| 孔维清,徐建广,周蔚,张涛,付一山,赵必增,王亭,连小峰,李琦.一期前后路联合手术治疗多节段胸腰椎结核[J].脊柱外科杂志,2009,7(3):135-138. |
一期前后路联合手术治疗多节段胸腰椎结核  点此下载全文 (Fulltext) |
| 孔维清 徐建广 周蔚 张涛 付一山 赵必增 王亭 连小峰 李琦 |
| 200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科;200233 上海, 上海交通大学附属第六人民医院骨科 |
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| 目的 探讨一期前后路联合手术治疗多节段胸腰椎结核的优点及适应证。方法 2004年8月~2007年8月，本院应用一期后路椎弓根螺钉固定并前路结核病灶清除植骨融合内固定术治疗胸腰椎结核14例，其中男8例，女6例；年龄为28~54岁，平均38.6岁；病灶范围：T6~10 6例，T8~L1 5例，T10~L2 2例，T11~L2 1例。所有患者均有胸背部疼痛，活动受限。Frankel分级：A级8例，B级2例，C级3例，D级1例。结果 平均手术时间为214 min，出血量为960 mL，血沉恢复时间平均为56.4 d，植骨融合时间为3.16个月。术中无神经障碍症状加重，术后切口均一期愈合，无窦道或瘘管形成，术后18个月停用抗结核药物无复发。结论 采用前后路2个切口分别进行后路椎弓根螺钉固定植骨融合术及前路结核病灶清除植骨融合并/不并内固定技术，既保证了植骨融合内固定的可靠性，又避免了切口混和感染造成的不愈合或窦道形成，是治疗多节段胸腰椎结核安全可靠的理想术式。 |
| 关键词：胸椎 腰椎 结核, 脊柱 内固定器 骨移植 |
| One stage combined anterior and posterior surgeries for multi-segemental thoracolumbar tuberculosis Fulltext |
| KONG Weiqing,XU Jianguang,ZHOU Wei,ZHANG Tao,FU Yishan,ZHAO Bizeng,WANG Ting,LIAN Xiaofeng and LI Qi |
| Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China;Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 20023, China |
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| Abstract: |
| Objective To explore the advantage and indication of one stage combined anterior and posterior surgeries for multi-segmental thoracolumbar tuberculosis. Methods From Augest 2004 to Augest 2007, 14 cases of thoracolumbar tuberculosis were treated with one stage combined anterior (focal debridement, bone graft fusion and internal fixation) and posterior (pedicle screws fixation) surgeries. There were 8 males and 6 females with the age of 28-54 years old, the mean age was 38.6 years old. The focus were located at T6-10 in 6 patients, at T8-L1 in 5 patients, at T10-L2 in 2 patients and at T10-L2 in 1 patient. All the patients had back pain and limitation of range of movement, with Frankel grade:A in 8 cases, B in 2 cases, C in 3 cases and D in 1 case.Results The average operation time was 214 min, blood loss was 960 mL. Blood sedimentation rate recovery time was 56.4 d on average. After operation, spinal fusion was achieved in all the cases within 3.16 months on average. All incisions were healed up primarily, no progress of neurological, no formation of sinus tract or fistulae. Eighteen months postoperative antituberculotic was taken out of service, and no recurrence.Conclusion To treat multi-segmental thoracolumbar tuberculosis with this surgical technique can ensure the dependability of internal fixation, and also can avoid disunion and formation of sinus induced by incision mixed infection. One stage combined anterior and posterior surgeries is a dependable and safe method for the treatment of multi-segmental thoracolumbar tuberculosis. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Tuberculosis, spinal Internal fixators Bone transplantation |
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