【摘要】：目的探討后路經單側椎弓根入路病灶清除、植骨融合、椎弓根螺釘內固定術治療胸腰椎結核的臨床療效。方法2010年1月～2014年1月,我科共收治胸腰椎結核患者174例,滿足納入標準者共97例,A組(治療組,53例)接受經單側椎弓根入路病灶清除植內固定術治療,B組(對照組,44例)接受傳統(tǒng)后路病灶清除植骨內固定術治療。通過A、B組的對比分析來評估單側椎弓入路病灶清除植骨內固定術治療胸腰椎結核的臨床療效。結果兩組患者均安全度過圍手術期,隨訪12～48個月,術后臨床癥狀緩解滿意,血沉、CRP恢復正常,術后X線片提示后凸畸形矯正滿意,術后3-9個月椎間植骨達骨性融合,末次隨訪后凸Cobb角較術后無明顯丟失,神經功能Frankel分級提高0-2級。A、B組患者組間比較：手術時間、術中出血量、術后住院時間、術后Cobb角丟失、VAS評分無明顯差異(P0.05)；A組術后引流量明顯少于B組(P0.05)；A組術后第3個月ODI指數明顯低于B組(P0.05),兩組ODI指數末次隨訪無統(tǒng)計學差異(P0.05)；A、B組術前及末次隨訪Frankel分級無明顯差異(P0.05)。A組1例患者術后1月出現腰大肌膿腫,經膿腫清除后痊愈,其余無內固定松動、斷裂等并發(fā)癥發(fā)生。結論采用經單側椎弓根入路病灶清除、植骨融合、椎弓根螺釘內固定術治療胸腰椎結核,臨床療效滿意,相比于傳統(tǒng)后路手術創(chuàng)傷更小,脊柱的穩(wěn)定性更強,術后功能恢復更快。
[Abstract]:Objective to investigate the clinical effect of posterior transpedicular approach for the treatment of thoracolumbar tuberculosis. Methods from January 2010 to January 2014, 174 patients with thoracolumbar tuberculosis were treated in our department, 97 of whom met the inclusion criteria. Group A (treatment group, 53 cases) received unilateral pedicle approach, and group B (control group) received unilateral pedicle debridement and internal fixation. 44 cases were treated with traditional posterior debridement, bone grafting and internal fixation. To evaluate the clinical effect of unilateral pedicle debridement, bone grafting and internal fixation for thoracolumbar tuberculosis. Results the patients in both groups survived the perioperative period safely and were followed up for 12 ~ 48 months. The clinical symptoms were satisfactory, the erythrocyte sedimentation rate and CRP returned to normal, the X-ray film showed that the correction of kyphosis was satisfactory, and the intervertebral bone graft reached bone fusion 3-9 months after operation. There was no significant loss of kyphosis Cobb angle after the last follow-up, and the Frankel grade of nerve function was increased by 0-2 grades. The time of operation, the amount of blood lost during operation, the time of hospitalization after operation, the loss of Cobb angle after operation in group A were compared. There was no significant difference in VAS score (P0.05). The postoperative drainage volume in group A was significantly lower than that in group B (P0.05). The ODI index in group); A was significantly lower than that in group B (P0.05). There was no significant difference in ODI index between the two groups at the last follow-up (P0.05). There was no significant difference in Frankel grade before and at the last follow-up in group A (P0.05). One patient in group). A had abscess of psoas major muscle one month after operation, which was cured after abscess removal, and no complications such as loosening of internal fixation and fracture occurred. Conclusion the treatment of thoracolumbar tuberculosis by unilateral pedicle approach with debridement, bone graft fusion and pedicle screw fixation is satisfactory. Compared with the traditional posterior approach, the trauma is less and the spine is more stable. The function recovered more quickly after operation.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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