【摘要】 目的:评价CT引导下经皮穿刺置管(percutaneous catheter drainage,PCD)灌洗治疗儿童腰骶段脊柱结核的疗效。方法:2006年1月~2011年2月我科采用CT引导下PCD灌洗治疗9例腰骶段脊柱结核患儿,其中男6例,女3例,年龄2岁2个月~7岁,平均5.4岁。术前血沉25~57mm/h,平均39mm/h,C反应蛋白22.9~40mg/L,平均29mg/L。术前4例有神经功能障碍,Frankel分级D级3例,C级1例。所有患儿在全身抗结核药物治疗的同时,在CT引导下经皮穿刺置管、异烟肼溶液灌洗病灶,同时行TLSO支具外固定保护。结果:9例患者全身抗结核药物治疗9~12个月,病灶局部灌洗10~12周,TLSO支具外固定6~18个月。随访12~36个月,平均24个月,术后1~3个月ESR、CRP恢复到正常。8例治愈,1例因过早停用抗结核药物致病灶复发,改行开放手术治疗。置管处均无窦道形成,3例Frankel D级患者恢复到E级,1例C级恢复到D级。末次随访时患者临床症状完全消失,影像学检查示结核病灶均愈合,无复发病例。结论:在全身抗结核药物治疗和术后TLSO支具外固定保护下,CT引导下PCD灌洗治疗儿童腰骶段脊柱结核是一种微创、简单、安全、有效的方法。更多还原

【Abstract】 Objectives: To evaluate the clinical efficacy of percutaneous intubation and irrigation under CT guidance for lumbosacral tuberculosis in children.Methods: 9 children suffering from lower lumbar spinal tuberculosis in our institute between January 2006 and February 2011 were reviewed retrospectively.There were 6 males and 3 females with a mean age at surgery of 5.4 years old(range,2.2 to 7 years).Preoperative ESR and CRP ranged from 25 to 57mm/h(average 39mm/h) and 22.9 to 40mg/L(average 29mg/L) respectively.Preoperative neurological deficits were noted in 4 cases,with 1 Frankel C and 3 Frankel D.All patients underwent routine chemotherapy which consisted of rifampin,isoniazid and ethambutol.9 children underwent percutaneous intubation,irrigation and continuous focal distillation of isoniazid under CT guidance,after that,all cases had thoracolumbar sacralorthosis(TLSO).Results: All patients received chemotherapy for 9-12 months,PCD for 10-12 weeks and thoracolumbar sacralorthosis(TLSO) for 6-18 months.All cases were followed up for 12-36 months(average,24 months).8 children had defect healed completely,tuberculosis recurrence was noted in 1 case due to early cease of chemotherapy,and this case received surgery.No sinus formation was detected,ESR and CRP decreased to normal after an average of 1 and a half months(range,1 to 3 months).The clinical symptoms completely disappeared and the defect healed.3 cases with Frankel D recovered to E and 1 from Franke C to D.There was no recurrence after final follow-up.Conclusions: Percutaneous intubation and irrigation under CT guidance is an easy,safe,efficient and less invasive method for lumbosacral vertebral tuberculosis in children on the presence of chemotherapy and thoracolumbar sacralorthosis.更多还原