后路个体化病椎置钉联合前路小切口病灶清除治疗腰椎结核

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摘要目的：探讨腰椎结核一期行后路个体化病椎置钉固定联合前路小切口病灶清除支撑植骨的临床疗效。方法：回顾性分析2011年2月至2014年5月采用一期后路个体化椎弓根螺钉固定联合前路小切口病灶清除治疗的62例腰椎结核患者的临床资料。术前在抗结核治疗的前提下根据临床症状、体征及影像学结果拟定手术方案。对手术前后Cobb角、视觉模拟评分（VAS）、血沉、Frankel分级行统计分析，并观察手术并发症、内植物稳定性和植骨融合情况。结果：术后随访15～36个月，平均（23.7±9.6）个月。有3例患者术后3个月发现前路手术对侧腰大肌脓肿形成，行二次手术排脓后治愈。余59例均一期愈合，无窦道形成，无切口疝，无脑脊液漏，无脊柱结核复发。末次随访Frankel分级：C级1例，D级5例，E级56例。末次随访后凸Cobb角由术前平均（16.34°±3.19°），减少至（4.52°±1.69°）；VAS评分由术前（6.72±1.02）分，至末次随访时（2.06±0.73）分；血沉由术前（40.12±1.53）mm/h，降至末次随访（10.67±0.72）mm/h。X线、CT片均显示骨性愈合，融合时间3～7个月，平均融合时间为4.6个月。结论：采用个体化椎弓根螺钉固定联合前路小切口病灶清除治疗腰椎结核是较为有效、安全的方法。

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	应小樟
	郑琦
	石仕元
	沈健
	汪翼凡
	朱博
	韩贵和
	郑铭锋

关键词 ：结核, 脊柱, 脊柱融合术, 骨移植

Abstract：Objective: To determine the efficacy of posterior individual fixation combined with anterior mini-open debridement and strut graft for the treatment of lumbar spinal tuberculosis. Methods: From February 2011 to May 2014, a total of 62 cases with lumbar spinal tuberculosis were treated with posterior individual fixation combined with anterior debridement and strut graft. The cohort comprised 33 males and 29 females with an average age of 51.3 years. The pre-operative Frankel grading showed that 2 cases were grade B, 8 grade C, 16 grade D, and 36 grade E. Anti-tuberculosis therapy was carried out for two to four weeks, and the operation plan was determined by symptoms, signs and image. The clinical efficacy was evaluated based on the kyphosis Cobb angle, the visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and the Frankel grade system before and after the surgery. Results: The average follow-up duration was 23.7 months (15-36 months). There were three patients presented with psoas abscess after three months on the contralateral side, and cured by drainage. At the final follow-up the Frankel grading showed that 1 was grade C, 5 were grade D, and 56 were grade E. The Cobb’s angle was decreased from (16.34°±3.19°) (pre-operation) to (4.52°±1.69°). The visual analogue scale (VAS) was decreased from (6.72±1.02) (pre-operation) to (2.06±0.73). The erythrocyte sedimentation rate (ESR) was decreased from (40.12±1.53) mm/1 h (pre-operation)to (10.67±0.72) mm/1 h. Graft union was observed 3 to 7 months after surgery, with a mean of 4.6 months. There was no vertebral tuberculous relapse or screw loose/abruption. Conclusion: It is effective to treat lumbar tuberculous with posterior individual fixation combined with anterior mini-open debridement and strut graft.

Key words： tuberculosis spinal spinal fusion bone transplantation

收稿日期: 2015-10-08

基金资助:杭州市科技发展计划项目（20110733Q16）。

通讯作者: 郑琦，主任医师，Email：drzhq007@sohu.com。

作者简介: 应小樟（1980-），男，浙江瑞安人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2016/V46/I4/274

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