摘要
目的探讨一期经肋横突与关节突入路治疗胸椎结核的安全性及临床疗效。方法对34例T10以上的胸椎结核采取一期后路椎弓根内固定、经肋横突与关节突入路清除胸椎结核病灶椎间植骨融合。术前抗结核治疗3周以上,术后卧床休息6~12周,持续使用抗结核药物12~18个月。对术前、术后1、3个月及末次随访的红细胞沉降率（ESR）及椎体Cobb角进行比较。结果术后切口均甲级愈合。随访28~48个月,结核均治愈;植骨块无滑移,植骨术后5~8个月骨性融合,椎体后突畸形矫正及维持矫正效果满意,11例有脊髓神经症状者明显改善。患者术后1、3个月及末次随访ESR均较术前显著降低（P〈0.05）;患者术后1、3个月及末次随访Cobb角与术前比较显著减小（P〈0.05）。结论一期后路内固定、肋横突与关节突入路胸椎结核病灶清除椎间植骨融合方法安全、疗效明显,脊髓减压充分和结核病灶清除彻底,可有效矫正脊柱后凸畸形和维持畸形矫正效果。
Objective To investigate the safety and clinical effect of one-stage treatment by approach of costotransverse and processus articularis on thoracic vertebra tuberculosis. Methods Thirty-four cases of patients with thoracic vertebra tuberculosis above T10 were treated by the means of the posterior pedicle screw fixation,and by the approach of costotransverse and processus articularis for removal of thoracic spine tuberculosis lesions and intervertebral bone grafting. All the cases had antituberculosis treatment lasted more than three weeks before the operation,and had bed rest after surgery for 6- 12 weeks,with anti-tuberculosis treatment lasted 12- 18 months. The erythrocyte sedimentation rate（ ESR） and vertebral kyphosis Cobb angle of preoperative,postoperative one month,postoperative three months and the final follow-up were compared. Results All operation incisions were healed up primarily after surgery. The tubercle were all cured and during the follow-up period of 28 to 48 months,there was no cases of bone block displacement,the patients had solid bony fusion after 5 to 8 months,all the lesion were healed and the vertebral kyphosis correction and maintain was satisfying. Eleven cases with neurological symptoms had obviously improved. The ESR of postoperative one month,postoperative three months and the final follow-up was lower significant than that of preoperative（ P〈0. 05）. The Cobb angle of postoperative one month,postoperative three months and the final follow-up was lower significant than that of preoperative（ P〈0. 05）. Conclusion It is safe and has obvious effect to treat thoracic vertebra tuberculosis by the means of the posterior pedicle screw fixation and by the approach of costotransverse and processus articularis for removal of thoracic spine tuberculosis lesions and intervertebral bone grafting,which can full decompress spinal cord,effective correct kyphosis deformity and maintain the deformity correction effect.
出处
《新乡医学院学报》
CAS
2015年第7期632-634,共3页
Journal of Xinxiang Medical University
基金
河南省医学科技攻关项目(编号:201304029)
关键词
胸椎结核
肋横突
关节突
椎弓根固定
thoracic vertebra tuberculosis
costotransverse
processus articularis
pedicle screw fixation
