经椎关节胸椎结核病灶切除植骨融合的临床研究.docVIP

经椎关节一次完成胸椎结核病灶切除、固定、矫形、植骨融合的临床研究 One-Off Posterior Debridement, Orthopedic, Bone Graft Internal Fixation Surgical Treatment of Thoracic Tuberculosis 官众 李德春 任磊 摘要　目的： 探讨应用后路同一个切口一次性行椎弓根系统内固定、病灶切除、矫形、360度植骨融合术治疗胸椎结核的临床效果。方法: 回顾性分析2005年7月至2010年2月期间行后路椎弓根系统内固定，同时前后路植骨融合,利用后路切口切除部分上下关节突、肋骨与横突，扩大视野。不但能逐步刮除病灶、逐步撑开。前路松解后也有利于后凸畸形的矫正，也不必担心撑开时前路病灶对脊髓的压迫。前路与后路植骨。观察胸椎结核患者70 例手术后和随访期间植骨融合率、截瘫恢复情况和后凸畸形矫正状况。得到随访的54例患者随访时间7个月-5年,平均17个月,按Frankel分型,其中A型有1例, B型有6例, C型有6例,D型有11例, E型有30例。结果: 术后7个月-5年所有患者均显示骨性融合, 11例合并截瘫患者中, 症状均有明显改善，术后一周后凸角平均为5.1°后凸畸形平均矫正90%以上, 最终后凸角平均为9.2°，后凸角度平均丢失约4.1°。随访3个月有88%（48/54）有骨痂形成，6个月92.6%（50/54）明显骨性愈合（见图），其余4例9-12个月内愈合,按Frankel分型2例为D型,其余均恢复至E型。结论: 后路椎弓根系统内固定加前后路植骨融合能加强脊柱的稳定性, 促进骨融合和截瘫恢复, 矫正后凸畸形。 关键词 　脊柱结核；胸椎；矫形；椎弓根系统;内固定;植骨融合 Abstract Objective To assessment the treatment effectness of thoracic tubersulosis: debridement, orthotics and 360 ° bone graft with posterior single-incision and one-off surgery. Methods Retrospective analysis from July 2005 to February 2010 posterior pedicle fixation, posterior incision using partial rib resection and transverse process, and expand horizons while bone graft fusion was made both of anterior and posterior. This made possible to well-done lesion curettage gradually and meantime enlarged the gap. Anterior release is helped to correct kyphosis deformation and less worry about spinal cord press coursed by the anterior lesion while enlarging the gap.?Thirty-nine cases among the sixty-two were successfully followed up in observing their fusion rate, recovery of paraplegia, and kyphosis correction. The followed up period was 7~60 months (averaged 17 months). According to Frankel classification, of which 1 cases were A-type , 6 cases were B-type, 6 cases were C-type, 11 cases were D-type and 30 cases were E-type. Listen Read phonetically Result All patients had bone union after 7~60 months followed up. Eleven patients with cauda equina injury were obviously back to normal. A week later of postoperation the kyphosis angle