摘要
目的:探讨一期后外侧经椎间孔入路病灶清除、椎间非结构性植骨融合内固定术治疗胸腰椎结核的临床疗效及可行性。方法:收集2016年1月—2020年1月我院收治的103例接受一期后外侧椎间孔入路病灶清除、椎间非结构性植骨融合内固定术的胸腰椎结核患者。记录患者的手术时间(min)、术中出血量(mL)、手术相关并发症及植骨融合情况。观察并比较患者手术前后神经功能(美国脊髓损伤协会ASIA分级)、血沉(ESR)、C-反应蛋白(CRP)、脊柱畸形改善(Cobb角)及疼痛评分(视觉模拟评分VAS)的变化。结果:所有患者随访时间(16.0~24.0)个月,平均随访时间(20.3±4.1)个月;手术时间(90~210)min,平均手术时间(163±55)min;术中出血量(200~1 200)mL,平均术中出血量(610±350)mL。2例患者出现脑脊液漏,2例发生伤口浅表感染,无其他严重手术不良并发症。ASIA分级E级人数比例从术前49.5%(51/103)上升至术后1年84.5%(87/103),差异具有统计学意义(P<0.05)。患者ESR与CRP在术后1个月及1年均有明显下降(P <0.001)。脊柱后凸Cobb角从术前(56.1±12.4)°降低至术后1周(26.1±5.2)°,术后1个月(23.2±5.0)°及术后1年(19.0±5.2)°,差异有统计学意义(P<0.05)。患者疼痛VAS评分从术前(8.0±2.2)分,下降至术后1周(5.0±1.3)分,术后1个月(3.2±1.2)分,术后1年下降至(2.1±1.0)分,差异有统计学意义(P<0.05)。结论:一期后外侧椎间孔入路病灶清除、椎间非结构性植骨融合内固定术治疗胸腰椎结核是一种安全有效的手术方式。该手术能有效校正脊柱畸形、改善神经功能、缓解疼痛及患者结核中毒症状。
Objective: This study aims to investigate the clinical efficacy and feasibility of one-stage debridement and non-structural bone graft fusion combined with internal fixation using posterior lateral transforaminal approach in the treatment of thoracolumbar tuberculosis.Methods: We retrospectively analyzed 103 patients with thoracolumbar tuberculosis treated with one-stage debridement and non-structural bone graft fusion combined with internal fixation using posterior lateral foramen approach,while recording the operation time(min),intraoperative blood loss(mL),operation related complications,and bone graft fusion status.We also investigated and compared neurological function(American Spinal Injury Association,ASIA),laboratory examination,including Erythrocyte Sedimentation Rate(ESR,mm/h) and C-reactive protein(CRP,mg/L),improvement of spinal deformity(Cobb angle),and pain prognosis(Visual Analogue Scale,VAS)before and after surgery.Results: The average age of the 103 patients was 45.5 years(17.0~76.0)years,with the average follow-up time of(20.3±4.1)months(16.0~24.0)months,the average operation time of(163±55)minutes(90~210)minutes and the average intraoperative blood loss was(610±350)mL(200~1 200)mL.There appeared cerebrospinal fluid leakage in 2 cases,superficial wound infection in 2 cases,and no other serious adverse complications.The proportion of ASIA grade E grade increased from 49.5%(51/103)before surgery to 1 years 84.5%(87/103)after operation,with statistically significant difference(P < 0.001).ESR and CRP decreased significantly at 1 month and 1 year after operation(P < 0.001).Cobb angle of kyphosis decreased from(56.1±12.4)°to(26.1±5.2)°in 1 week,(23.2±5.0)°in 1 month,and(19.0±5.2)°in 1 year(P < 0.001).The VAS score decreased from(8.0±2.2)preoperatively to(5.0±1.3)at 1 week,(3.2±1.2)at 1 month,and(2.1±1.0)at 1 year after operation(P < 0.001).Conclusion: One-stage debridement and non-structural bone graft fusion combined with internal fixation using posterior lateral transforaminal approach are effective and safe in the treatment of thoracolumbar tuberculosis,which can effectively correct spinal deformity,improve the prognosis of neurological function and pain,and relieve the poisoning symptoms of tuberculosis.
作者
李占银
阿尖措
郝岩
马继伟
贾生龙
Li Zhanyin;A Jiancuo;Hao Yan;Ma Jiwei;Jia Shenglong(Qinghai Red Cross Hospital,810001)
出处
《青海医药杂志》
CAS
2021年第8期1-7,共7页
Qinghai Medical Journal
关键词
胸腰椎结核
椎间孔入路
病灶清除
椎间非结构性植骨融合
一期手术
Thoracolumbar tuberculosis
Transforaminal approach
Debridement
Non-structural bone fusion
One stage operation
