中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
6期
461-466
,共6页
脊柱%结核%骨质疏松症%外科手术
脊柱%結覈%骨質疏鬆癥%外科手術
척주%결핵%골질소송증%외과수술
Spine%Tuberculosis%Osteoporosis%Surgery
背景:老年性骨质疏松症伴脊柱结核的治疗非常棘手。目前针对此类患者的研究报道较少,并缺乏对其临床疗效观察的随访研究。<br> 目的:探讨老年性骨质疏松症伴脊柱结核患者的手术治疗及围手术期处理策略。<br> 方法:本文对2008年9月至2011年9月采用分期前后路手术治疗的76例老年骨质疏松症伴脊柱结核患者的完整临床资料进行回顾性分析。其中男34例,女42例;年龄65~81岁,平均73.2岁。胸椎30例,胸腰段13例,腰椎29例,腰骶段4例。所有患者通过围手术期积极处理完成手术。分析术前至末次随访患者临床症状、骨密度、Cobb角、神经功能、红细胞沉降率(ESR)的变化情况及JOA评分,评价骨密度改善和脊柱结核治愈情况。<br> 结果:76例患者手术顺利,无麻醉意外。手术时间160~300 min,平均280 min;术中出血量680~1100 ml,平均860 ml;术中输血量600~1200 ml,平均900 ml。术后随访18~54个月,平均38个月。术后JOA标准疗效评分:优74例,中2例,优良率95%。ESR术后8~12周降至正常。末次随访时Frankle分级除2例恢复至D级,余均达到E级。术后6~12个月CT示均获得植骨融合。末次随访时患者脊柱结核治愈,骨密度显著改善,脊柱后凸畸形明显矫正且矫正角度无明显丢失。无严重并发症。<br> 结论:通过有效的抗骨质疏松、抗结核治疗等围手术期处理,分期前后路手术治疗老年性骨质疏松症伴脊柱结核的疗效满意。
揹景:老年性骨質疏鬆癥伴脊柱結覈的治療非常棘手。目前針對此類患者的研究報道較少,併缺乏對其臨床療效觀察的隨訪研究。<br> 目的:探討老年性骨質疏鬆癥伴脊柱結覈患者的手術治療及圍手術期處理策略。<br> 方法:本文對2008年9月至2011年9月採用分期前後路手術治療的76例老年骨質疏鬆癥伴脊柱結覈患者的完整臨床資料進行迴顧性分析。其中男34例,女42例;年齡65~81歲,平均73.2歲。胸椎30例,胸腰段13例,腰椎29例,腰骶段4例。所有患者通過圍手術期積極處理完成手術。分析術前至末次隨訪患者臨床癥狀、骨密度、Cobb角、神經功能、紅細胞沉降率(ESR)的變化情況及JOA評分,評價骨密度改善和脊柱結覈治愈情況。<br> 結果:76例患者手術順利,無痳醉意外。手術時間160~300 min,平均280 min;術中齣血量680~1100 ml,平均860 ml;術中輸血量600~1200 ml,平均900 ml。術後隨訪18~54箇月,平均38箇月。術後JOA標準療效評分:優74例,中2例,優良率95%。ESR術後8~12週降至正常。末次隨訪時Frankle分級除2例恢複至D級,餘均達到E級。術後6~12箇月CT示均穫得植骨融閤。末次隨訪時患者脊柱結覈治愈,骨密度顯著改善,脊柱後凸畸形明顯矯正且矯正角度無明顯丟失。無嚴重併髮癥。<br> 結論:通過有效的抗骨質疏鬆、抗結覈治療等圍手術期處理,分期前後路手術治療老年性骨質疏鬆癥伴脊柱結覈的療效滿意。
배경:노년성골질소송증반척주결핵적치료비상극수。목전침대차류환자적연구보도교소,병결핍대기림상료효관찰적수방연구。<br> 목적:탐토노년성골질소송증반척주결핵환자적수술치료급위수술기처리책략。<br> 방법:본문대2008년9월지2011년9월채용분기전후로수술치료적76례노년골질소송증반척주결핵환자적완정림상자료진행회고성분석。기중남34례,녀42례;년령65~81세,평균73.2세。흉추30례,흉요단13례,요추29례,요저단4례。소유환자통과위수술기적겁처리완성수술。분석술전지말차수방환자림상증상、골밀도、Cobb각、신경공능、홍세포침강솔(ESR)적변화정황급JOA평분,평개골밀도개선화척주결핵치유정황。<br> 결과:76례환자수술순리,무마취의외。수술시간160~300 min,평균280 min;술중출혈량680~1100 ml,평균860 ml;술중수혈량600~1200 ml,평균900 ml。술후수방18~54개월,평균38개월。술후JOA표준료효평분:우74례,중2례,우량솔95%。ESR술후8~12주강지정상。말차수방시Frankle분급제2례회복지D급,여균체도E급。술후6~12개월CT시균획득식골융합。말차수방시환자척주결핵치유,골밀도현저개선,척주후철기형명현교정차교정각도무명현주실。무엄중병발증。<br> 결론:통과유효적항골질소송、항결핵치료등위수술기처리,분기전후로수술치료노년성골질소송증반척주결핵적료효만의。
Background:It is very difficult to treat senile osteoporosis combined with spinal tuberculosis. And there are few studies on the surgical outcomes. <br> Objective:To explore surgical treatment and perioperative management for senile osteoporosis combined with spinal tuber-culosis. <br> Methods:A retrospective study was done in 76 senile osteoporosis patients with spinal tuberculosis who received active peri-operative management and underwent staged surgical treatment by anterior and posterior approaches between September 2008 and September 2011 in our hospital. There were 34 males and 42 females with a mean age of 73.2 years (range 65-81 years). Clinical data, including clinical manifestations, bone density, Cobb angle, nerve function and erythrocyte sedimenta-tion rate (ESR) were retrospectively analyzed from preoperative period to the last follow-up. <br> Results:Surgery was successfully performed in the 76 patients and no anesthetic accidents happened. The surgical procedure lasted for 280 min on average (range, 160-300 min). The mean intraoperative blood loss was 860 ml (range, 680-1100 ml) and intraoperative blood transfusion was 900 ml (600-1200 ml). The mean follow-up period was 38 months (range, 18-54 months). The clinical symptoms were relieved and the excellent rate of JOA score was 95%. ESR returned to normal level at 8-12 weeks after surgery. Frankle grade recovered to grade E, except two on grade D. No loosening and breakage of internal fixation were observed after surgery. Bone fusion was achieved in 6-12 months after surgery accompanied by the improve-ment of bone density and significant kyphosis correction. No serious complications were found. All patients were satisfied with the therapeutic effect. <br> Conclusions:Staged surgical treatment by anterior and posterior approaches and perioperative management including anti-tuberculosis and antiosteoporosis treatments is effective for senile osteoporosis combined with spinal tuberculosis.