摘要
目的探讨在一期后路病灶清除、椎间植骨融合内固定的基础上,应用有限减压及异体骨椎板重建治疗胸腰段脊柱结核的临床疗效。方法对20例胸腰段(T11~L2)脊柱结核患者采用一期后路有限减压及异体骨椎板重建手术治疗。采用后凸Cobb角、神经功能、疼痛VAS评分和植骨融合情况评价疗效。结果患者均获得随访,时间36~60(47.0±7.6)个月。后凸Cobb角术前为18°~41°(31.2°±6.6°),末次随访为12°~26°(18.2°±4.3°),差异有统计学意义(P<0.01)。疼痛VAS评分术前为6~9(7.6±0.9)分,末次随访为0~2(0.7±0.7)分,差异有统计学意义(P<0.01)。患者在术后9~15(11.6±2.2)个月显示植骨融合。末次随访时ASIA分级:1例由术前B级恢复至D级,4例由术前C级恢复至D级,5例由术前C级恢复至E级,8例由术前D级恢复至E级,2例术前E级仍为E级。结论应用一期后路有限减压及异体骨椎板重建、病灶清除、椎间植骨融合内固定治疗胸腰段脊柱结核安全有效。
Objective To investigate the effect of thoracolumbar spinal tuberculosis treated by limited decompression combined with allograft bone vertebral plate reconstruction based on one-stage posterior approach,debridement,intervertebral bone graft fusion and instrumentation.Methods Twenty patients with thoracolumbar tuberculosis(T11~L2)were treated with one-stage posterior limited decompression and allograft bone vertebral plate reconstruction.Cobb angle,nerve function,VAS and bone graft fusion were used to evaluate the efficacy.Results All patients were followed up for 36~60(47.0±7.6)months.Preoperative Cobb angle of kyphosis was 18°~41°(31.2°±6.6°),and 12°~26°(18.2°±4.3°)at the last follow-up,the difference was significant(P<0.01).VAS before surgery was 6~9(7.6±0.9)points,and 0~2(0.7±0.7)points at the last follow-up,the difference was significant(P<0.01).The patient got bone graft fusion within 9~15(11.6±2.2)months after surgery.At the last follow-up,1 case with ASIA grade B was restored to grade D,4 cases were restored from grade C to grade D,5 cases were restored from grade C to grade E,and 8 cases were restored from grade D to grade E,2 cases with grade E were still grade E.Conclusions Limited decompression combined with allograft bone vertebral plate reconstruction based on one-stage posterior debridement,intervertebral bone graft fusion,and instrumentation are an effective and feasible treatment option for thoracolumbar spinal tuberculosis.
作者
徐震超
王锡阳
刘政
XU Zhen-chao;WANG Xi-yang;LIU Zheng(Dept of Spine Surgery, Xiangya Hospital, Central South University,Changsha, Hunan 410008, China)
出处
《临床骨科杂志》
2020年第3期305-309,共5页
Journal of Clinical Orthopaedics
基金
国家自然科学基金(编号:81672191)。
关键词
胸腰段结核
一期后路
有限减压
异体骨
椎板重建
thoracolumbar spinal tuberculosis
one-stage posterior approach
limited decompression
allograft bone
vertebral plate reconstruction
