摘要
目的:探讨保守与不同手术方式治疗胸腰椎结核的适应证及临床效果。方法:2000年5月至2008年6月对治疗的162例胸腰椎结核患者进行回顾性研究。其中男89例,女73例;年龄4～71岁,平均43.6岁。38例发病时间短、X线示椎间隙狭窄、MRI示椎体信号改变、全身情况较好者应用抗结核药物(6HREZ(S)/6-9HRE)加中药辨证治疗;51例伴脓肿及椎体边缘型破坏,不影响脊柱稳定性者采用结核病灶清除手术治疗;73例椎体中央型破坏,伴脓肿死骨、脊柱不稳或伴脊髓功能损害者,采用病灶清除加椎间植骨加内固定手术治疗。依照骨结核临床治愈标准进行评估,观察疗效。结果:保守治疗38例于1～2年均获痊愈。施行病灶清除的51例中,有3例发生切口旁窦道,4例后凸Cobb角较治疗前丢失5°～10°,平均4.5°。73例内固定患者中,神经缺失症状明显恢复,2例发生切口旁窦道,3例出现取髂骨部位短期皮下气肿及局部疼痛,不需特殊处理。共随访136例,时间12～60个月,平均32.8个月,均获临床治愈。结论:早期发现的无合并症患者可以保守治愈;对合并脓肿、椎体破坏轻,不影响脊柱稳定性者,采用单纯病灶清除手术亦可获得较好疗效;椎体破坏重致脊柱不稳或伴脊髓神经功能损害者,则需要在清除结核病灶的同时,给予植骨和脊柱内固定。
Objective：To explore the differences between conservative and surgical treatment for thoracic and lumbar spine tuberculosis on indications and clinical results.Methods：From May 2000 to June 2008,162 cases of thoracic spinal tuberculosis patients were studied retrospectively,including 89 males and 73 females,aged from 4 to 71 years（means 43.6 years）.Among them,38 cases of onset time was short,X ray showed a narrow cone gap and MRI showed vertebral body signal changes,the ones who had better general condition were applicated of anti TB drugs [6HREZ（S） /6-9HRE] and traditional Chinese medicine dialectical;51 cases with thick swollen and vertebral body marginal damage but not affect the stability of spine,were treated with spinal tuberculosis debridement surgery;73 cases with abscess,vertebral destruction of center,spinal instability or spinal cord function associated with damage to persons,were treated with surgical debridement and interbody bone grafting and fixation.Clinical observation were evaluated according to the standard cure for bone tuberculosis.Results：Thirty eight cases by conservative treatment,had been cured in 1 to 2 years.Focus of infection cleared in 51 cases,3 cases occurrenced the sinus next to incision,4 cases of kyphosis angle（Cobb） lost 5°-10° compared with that before treatment（means 4.5°）.Seventy three cases by internal fixation obtained neurological deficiency symptoms recovery;2 occurenced the sinus next to the incision,3 cases appeared subcutaneous emphysema of iliac area and local pain,but need no special treatment.A total of 136 patients were followed up from 12 to 60 months with an average of 32.8 months,and had been all clinically cured.Conclusion：Patients with early detection only on the imaging showing vertebral lesions,without obvious sequestrum,abscesses,can be selected for conservative anti tuberculosis treatment.Patients combined with abscess,vertebral destruction on light degree and not affected the stability of the spine,can be removed by simple surgery to obtain better efficacy.Patients with abscesses,sequestrum,spinal vertebral instability leading to heavy damage associated with spinal cord or nerve function impairment,will need surgical removal of lesions of tuberculosis,give graft and spinal fixation at the same time.
出处
《中国骨伤》
CAS
2010年第7期497-499,共3页
China Journal of Orthopaedics and Traumatology
关键词
结核
脊柱
抗结核药
外科手术
Tuberculosis spinal Antitubercular agents Surgical procedures operative
