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姜棚菲,邓亚军.经后路椎弓根病灶清除术治疗脊柱结核[J].脊柱外科杂志,2016,14(3):150-153.
经后路椎弓根病灶清除术治疗脊柱结核     点此下载全文 (Fulltext)
姜棚菲  邓亚军
延安大学附属医院骨科, 陕西 716000
基金项目:延安市科技局基金项目(2010ks-11)
DOI:10.3969/j.issn.1672-2957.2016.03.005
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摘要:
      目的 探讨经后路椎弓根病灶清除术治疗脊柱结核的临床疗效。方法 2009年1月-2013年12月,60例经X线、CT及MRI检查诊断患有脊柱结核的患者纳入本研究,随机分为对照组和研究组,每组30例。对照组行前路病灶清除术;研究组经后路椎弓根行病灶清除术。记录并比较2组的手术时间、术中出血量、运动评分、触觉评分、Cobb角、患椎高度以及美国脊髓损伤协会(ASIA)神经功能分级情况。结果 所有手术顺利完成,术后随访12~20个月,平均17.3个月,所有患者术后均恢复良好。研究组手术时间、术中出血量明显少于对照组,差异有统计学意义(P<0.05);术后研究组患者后凸畸形Cobb角、运动评分、触角评分、患椎高度恢复及ASIA改善情况均优于对照组,差异有统计学意义(P<0.05);2组患者术后神经损伤率均较低,其中对照组出现1例(3.33%),研究组出现2例(6.67%),差异无统计学意义(P>0.05)。结论 后路椎弓根内固定联合经椎弓根病灶清除植骨融合术治疗脊柱结核,能有效清除病灶,稳定脊柱,是一种疗效确切的手术方法。
关键词:胸椎  腰椎  结核,脊柱  清创术  内固定器
Transpedicle lesion debridement by posterior approach for spinal tuberculosis    Fulltext
JIANG Peng-fei  DENG Ya-jun
Department of Orthopaedics, Affiliated Hospital of Yan'an University, Yan'an 716000, Shaanxi, China
Fund Project:
Abstract:
      Objective To evaluate the clinical efficacy of transpedicle lesion debridement via posterior approach for spinal tuberculosis. Methods From January 2009 to December 2013, 60 patients diagnosed with spinal tuberculosis by roentgenograph, CT and MRI were selected in the study. The patients were equally divided into control group and research group randomly. Patients in the control group were treated by anterior approach transpedicle lesion debridement and those in the research group by posterior approach. The operative time, intraoperative blood loss, motor scores, tactile score, Cobb's angle, height of the sick vertebra and American Spinal Injury Association(ASIA) classification were recorded and compared betwen the 2 groups. Results All operations were completed successfully. All the patients were followed for a mean period of 17.3 months (ranged 12-20 months), and recovered well after surgery. Operative time and intraoperative blood loss of were significantly shorter or less in the research group than in the control group, and the differences were statistically significant(P<0.05). Motor score, tactile score, Cobb's angle, height of the sick vertebra and ASIA grade post-operation were significantly superior in the research group than in the control group with statistically significant differences(P<0.05). The postoperative nerve injury rate was low in both groups:3.33%(1 case) in the control group and 6.67%(2 cases) in the research group, and the difference was not significant statistically(P>0.05). Conclusion Posterior pedicle screw fixation combined with debridement followed by bone grafting and fusion in the treatment of spinal tuberculosis can effectively remove the lesion and stabilize the spine, thus being an effective surgical method.
Keywords:Thoracic vertebrae  Lumbar vertebrae  Tuberculosis, spinal  Debridement  Internal fixators
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