【作者】 陈华龙；

【导师】 廖琦；

【作者基本信息】 南昌大学 ， 外科学， 2008， 硕士

【摘要】 目的回顾性研究我院近年手术治疗的98例胸腰骶椎结核病例,总结脊柱结核各术式的优缺点和适应症。方法2001年1月～2007年6月我院共采用手术治疗胸、腰、骶椎脊柱结核126例,98例获有效随访。其中男53例,女45例;年龄16~76岁,平均39.6岁;病史3~39个月,平均15个月。根据不同的术式分组:A组(21例)采用单纯病灶清除术,B组(16例)采用前路病灶清除并植骨融合+内固定术,C组(49例)采用一期前路病灶清除、后路植骨融合并内固定术;D组(12例)采用单纯后路植骨融合并椎弓根内固定术。结果所有患者切口均一期愈合,无慢性窦道形成。除28例失访外,其余98例获得6个月~72个月随访,平均33个月。75例有后凸畸形者,后凸畸形平均矫正18.3度,随访期内丢失3~5度。除A组2例二次手术治愈,其余患者均一次治愈。45例有神经损害的患者术后均获得明显改善,平均改善1.33级。组间两两比较χ2检验,A/D组手术时间及术中出血量明显少于B/C组(P<0.05)。结论在有效抗结核化疗基础上,脊柱稳定性在脊柱结核治疗中具有重要意义。采用能够有效稳定脊柱的外科术式是取得满意临床疗效的保证。有脊髓压迫、截瘫及脊柱不稳定者需要外科干预。有明显前路压迫致神经损害的患者适合采用前路病灶清除术。骨缺损小于2个节段可行前路内固定术;多椎体结核或跳跃性结核及腰骶部结核最好行后路椎弓根内固定术。单纯后路椎弓根钉内固定、后外侧脊柱融合术可有效稳定脊柱,防止迟发后凸畸形,治疗骨质破坏较轻、神经损害较轻的脊柱结核,具有手术创伤轻,技术较易开展的优点。更多还原

【Abstract】 Objective: To summarize advantages and disadvantages of spinal tuberculosis operation methods by retrospective studying 98 thoracic-waist-sacral vertebrae tuberculosis cases with operation therapy of my hospital in recent years.Method: We treated 126 thoracic-waist-sacral vertebrae tuberculosis cases by operation from Jan ,2001 to Jun,2007,98 cases of which were followed up effectively(53 male cases ,45 female cases, age: 16--76years, average age 39.6 years, case history :3--39 months, average 15 months). Grouping by different operation methods’group(21 cases) was used simple clearance of focal lesion, B group(16 cases) focus clearance combining bone graft fusion and property internal fixation group(49 cases)Ⅰproperty focus clearance and post path bone graft fusion combining internal fixation as well as D group(12 cases) simple post path bone graft fusion combining pedicle of vertebral arch internal fixation.Result: All patients’nicks were primary healing without formation of chronic sinus tract.98 cases were followed up 6～72 months (average 33).75 cases with post crypto-deformity were reacted for 18.3 degrees but loss 3-5degrees in the following up terms. All cases were obtained one–time curing other than two-time curing of 2 cases in the A group .45cases with obvious nervous lesion were significant improved. Comparisons between groups were used with chi square. The time and bleeding volume of operation of A/D groups were less than those of B/C groups.Conclusion: Spinal stability has significance in the process of treating spinal tuberculosis on condition of effective anti tuberculosis chemotherapy. The operations of simple post path pedicle of vertebral arch internal fixation and post lateral spinal fusion can treat spinal tuberculosis with nervous lesion effectively, which have merits of slight surgical trauma and easy to carry out.更多还原