腰椎结核术式及血沉对手术疗效探析.docVIP

腰椎结核术式及血沉对手术疗效探析【摘要】 目的 探讨腰椎结核术式及血沉对手术疗效的影响。方法 回顾性分析21例侧前方入路清除病灶、后路内固定以及植骨融合手术，联合药物治疗对腰椎结核患者后凸Cobb?s角和神经系统功能Frankel分级的影响；探讨不同血沉对手术疗效的影响。结果 所有患者手术切口均一期愈合，血沉2周内恢复正常，植骨于6~9个月融合。术后腰椎后凸Cobb?s角(8.3 ± 2.4)°较术前(21.3 ± 4.6)°明显减小(P0.05)。结论 侧前方入路清除病灶、后路内固定以及植骨融合术是治疗腰椎结核的有效方法；血沉85 mm/h不是手术绝对禁忌证。 【关键词】 腰椎结核；后前路联合；植骨；内固定；血沉 Effects of blood sedimentation rate (BSR)-associated operation methods on lumbar vertebra tuberculosis LIU Yan-Xiong, LI Mei, GUO Long, et al.Department of Orthopedics, Affiliated Hospital of Yan?an University; Centreal Hospital for Staff of Yanchang Petroleum, Yan?an 716000, China 【Abstract】 Objective To explore the operation methods of lumbar vertebra tuberculosis, and to investigate the effects of blood sedimentation rate (BSR) on operative effect. Methods Twenty-one patients with lumbar vertebra tuberculosis received operation of anterior debridement, bone grafting and internal fixation in addition to drug administration. Cobb?s angle and Frankel grade system for evaluate the neurological deficits were compared between pre-operation and post-operation. Additionally, operative effect on patients with different BSR was studied. Results Operative incisions of 21 cases were primary healing, BSR was normalized within 2 weeks, and grafting bones were fused within 6~9 months. The Cobb?s angle was significantly reduced, and the Frankel grade was generally improved after operation compared with pre-operation［Cobb?s angle: post-operation (8.3 ± 2.4)°, VS. pre-operation (21.3 ± 4.6)°, P0.05). Conclusion Lumbar vertebratuberculosis treated with operation methods of anterior debridement, bone grafting and internal fixation contribute to spinal stability. Patients with BSR at 85 mm/h can not be excluded from operation. 【Key words】 Lumbar vertebra tuberculosis; Anterior and posterior operation; Bone grafting; Internal fixation; Blood sedimentation rate 随着结核耐药菌株的增加，骨与关节结核发病率呈逐年上升趋势，其中约50%为脊柱结核［1］。腰椎椎体负重大、活动度高，是脊柱结核的好发部位［2］。恰当的手术治疗可以在清除结核病灶的基础上解除脊髓压迫、矫正畸形