病灶清除椎间植骨融合内固定治疗胸椎结核合并脊髓损伤的临床研究
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摘要
目的探讨病灶清除、椎间植骨融合及内固定术治疗胸椎结核合并脊髓损伤的临床效果。方法选取2013-01-2015-01我院收治的胸椎结核合并脊髓损伤患者60例,所有患者均行病灶清除、椎间植骨融合及内固定治疗,记录手术时间、术后出血量及术后骨融合时间。比较术前、术后3周及术后24个月患者的Cobb角变化、脊柱疼痛情况、神经功能恢复情况,使用CT或X线检查评价Cobb角变化,使用VAS疼痛视觉评分法评价疼痛情况,使用ASIA神经功能分级评价神经功能恢复情况。结果:手术时间105～356 min,平均220.5 min;术中出血量112～1895 ml,平均821.8 ml;术后随访期间所有患者结核均未复发;术后3周及术后24个月患者的Cobb角和VAS评分较术前均显著降低(P<0.05);术后24个月随访患者神经功能评分较术前显著改善(P<0.05)。结论病灶清除、椎间植骨融合及内固定胸椎结核合并脊髓损伤效果良好,可有效缓解患者疼痛,恢复患者神经功能,并重建脊柱稳定性,值得临床推广应用。
Objective To investigate the clinical effect of debridement, interbody fusion and internal fixation in the treatment of thoracic spinal tuberculosis and spinal cord injury. Methods From January 2013 to January 2015, 60 patients with thoracic spinal tuberculosis and spinal cord injury were treated in our hospital. All patients were treated with debridement, interbody fusion and internal fixation. The operation time, the amount of bleeding and the time of bone fusion were recorded. The changes of Cobb angle, pain and recovery of neurological function were compared before and 3 weeks after operation and at the end of the operation for 24 months. CT and X-ray examination were used to evaluate the changes of Cobb angle, and the pain was evaluated by VAS pain visual score. The neurological function was evaluated by ASIA neural function classification.Results The operation time was 105 ～356 min, with an average of 220.5 min. The intraoperative blood loss was 112 ～1895 ml, with an average of 821.8 ml. All patients had no recurrence during follow-up. The Cobb angle and VAS score of the patients at postoperative 3 weeks and 24 months were significantly lower than before operation(P<0.05). After 24 months of follow-up, the neurological function score was significantly improved(P <0.05). Conclusion Debridement, interbody fusion and internal fixation in the treatment of thoracic spinal tuberculosis complicated with spinal cord injury has good effect, can effectively relieve the pain of patients, promote the recovery of neurological function, and reconstruction of spinal stability, it is worthy of clinical application.
Objective To investigate the clinical effect of debridement, interbody fusion and internal fixation in the treatment of thoracic spinal tuberculosis and spinal cord injury. Methods From January 2013 to January 2015, 60 patients with thoracic spinal tuberculosis and spinal cord injury were treated in our hospital. All patients were treated with debridement, interbody fusion and internal fixation. The operation time, the amount of bleeding and the time of bone fusion were recorded. The changes of Cobb angle, pain and recovery of neurological function were compared before and 3 weeks after operation and at the end of the operation for 24 months. CT and X-ray examination were used to evaluate the changes of Cobb angle, and the pain was evaluated by VAS pain visual score. The neurological function was evaluated by ASIA neural function classification.Results The operation time was 105 ～356 min, with an average of 220.5 min. The intraoperative blood loss was 112 ～1895 ml, with an average of 821.8 ml. All patients had no recurrence during follow-up. The Cobb angle and VAS score of the patients at postoperative 3 weeks and 24 months were significantly lower than before operation(P<0.05). After 24 months of follow-up, the neurological function score was significantly improved(P <0.05). Conclusion Debridement, interbody fusion and internal fixation in the treatment of thoracic spinal tuberculosis complicated with spinal cord injury has good effect, can effectively relieve the pain of patients, promote the recovery of neurological function, and reconstruction of spinal stability, it is worthy of clinical application.
引文
[1]姚晓伟,董昭良,贾晨光,等.胸椎结核并脊髓损伤手术时机及对预后的影响[J].临床误诊误治,2016,29(12):60-63.
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[6]赵敏,张立,许建中,等.一期后路病灶清除、椎体间钛笼植骨椎弓根钉内固定治疗胸椎结核[J].临床骨科杂志,2012,15(3):251-252,255.
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[8]李志荣,李越,刘志明,等.经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核的临床疗效[J].生物骨科材料与临床研究,2015,12(1):59-61.
[9]詹翼,谭海涛,吴增晖,等.前路病灶清除植骨融合内固定治疗胸椎结核27例的临床分析[J].广西医学,2012,34(10):1386-1387.
[10]谭亮,徐皓,叶永平,等.后路一期病灶清除椎弓根钉内固定术治疗胸椎结核[J].临床军医杂志,2011,39(2):295-297.
[11]曹秦辉,李永民,王旭,等.一期前路病灶清除加钛网植骨钢板内固定治疗胸椎结核[J].河北医药,2012,34(11):1685-1686.
[2]郭春生,柳盛春,陈凯,等.采用经肋横突入路术式一期治疗老年胸椎结核合并截瘫患者的疗效分析[J].中国防痨杂志,2015,37(3):266-270.
[3]张宏其,郭虎兵,陈筱,等.单纯一期后路病灶清除椎体间植骨融合内固定治疗胸椎结核的临床研究[J].中国矫形外科杂志,2012,20(1):34-40.
[4]杨海青,段洪,闵捷,等.钛网植骨结合椎弓根钉棒内固定修复胸椎结核:重建脊柱生理曲度及稳定性[J].中国组织工程研究,2014,18(53):8590-8595.
[5]何超,余雨.一期前路病灶清除植骨融合内固定与前后路联合治疗多发下胸椎结核的临床疗效比较[J].重庆医学,2015,(14):1936-1938.
[6]赵敏,张立,许建中,等.一期后路病灶清除、椎体间钛笼植骨椎弓根钉内固定治疗胸椎结核[J].临床骨科杂志,2012,15(3):251-252,255.
[7]刘进南,陈谷才,刘刚,等.经椎弓根截骨病灶清除植骨融合内固定治疗胸椎结核[J].颈腰痛杂志,2016,37(4):303-306.
[8]李志荣,李越,刘志明,等.经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核的临床疗效[J].生物骨科材料与临床研究,2015,12(1):59-61.
[9]詹翼,谭海涛,吴增晖,等.前路病灶清除植骨融合内固定治疗胸椎结核27例的临床分析[J].广西医学,2012,34(10):1386-1387.
[10]谭亮,徐皓,叶永平,等.后路一期病灶清除椎弓根钉内固定术治疗胸椎结核[J].临床军医杂志,2011,39(2):295-297.
[11]曹秦辉,李永民,王旭,等.一期前路病灶清除加钛网植骨钢板内固定治疗胸椎结核[J].河北医药,2012,34(11):1685-1686.