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李勇,漆艺伟,关邯峰,方忠,熊伟,李锋,吴巍*.前路病灶清除自体髂骨植骨融合内固定术联合抗结核药物治疗下颈椎结核[J].脊柱外科杂志,2021,19(2):105-109.
前路病灶清除自体髂骨植骨融合内固定术联合抗结核药物治疗下颈椎结核     点此下载全文 (Fulltext)
李勇  漆艺伟  关邯峰  方忠  熊伟  李锋  吴巍*
华中科技大学同济医学院附属同济医院骨科, 武汉 430030
基金项目:
DOI:10.3969/j.issn.1672-2957.2021.02.007
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摘要:
      目的 探讨前路病灶清除自体髂骨植骨融合内固定术联合抗结核药物治疗下颈椎结核。方法 回顾性分析2010年1月—2017年12月本院收治的25例下颈椎结核患者,所有患者术前采用抗结核药物治疗2周以上,均采用一期前路病灶清除自体髂骨植骨融合内固定术治疗,术后继续规范抗结核药物治疗12~18个月。随访观察记录颈部疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分、局部后凸Cobb角、C2~7 Cobb角、红细胞沉降率(ESR)、C反应蛋白(CRP)及植骨融合情况。结果 所有患者随访18~45个月,平均30个月。所有患者术后临床症状均明显改善,末次随访时颈部疼痛VAS评分为(2.1±1.5)分,JOA评分为(15.3±1.5)分,下颈椎局部后凸Cobb角为-6.2°±3.5°,C2~7 Cobb角为-10.0°±4.5°,ESR为(8.1±4.2)mm/h,CRP为(3.8±2.2)mg/L;均较术前明显改善,差异有统计学意义(P<0.05)。末次随访时所有患者病灶区域植骨均完全融合,无内固定松动断裂。结论 前路病灶清除自体髂骨植骨融合内固定术联合抗结核药物能有效治疗下颈椎结核。
关键词:颈椎  结核,脊柱  清创术  脊柱融合术  骨移植  内固定器
Anterior debridement with autogenous iliac bone graftting and internal fixation combined with anti-tuberculosis drugs in treatment of lower cervical tuberculosis    Fulltext
Li Yong  Qi Yiwei  Guan Hanfeng  Fang Zhong  Xiong Wei  Li Feng  Wu Wei*
Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
Fund Project:
Abstract:
      Objective To explore the clinical efficacy of anterior debridement with autogenous iliac bone grafting and internal fixation combined with anti-tuberculosis drugs in the treatment of lower cervical tuberculosis. Methods From January 2010 to December 2017,25 patients with lower cervical tuberculosis were analyzed retrospectively. All the patients were treated with anti-tuberculosis drugs for more than 2 weeks before operation and in combination with one-stage anterior debridement with autogenous iliac bone grafting and internal fixation,and continued to standardize anti-tuberculosis drug treatment for 12-18 months after operation. The neck pain visual analogue scale(VAS) score,Japanese Orthopaedic Association(JOA) score,the local kyphosis Cobb's angle,C2-7 Cobb's angle,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP) and bone grafting fusion were recorded and evaluated. Results All the patients were followed up for 18-45 months,with an average of 30 months. At the final follow-up,VAS score was 2.1±1.5,JOA score was 15.3±1.5,the local kyphosis Cobb's angle was -6.2°±3.5°,C2-7 Cobb's angle was -10.0°±4.5°,ESR was (8.1±4.2)mm/h,CRP was (3.8±2.2)mg/L;all of them significantly improved compared with those before operation,all with a statistical significance(P<0.05). Conclusion Anterior debridement autogenous iliac bone graftting and internal fixation combined with anti-tuberculosis drugs can effectively treat lower cervical tuberculosis.
Keywords:Cervical vertebrae  Tuberculosis,spinal  Debridement  Spinal fusion  Bone transplantation  Internal fixators
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