中国伤残医学
中國傷殘醫學
중국상잔의학
CHINESE JOURNAL OF TRAUMA AND DISABILITY MEDICINE
2014年
4期
14-16,17
,共4页
孙道植%万世勇%梁柱%徐健%王宏磊%殷立东
孫道植%萬世勇%樑柱%徐健%王宏磊%慇立東
손도식%만세용%량주%서건%왕굉뢰%은립동
椎弓根%内固定%胸椎结核%病灶清除%胸膜外
椎弓根%內固定%胸椎結覈%病竈清除%胸膜外
추궁근%내고정%흉추결핵%병조청제%흉막외
Pedicle screw%Internal fixation%Thoracic spinal tuberculosis%Debridement%Extrapleural approach
目的:探讨经胸膜外侧前方入路病灶清除,椎间植骨融合后路经椎弓根内固定术治疗胸椎结核的疗效。方法:对27例胸椎结核患者,术前四联抗结核治疗3周后,采取侧前方入路行1期病灶清除、前路减压、椎间植骨及钉板系统内固定术。术后抗结核药物治疗9个月。观察切口1期愈合率,结核复发率,椎间植骨融合率,脊髓功能恢复程度,术后后凸成角均矫正及畸形矫正丢失角度。结果:随访1~6年,患者切口均1期,植骨全部融合,结核治愈无复发。神经功能明显恢复,Fankel分级在D级的2例,E级17例。 Cobb角由术前23~50°矫正至术后5~20°。末次随访平均丢失2.5°。结论:经胸膜外侧前方入路病灶清除椎间植骨融合经椎弓根内固定术治疗胸椎结核是有效方法。能够1期完成病灶清除、脊髓减压、矫正后凸畸形,重建脊柱稳定性。
目的:探討經胸膜外側前方入路病竈清除,椎間植骨融閤後路經椎弓根內固定術治療胸椎結覈的療效。方法:對27例胸椎結覈患者,術前四聯抗結覈治療3週後,採取側前方入路行1期病竈清除、前路減壓、椎間植骨及釘闆繫統內固定術。術後抗結覈藥物治療9箇月。觀察切口1期愈閤率,結覈複髮率,椎間植骨融閤率,脊髓功能恢複程度,術後後凸成角均矯正及畸形矯正丟失角度。結果:隨訪1~6年,患者切口均1期,植骨全部融閤,結覈治愈無複髮。神經功能明顯恢複,Fankel分級在D級的2例,E級17例。 Cobb角由術前23~50°矯正至術後5~20°。末次隨訪平均丟失2.5°。結論:經胸膜外側前方入路病竈清除椎間植骨融閤經椎弓根內固定術治療胸椎結覈是有效方法。能夠1期完成病竈清除、脊髓減壓、矯正後凸畸形,重建脊柱穩定性。
목적:탐토경흉막외측전방입로병조청제,추간식골융합후로경추궁근내고정술치료흉추결핵적료효。방법:대27례흉추결핵환자,술전사련항결핵치료3주후,채취측전방입로행1기병조청제、전로감압、추간식골급정판계통내고정술。술후항결핵약물치료9개월。관찰절구1기유합솔,결핵복발솔,추간식골융합솔,척수공능회복정도,술후후철성각균교정급기형교정주실각도。결과:수방1~6년,환자절구균1기,식골전부융합,결핵치유무복발。신경공능명현회복,Fankel분급재D급적2례,E급17례。 Cobb각유술전23~50°교정지술후5~20°。말차수방평균주실2.5°。결론:경흉막외측전방입로병조청제추간식골융합경추궁근내고정술치료흉추결핵시유효방법。능구1기완성병조청제、척수감압、교정후철기형,중건척주은정성。
Objective:To evaluate the clinical efficacy of one -stage debridement and interbody thoracic fusion via anterolateral extra-pleural approach and posterior pedicle screw internal fixation in treating thoracic spinal tuberculosis .Methods:After 3 weeks systemic anti-tuberculosis treatment , 27 adult patients with thoracic tuberculosis were underwent one -stage debridement and interbody thoracic fu-sion via anterolateral extrapleural approach and posterior pedicle screw internal fixation in same incisions , and followed anti-tuberculosis treatment for 9 months.Rate of primary healing of incision, tuberculosis recurrence, interbody fusion, neurological function, rate of de-formity correction and loss of corrected angle were investigated .Results:All cases were followed up for 1-6 years.All had primary heal-ing of incision.The rate of bone fusion was 100%, with a 100%cure rate.Patients whose neurological function improved significantly , there were 2 cases of grade D and 17 cases of grade E , according to Frankel classification .The Cobb angle of the kyphosis were corrected from (13-50°) to (5-20°), and loss of corrected angle were average 2.5°.Conclusion:One-stage debridement and interbody tho-racic fusion via anterolateral extrapleural approach and posterior pedicle screw internal fixation could successfully remove the focus of tu -berculosis with complete interbody thoracic fusion after operation , which restores spinal stability .