| 骶骨钉内固定在腰骶区脊柱结核的应用 |
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投稿时间：2012-01-03
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| 作者 | Author | 单位 | Address | E-Mail |
| 荆志振 |
JING Zhi-zhen |
山西省人民医院骨科,山西 太原 030012 |
Department of Orthopaedics,People's Hospital of Shanxi,Taiyuan 030012,Shanxi,China |
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| 宋洁富 |
SONG Jie-fu |
山西省人民医院骨科,山西 太原 030012 |
Department of Orthopaedics,People's Hospital of Shanxi,Taiyuan 030012,Shanxi,China |
songjiefu@yahoo.com.cn |
| 陈斌 |
CHEN Bin |
山西省人民医院骨科,山西 太原 030012 |
Department of Orthopaedics,People's Hospital of Shanxi,Taiyuan 030012,Shanxi,China |
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| 胡伟 |
HU Wei |
山西省人民医院骨科,山西 太原 030012 |
Department of Orthopaedics,People's Hospital of Shanxi,Taiyuan 030012,Shanxi,China |
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| 期刊信息：《中国骨伤》2012年，第25卷，第11期，第906-909页 |
| DOI：10.3969/j.issn.1003-0034.2012.11.007 |
| 基金项目: |
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中文摘要:
目的：探讨一期病灶清除、植骨融合、骶骨钉内固定治疗腰骶区脊柱结核的临床疗效.
方法：自2004年3月至2008年11月,抗结核治疗2～3周后,采用经下腰椎侧方入路一期病灶清除、髂骨植骨及骶骨钉内固定治疗腰骶区结核11 例,其中男5 例,女6 例;年龄29～56 岁,平均(44.45±8.50)岁;病程8～15 个月,平均11个月.患者均有不同程度腰骶部疼痛,1例伴下肢放射痛,2例鞍区麻木,6例伴有结核中毒症状.术前摄X线片,并行CT或MR检查,诊断为脊柱结核.术前控制结核中毒症状,血沉降低到(37.2±9.6) mm/h (25～54 mm/h).术前、术后评估腰骶角、视觉模拟评分及血沉变化.
结果：患者均未出现术中及术后并发症,结核无复发,无窦道形成.随访时间平均(19.64±5.43)个月.腰骶角由术前的平均(12.9±5.0)°提高到术后的(21.5±6.1)°和末次随访时的(20.1±5.2)° (P<0.001).视觉模拟评分和血沉由术前的(7.3±1.2)分和(37.2±9. 6) mm/h降低到末次随访时的(0.6±0.5)分和(10.5±2.3) mm/h(P<0.001).所有患者术后6～12个月骨融合,平均(9.0±1.9)个月.术前有神经功能损伤3例,术后神经功能恢复正常.
结论：一期前路病灶清除、植骨融合、骶骨钉内固定是治疗腰骶区脊柱结核的一种有效方法. |
| 【关键词】腰骶部 结核 内固定器 外科手术 |
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| Application of sacral rod fixation for the treatment of lumbosacral segment tuberculosis |
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ABSTRACT
Objective:To evaluate the clinical outcomes of primary anterior radical debridement,bone autograft,and sacral rod fixation for the treatment of tuberculosis of the lumbosacral segment.
Methods:From March 2004 to November 2008,11 patients with tuberculosis of the lumbosacral segments received antituberculosis medications for 2 to 3 weeks before anterior radical debridement,autologous iliac bone grafting,and internal sacral rod fixation. Among the patients,5 patients were male and 6 patients were female,with an average age of (44.45±8.50)years (ranged from 29 to 56 years). The average time from stage of onset to operation was 11 months (ranged from 8 to 15 months). All the patients presented with various degrees of lower back pain; one patient experienced preoperative lower extremity radicular pain,while 2 patients experienced saddle area anaesthesia. However,only 6 patients exhibited mild to moderate tuberculous toxic reactions. All the patients were evaluated by plain radiography,computed tomography (CT),and magnetic resonance imaging (MRI). The diagnosis of tuberculosis was made with reference to clinical and radiological findings. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to (37.2±9.6) mm/h (25 to 54 mm/h). Lumbosacral angle,visual analogue scale (VAS) scores,ESR,and neurological performance were assessed before and after surgery.
Results:All surgical procedures were performed successfully without intra or postoperative complications. There were no instances of spinaltuberculosis recurrence. Patients were followed up for a mean of(19.64±5.43)months. The mean lumbosacral angle significantly increased from the preoperative mean (12.9±5.0) ° to postoperative (21.5±6.1) ° and at final follow-up (20.1±5.2) ° (P<0.001). The mean VAS scores and ESR significantly decreased from preoperative (7.3±1.2) score and (37.2±9.6) mm/h respectively to final follow-up(0.6±0.5) score and(10.5±2.3) mm/h respectively(P<0.001). Bone fusion occurred in all patients at a mean of (9.0±1.9) months (ranged 6 to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery.
Conclusion:Our findings suggest that anterior radical debridement,interbody fusion,and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis. |
| KEY WORDS Lumbosacral region Tuberculosis Internal fixators Surgical procedures,operative |
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| 中文格式: | 荆志振,宋洁富,陈斌,胡伟.骶骨钉内固定在腰骶区脊柱结核的应用[J].中国骨伤,2012,25(11):906~909 |
| 英文格式: | JING Zhi-zhen,SONG Jie-fu,CHEN Bin,HU Wei.Application of sacral rod fixation for the treatment of lumbosacral segment tuberculosis[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(11):906~909 |
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