摘要:
Objective To evaluate the clinical efficacy stage one posterior tuberculosis removal, interbody fusion and pedicle screw fixation in the treatment of thoracolumbar spinal tuberculosis. Methods The clinical data of 53 cases of thoracolumbar spine tuberculosis admitted to Department of Orthopedics,Fuyang Second People's Hospital from Feb. 2012 to Jun. 2015 were retrospectively analyzed. The selected cases were treated with one-stage posterior lesion clearance, interbody fusion,nail stick fixation systematic treatment. Preoperative and postoperative inflammatory parameters[erythrocyte sedimentation rate,C-reactive protein(CRP)],back and back pain[pain visual analogue scale(VAS)],kyphosis(Cobb angle), kyphosis correction rate,kyphosis deformity loss angle,neurological function[American Spinal Injury Association(ASIA)], bone graft fusion and tuberculosis recurrence were compared. Results The operative time was (165 ± 42) min and the intraoperative bleeding was (523 ± 142) mL. The mean follow-up time was (16. 0 ± 3. 7) months. The erythrocyte sedimentation rate and the postoperative CRP returned to normal from six months to one year, and the average score of preoperative VAS was (7. 3 ± 1. 1) score,of postoperative VSA was (2. 0 ± 0. 5) score, the difference was statistically significant(P <0. 05). Cobb angle was (25. 5 ± 3. 6) ° before operation and decreased to (10. 2 ± 3. 8) ° after operation(P < 0. 05). Recovery of neurological function using ASIA classification to judge, one case recovered from A to postoperative B, one case of grade B recovered to grade C, once case of grade A, two cases of grade B, three cases of grade C recovered to grade D after operation, five cases of grade C, and 12 cases of grade D recovered to grade E with 1-3 neurological grade recovery; bone graft fusion time was 6-18 months. Conclusion For the indications of thoracolumbar vertebral tuberculosis, the clinical efficacy of stage one post-tuberculosis clearance, interbody fusion, screw fixation is good, thus is worth of clinical promotion.%目的评估一期后路结核病灶清除、椎体间植骨、钉棒内固定治疗胸腰段脊柱结核的临床疗效.方法回顾性分析2012年2月至2015年6月阜阳市第二人民医院收治的53例胸腰段脊柱结核患者的临床资料,选取病例均采用一期后路病灶清除、椎体间植骨融合、钉棒内固定系统治疗.对比患者手术前后炎性指标[红细胞沉降率、C反应蛋白(CRP)]、腰背部疼痛[疼痛视觉模拟评分(VAS)]、后凸畸形(Cobb角)、后凸畸形矫正率、后凸畸形丢失角度、神经功能[美国脊柱损伤协会(ASIA)]、植骨融合及结核复发情况.结果手术时间为(165 ± 42) min,术中出血(523 ± 142) mL,随访时间平均为(16. 0 ± 3. 7)个月,红细胞沉降率、CRP术后半年至1年恢复正常,术前VAS评分为(7. 3 ± 1. 1)分,术后VAS评分为(2. 0 ± 0. 5)分,差异有统计学意义(P<0. 01); 术前患者的平均Cobb角(25. 5 ± 3. 6)°,术后下降至(10. 2 ± 3. 8)°,差异有统计学意义(P<0. 01); 神经功能的恢复情况:术前1例由A级恢复至术后B级,1例由B级恢复至术后C级,1例A级、2例B级、3例C级恢复至术后D级,5例C级、12例D级恢复至术后E级,神经功能恢复1~3个级别; 植骨融合的时间为6~18个月.结论对于有适应证的胸腰段椎体结核,一期后路结核病灶清除、椎体间植骨、钉棒内固定的手术方式临床疗效良好.