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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (5): 521-528.doi: 10.3969/j.issn.1000-6621.2019.05.010

• 论著 • 上一篇    下一篇

前路翻修术对胸腰椎结核后路固定术后失败的治疗效果

钟鑫(),张强,许祖远,方德健   

  1. 510095 广州市胸科医院骨科
  • 收稿日期:2019-03-25 出版日期:2019-05-10 发布日期:2019-05-10

Efficacy of anterior revision on failure in patients with thoracolumbar tuberculosis underwent posterior fixation

Xin ZHONG(),Qiang ZHANG,Zu-yuan XU,De-jian. FANG   

  1. Department of Orthopedics, Guangzhou Chest Hospital, Guangzhou 510095, China
  • Received:2019-03-25 Online:2019-05-10 Published:2019-05-10

摘要:

目的 探讨前路翻修术[彻底病灶清除和(或)支撑植骨融合术]治疗胸腰椎结核后路固定术后失败的临床效果。方法 搜集2011年3月至2017年1月广州市胸科医院收治的外院行单纯后路手术治疗胸腰椎结核术后失败,于本院行前路翻修术治疗的32例患者临床资料。评价手术治疗方案,以及对比分析患者术前与术后3个月的临床表现、血红细胞沉降率(ESR)、疼痛视觉模拟量表 (VAS)评分,以及末次随访时按照美国脊髓损伤协会(ASIA)制定的脊髓损伤神经功能评定标准、植骨融合情况(Brantigan融合标准)。使用SPSS 19.0软件进行数据的统计学分析,计量资料采用配对t检验,以P<0.05为差异有统计学意义。结果 术后所有患者抗结核药物治疗1.5~2年,随访2~2.5年,随访期间X线摄影和CT检查均未见内固定松动,植骨明显移位、破裂。末次随访时所有患者均已治愈,未发现结核复发。出院时2例既往窦道较长的患者窦道口未完全愈合,经门诊换药2~3个月后窦道逐渐收敛、闭合,其余患者均愈合良好。32例患者术后3个月时疼痛VAS评分[(1.25±0.87)分]、ESR数值[(7.09±3.59)mm/1h]均明显低于术前[(6.06±1.60)分,(69.21±25.76)mm/1h] (t=18.004、 13.766,P值均<0.05);末次随访时ASIA神经功能分级由术前E级29例、D级1例、C级2例,改善为术后的E级29例,D级3例;椎间植骨融合情况(Brantigan融合标准)为E级31例,C级1例。结论 采用前路翻修术是治疗胸腰椎结核后路固定术后失败的一种有效治疗方法。

关键词: 结核, 脊柱, 治疗失败, 复发, 再手术, 治疗结果

Abstract:

Objective To investigate the efficacy of anterior revision, which is complete focus debridement and/or bone graft fusion, on failure in patients with thoracolumbar tuberculosis underwent posterior fixation.Methods The clinical data were collected from 32 failure patients with thoracolumbar tuberculosis underwent anterior revision and performed anterior revision in Guangzhou City chest hospital during March 2011 to January 2017. Operative treatment scheme was evaluated and the clinical manifestations, erythrocyte sedimentation rates (ESR), pain visual analogue scale (VAS) before operation and three months after operation were compared. At last follow up, neurological function and bone graft fusion were evaluated according to the criteria approved by American Spinal Injury Association (ASIA). SPSS 19.0 software was used for statistical analysis of the data. The data were measured by paired t-test. The difference was statistically significant when P less than 0.05.Results All the patients were treated with anti-tuberculosis drugs for 1.5-2 years after operation and followed up for 2-2.5 years. During the follow-up period, no loosening of internal fixation, obvious displacement of bone graft and rupture of bone graft were observed by X-ray and CT. At the last follow-up, all patients were cured and no case was relapse. At the time of discharge, 2 patients with a long sinus had not completely healed, but they were cured underwent dressing change for 2 to 3 months, the others were good healing. The VAS score(1.25±0.87) and the ESR value ((7.09±3.59)mm/1h) at the third month after operation were significantly lower than those ((6.06±1.60) in VAS score and (69.21±25.76)mm/1h in ESR) before operation with significant statistically difference(t=18.004 and 13.766,Ps<0.05). The ASIA neurological function was improved from grade E in 29 cases, grade D in one case and grade C in 2 cases before operation to grade E in 29 cases, grade D in 3 cases and no case with grade C after operation. The bone graft fusion according to Brantigan fusion standard was grade E in 31 cases and grade C in one case.Conclusion Anterior revision is an effective treatment for failure patients with thoracolumbar tuberculosis underwent posterior fixation.

Key words: Tuberculosis, spinal, Treatment failure, Recurrence, Reoperation, Treatment outcome