摘要
目的探讨单纯后路手术进行椎弓根螺钉内固定、病灶清除、植骨融合术治疗胸腰椎结核的方法和临床疗效。方法回顾分析近6年来收治的56例胸腰椎结核患者的临床资料。采用全麻,俯卧位,以病变椎体棘突为中心纵向切开,暴露棘突、椎板、椎间关节和横突,在上下相邻正常椎体植入椎弓根螺钉,常规对病椎植入短的椎弓根螺钉,从病变严重一侧或病变双侧咬除一侧或双侧椎板,清除硬脊膜外干酪样坏死组织,经椎间隙清除破坏的椎间盘、椎体内游离死骨,吸净椎管内及椎旁脓液,用链霉素2 g加生理盐水1000 m L作术野反复冲洗,再在病灶内放置链霉素粉剂2 g,装上预弯好的连接棒撑开、固定螺帽以矫正脊柱后凸畸形及恢复椎间隙高度,取咬除的棘突、椎板骨粒或同种异体骨或人工骨置于椎体骨缺损处及横突旁,放置多侧孔引流管,逐层严密缝合切口。术后正规抗结核治疗12~16月。结果采用单纯后路椎弓根螺钉固定、病灶清除、局部使用链霉素、植骨融合及术后正规抗结核治疗胸腰椎结核患者56例,术中术后均无并发症。平均手术时间为(2.5±0.5)h,术中平均出血量为(350±55)m L,术后3~10 w血沉均恢复正常,术后随访18个月,脊柱内固定无松动、断裂、拔出等,植骨处均已骨性融合。术前脊髓神经功能按美国脊柱损伤学会评分(American Spinal Injury Association,ASIA):A级3例,B级5例,C级8例,D级13例,术后均恢复到ASIA E级。结核椎体矢状面Cobb角的变化由术前(26.5±5.3)°降低为术后(3.5±2.8)°。结论单纯采用后路手术治疗胸腰椎结核与采用经典的前后路联合手术治疗相比,具有手术简单、手术时间短、术中出血少、并发症少及脊柱后凸畸矫正良好、神经功能恢复好等特点,值得推广应用。
Objective The method and clinical effect of pedicle screw fixation, focus clearance and bone graft fusion in the treatment of thoracic and lumbar tuberculosis were discussed. Methods The clinical data of 56 cases of thoracic and lmnbar tuberculosis admitted in recent 6 years were analyzed retrospectively. Using general anesthesia and prone position, the center of the spinous process of the diseased vertebral body was opened longitudinally to expose spinous process, lamina, intervertebral joint and transverse process. The pedicle screws were implanted in the upper and lower adjacent normal vertebrae, and the pedicle screws were inserted into the diseased vertebrae. From the side of the lesion or bilateral bite, the cheese necrosis of the dura mater was removed, the intervertebral disc, the free dead bone in the vertebral body, the Pus and the Pus fluid were removed, with 2 g of streptomycin and 1000 mL of normal saline were used for repeated rinsing, and then 2 g of the streptomycin powder were placed in the lesion. To correct the deformity of the spine and restore the height of the intervertebral space, the spines, lamina or variant bone or artificial bone were placed at the bone defect and transverse process of the vertebral body. The multiple side hole drainage tube was placed, and the incision was closely sutured layer by layer. The post-operative regular anti- tuberculosis therapy was perfomed from 12 to 18 months. Results There were 56 cases of thoracic and lumbar tuberculosis treated with simple posterior pedicle screw fixation, lesion clearance, local use of streptomycin, bone graft fusion and post-operative regular antituberculosis therapy. No complication was found in the operation. The average operation time was （2. 5 ± 0. 5） h, and the average bleeding amount was （350 ± 55） mL. The erythrocyte sedimentation rate （ESR） was normal in 3 - 10 w after operation. All of the patients were followed up for 18 months after the operation. No loosening, fracture, or pulling out occurred. All the bone grafts had been fused. Spinal neurological function was graded according to American Spinal Injury Association （ASIA） ： 3 cases were Grade A, 5 cases were Grade B, 8 cases were Grade C and 13 cases were Grade D. All patients recovered to ASIA Grade E after operation. The change of Cobb angle in the sagittal plane of tuberculosis was reduced from （26.5 ＋5.3）~ to （3.5 ~ 2. 8）° after operation. Conclusion Compared with the conventional combined anterior and posterior approach operation, the posterior approach for the treatment of thoracic and lumbar spinal tuberculosis has the characteristics of simplicity, short operative time, less bleeding, less complications, good kyphosis correction, good neural function recovery and so on. It is worth promoting and applying.
出处
《中华神经外科疾病研究杂志》
CAS
2017年第6期534-537,共4页
Chinese Journal of Neurosurgical Disease Research
关键词
脊柱结核
胸椎
腰椎
后路手术
Tuberculosis of spine
Thoracic vertebra
Lumbar vertebra
Posterior operation
