腹膜后一期前路单节段病灶清除植骨内固定术治疗老年L_(4～5)椎体结核临床疗效研究
|
摘要
目的:探讨经腹膜后一期前路单节段病灶清除植骨内固定术治疗L4～5椎体结核的临床疗效。方法:选择年龄大于65岁,需行手术治疗的L4～5椎体结核患者18例,全部采用经腹膜后前路病灶清除、植骨、钢板螺钉内固定术治疗。结果:18例患者切口均一期愈合,手术时间110～190min,平均(150.35±25.81)min;术中出血量400～900ml,平均(600.32±56.92)ml;术后植骨均达到骨性融合,融合时间4～7个月,平均6个月;术后随访6～36个月,平均24个月;随访期无死亡及严重并发症发生。至末次随访,Cobb角术后无明显丢失,腰背部疼痛、下肢放射痛、麻木症状完全消失;神经功能均有不同程度恢复,Frankel分级,A级0例,B级0例,C级1例,D级6例,E级11例。无内固定松动及断裂现象。植骨块无滑脱、假关节形成;结核无复发。结论:经腹膜后手术治疗L4～5椎体结核对于年老体弱的患者手术时间短、创伤小、出血量少、疗效确切,安全性高。
Objective:To investigate the clinical efficacy of retroperitoneal anterior approach for L4～5 vertebral tuberculosis.Methods:18 patients with L4～5 vertebral tuberculosis who were treated with surgery for more than 65 years old.All of them were treated with transperitoneal anterior debridement and bone grafting,plate screw internal fixation.Results:All the 18 patients underwent one-stage incision.The operation time was 110～190 min,with an average of(150.35±25.81)min.The intraoperative blood loss was 400～900 ml,with an average of(600.32±56.92)ml.The postoperative bone grafts reached bony fusion.The fusion time was 4～7 months,with an average of 6 Months,followed up for 6～36 months,an average of 24 months;no deaths and serious complications occurred during follow-up.At the last follow-up,there was no significant loss of cobb angle,and the pain in the lower back,radiation pain in the lower extremities,and numbness disappeared completely.Neurological function has different degrees of recovery,Frankel classification,0 cases of grade A,0 cases of grade B,1 case of grade C,6 cases of grade D,11 cases of grade E.No internal fixation loose and broken.There is no slippage and pseudoarticular formation in the bone graft;there is no recurrence of tuberculosis.Conclusion:Treatment of L4～5 vertebral tuberculosis by retroperitoneal surgery for elderly and frail patients with short operation time,less trauma,less bleeding,effective curative effect and high safety.Recommended.
Objective:To investigate the clinical efficacy of retroperitoneal anterior approach for L4～5 vertebral tuberculosis.Methods:18 patients with L4～5 vertebral tuberculosis who were treated with surgery for more than 65 years old.All of them were treated with transperitoneal anterior debridement and bone grafting,plate screw internal fixation.Results:All the 18 patients underwent one-stage incision.The operation time was 110～190 min,with an average of(150.35±25.81)min.The intraoperative blood loss was 400～900 ml,with an average of(600.32±56.92)ml.The postoperative bone grafts reached bony fusion.The fusion time was 4～7 months,with an average of 6 Months,followed up for 6～36 months,an average of 24 months;no deaths and serious complications occurred during follow-up.At the last follow-up,there was no significant loss of cobb angle,and the pain in the lower back,radiation pain in the lower extremities,and numbness disappeared completely.Neurological function has different degrees of recovery,Frankel classification,0 cases of grade A,0 cases of grade B,1 case of grade C,6 cases of grade D,11 cases of grade E.No internal fixation loose and broken.There is no slippage and pseudoarticular formation in the bone graft;there is no recurrence of tuberculosis.Conclusion:Treatment of L4～5 vertebral tuberculosis by retroperitoneal surgery for elderly and frail patients with short operation time,less trauma,less bleeding,effective curative effect and high safety.Recommended.
引文
[1]马远征,胡明,才小军,等.脊柱结核外科治疗探讨[J].中国骨科杂志,2005,25(2):68-73.
[2]沈成华,房晓彬,蒋华富,等.腰骶椎脊柱结核手术治疗14例临床分析[J].颈腰痛杂志,2005,26(2):137-138.
[3]余利民,贾德卫,邵明.前后联合入路手术治疗腰骶段脊柱结核[J].西部医学,2007,19(6):1107-1108.
