后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核的疗效分析
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摘要
目的探讨后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核的临床疗效分析。方法 2011年6月-2015年10月期间于本院采用后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核患者18例,男性11例、女7例,年龄3~11岁,平均5.8岁。对所有患者术后进行定期随访,现对其临床数据进行回顾性分析。根据后凸畸形Cobb角及脊髓功能Frankle分级评价临床疗效。结果手术时间150~240 min,平均196 min。术中出血量200~480 mL,平均328 mL。随访时间1~3年,平均2.18年。Cobb角由术前48.4°矫正至术后10.8°,矫正率为78%(P<0.05)。1例患者出现植骨块骨折,返修术后治愈。末次随访,根据Frankle分级,所有患者神经功能均恢复正常(P<0.05)。Cobb角平均丢失3.4°。随访中未发现结核复发及内固定失败。结论后路内固定联合前路病灶清除植骨融合是治疗小儿脊柱结核有效、安全的手术方式,该技术能够较理想地维持后凸畸形的矫正率。
Objective To investigate the clinical outcomes of one-stage posterior instrumentation combined with anterior debridement and grafting for children with spinal tuberculosis. Methods From June 2011 to October 2015,18 children with spinal tuberculosis treated by one-stage posterior instrumentation combined with anterior debridement and grafting in our institution,including11 males,7 females,aged between 3-11 years,average age is 5.8 years. All of the patients were terminally followed up,as now the collected date were retrospectively analyzed. Clinical outcomes were evaluated based on Cobb angle and the Frankel motor score system.Results The mean operation time was 196 min(range 150-240 ml). The mean blood loss was 328 ml(range 200-480 ml). All cases were followed up for 1-3 years,average was 2.18 years. The mean Cobb angle was corrected from preoperative 48.4° to postoperative10.8°with a accurate rate of 78%(P<0.05). One case suffered from graft bone displacement,and was undergo revision surgery. At the last follow up,according to the Frankle grade,neurological deficits were back to normal(P<0.05). The mean loss of correction was 3.4°.There was no cases experienced with instrumentation failure and recurrence of the disease. Conclusion For young children with spinal tuberculosis,one-stage posterior instrumentation combined with anterior debridement and grafting is a safe and simple procedure,and it is more effective in long-term maintenance of the surgical correction.
Objective To investigate the clinical outcomes of one-stage posterior instrumentation combined with anterior debridement and grafting for children with spinal tuberculosis. Methods From June 2011 to October 2015,18 children with spinal tuberculosis treated by one-stage posterior instrumentation combined with anterior debridement and grafting in our institution,including11 males,7 females,aged between 3-11 years,average age is 5.8 years. All of the patients were terminally followed up,as now the collected date were retrospectively analyzed. Clinical outcomes were evaluated based on Cobb angle and the Frankel motor score system.Results The mean operation time was 196 min(range 150-240 ml). The mean blood loss was 328 ml(range 200-480 ml). All cases were followed up for 1-3 years,average was 2.18 years. The mean Cobb angle was corrected from preoperative 48.4° to postoperative10.8°with a accurate rate of 78%(P<0.05). One case suffered from graft bone displacement,and was undergo revision surgery. At the last follow up,according to the Frankle grade,neurological deficits were back to normal(P<0.05). The mean loss of correction was 3.4°.There was no cases experienced with instrumentation failure and recurrence of the disease. Conclusion For young children with spinal tuberculosis,one-stage posterior instrumentation combined with anterior debridement and grafting is a safe and simple procedure,and it is more effective in long-term maintenance of the surgical correction.
引文
[1]World Health Organization(2016)Global tuberculosis report 2016[J].Geneva:World Health Organization Available at:http://www.who.int/tb/publications/global_report/en/.Accessed October 2016
[2]Jain AK.Tuberculosis of the spine:a fresh look at an old disease[J].J Bone Joint Surg Br.2010 Jul;92:905-913
[3]Benzagmout M,Boujraf S,Chakour K,et al.Pott's disease in children[J].Surg Neurol Int,2011,1(11):21-31
[4]Upadhyay SS.17-Year prospective study of surgical management of spinal tuberculosis in children.[J]Spine;2006,11(12):1704-1711.
