中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2012年
11期
1214-1217
,共4页
李锐%施永彦%张功礼%李锋
李銳%施永彥%張功禮%李鋒
리예%시영언%장공례%리봉
后路脊柱切除重建术%陈旧性结核%截瘫%胸腰椎%脊柱后凸
後路脊柱切除重建術%陳舊性結覈%截癱%胸腰椎%脊柱後凸
후로척주절제중건술%진구성결핵%절탄%흉요추%척주후철
Posterior vertebral column resection%Chronic thoracolumbar tuberculosis%Paraplegia%Thoracolumbar vertebra%Kyphosis
目的 观察后路脊柱切除重建术治疗胸腰椎陈旧性结核继发截瘫的临床效果,为胸腰椎陈旧性脊柱结核继发截瘫手术治疗提供一种安全有效的手术方式.方法 2007年8月至2010年3月对12例胸腰椎结核继发截瘫病例采用经后路病椎节段全切,钛网支撑植骨内固定术式治疗,术前、术后随访期间拍摄X线片测量后凸Cobb角,并观察内固定情况,采用Frankel分级评价神经功能状态.结果 随访6 ～18个月,平均11个月,通过手术所有患者的胸背部疼痛症状得到缓解.术后Frankel分级1例由B级恢复到C级；6例由C级恢复到D或E级,4例由D级恢复到E级,另1例B级无明显恢复；术前后凸Cobb角平均(76.0±23.4)°,术后1周Cobb角(15.5±6.3)°,与术前比较差异有统计学意义(t=3.41,P＜0.01)；末次随访时Cobb角(16.0±8.2)°,与术后1周比较差异无统计学意义(t=1.58,P＞0.05).末次随访显示,所有病例钛网植骨融合,无内固定并发症.结论 后路脊柱切除重建术治疗胸腰椎陈旧性结核继发截瘫手术方式可行,具有减压充分、矫正率高,而且创伤较小不需改变体位再行前路手术.
目的 觀察後路脊柱切除重建術治療胸腰椎陳舊性結覈繼髮截癱的臨床效果,為胸腰椎陳舊性脊柱結覈繼髮截癱手術治療提供一種安全有效的手術方式.方法 2007年8月至2010年3月對12例胸腰椎結覈繼髮截癱病例採用經後路病椎節段全切,鈦網支撐植骨內固定術式治療,術前、術後隨訪期間拍攝X線片測量後凸Cobb角,併觀察內固定情況,採用Frankel分級評價神經功能狀態.結果 隨訪6 ～18箇月,平均11箇月,通過手術所有患者的胸揹部疼痛癥狀得到緩解.術後Frankel分級1例由B級恢複到C級；6例由C級恢複到D或E級,4例由D級恢複到E級,另1例B級無明顯恢複；術前後凸Cobb角平均(76.0±23.4)°,術後1週Cobb角(15.5±6.3)°,與術前比較差異有統計學意義(t=3.41,P＜0.01)；末次隨訪時Cobb角(16.0±8.2)°,與術後1週比較差異無統計學意義(t=1.58,P＞0.05).末次隨訪顯示,所有病例鈦網植骨融閤,無內固定併髮癥.結論 後路脊柱切除重建術治療胸腰椎陳舊性結覈繼髮截癱手術方式可行,具有減壓充分、矯正率高,而且創傷較小不需改變體位再行前路手術.
목적 관찰후로척주절제중건술치료흉요추진구성결핵계발절탄적림상효과,위흉요추진구성척주결핵계발절탄수술치료제공일충안전유효적수술방식.방법 2007년8월지2010년3월대12례흉요추결핵계발절탄병례채용경후로병추절단전절,태망지탱식골내고정술식치료,술전、술후수방기간박섭X선편측량후철Cobb각,병관찰내고정정황,채용Frankel분급평개신경공능상태.결과 수방6 ～18개월,평균11개월,통과수술소유환자적흉배부동통증상득도완해.술후Frankel분급1례유B급회복도C급；6례유C급회복도D혹E급,4례유D급회복도E급,령1례B급무명현회복；술전후철Cobb각평균(76.0±23.4)°,술후1주Cobb각(15.5±6.3)°,여술전비교차이유통계학의의(t=3.41,P＜0.01)；말차수방시Cobb각(16.0±8.2)°,여술후1주비교차이무통계학의의(t=1.58,P＞0.05).말차수방현시,소유병례태망식골융합,무내고정병발증.결론 후로척주절제중건술치료흉요추진구성결핵계발절탄수술방식가행,구유감압충분、교정솔고,이차창상교소불수개변체위재행전로수술.
Objective To observe the therapeutical effect of posterior vertebral column resection on chronic thoracolumbar tuberculosis with secondary paraplegia and to provide a safe and effective method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.Methods From Aug.2007 to Mar.2010,12 cases with chronic thoracolumbar tuberculosis and secondary paraplegia were surgically treated by posterior vertebral column resection and Titanium net support for bone graft and internal fixation operation treatment.Cobb angle was measured,and conditions of internal fixation were observed before and after the operation by X-ray films.Neurological status were evaluated by Frankel grades.Results The follow-up periods was 6- 18 months( on average 11 months).Operations eased all patients' back and chest pain.Frankel grade increased from C preoperatively to grade D or E postoperatively in 6 cases,from grade D to E in 4 cases and from grade B to C in 1 case.No obvious improvement of Frankel grade was observed in the other patient of grade B.The average Cobb angles were(76.0 ± 23.4) ° before surgery,( 15.5 ± 6.3 ) ° at one week after surgery and ( 16.0 ± 8.2) °at the last follow-up.The difference in the Cobb angle before and at one week after treatment was significant( t =3.41,P ＜ 0.01 ).No difference was found in the Cobb angle between at one week after treatment and at the last follow-up (t =1.58,P ＞ 0.05 ).All patients got bony fusion with Titanium net.No complications occurred with internal fixation.Conclusion Posterior vertebral column resection is a feasible method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.It achieves neurological decompression with high correction rate and minor injury,and no anterior surgery is needed.
