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王延国,宫庆娜,周忠水,王军,师大雷,翟贵亮.一期病灶清除并植骨内固定术治疗颈椎结核[J].脊柱外科杂志,2017,15(2):94-99.
一期病灶清除并植骨内固定术治疗颈椎结核     点此下载全文 (Fulltext)
王延国  宫庆娜  周忠水  王军  师大雷  翟贵亮
滨州市中心医院脊柱外科, 山东 251700
基金项目:
DOI:10.3969/j.issn.1672-2957.2017.02.006
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摘要:
      目的 探讨规范抗结核药物治疗基础上一期手术病灶清除术并植骨融合内固定治疗颈椎结核的临床疗效。方法 回顾性分析2008 年1 月-2014 年12 月在本院接受规范抗结核治疗基础上一期手术行病灶清除并自体髂骨植骨融合内固定术治疗的26 例颈椎结核患者资料,男17 例,女9 例;年龄26-75 岁,平均45.4 岁。其中累及颈椎单椎体7 例、相邻双椎体12 例、3 椎体4 例,合并脊柱其他部位结核病灶3 例(包括T5 1 例、T12 1 例、L3 1 例)。1 例合并颈椎后纵韧带骨化症。术前颈部疼痛视觉模拟量表(VAS)评分4-9 分,平均5.7 分;日本骨科学会(JOA)评分7-12 分,平均10.1 分;术前病变节段Cobb 角21.5°±6.1°;美国脊髓损伤协会(ASIA)分级C 级 2 例,D 级3 例,E 级21 例。术前行规范的抗结核治疗,待红细胞沉降率(ESR)<50 mm/h 后行手术治疗。根据手术节段及病变情况选择颈椎前路、后路或联合入路进行手术。术后继续规范抗结核治疗12-18 个月。结果 术后随访13-49 个月,平均25.3 个月。术前症状均明显改善,骨性融合时间3-6 个月,平均4.5 个月。末次随访时,颈部VAS 评分(1.1±2.7)分,JOA 评分(15.1±3.9)分,病变节段Cobb 角4.7°±6.1°。1 例上颈椎结核患者术后出现取骨区皮下脂肪液化、切口不愈合,给予手术清创缝合后二期愈合。术后未发生颈椎结核复发。结论 在术前规范抗结核治疗基础上,根据病变节段采用一期彻底病灶清除联合植骨融合内固定手术可有效治疗颈椎结核,术后规范的抗结核治疗是提高颈椎结核治愈率的关键。
关键词:颈椎  结核,脊柱  清创术  内固定器  骨移植
One-stage debridement and fusion with internal fixation for adult cervical tuberculosis    Fulltext
WANG Yan-guo  GONG Qing-na  ZHOU Zhong-shui  WANG Jun  SHI Da-lei  ZHAI Gui-liang
Department of Spinal Surgery, Binzhou City Center Hospital, Binzhou 251700, Shandong, China
Fund Project:
Abstract:
      Objective To evaluate the clinical outcomes of one-stage debridement and fusion with internal fixation for adult cervical tuberculosis on the basis of regular anti-tuberculosis(TB) treatment. Methods Clinical data of 26 adult patients(male 17, female 9) with cervical tuberculosis treated by one stage debridement and bone fusion with internal fixation from January 2008 to December 2014 were reviewed retrospectively. The average age of these patients was 45.4 years(26-75 years). Among them, 7 cases were involved in single level, 12 in the adjacent two levels, 4 in three levels, and 3 in other spinal levels(T5 in 1 case, T12 in 1 case, L3 in 1 case). Cervical ossification of the posterior longitudinal ligament was found in 1 case.Before surgery, the mean VAS and JOA scores were 5.7(range, 4-9) and 10.1(range, 7-12) respectively and the Cobb's angle of the lesion segment was 21.5°±6.1°. All the patients underwent regular anti-TB treatment preoperatively. Surgical treatment was performed when erythrocyte sedimentation rate(ESR) was lower than 50 mm/h. Anterior, posterior or combined surgical approaches were chosen according to the lesion involvement.Regular anti-TB treatment was performed postoperatively for 12-18 months. Results Mean follow up duration was 25.3 months(range, 13-49 months). Clinical symptoms were improved significantly in allthe patients. Mean time of union was 4.5 months(range, 3-6 months). At the final follow up, the VAS and JOA scores were 1.1±2.7 and 15.1±3.9, respectively, and the Cobb's angle of the lesion segment was 4.7°±6.1°. One upper cervical TB patient was found to have subcutaneous fat liquefaction at the area where the graft bone was taken and gained second intention by debridement and suture. No cervical tuberculosis recurrence was found during the follow up. Conclusion With appropriate preoperative anti-TB treatment, cervical tuberculosis can be treated by one stage debridement bone fusion with internal fixation by different approaches according to the lesion segment. Postoperative regular anti-TB treatment is a crucial factor for the final recovery of cervical tuberculosis.
Keywords:Cervical vertebrae  Tuberculosis, spinal  Debridement  Internal fixators  Bone transplantation
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