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张泽华,李建华,黄学全,代飞,罗飞,周强,何清义,张劲松,陈永林,许建中.CT引导下置管引流局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿[J].脊柱外科杂志,2014,12(6):326-330.
CT引导下置管引流局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿     点此下载全文 (Fulltext)
张泽华  李建华  黄学全  代飞  罗飞  周强  何清义  张劲松  陈永林  许建中
400038 重庆, 第三军医大学西南医院骨科;400038 重庆, 第三军医大学西南医院骨科;第三军医大学西南医院放射科;400038 重庆, 第三军医大学西南医院骨科;400038 重庆, 第三军医大学西南医院骨科;400038 重庆, 第三军医大学西南医院骨科;400038 重庆, 第三军医大学西南医院骨科;400038 重庆, 第三军医大学西南医院骨科;第三军医大学西南医院放射科;400038 重庆, 第三军医大学西南医院骨科
基金项目:第三军医大学临床创新基金(SWH2011015)
DOI:10.3969/j.issn.1672-2957.2014.06.002
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摘要:
      目的 探讨CT引导下置管穿刺引流、局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿的安全性和有效性。方法 纳入脊柱结核伴腰大肌脓肿和椎旁脓肿患者35例,进行CT引导下置管穿刺引流、局部强化化疗,同时行口服药物全身化疗18个月,每个月监测肝功、血沉,术后1、3、6、9、12、18、24个月复查,分析治疗前后临床表现、脓肿吸收、病椎愈合情况。结果 平均随访时间25个月(18~36个月),引流时间3周~3个月,35例均获得临床治愈,治疗前疼痛视觉模拟量表(visual analogue scale, VAS)评分平均3.6分(2~7分),最后一次随访VAS评分平均1.1分(0~3分),无神经功能障碍及其他并发症。结论 CT引导下置管引流、局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿安全有效,费用低、创伤小,适应证得当可代替病灶清除术。
关键词:结核,脊柱  腰椎  腰肌脓肿  引流术  外科手术,计算机辅助
CT-guided percutaneous drainage and local chemotherapy for tuberculous psoas and paraspinal abscess    Fulltext
ZHANG Ze-hua  LI Jian-hua  HUANG Xue-quan  DAI Fei  LUO Fei  ZHOU Qiang  HE Qing-yi  ZHANG Jin-song  CHEN Yong-lin  XU Jian-zhong
Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Abstract:
      Objective To investigate the safty and effect of CT-guided percutaneous drainage and local chemotherapy for tuberculous psoas and paraspinal abscesses. Methods A total of 35 patients with tuberculous psoas and paraspinal abscesses were enrolled for CT-guided percutaneous drainage and local chemotherapy and followed-up.The patients were followed up at 1, 3, 6, 9, 12, 18, 24 months. The clinical manifestations, abscesse absorption, the outcome of affected vertebra, erythrocyte sedimentation rate and liver function were the outcomes to be concerned and analyzed. Results A mean of 25 months' follow-up (ranged 18-36 months) was achieved in 35 patients, who all achieved finallly cure of tuberculosis lesions .The duration of drainage was between 3 weeks and 3 months. The mean visual analogue scale(VAS) score before chemotherapy was 3.6(2-7),the mean VAS score at the final follow-up was 1.1(0-3). There was no neurological deficit and other complications. Conclusion For tuberculous psoas and paraspinal abscesses, CT-guided percutaneous drainage and local chemotherapy can work effectively and safely, and it's has superiority of lower cost and mini-invasive. It can take the place of debridement if the indication suitable.
Keywords:Tuberculosis, spinal  Lumbar vertebrae  Psoas abscessy  Drainage  Surgery, computer-assisted
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