| 经皮内镜下病灶清除灌洗引流联合后路内固定治疗老年腰椎结核 |
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投稿时间：2018-02-13
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| 作者 | Author | 单位 | Address | E-Mail |
| 沈健 |
SHEN Jian |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China |
13858143113@163.com |
| 郑琦 |
ZHENG Qi |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China |
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| 汪翼凡 |
WANG Yi-fan |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China |
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| 应小樟 |
YING Xiao-zhang |
杭州市红十字会医院骨科, 浙江 杭州 310003 |
Department of Orthopaedics, Hangzhou Red Cross Hospital, Hangzhou, 310003, Zhejiang, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第11期，第987-992页 |
| DOI：10.3969/j.issn.1003-0034.2018.11.002 |
| 基金项目: |
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中文摘要:
目的：探讨经皮内镜下病灶清除灌洗引流联合后路内固定治疗老年腰椎结核的临床效果和优势。
方法：对2013年5月至2016年5月经皮内镜下病灶清除灌洗引流联合后路内固定治疗的32例老年腰椎结核病患者进行回顾性分析，男13例，女19例；年龄62~85岁，平均75岁；病变节段Cobb角13°~21°，平均（16.52±3.20）°。结核病灶累及节段：L1-L2 1例，L2-L3 4例，L3-L4 15例，L4-L5 10例，L5-S1 2例。比较手术前后的Cobb角、VAS评分、红细胞沉降率（ESR）、C-反应蛋白（CRP）、ASIA分级，评价患者脊柱稳定性及结核复发情况。
结果：32例患者均获随访，时间12~36个月，平均24个月。3例术前伴巨大椎旁腰大肌脓肿的患者，术后灌洗引流管口出现窦道，术后3个月内愈合。其余29例均为Ⅰ期痊愈，无窦道形成。术后2周~3个月患者临床症状明显改善，没有出现严重心肺肝肾功能不全的并发症。VAS评分由术前的（6.77±1.23）分改善为术后1周的（4.71±0.69）分；Cobb角由术前的（16.52±3.20）°改善为术后1周的（4.24±1.22）°。随访期间均未出现感染或结核复发。末次随访ESR、CRP正常，ASIA分级有明显改善。
结论：经皮内镜下病灶清除灌洗引流联合后路内固定是治疗老年腰椎结核简单、有效、安全的手术方式，值得临床推广。 |
| 【关键词】结核 腰椎 外科手术,内窥镜 引流术 后路内固定 |
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| Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation |
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ABSTRACT
Objective: To explore the clinical effects and advantages of percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation in the treatment of tuberculosis of lumbar spine in elderly.
Methods: The clinical data of 32 patients with tuberculosis of lumbar spine received percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation from May 2013 to May 2016 were retrospectively analyzed. There were 13 males and 19 females, aged from 62 to 85 years old with an average of 75 years. Lesion segmental Cobb angle was 13° to 21° with an average of (16.52±3.20)°. Tuberculosis focal involved L1-L2 of 1 case, L2-L3 of 4 cases, L3-L4 of 15 cases, L4-L5 of 10 case, L5-S1 of 2 cases. Cobb angle, VAS score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ASIA grade were compared before and after operation. The stability of the spine and the recurrence of tuberculosis were evaluated.
Results: All patients were followed up for 12-36 months with the mean of 24 months. Three patients complicated with giant paravertebral psoas abscess occurred sinus tract in canal orifice of drainage tube after irrigation, and healed in 3 months after operation. Other 29 patients obtained healing of phaseⅠwithout sinus tract formation. The clinical symptoms of all patients obvious improved at 2 weeks to 3 months after operation and no complications such as severe heart and lung, liver and kidney dyfunction were found. VAS scores and Cobb angles were improved from preoperative (6.77±1.23) points and (16.52±3.20)° to (4.71±0.69)points and (4.24±1.22)° at 1 week after operation. No infection and tuberculosis recurrence were found at follow-up period. ESR and CRP were normal at final follow-up and ASIA grade had obvious improved.
Conclusion: Percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation is a simple, effective and safe method for tuberculosis of lumbar spine in elderly, and is worthy to recommend its clinical use. |
| KEY WORDS Tuberculosis Lumbar vertebrae Surgical procedures,endoscopic Drainage Posterior internal fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 沈健,郑琦,汪翼凡,应小樟.经皮内镜下病灶清除灌洗引流联合后路内固定治疗老年腰椎结核[J].中国骨伤,2018,31(11):987~992 |
| 英文格式: | SHEN Jian,ZHENG Qi,WANG Yi-fan,YING Xiao-zhang.Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(11):987~992 |
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