| 单一后路病灶清除植骨内固定加局部化疗治疗胸腰椎结核 |
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投稿时间：2014-07-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 严盈奇 |
YAN Ying-qi |
嘉兴市第二医院骨科7病区, 浙江 嘉兴 314000 |
The Seventh Department of Orthopaedics, the Second Hospital of Jiaxing City, Jiaxing 314000, Zhejiang, China |
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| 夏满莉 |
XIA Man-li |
浙江省嘉兴学院医学院, 浙江 嘉兴 314000 |
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| 戴加平 |
DAI Jia-ping |
嘉兴市第二医院骨科7病区, 浙江 嘉兴 314000 |
The Seventh Department of Orthopaedics, the Second Hospital of Jiaxing City, Jiaxing 314000, Zhejiang, China |
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| 龚遂良 |
GONG Sui-liang |
嘉兴市第二医院骨科7病区, 浙江 嘉兴 314000 |
The Seventh Department of Orthopaedics, the Second Hospital of Jiaxing City, Jiaxing 314000, Zhejiang, China |
gongsuiliang@163.com |
| 陈刚 |
CHEN Gang |
嘉兴市第二医院骨科7病区, 浙江 嘉兴 314000 |
The Seventh Department of Orthopaedics, the Second Hospital of Jiaxing City, Jiaxing 314000, Zhejiang, China |
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| 周晓 |
ZHOU Xiao |
嘉兴市第二医院骨科7病区, 浙江 嘉兴 314000 |
The Seventh Department of Orthopaedics, the Second Hospital of Jiaxing City, Jiaxing 314000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2015年，第28卷，第4期，第323-326页 |
| DOI：10.3969/j.issn.1003-0034.2015.04.007 |
| 基金项目: |
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中文摘要:
目的:探讨单一后路病灶清除植骨内固定加局部化疗治疗胸腰椎结核的临床疗效。
方法:自2009年2月至2012年9月,对胸腰椎结核11例患者行单一后路病灶清除植骨内固定加局部化疗治疗,男7例,女4例;年龄27～65岁,平均53.7岁;病程3个月～2年,平均9个月。脊髓损伤程度根据ASIA损伤分级:C级3例,D级8例。根据ASIA损伤分级评估神经功能恢复程度,依据疼痛视觉评分(VAS)、Oswestry功能障碍指数(ODI)评价临床症状改善情况,通过胸腰椎侧位X线片评估后凸Cobb角的变化。
结果:11例均获随访,时间12～29个月,平均18个月。脊髓损伤ASIA损伤分级:3例C级患者中2例术后提高至D级,1例提高至E级;8例D级患者中7例提高至E级,1例无变化。VAS术前为6.10±1.30,术后3 d为1.70±0.80,较术前明显改善(P<0.05).Oswestry功能障碍指数术前为(68.36±10.41)%,术后3 d为(14.55±8.99)%,较术前明显改善(P<0.05).后凸Cobb角术前为(22.64±4.84)°,术后3 d为(4.27±1.49)°,较术前明显改善(P<0.05),末次随访时为(4.55±1.70)°,与术后3 d比较Cobb角差异无统计学意义(P>0.05).随访期间无复发病例。
结论:单一后路病灶清除植骨内固定加局部化疗治疗胸腰椎结核具有切口单一、手术创伤小、有效清除病灶、改善神经功能、矫正畸形、复发率低的优点,但仍需结合长期、规范的全身抗结核药物治疗。 |
| 【关键词】结核,脊柱 清创术 骨移植 矫形外科固定装置 抗结核药 |
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| Treatment of thoracolumbar spinal tuberculosis with single posterior debridement,bone grafting,internal fixation and local chemotherapy |
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ABSTRACT
Objective:To evaluate the clinical effects of single posterior debridement, bone grafting, internal fixation and local chemotherapy in treating thoracolumbar spinal tuberculosis.
Methods:From February 2009 to September 2012, 11 patients with thoracolumbar spinal tuberculosis were treated by single posterior debridement, bone grafting, internal fixation and local chemotherapy. There were 7 males and 4 females, aged from 27 to 65 years old with an average of 53.7 years. The courses of disease was from 3 months to 2 years with the mean of 9 months. According to ASIA standard of spinal cord injury, 3 cases were grade C and 8 cases D. After treatment, clinical effects were evaluated by ASIA grade, visual analogue score (VAS) and Oswestry Disability Index (ODI); kyphosis Cobb angle change was observed by X-rays.
Results:Eleven patients were followed up from 12 to 29 months with an average of 18 months. ASIA grade of spinal cord injury, 3 patients with grade C improved to grade D in 2 cases and grade E in 1 case;8 patients with grade D improved to grade E in 7 cases and unchanged in 1 case. VAS decreased from preoperative 6.10±1.30 to 1.70±0.80 at 3 d after operation(P<0.05). ODI improved from preoperative (68.36±10.41)% to (14.55±8.99)%(P<0.05) at 3 d after operation. Kyphotic Cobb angle was corrected from preoperative (22.64±4.84)° to(4.27±1.49)°(P<0.05) on the 3rd day after operation, and angle loss was mild at final follow-up, there was no significant difference between postoperative at 3 d and final follow-up.
Conclusion:Single posterior debridement, bone grafting, internal fixation and local chemotherapy for the treatment of thoracolumbar spinal tuberculosis can effectively remove the lesion, improve nerve function and correct deformity, has advantage of single incision, little trauma, and low recurrence rate. But it still need long-term and systemic treatment with anti-TB drugs. |
| KEY WORDS Tuberculosis,spinal Debridment Bone transplantation Orthopedic fixation devices Antitubercular agents |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 严盈奇,夏满莉,戴加平,龚遂良,陈刚,周晓.单一后路病灶清除植骨内固定加局部化疗治疗胸腰椎结核[J].中国骨伤,2015,28(4):323~326 |
| 英文格式: | YAN Ying-qi,XIA Man-li,DAI Jia-ping,GONG Sui-liang,CHEN Gang,ZHOU Xiao.Treatment of thoracolumbar spinal tuberculosis with single posterior debridement,bone grafting,internal fixation and local chemotherapy[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(4):323~326 |
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