| 后路经皮螺钉固定联合局部经皮内窥镜下病灶清除治疗老年脊柱结核 |
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投稿时间：2018-06-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 许楠健 |
XU Nan-jian |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 陈云琳 |
CHEN Yun-lin |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 蒋伟宇 |
JIANG Wei-yu |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
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| 马维虎 |
MA Wei-hu |
宁波市第六医院脊柱外科, 浙江 宁波 315040 |
Department of Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China |
weihu_ma@163.com |
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| 期刊信息：《中国骨伤》2018年，第31卷，第11期，第1005-1011页 |
| DOI：10.3969/j.issn.1003-0034.2018.11.005 |
| 基金项目: |
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中文摘要:
目的：探讨后路经皮螺钉固定联合局部经皮内窥镜下病灶清除治疗老年脊柱结核的近期疗效。
方法：对2015年1月至2016年9月接受手术治疗的19例老年脊柱结核患者的临床资料进行回顾性分析，男14例，女5例；年龄60~73（66.2±4.0）岁。所有患者入院前已被确诊为脊柱结核，有脓肿、死骨形成但无窦道、神经症状，无开放手术指征。19例患者术前均进行了3周或以上的正规4联药物抗结核治疗。均采用后路经皮螺钉固定联合局部经皮内窥镜下病灶清除术。记录手术前后腰部疼痛的视觉模拟评分（visual analogue score，VAS）、Oswestry功能障碍指数（Oswestry Disability Index，ODI），病变节段的矢状面Cobb角，红细胞沉降率（erythrocyte sedimentation rate，ESR）及C-反应蛋白（C-reactive protein，CRP），对比分析不同时间点以上参数变化。
结果：19例患者均顺利完成手术及安全渡过围手术期，术中未改变手术方式，手术时间为（153.2±14.0）min。除1例患者切口延迟愈合，其余患者术后2周内切口均Ⅰ期愈合。所有患者获得随访，随访时间为15~26（19.6±3.2）个月。VAS评分由术前的（5.9±1.1）分下降到末次随访时的（1.8±0.9）分（P<0.05）。ODI由术前的（80.9±4.0）%下降到末次随访时的（66.4±5.4）%（P<0.05）。病变节段的矢状面Cobb角由术前的（30.8±5.5）°下降到末次随访时的（15.9±2.5）°（P<0.05）。ESR由术前的（79.6±14.4）mm/h下降到末次随访时的（32.0±8.1）mm/h（P<0.05）。CRP由术前的（56.9±9.5）mg/L下降到末次随访时的（20.4±4.6）mg/L（P<0.05）。
结论：老年脊柱结核患者并发症较多，全身基础条件较差，后路经皮螺钉固定联合局部经皮内窥镜下病灶清除术能减少创伤，并能取得满意的临床效果。 |
| 【关键词】脊柱结核 经皮椎弓根螺钉固定 内窥镜 老年人 |
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| Treatment of senile spinal tuberculosis with posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement |
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ABSTRACT
Objective: To explore the short-term efficacy of posterior percutaneous screw fixation combined with local percutaneous endoscopic debridement in treating senile spinal tuberculosis.
Methods: The clinical data of 19 senile patients with spinal tuberculosis underwent surgical treatment from January 2015 to September 2016 were retrospectively analyzed. There were 13 males and 6 females, aged from 60 to 73 years old with an average of (66.2±4.0) years. All patients have been diagnosed with spinal tuberculosis prior to hospitalization with abscess, dead bone formation but no sinus, neurological symptoms, open surgical indications. All patients were treated with posterior percutaneous screw fixation combined with local percutaneous endoscopic debridement, and were given appropriate chemotherapy for 3 weeks preoperatively. Pre-and post-operative visual analogue score (VAS), Oswestry Disability Index (ODI), sagittal Cobb angle of lesion segment, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) were analyzed.
Results: All the 19 patients successfully completed the operation and passed through the perioperative period safely. The operation method was unchanged during the operation. The average operation time was (153.2±14.0) min. Except for 1 patients who had delayed incision healing, other patients healed atⅠstage within 2 weeks after operation. All patients were followed up for 15 to 26 months with an average of (19.6±3.2) months.VAS, ODI, sagittal Cobb angle of lesion segment, ESR, CRP were decreased from preoperative (5.9±1.1)points, (80.9±4.0)%, (30.8±5.5)°, (79.6±14.4) mm/h, (56.9±9.5) mg/L to (1.8±0.9) points, (66.4±5.4)%, (15.9±2.5)°, (20.4±4.6) mg/L, (32.0±8.1) mm/h at final follow-up (P<0.05).
Conclusion: Senile spinal tuberculosis have more complications and poor general body condition. Posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement in treating the patients can reduce trauma, got satisfactory effect. |
| KEY WORDS Spinal tuberculosis Percutaneous pedicle screw fixation Endoscope Elderly |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 许楠健,陈云琳,蒋伟宇,马维虎.后路经皮螺钉固定联合局部经皮内窥镜下病灶清除治疗老年脊柱结核[J].中国骨伤,2018,31(11):1005~1011 |
| 英文格式: | XU Nan-jian,CHEN Yun-lin,JIANG Wei-yu,MA Wei-hu.Treatment of senile spinal tuberculosis with posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(11):1005~1011 |
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