5歲;病史3-36個(gè)月,平均14.5個(gè)月,術(shù)前“四聯(lián)”抗癆2-4周。根據(jù)后凸畸形、椎體塌陷及移位等影響脊柱穩(wěn)定性的潛在因素并結(jié)合Denis的三柱理論(損傷2柱或以上為脊柱失穩(wěn)),分為A組7例(穩(wěn)定組),B組38例(不穩(wěn)定組);穩(wěn)定組采取前路病灶清除術(shù);不穩(wěn)定組根據(jù)術(shù)前椎體破壞程度、后凸畸形及術(shù)中殘椎高度分別對(duì)17例(B1組)行前路病灶清除并植骨融合+單節(jié)段內(nèi)固定術(shù)、13例(B2組)采用前路病灶清除植骨融合+后路單節(jié)段內(nèi)固定術(shù)、8例(B3組)采用后路病灶清除植骨融合并單節(jié)段椎弓根內(nèi)固定;本組植骨均采取自體骨。術(shù)后常規(guī)抗癆治療12-18個(gè)月,隨訪測(cè)量Cobb角矯正水平、評(píng)估植骨融合情況,檢測(cè)C-反應(yīng)蛋白(CRP)及血沉(ESR)的變化,結(jié)合神經(jīng)功能恢復(fù)情況(Frankel分級(jí))進(jìn)行綜合評(píng)價(jià)。結(jié)果:1.單純前柱破壞未發(fā)現(xiàn)脊柱失穩(wěn);累及前、中柱的破壞均對(duì)脊柱的穩(wěn)定性造成破壞;2.本組45例后凸角平均矯正17.5°,隨訪期內(nèi)丟失3-5°;B組植骨融合(自體肋骨或髂骨)患者在7-9個(gè)月植骨融合,平均8個(gè)月;31例合并脊髓神經(jīng)功能障礙者術(shù)后按Frankel分級(jí)評(píng)估,均獲不同程度改善,平均改善約1級(jí)。結(jié)論:1.單純前柱破壞對(duì)脊柱穩(wěn)定性無(wú)明顯影響;累及前、中柱破壞的脊柱結(jié)核,可認(rèn)為脊柱失穩(wěn);2.行病灶清除、單節(jié)段植骨融合內(nèi)固定可重建前、中柱的穩(wěn)定性,對(duì)單運(yùn)動(dòng)節(jié)段脊柱結(jié)核有確切的臨床療效。
[Abstract]:Objective: to study retrospectively the effects of single segmental thoracic, lumbar and sacral tuberculosis on spinal stability in 45 patients in our hospital, and to explore the methods of debridement, single segment fixation, indications, advantages and disadvantages. Methods: the clinical data of 45 patients with single segmental thoracic, lumbar and sacral tuberculosis admitted in our hospital from June 2011 to August 2014 were retrospectively analyzed. The clinical data were 21 males and 24 females, aged 17-69 years with an average of 38.5 years. The history ranged from 3 to 36 months (mean 14.5 months). According to the underlying factors such as kyphosis, collapse and displacement of vertebral body, and combined with Denis's three-column theory (injury 2 column or above is spinal instability), 7 cases were divided into group A (stable group), B group 38 cases (unstable group). The patients in the stable group were treated with anterior approach debridement. According to the degree of destruction of vertebral body before operation, kyphosis and the height of residual vertebrae in unstable group, 17 cases (group B1) underwent anterior debridement and single segment internal fixation with bone graft fusion, respectively. 13 cases (B2 group) were treated with anterior debridement, bone grafting, posterior single-segment internal fixation, and 8 cases (B3 group) were treated with posterior debridement and fusion with single pedicle fixation. Autogenous bone was used in all cases. Postoperative routine antituberculosis therapy for 12 to 18 months was followed up to measure the level of Cobb angle correction, to evaluate the fusion of bone graft, to detect the changes of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (ESR), and to evaluate the neurological function recovery (Frankel grade). The result is 1: 1. No instability of spine was found in simple destruction of anterior column, destruction of middle column before involvement caused damage to the stability of spine; 2. The mean correction of kyphosis angle in 45 cases was 17.5 擄, and the loss was 3-5 擄during the follow-up period, while in group B, bone graft fusion (autogenous rib or iliac bone) was performed in 7-9 months (mean 8 months). According to the Frankel grading, 31 patients with spinal cord neurological dysfunction improved in different degree, the average improvement was about 1 grade. Conclusion: 1. Simple anterior column destruction had no obvious effect on spinal stability, spinal tuberculosis with anterior and middle column destruction could be considered as spinal instability, and 2. The stability of the middle column can be reconstructed before single segment bone graft fusion and internal fixation. It has definite clinical effect on single segment spinal tuberculosis.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3
本文編號(hào)：2317863
[Abstract]:Objective: to study retrospectively the effects of single segmental thoracic, lumbar and sacral tuberculosis on spinal stability in 45 patients in our hospital, and to explore the methods of debridement, single segment fixation, indications, advantages and disadvantages. Methods: the clinical data of 45 patients with single segmental thoracic, lumbar and sacral tuberculosis admitted in our hospital from June 2011 to August 2014 were retrospectively analyzed. The clinical data were 21 males and 24 females, aged 17-69 years with an average of 38.5 years. The history ranged from 3 to 36 months (mean 14.5 months). According to the underlying factors such as kyphosis, collapse and displacement of vertebral body, and combined with Denis's three-column theory (injury 2 column or above is spinal instability), 7 cases were divided into group A (stable group), B group 38 cases (unstable group). The patients in the stable group were treated with anterior approach debridement. According to the degree of destruction of vertebral body before operation, kyphosis and the height of residual vertebrae in unstable group, 17 cases (group B1) underwent anterior debridement and single segment internal fixation with bone graft fusion, respectively. 13 cases (B2 group) were treated with anterior debridement, bone grafting, posterior single-segment internal fixation, and 8 cases (B3 group) were treated with posterior debridement and fusion with single pedicle fixation. Autogenous bone was used in all cases. Postoperative routine antituberculosis therapy for 12 to 18 months was followed up to measure the level of Cobb angle correction, to evaluate the fusion of bone graft, to detect the changes of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (ESR), and to evaluate the neurological function recovery (Frankel grade). The result is 1: 1. No instability of spine was found in simple destruction of anterior column, destruction of middle column before involvement caused damage to the stability of spine; 2. The mean correction of kyphosis angle in 45 cases was 17.5 擄, and the loss was 3-5 擄during the follow-up period, while in group B, bone graft fusion (autogenous rib or iliac bone) was performed in 7-9 months (mean 8 months). According to the Frankel grading, 31 patients with spinal cord neurological dysfunction improved in different degree, the average improvement was about 1 grade. Conclusion: 1. Simple anterior column destruction had no obvious effect on spinal stability, spinal tuberculosis with anterior and middle column destruction could be considered as spinal instability, and 2. The stability of the middle column can be reconstructed before single segment bone graft fusion and internal fixation. It has definite clinical effect on single segment spinal tuberculosis.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【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)：2317863
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