【摘要】：目的探討后路經(jīng)單側(cè)椎弓根入路病灶清除、植骨融合、椎弓根螺釘內(nèi)固定術(shù)治療胸腰椎結(jié)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(jié)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(jīng)單側(cè)椎弓根入路病灶清除植內(nèi)固定術(shù)治療,B組(對照組,44例)接受傳統(tǒng)后路病灶清除植骨內(nèi)固定術(shù)治療。通過A、B組的對比分析來評估單側(cè)椎弓入路病灶清除植骨內(nèi)固定術(shù)治療胸腰椎結(jié)核的臨床療效。結(jié)果兩組患者均安全度過圍手術(shù)期,隨訪12～48個月,術(shù)后臨床癥狀緩解滿意,血沉、CRP恢復正常,術(shù)后X線片提示后凸畸形矯正滿意,術(shù)后3-9個月椎間植骨達骨性融合,末次隨訪后凸Cobb角較術(shù)后無明顯丟失,神經(jīng)功能Frankel分級提高0-2級。A、B組患者組間比較：手術(shù)時間、術(shù)中出血量、術(shù)后住院時間、術(shù)后Cobb角丟失、VAS評分無明顯差異(P0.05)；A組術(shù)后引流量明顯少于B組(P0.05)；A組術(shù)后第3個月ODI指數(shù)明顯低于B組(P0.05),兩組ODI指數(shù)末次隨訪無統(tǒng)計學差異(P0.05)；A、B組術(shù)前及末次隨訪Frankel分級無明顯差異(P0.05)。A組1例患者術(shù)后1月出現(xiàn)腰大肌膿腫,經(jīng)膿腫清除后痊愈,其余無內(nèi)固定松動、斷裂等并發(fā)癥發(fā)生。結(jié)論采用經(jīng)單側(cè)椎弓根入路病灶清除、植骨融合、椎弓根螺釘內(nèi)固定術(shù)治療胸腰椎結(jié)核,臨床療效滿意,相比于傳統(tǒng)后路手術(shù)創(chuàng)傷更小,脊柱的穩(wěn)定性更強,術(shù)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

【相似文獻】

相關(guān)期刊論文 前10條

1 盧成曉;王榮冠;王庚軍;趙杰;;側(cè)前路減壓植骨鋼板內(nèi)固定治療胸腰椎結(jié)核伴不全癱的體會[J];中原醫(yī)刊;2006年04期

2 馬春光;楊麗;;胸腰椎結(jié)核手術(shù)副損傷的防治[J];中國社區(qū)醫(yī)師(綜合版);2006年12期

3 張可成;蔣塔麗;伊力哈木;劉金林;;胸腰椎結(jié)核的手術(shù)治療[J];中醫(yī)正骨;2006年08期

4 劉炯;龍浩;肖杰;王積輝;陳洪強;;胸腰椎結(jié)核35例手術(shù)治療體會[J];貴州醫(yī)藥;2007年07期

5 王忠遠;閆飛;施向春;胡曉峰;陸庭永;李永碧;;胸腰椎結(jié)核22例手術(shù)治療體會[J];貴州醫(yī)藥;2007年11期

6 陳敢峰;簡紹鋒;;綜合治療胸腰椎結(jié)核臨床觀察[J];甘肅中醫(yī)學院學報;2008年06期

7 羅晉光;賴新平;李國慶;羅月蘭;羅利萍;;168例胸腰椎結(jié)核臨床治療分析[J];內(nèi)蒙古中醫(yī)藥;2008年09期

8 李大偉;馬遠征;薛海濱;馮孟明;;耐藥胸腰椎結(jié)核的外科治療[J];軍醫(yī)進修學院學報;2010年06期

9 胡章勇;劉曉林;牟風云;;胸腰椎結(jié)核32例臨床診治[J];重慶醫(yī)學;2010年13期

10 湯文衛(wèi);;胸腰椎結(jié)核臨床療效分析[J];中外醫(yī)療;2011年35期

相關(guān)會議論文 前10條

1 王杰;;胸腰椎結(jié)核的診斷(附39病例)[A];第十六屆全國中西醫(yī)結(jié)合骨傷科學術(shù)研討會暨中西醫(yī)結(jié)合手法治療骨傷科疾病新進展學習班論文匯編[C];2008年

2 滕曉;張招波;丁凌志;張景生;朱賢平;;后入路手術(shù)治療復發(fā)性胸腰椎結(jié)核的臨床研究[A];浙江省醫(yī)學會骨科學分會30年慶典暨2011年浙江省骨科學學術(shù)年會論文匯編[C];2011年

3 羅春山;李波;田曉濱;周焯家;彭智;簡月奎;趙偉峰;;多節(jié)段胸腰椎結(jié)核外科治療48例[A];貴州省中西醫(yī)結(jié)合學會骨傷分會第二次學術(shù)交流會議論文匯編[C];2011年

4 李松巍;張明;陳斌輝;張勇鵬;;前路病灶清除植骨固定治療胸腰椎結(jié)核臨床觀察[A];浙江省中西醫(yī)結(jié)合學會骨傷科專業(yè)委員會第十四次學術(shù)年會暨省級繼續(xù)教育學習班論文匯編[C];2008年

5 賀躍光;李公倫;孫杰;李旭東;張曉棠;張濤;歐陽海鷹;黃建黨;王國蕊;;前路鋼板加鈦網(wǎng)融合術(shù)治療胸腰椎結(jié)核的療效評價[A];第十九屆中國康協(xié)肢殘康復學術(shù)年會論文選集[C];2010年

6 賀躍光;李公倫;孫杰;李旭東;張濤;;前路鋼板加鈦網(wǎng)融合術(shù)治療胸腰椎結(jié)核的療效評價[A];第六屆西部骨科論壇暨貴州省骨科年會論文匯編[C];2010年

7 王p，

本文編號：2373825