摘要
目的总结胸腰椎结核患者体温、红细胞沉降率（ESR）变化的临床意义，并探讨胸腰椎结核的手术时机及入路选择。方法选择43例胸腰椎结核手术患者资料进行总结和随访。总结手术方法，观察患者术前术后ESR、体温变化，术后恢复情况，随访12—36个月。结果胸椎结核8例，旁正中入路2例，后正中入路6例；胸腰段（T1～L2）结核15例，前路4例，后路5例，前后路联合6例；腰骶部（L3～S2）结核20例，前路6例，后路5例，前后路联合9例。入院ESR（66．7±30．06）mm／h，术前3～5天ESR（59．8±29．43）mm／h，两者差异无统计学意义（α=0．204）。术后3天内ESR（102．6±26．38）mm／h，术后10—14天ESR（69．2±27．18）mm／h，术后3个月ESR（15．02±6．33）mm／h，术前出现低热（〈38℃）16例，出现一过性高热1例，术后无体温升高者1例，3大体温恢复正常者8例，3～7天体温恢复正常者22例，7—14天体温恢复正常者9例，大于14天体温恢复正常者3例，其中出现高热5例。3例腰椎前路切口术后渗液，换药治疗后切口甲级愈合，1例腰椎结核前路病灶清除植骨内固定术后2个月出现腰部窦道。结论胸腰椎结核椎旁脓肿明显形成，术前正规抗痨不少于3周后，体温〈38℃，即使ESR无明显下降仍可考虑手术，不同部位结核采取不同手术入路和方式，彻底清除病灶融合稳定病变区叮取得满意疗效。
Objective To summarize the importance of erythrocyte sedimentation rate （ESR） and body temperature （BT） and evaluate the proper time and operation approach for thoracic and lumbar tuberculosis. Method 43 thoracic and lumbar tuberculosis patients underdoing opration were reveiwed retrospectively. Patients were followed up for an aver- age of 27 months（ range, 12 -36 months）. To observe the ESR and BT of preoperation and postoperation, and the recov- ery. Alter operation,all the patients took oral antituberculotics drugs at least 1 year. Result There were 8 thoracic tuber- culosis cases, 2 cases with para- midline approach, 6 cases with posterior median approach. There were 15 thoracolum- bar tuberculosis cases, 4 cases with anterior approach, 5 cases with posterior approach,others with anterior - posterior ap- proach. There were 20 thoracolumbar tuberculosis cases, 6 cases with anterior approach, 5 cases with posterior approach, others with anterior - posterior approach. The first average value of ESR after admission was （66.7± 30.06） mm/h, the ESR before operation 3 - 5 days was （59.8± 29.43 ） mm/h, there were no statistical differences between the both （ α = 0. 204）. The average value of ESR in 3 days after operation was （ 102.6 ±26.38） ram/h, at 10 - 14 days after operation was （69.2 ±27.18） rant/h, after 3 months the ESR was （ 15.02 ± 6.33） mm/h. Patients with kyphotic deformity were fixed and reconstructed by screw - rods system. 3 cases of anterior operations had incision exudation, and in the end the incision got first grade coalesce afer changing dressing. 1 anterior debridement, fusion and internal fixation case appeared sinus 2 months later. Conclusion After a minimum of three weeks antituberculotics drugs, with BT 〈 38℃, even if the ESR decline unobviously, the operation of thoracic and lumbar tuberculosis with apparent paraspinal abscess can be performed. The operation approach and surgical methods should be chosen according to the lesion site. And above all, focus must be debrided thorougbly, then satisfied results can be found after fusing and fixing lesion area.
出处
《徐州医学院学报》
CAS
2013年第3期180-183,共4页
Acta Academiae Medicinae Xuzhou
关键词
脊柱结核
手术时机
手术方式
红细胞沉降率
体温
spine tuberculosis
timing of operation
operative method
erythrocyte sedimentation rate
body tem- perature
