[1]杨辉,王伟彤,丁龙,等.一期后路脊椎切除钛网植骨融合内固定治疗活动期胸腰椎结核[J].中医正骨,2021,33(05):50-53.
 YANG Hui,WANG Weitong,DING Long,et al.Primary posterior vertebral column resection combined with titanium mesh bone graft fusion and internal fixation for treatment of active thoracolumbar tuberculosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(05):50-53.
点击复制

一期后路脊椎切除钛网植骨融合内固定治疗活动期胸腰椎结核()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年05期
页码:
50-53
栏目:
临床报道
出版日期:
2021-05-20

文章信息/Info

Title:
Primary posterior vertebral column resection combined with titanium mesh bone graft fusion and internal fixation for treatment of active thoracolumbar tuberculosis
作者:
杨辉王伟彤丁龙龚智勇张琰谭灏彭霖
(慈利县人民医院,湖南 慈利 427200)
Author(s):
YANG HuiWANG WeitongDING LongGONG ZhiyongZHANG YanTAN HaoPENG Lin
关键词:
结核脊柱 胸椎 腰椎 脊柱融合术 骨移植 内固定器
摘要:
目的:观察一期后路脊椎切除钛网植骨融合内固定治疗活动期胸腰椎结核的临床疗效及安全性。方法:2015年1月至2018年2月,采用一期后路脊椎切除钛网植骨融合内固定治疗活动期胸腰椎结核患者18例。男12例,女6例。年龄25~60岁,中位数48岁。病变节段位于胸椎7例、腰椎3例、胸腰段8例。单节段病变10例,多节段病变8例。脊髓神经损伤情况按照美国脊柱损伤协会(American Spinal Injury Association,ASIA)分级标准,B级1例、C级3例、D级6例、E级8例。病程2~14年,中位数10年。采用视觉模拟量表(visual analogue scale,VAS)评分评价腰背部疼痛程度,测量病椎Cobb角,观察植骨融合、脊髓神经损伤恢复及并发症发生情况。结果:所有患者均顺利完成手术,术后切口均甲级愈合。所有患者均获随访,随访时间24~30个月,中位数27个月。植骨均获得骨性融合,植骨融合时间(7.75±1.76)个月。腰背部疼痛VAS评分,术前(6.22±1.35)分、术后1个月(2.23±1.56)分、末次随访时(1.39±1.65)分。病椎Cobb角,术前47.56°±7.13°、术后1个月12.23°±4.41°、末次随访时11.50°±5.09°。脊髓神经损伤情况按照ASIA分级,D级8例、E级10例。至末次随访时,所有患者均未出现内固定物松动、断裂或脊柱后凸矫正度明显丢失等并发症。结论:一期后路脊椎切除钛网植骨融合内固定治疗活动期胸腰椎结核,可以缓解腰背部疼痛、矫正脊柱后凸畸形、改善脊髓神经功能,且植骨融合率高、并发症少。

参考文献/References:

[1] 张会军,鲁增辉,朱昌生.经病椎短钉内固定术治疗短节段脊柱结核的临床分析[J].中国矫形外科杂志,2018,26(2):178-181.
[2] CUI X,LI L T,MA Y Z.Anterior and posterior instrumentation with different debridement and grafting procedures for multi-level contiguous thoracic spinal tuberculosis[J].Orthop Surg,2016,8(4):454-461.
[3] 田志国,张建伟,拾坤,等.多平面截骨矫形骨水泥强化椎弓根钉内固定治疗骨质疏松性脊柱后凸畸形[J].中国骨与关节损伤杂志,2019,34(7):714-716.
[4] 陈仲强,刘忠军,党耕町.脊柱外科学[M].北京:人民卫生出版社,2013:10.
[5] PAPPOU I P,PAPADOPOULOS E C,SWANSON A N,et al.Pott disease in the thoracolumbar spine with marked kyphosis and progressive paraplegia necessitating posterior vertebral column resection and anterior reconstruction with a cage[J].Spine(Phila Pa 1976),2006,31(4):E123-E127.
[6] QIAN J,RIJIEPU A,ZHU B,et al.Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis[J].Int Orthop,2016,40(10):2081-2088.
[7] LIN T Y,TSAI T T,LU M L,et al.Comparison of two-stage open versus percutaneous pedicle screw fixation in treating pyogenic spondylodiscitis[J].BMC Musculoskelet Disord,2014,15:443.
[8] 罗鹏,方忠,熊伟,等.三种腰椎结核手术方式的比较研究[J].颈腰痛杂志,2012,33(1):26-29.
[9] 李卫平,荀传辉,盛伟斌,等.前路病灶清除植骨融合联合经皮椎弓根螺钉治疗胸腰椎结核[J].实用骨科杂志,2019,25(5):442-445. 中医正骨2021年5月第33卷第5期 J Trad Chin Orthop Trauma,2021,Vol.33,No.5(总373)(总374)中医正骨2021年5月第33卷第5期 J Trad Chin Orthop Trauma,2021,Vol.33,No.5
[10] OMRAN K,ABDEL-FATTAH A S,OTHMAN A M A,et al.Lateral extracavitary approach versus posterior extensive circumferential decompression in the treatment of complicated thoracic and lumbar tuberculous spondylitis[J].Clin Spine Surg,2017,30(9):E1211-E1219.
[11] ZHANG H Q,LIN M Z,GE L,et al.Surgical management by one-stage posterior transforaminal lumbar debridement,interbody fusion,and posterior instrumentation for lumbo-sacral tuberculosis in the aged[J].Arch Orthop Trauma Surg,2012,132(12):1677-1683.
[12] 李晶,王孝宾,吕国华,等.伴有神经损害的儿童胸腰椎朗格汉斯组织细胞增生症的手术治疗[J].中国脊柱脊髓杂志,2014,24(11):995-1000.
[13] RAJASEKARAN S,VIJAY K,SHETTY A P.Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine:a 3-year follow-up of 17 patients[J].Eur Spine J,2010,19(4):583-592.
[14] 王春国,胡文浩,李静,等.治疗脊柱畸形常用后路截骨术术式研究进展[J].脊柱外科杂志,2018,16(6):368-374.
[15] CHEN I H,CHIEN J T,YU T C,et al.Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis:experience with 78 patients[J].Spine(Phila Pa 1976),2001,26(16):E354-E360.
[16] BAO H,HE S,LIU Z,et al.Will immediate postoperative imbalance improve in patients with thoracolumbar/lumbar degenerative kyphoscoliosis?A comparison between Smith-Petersen osteotomy and pedicle subtraction osteotomy with an average 4 years of follow-up[J].Spine(Phila Pa 1976),2015,40(5):E293-E300.
[17] LIU H,YANG C S,ZHENG Z M,et al.Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2015,40(8):570-579.
[18] 杨宗强,施建党,牛宁奎,等.后路全脊椎截骨矫形联合钛网支撑治疗脊柱结核角状后凸畸形的临床疗效观察[J].骨科,2018,9(6):451-457.
[19] SUK S I,KIM J H,KIM W J,et al.Posterior vertebral column resection for severe spinal deformities[J].Spine(Phila Pa 1976),2002,27(21):2374-2382.
[20] 邓幼文,吕国华,王冰,等.一期后路VCR技术治疗活动期胸腰段脊柱结核伴严重后凸畸形[J].中南大学学报(医学版),2008,33(9):865-870.
[21] YANG C S,ZHENG Z M,LIU H,et al.Posterior vertebral column resection in spinal deformity:a systematic review[J].Eur Spine J,2016,25(8):2368-2375.

