手术治疗胸腰段结核的中期随访研究.docVIP

手术治疗胸腰段结核的中期随访研究 赖震( 石仕元 费骏 魏威 韩贵和 胡胜平 (杭州市红十字会医院骨科，浙江，杭州 310003) 摘要：目的 探讨手术治疗胸腰段结核的中期临床疗效。方法 自2006年7月~2011年7月，采用一期前路病灶清除、植骨融合加后路椎弓根内固定治疗的胸腰段结核患者，且获得中期随访患者28例，男17例，女11例， 17例患者合并神经损伤，根据Frankel分级，B级例级例D级(平均57个月)的随访，术后患者结核症状逐渐得到控制，胸腰痛缓解。17例合并神经损伤患者中，术前例级患者例恢复至D级例恢复至E级，例级D级患者神经功能基本恢复正常。67.86％、82.14％、85.71％、89.29％、91.30％术后6月、1年优良率与术后3个月进行χ2检验比较，P＞0.05，差异无统计学意义，术后3、5年与术后3个月进行χ2检验比较，P0.05，差异有统计学意义，术后5年与术后3年进行χ2检验比较，P＞0.05，差异无统计学意义。根据加州大学(Universith of California at LosAngeles，UCLA)评分对邻近节段退变情况进行评价，术后3年53.57%。与术前相比差异有统计学意义（P0.05）。23例患者术后获得5年随访，退变率为86.96%，与术前及术后3年差异有统计学意义（P0.05）。结论 手术治疗胸腰段脊柱结核能达到彻底清除病灶、重建脊柱的稳定性、恢复腰椎功能和促进脊髓神经功能恢复，是一种有效的治疗方法。但中期随访发现术后邻近节段出现较高的退行性改变。 关键词：胸腰段结核；手术；随访研究 Mid-term outcome of surgical operation for thoracolumbar tuberculosis LAI Zhen, SHI Shi yuan, FEI Jun,WEI Wei,HANG Guihe, HU shengping. Department of Orthopaedics，Red Cross Hospital of Hangzhou，Hangzhou 310003，Zhejiang，China ABSTRACT Objective：To investigate the of operation for thoracolumbar tuberculosis. Methods: Summary patiens with horacolumbar spinal tuberculosis had accepted one stage anterior debridement, bone graft fusion and posterior pedicle screw internal fixation operation treatment from July 2006 to July 2011 , 28 cases were followed up mid-term. Male 17 cases, female 11 cases, 17 cases complicated with nerve injury in patients, according to Frankel classification, 6 cases of grade B, 5 cases of grade C, 6 cases of grade D. Supervision in the process of anti-tuberculosis treatment, surveyed the situation of tuberculosis, poisoning symptoms and postoperative neurological function of plant recovery of paraplegia and lumbar function assessment of bone fusion, respectively. Results: 28 patients received 39 to 85 months (mean 57 months) follow-up, postoperative symptoms of tuberculosis patients gradually under control, chest pain relief. 17 cases were complicated with nerve injury patients, preoperative B level in patients with 6 cases, 3 cases recovered to grade D, 3 cases recovered to g