一期前后路联合手术治疗儿童腰椎结核的临床疗效分析

doi:10.3969/j.issn.1000-6621.2020.10.008

摘要/Abstract

摘要：

目的分析一期前后路联合手术治疗儿童腰椎结核的临床效果。方法搜集2009年2月至2017年2月于北京儿童医院行一期前后路联合手术治疗的68例腰椎结核患儿的临床资料并进行回顾性分析。其中,男38例,女30例;年龄范围为3~12岁,平均年龄为(7.6±2.3)岁;病程范围为3~10个月,平均病程为(5.6±1.5)个月。所有患儿随访时间达36~48个月,平均(41.2±3.4)个月。分析患儿术前及术后血红细胞沉降率(ESR)、C反应蛋白(CRP)、Cobb角、局部后凸角、脊髓神经功能变化情况,以及植骨融合和并发症发生情况。结果术后3个月ESR值为(20.2±5.8)mm/1h,较术前[(50.2±13.3)mm/1h]明显降低,差异有统计学意义(t=16.668,P<0.01);CRP值为8(2,10)mg/L,较术前[20(4,30)mg/L]明显下降,差异有统计学意义(Z=-6.742,P<0.01);Cobb角为(11.6±3.7)°,较术前[(25.2±6.7)°]明显改善(t=10.334,P<0.01);腰椎后凸角为(35.6±5.4)°,较术前[(15.2±4.7)°]明显改善(t=23.500,P<0.01)。术前共有54例患儿(79.4%)出现脊髓神经功能改变,术后末次随访时降至8例(11.8%),差异有统计学意义(χ²=62.724,P<0.01)。患儿术后植骨融合均达到Bridwell Ⅰ级标准,融合率达100%,融合时间为3~11个月,平均为(6.6±2.1)个月。至末次随访时,共有4例(5.9%)发生术后并发症,经对症治疗后均好转。结论在使用抗结核药品有效治疗的基础上,采用一期前后路联合手术治疗能有效改善腰椎结核患儿腰椎后凸畸形及神经功能,植骨融合率高且术后并发症较少,临床疗效确切。

关键词: 结核, 脊柱, 腰椎, 儿童, 外科手术, 治疗结果, 评价研究

Abstract:

Objective To analyze the clinical effect of stageⅠanterior-posterior approach surgery for lumbar tuberculosis in children. Methods Clinical data of 68 lumbar tuberculosis children (male: 38, female: 30) who received stageⅠ anterior-posterior approach surgery in Beijing Children’s Hospital from February 2009 to February 2017 were retrospectively analyzed. They aged between 3 and 12 years with mean of (7.6±2.3) years, and the course of disease ranged from 3 to 10 months with mean of (5.6±1.5) months, with follow up of 36-48 months (mean, (41.2±3.4) months). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle, local kyphosis and function changes of spinal nerve cord before and after the operation, as well as fusion of bone graft the complications postoperative were observed. Results Three months after the operation, the ESR, CRP, Cobb angle and local kyphosis in patients were all significantly improved than those before the operation (20.2±5.8) mm/1 h vs. (50.2±13.3) mm/1 h, t=16.668, P<0.01; 8 (2, 10) mg/L vs. 20 (4, 30) mg/L, Z=-6.742, P<0.01; (11.6±3.7)° vs. (25.2±6.7)°, t=10.334. P<0.01; (35.6±5.4)° vs. (15.2±4.7)°, t=23.500, P<0.01). Change of spinal cord nerve function before the operation were found in 54 children (79.4%), however, the number was significantly decreased to 8 (11.8%) at the last visit (χ²=62.724, P<0.01). The bone graft fusion of all the 68 children reached the BridwellⅠ, and the fusion rate was 100% with duration of 3 to 11 months (mean, (6.6±2.1) months). Until the last follow-up, there were totally 4 cases (5.9%) suffering postoperative complications and getting better after receiving treatment. Conclusion Based on the usage of effective anti-tuberculosis medicines, stage Ⅰ anterior-posterior approach surgery could effectively improve the lumbar kyphosis deformity and nerve function of the tuberculosis children. The rate of bone graft fusion was high and occurrence of postoperative complications is rare, the clinical effect is significant.

Key words: Tuberculosis, spinal, Lumbar vertebrae, Child, Surgical procedures, operative, Treatment outcome, Evaluation studies

白云松, 张学军, 曹隽, 冯磊, 祁新禹, 郭东, 姚子明, 李承鑫. 一期前后路联合手术治疗儿童腰椎结核的临床疗效分析[J]. 中国防痨杂志, 2020, 42(10): 1048-1052. doi: 10.3969/j.issn.1000-6621.2020.10.008

BAI Yun-song, ZHANG Xue-jun, CAO Jun, FENG Lei, QI Xin-yu, GUO Dong, YAO Zi-ming, LI Cheng-xin. Analysis of clinical efficacy of stageⅠanterior-posterior approach surgery for lumbar tuberculosis in children[J]. Chinese Journal of Antituberculosis, 2020, 42(10): 1048-1052. doi: 10.3969/j.issn.1000-6621.2020.10.008

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