相似文献/References:

[1]徐帮杰,杨楠,白伟杰,等.坐位定点旋转整复法治疗腰椎间盘突出症的疗效观察[J].中医正骨,2015,27(11):17.
 XU Bangjie,YANG Nan,BAI Weijie,et al.Observation on the curative effect of fixed-point rotational reduction in sitting position in the treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):17.
[2]江建春.神经根型颈椎病的中医药治疗研究概况[J].中医正骨,2015,27(11):71.
[3]钱济先,高浩然,李存孝,等.后路经皮椎弓根螺钉内固定联合前路病灶清除植骨融合术治疗胸腰椎结核脊柱后凸畸形[J].中医正骨,2014,26(03):33.
[4]费骏,赖震,石仕元,等.经肋横突入路病灶清除植骨加后路椎弓根内固定治疗进展性胸椎结核[J].中医正骨,2013,25(06):58.
[5]张志强,刘国泰,刘杰,等.施氏整颈三步九法治疗颈性眩晕[J].中医正骨,2013,25(07):39.
[6]卢中道,杨勇,梅伟,等.一期前路病灶清除植骨内固定治疗胸腰椎结核[J].中医正骨,2013,25(07):71.
[7]龚星军,马文央,王倩芬.牵引配合经筋推拿治疗颈椎间盘突出症的临床研究[J].中医正骨,2011,23(03):16.
 GONG Xing-jun*,MA Wen-yang,WANG Qian-fen.*.Clinical study on the treatment of cervical disc herniation through the method of traction combined with muscle meridian manipulation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2011,23(05):16.
[8]高仰来.从手法角度探讨颈椎病分型的新方法[J].中医正骨,2011,23(04):43.
[9]宋永伟.应用孙氏旋提手法治疗神经根型颈椎病[J].中医正骨,2011,23(04):67.
[10]宋永伟,邓文涛.三阶段治筋正骨综合疗法治疗 复发性腰椎间盘突出症12例[J].中医正骨,2011,23(06):61.
[11]郭小伟,梅伟,潘玉林,等.一期后路病灶清除纳米仿生骨椎体支撑体植骨融合 内固定治疗胸腰椎结核[J].中医正骨,2015,27(07):66.
[12]胡金平,费骏,罗赟,等.经皮椎间孔镜下病灶清除持续灌洗治疗腰椎结核[J].中医正骨,2017,29(10):60.
[13]吕振超,丁锏,曹向阳,等.后路病灶清除脊柱短缩融合内固定术治疗胸腰椎结核骨缺损[J].中医正骨,2018,30(06):74.
[14]何国忠,应永生,俞春生,等.前路与后路一期病灶清除植骨内固定 治疗胸腰椎结核的Meta分析[J].中医正骨,2018,30(08):29.
 HE Guozhong,YING Yongsheng,YU Chunsheng,et al.Primary debridement combined with bone grafting and internal fixation through anterior approach versus posterior approach for treatment of thoracolumbar tuberculosis:a meta analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(05):29.

备注/Memo

备注/Memo:
通讯作者:杨辉 E-mail:1049407898@qq.com
更新日期/Last Update: 1900-01-01