[5]Hassan K,Elmorshidy E(2016)Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine.[J]Eur?Spine?J.2016;25(4):1056-1063
[6]Wang XB,Li J,LüGH et al(2012)Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity.[J]Int Orthop.2012;36(2):373-380
[7]Soares do Brito J,Batista N,Tirado A,et al.Surgical treatment of spinal tuberculosis:an orthopedic service experience.[J]Acta Med Port,2013,26(4):349-56
[8]Wiley AM,Trueta J.The vascular anatomy of the spine and its relationship to pyogenie vertebral ostromyelitis.[J]Bone Joint Surg Br,1995,41(2):796-809
[9]Rajasekaran S.Buckling collapse of the spine in childhood spinal tuberculosis.[J]Clin Orthop Relat Res,2007,35(460):86-92
[10]Rajasekaran S.Natural history of Pott’s kyphosis.[J]Eur Spine,2013,22(4):634-640
[11]Rajasekaran S.The natural history of post-tubercular kyphosis in children:radiological signs which predict late increase in deformity.[J]Bone Joint Surg,2001,83(79):954-962.
[12]Rajasekaran S,Soundarapandian S.Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis.[J]J Bone Joint Surg Am.1989;71:1314-1323
[13]Sundararaj GD,Behera S,Ravi V.Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine.[J]J Bone Joint Surg Br2003;85:100-106
[14]张宏其,王昱翔,郭超峰,等.一期后路病灶清除植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的临床初步报告[J].中国矫形外科杂志,2011,19(1):31-35.
[15]Huang QS,Zheng C,Hu Y et al(2009)One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation.[J]Int Orthop 2009;33(5):1385-1390
[16]Wang X,Pang X,Wu P,et al.One-stage anterior debridement,bone grafting and posterior instrumentation vs.single posterior debridement,bone grafting,and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis.[J]Eur Spine J.2014;23(4):830-837
[2]Jain AK.Tuberculosis of the spine:a fresh look at an old disease[J].J Bone Joint Surg Br.2010 Jul;92:905-913
[3]Benzagmout M,Boujraf S,Chakour K,et al.Pott's disease in children[J].Surg Neurol Int,2011,1(11):21-31
[4]Upadhyay SS.17-Year prospective study of surgical management of spinal tuberculosis in children.[J]Spine;2006,11(12):1704-1711.
[5]Hassan K,Elmorshidy E(2016)Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine.[J]Eur?Spine?J.2016;25(4):1056-1063
[6]Wang XB,Li J,LüGH et al(2012)Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity.[J]Int Orthop.2012;36(2):373-380
[7]Soares do Brito J,Batista N,Tirado A,et al.Surgical treatment of spinal tuberculosis:an orthopedic service experience.[J]Acta Med Port,2013,26(4):349-56
[8]Wiley AM,Trueta J.The vascular anatomy of the spine and its relationship to pyogenie vertebral ostromyelitis.[J]Bone Joint Surg Br,1995,41(2):796-809
[9]Rajasekaran S.Buckling collapse of the spine in childhood spinal tuberculosis.[J]Clin Orthop Relat Res,2007,35(460):86-92
[10]Rajasekaran S.Natural history of Pott’s kyphosis.[J]Eur Spine,2013,22(4):634-640
[11]Rajasekaran S.The natural history of post-tubercular kyphosis in children:radiological signs which predict late increase in deformity.[J]Bone Joint Surg,2001,83(79):954-962.
[12]Rajasekaran S,Soundarapandian S.Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis.[J]J Bone Joint Surg Am.1989;71:1314-1323
[13]Sundararaj GD,Behera S,Ravi V.Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine.[J]J Bone Joint Surg Br2003;85:100-106
[14]张宏其,王昱翔,郭超峰,等.一期后路病灶清除植骨融合内固定矫形治疗伴后凸畸形的儿童胸腰段脊柱结核的临床初步报告[J].中国矫形外科杂志,2011,19(1):31-35.
[15]Huang QS,Zheng C,Hu Y et al(2009)One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation.[J]Int Orthop 2009;33(5):1385-1390
[16]Wang X,Pang X,Wu P,et al.One-stage anterior debridement,bone grafting and posterior instrumentation vs.single posterior debridement,bone grafting,and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis.[J]Eur Spine J.2014;23(4):830-837