| CT引导下微创手术治疗腰骶椎结核的中远期临床观察 |
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投稿时间：2015-05-25
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| 期刊信息：《中国骨伤》2016年，第29卷，第3期，第270-274页 |
| DOI：10.3969/j.issn.1003-0034.2016.03.015 |
| 基金项目: |
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| 中文摘要:目的:探讨CT引导下微创手术治疗腰骶椎结核的临床疗效。方法:对2002年1月至2013年3月收治的保守治疗无效的145例腰骶椎结核患者的临床资料进行回顾性分析,男84例,女61例;其中143例获得随访,年龄2.5～81岁,平均(42.60±17.14)岁。术后复发患者14例(6例有内固定,8例无内固定);椎旁脓肿的患者32例。术前合并左下肢无力浅感觉差1例,肌力减退1例,此2例患者Frankel分级均为D级,其他患者为E级。144例实施CT引导下在病灶和脓肿内置管局部化疗灌注冲洗,1例行小开窗手术结合局部化疗治疗。观察患者治疗前及末次随访时的血沉及腰椎前凸角度(lumbar lordosis,LL).结果:143例患者获随访,时间为21～149个月,平均67个月,其中73例获得5年以上随访。所有患者达临床愈合。术前血沉(44.96±12.41) mm/h,末次随访时(7.25±3.43) mm/h,两者差异有统计学意义(t=35.06,P=0.000).治疗前腰椎前凸角为(36.32±8.55)°,末次随访时为(33.35±8.16)°,两者差异有统计学意义(t=13.90,P=0.000).结论:经保守治疗3个月以上无效,脊柱稳定性较好且神经症状的程度在Frankel分级D级以上的患者,行微创治疗辅以全身抗结核药物化学治疗效果较好。 |
| 【关键词】结核,脊柱 外科手术,微创性 抗结核药 局部化疗 |
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| Long-term clinical studies on the treatment of lumbosacral spinal tuberculosis with CT-guided minimally invasive surgery |
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| ABSTRACT Objective:To evaluate the clinical effects of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis. Methods:From January 2002 to March 2013, 145 patients (84 males and 61 females) with lumbosacral spinal tuberculosis underwent failed conservative treatment were treated with CT-guided minimally invasive surgery. Their clinical data were retrospectively analyzed. Among them, 143 patients were followed up, aged from 2.5 to 81 years with an average of (42.60±17.14) years. Fourteen cases (6 cases with internal fixation and 8 cases without internal fixation) recurred and 32 cases complicated with paraspinal abscess after operation. Preoperatively 1 case complicated with lower limb weakness and superficial sensation worse, 1 case with muscle strength decrease, this 2 cases were grade D of Frankle, other cases were grade E. And 1 patient underwent fenestration operation and local chemotherapy, 144 cases with CT-guided percutaneous puncture and local chemotherapy. ESR and lumbar lordosis angle of all patients were observed preoperatively and final follow-up. Results:The mean follow-up time was 67 months (ranged, 21 to 149 months) in 143 cases, and 73 cases more than 5 years. All patients obtained clinical healing. ESR was (44.96±12.41) mm/h before operation and (7.25±3.43) mm/h at final follow-up, there was significant difference between preoperative and postoperative(t=35.06, P=0.000). Lumbar lordosis angle was(36.32±8.55)° before operation and(33.35±8.16)° at final follow-up, there was significant difference between preoperative and postoperative(t=13.90, P=0.000). Conclusion:When conservative treatment fails for 3 months or more, the patients have good spinal stabilization, nerve function is more than grade D of Frankel, CT-guided percutaneous puncture and local chemotherapy can get satisfactory outcomes for lumbosacral spinal tuberculosis. |
| KEY WORDS Tuberculosis,spinal Surgical procedures,minimally invasive Antitubercular agents Local chemotherapy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张琳,张西峰,侯克东,杨华东,蒋续钢,李凝道.CT引导下微创手术治疗腰骶椎结核的中远期临床观察[J].中国骨伤,2016,29(3):270~274 |
| 英文格式: | ZHANG Lin,ZHANG Xi-feng,HOU Ke-dong,YANG Hua-dong,JIANG Xu-gang,LI Ning-dao.Long-term clinical studies on the treatment of lumbosacral spinal tuberculosis with CT-guided minimally invasive surgery[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(3):270~274 |
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