[4]张宏基,林曼中李劲松,等.一期后路病灶清除植骨融合内固定矫形治疗成人骶椎段结核[J].中国脊柱脊髓杂志,2013,23(6):493-498.
[5]李志刚,于海锋,全炳炫.后路内固定术治疗多节段胸腰椎椎体结核近远期疗效观察[J].陕西医学杂志,2017,46(9):1208-1211.
[6]chen WJ,Wu CC,Jung CH,et al.Combinecl anterior and posterior surgeries in the treatment of spinal tuberenulous Spondylitis[J].Clin Orthop Relat Res,2002,39(8):50-59.
[7]Jain AK Dhammi IK,prashad B,et al.Simultaneous antenior decompression and posterior inst numentaion of t he tuberculous spinc using an anterolateral ext rapleural approach[J].JBone Jonit Surg Br,2008,90(II):1477-1481.
[8]Zhang HQ,Guo CF,Xiao XG,et al.One-stage sugieal managerment for multilevelous spondylitis of theupper thoracicregion by antcrior decompression.strututuografing postenrior instrumentation and fusion[J].J Spinal Disord Tech,2007,20(4):263-267:.
[9]何江涛,蔚芃,赵吕国,等.后路椎弓根固定联合前路病灶清除植骨治疗腰骶椎结核[J].川北医学院学报,2006,219(5):420-422.
[10]施建党,王自立.脊柱结核术后未愈及术后复发的原因探讨[J].中国矫形外科杂志,2005,13(15):1184-1186.
[11]yilimaz C,Selek HY,Gur K,et al.Anteror instrumentation for the treatment of spinal tuberculosis[J].J Bone Joint Surg(AM),1999,81(9):1261-1267.
[12]翟东滨,金大地,陈建庭,等.脊柱结核外科治疗术式选择[J].中华骨科杂志,2004,10(4):317-318.
[13]宋明辉,王振汉,刘兴国,等.一期病灶清除和椎体间植骨并内固定治疗胸腰椎结核97例[J].陕西医学杂志,2008,37(7):897-898.
[2]沈成华,房晓彬,蒋华富,等.腰骶椎脊柱结核手术治疗14例临床分析[J].颈腰痛杂志,2005,26(2):137-138.
[3]余利民,贾德卫,邵明.前后联合入路手术治疗腰骶段脊柱结核[J].西部医学,2007,19(6):1107-1108.
[4]张宏基,林曼中李劲松,等.一期后路病灶清除植骨融合内固定矫形治疗成人骶椎段结核[J].中国脊柱脊髓杂志,2013,23(6):493-498.
[5]李志刚,于海锋,全炳炫.后路内固定术治疗多节段胸腰椎椎体结核近远期疗效观察[J].陕西医学杂志,2017,46(9):1208-1211.
[6]chen WJ,Wu CC,Jung CH,et al.Combinecl anterior and posterior surgeries in the treatment of spinal tuberenulous Spondylitis[J].Clin Orthop Relat Res,2002,39(8):50-59.
[7]Jain AK Dhammi IK,prashad B,et al.Simultaneous antenior decompression and posterior inst numentaion of t he tuberculous spinc using an anterolateral ext rapleural approach[J].JBone Jonit Surg Br,2008,90(II):1477-1481.
[8]Zhang HQ,Guo CF,Xiao XG,et al.One-stage sugieal managerment for multilevelous spondylitis of theupper thoracicregion by antcrior decompression.strututuografing postenrior instrumentation and fusion[J].J Spinal Disord Tech,2007,20(4):263-267:.
[9]何江涛,蔚芃,赵吕国,等.后路椎弓根固定联合前路病灶清除植骨治疗腰骶椎结核[J].川北医学院学报,2006,219(5):420-422.
[10]施建党,王自立.脊柱结核术后未愈及术后复发的原因探讨[J].中国矫形外科杂志,2005,13(15):1184-1186.
[11]yilimaz C,Selek HY,Gur K,et al.Anteror instrumentation for the treatment of spinal tuberculosis[J].J Bone Joint Surg(AM),1999,81(9):1261-1267.
[12]翟东滨,金大地,陈建庭,等.脊柱结核外科治疗术式选择[J].中华骨科杂志,2004,10(4):317-318.
[13]宋明辉,王振汉,刘兴国,等.一期病灶清除和椎体间植骨并内固定治疗胸腰椎结核97例[J].陕西医学杂志,2008,37(7):897-898.