【作者】 杨波；

【导师】 杨群；

【作者基本信息】 大连医科大学 ， 外科学， 2017， 硕士

【摘要】 目的:探讨一种新型可滑动椎弓根钉棒内固定系统在胸腰椎椎体结核中手术治疗的临床效果和安全性。方法:分析2014年11月~2016年6月我院采用椎弓螺根钉滑动棒内固定系统治疗的胸腰椎结核患者21例,其中男14例,女7例,年龄为37岁~71岁,平均55.4岁。手术术式均采用后入路病灶清除减压,椎间植骨融合椎弓根螺钉内固定术,评价指标包括术前与术后的美国脊髓损伤神经学分类国际标准ASIA损伤分级,评价患者术前、术后脊髓损伤和恢复情况。应用日本骨科协会评估治疗分数(Japanese Orthopaedic Association,JOA)胸腰椎评分法,评价患者术前、术后胸腰椎功能改善情况。应用疼痛视觉模拟10分评分法(A 10-point visual analogue scale,VAS),评价患者治疗前后腰背部疼痛及双下肢疼痛麻木的改善情况,通过影像学(主要是术前、术后X线)分析椎间植骨融合情况、椎间高度变化及手术前后Cobb角的纠正及远期丢失角度。结果:21例患者均顺利完成手术,均得到随访,随访时间3-12个月,17例随访时间超过12个月,平均10.7个月。术后患者的神经功能ASIA分级较术前明显改善,只有一例ASIA分级与术前无明显变化,考虑可能由于病椎周围结核冷脓肿及术前脊柱后凸压迫脊髓神经时间较长,造成脊髓神经不可逆性损伤术后患者造成。所有患者的VAS、JOA评分较术前均下降,其中VAS评分由术前的(8.48±1.21)分下降到术后3个月的(1.81±0.60)分,至术后6个月时,进一步下降到(0.90±0.62)分,JOA评分由术前的(8.14±2.056)分,上升到术后3个月的的(24.57±1.63)分,至术后6个月时,进一步上升到(25.52±1.88)分差异均有统计学意义(p<0.001)。术后影像学显示术后1周,1月,3月,6月融合椎体之间高度有变化,由术后1周的(12.17±1.67)mm降至术后12个月的(9.86±1.35)mm,差异有统计学意义(p<0.001),术后6个月趋于稳定,无一例出现神经损害表现。所有患者术后不同随访时间节点滑动棒固定螺钉和球头钉之间的距离也有不同程度的变化,6个月后基本稳定。Cobb角度术后较术前明显改善,术后1周及术后6个月较术前明显改善,术后17例超过12个月的患者影像学均达到融合指证,3例随访6个月的患者,X线显示基本植骨基本达到融合指证,剩下1例随访3个月的患者X线不能明确是否完全融合,但植骨间隙的透亮区面积明显减少。所有手术患者经正规抗结核、换药、拆线治疗出院后,在随访期间均未出现切口感染及手术节段结核复发,未见内固定装置的松动、断裂及融合椎间隙下沉过大导致后凸畸形等现象发生。结论:可滑动椎弓根钉棒内固定系统治疗胸腰椎结核近期临床效果满意,有益于植骨节段融合,可维持手术矫正的后凸畸形,但其远期效果还需长期、大量样本临床观察。更多还原

【Abstract】 Objective: To investigate the efficacy and safety of a slideable pedicle screw-rod system as a novel type of pedicle internal fixation system in the treatment of thoracolumbar tuberculosis.Methods: We analysed 21 patients(14 males and 7 females)with thoracolumbar tuberculosis using the novel slideable pedicle screw-rod system from November 2014 to June 2016,aged37-31 y and average 55.2 y.Visual analogue scale(VAS),The Japanese Orthopaedic Association score(JOA),ASIA grade,the fusion situation,the height variation of slideable pedicle screw-rod system and Cobb’s angle before and after surgery were used to evaluate the clinical efficacy.Results: 21 patients were successfully completed the operation,all were followed up for 3-12 months,17 cases were followed up for more than 12 months,with an average of 10.7 months.Patients at every time after operation compared with preoperative VAS and JOA scores decreased,postoperative ASIA grade were significantly improved compared with preoperative,the difference was statistically significant(p<0.05),postoperative imaging showed 3 days after January,March,June is the height of fusion segment changes,but no case showed the neurologic damage symptoms.The postoperative Cobb angle improved significantly compared with the preoperative,postoperative 3 months after stabilized,postoperative imaging of 17 cases of more than 12 months were basically reached the fusion,there were no pedicle screw-rod loosening,breakage,intervertebral fusion sinking too much lead to the occurrence of kyphosis phenomenon.Conclusion: The novel slideable pedicle screw-rod system for treatment of thoracolumbar tuberculosis,the short-term clinical efficacy is satisfied,can promote the segment fusion,but its long-term efficacy still need long-term and large sample clinical further follow-up.更多还原