[1]王天堂 马战军△.病灶清除植骨内固定治疗胸腰椎结核的术式选择与评价[J].中国中医骨伤科杂志,2017,25(07):34-38，43.
　WANG Tiantang MA Zhanjun.Selection and Evaluation of Surgical Treatment for Thoracic and Lumbar Spinal Tuberculosis[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2017,25(07):34-38，43.
点击复制

病灶清除植骨内固定治疗胸腰椎结核的术式选择与评价()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第25卷
期数:
2017年07期
页码:
34-38，43
栏目:
临床研究
出版日期:
2017-07-15

文章信息/Info

Title:
Selection and Evaluation of Surgical Treatment for Thoracic and Lumbar Spinal Tuberculosis
文章编号:
1005-0205(2017)07-0034-05
作者:
王天堂1; 2 马战军1△
1.新疆阿克苏地区第一人民医院(新疆 阿克苏,843000)
2.石河子大学
△.通信作者 E-mail:mazhanjun@whu.edu.cn
Author(s):
WANG Tiantang1 MA Zhanjun1△
1.The First People's Hospital of Xinjiang Akesu,Akesu 843000,Xinjiang China.
2.Shihezi University,Shihezi 832003,Xinjiang China.
关键词:
脊柱结核;  手术方式;  效果评价
Keywords:
spinal tuberculosis;  surgical approach;  efficacy evaluation
分类号:
R681.5
文献标志码:
A
摘要:
目的:分析胸椎和腰骶椎结核与其对应的三种手术入路,评价脊柱结核三种手术入路的优缺点,以确定不同部位脊柱结核手术入路选择。方法:纳入本院2011年1月至2015年1月共60例行病灶清除植骨融合内固定术的脊柱结核患者,将患者手术时间、出血量、Cobb角和椎体高度重建作为手术评价的相关指标。结果:前后联合入路组的手术时间、出血量和椎体高度重建明显高于前入路组和后入路组,差异有统计学意义(P<0.05); 在前入路组与后入路组比较中其以上指标差异无统计学意义(P>0.05)。结论:前路手术适合于椎体前方破坏严重,并伴有前方脓肿的患者; 后路手术适合于椎体后方严重破坏,并形成明显后凸畸形及有后方窦道的患者; 前后联合入路适合于椎体严重破坏超过3个以上,且前方伴有巨大脓肿,椎体后方后凸畸形明显的患者,但是手术风险和患者负担会加重。
Abstract:
Objective: To evaluate the advantages and disadvantages of three surgical approaches for the treatment of thoracic and lumbar spinal tuberculosis, and to evaluate the surgical approach to determine the surgical approach for different sites of spinal tuberculosis. Methods: From January 2011 to January 2015, 60 cases of spinal tuberculosis in our hospital underwent debridement and fusion with internal fixation were enrolled, and the operative time, blood loss, Cobb angle and the height of vertebral body were used as the evaluation indexes. Results: In the comparison of different types of spinal surgery, the operation time, bleeding volume and vertebral height reconstruction in combined anterior and posterior approach group were significantly higher than those in the anterior group and the posterior group(P<0.05).There was no significant difference between the anterior approach group and the posterior approach group(P>0.05). Conclusion: Anterior approach is suitable for patients with severe anterior vertebral destruction accompanied by anterior abscess. Posterior surgery is suitable for patients with serious posterior damage accompanied by the formation of vertebral kyphosis and posterior sinus. The anterior and posterior combined approach is suitable for patients with more than 3 vertebrae destruction accompanied by anterior huge abscess and vertebral kyphosis, but the risk of surgery and patient's economic burden will be increased.

参考文献/References:

[1] 葛新江,刘晓峰,马英,等.一期前路结核病灶清除内固定植骨融合治疗多节段颈椎结核[J].中国中医骨伤科杂志,2016,24(1):55-57.
[2] Lagios K,Karaolanis G,Perdikides T,et al.Thoracic aortic Injury:embolization of the tenth intercostal artery and endovascular treatment in a young woman after posterior spinal instrumentation[J].Case Rep Vasc Med,2015,2015:531201.
[3] 张羽浩,王天堂,马战军,等.病灶清除植骨内固定治疗多节段胸腰椎结核[J].中国中医骨伤科杂志,2014,22(10):49-50.
[4] Luk KD.Commentary:Instrumentation in the treatment of spinal tuberculosis,anterior or posterior?[J].Spine J,2011,11(8):734-736.
[5] 王自立.恰当选择脊柱结核手术入路[J].中国脊柱脊髓杂志,2012,22(9):769-770.
[6] 施建党,王自立,丁惠强,等.前后路联合手术治疗腰骶段脊柱结核的效果分析[J].宁夏医学杂志,2009,31(3):227-228.
[7] 艾雨.单纯后路手术与前后路联合手术治疗脊柱结核的临床疗效对比研究[D].南昌:南昌大学,2015.
[8] 王秀景.超声在脊柱结核合并寒性脓肿诊断中的应用价值分析[J].河南医学研究,2016,25(9):1619-1620.
[9] 陈非凡.脊柱结核再次手术原因分析及治疗方案选择的临床回顾性研究[D].重庆:第三军医大学,2015.
[10] 傅俊伟,陈卓,吴俊彪,等.脊柱结核早期诊断的研究进展[J].中国骨伤,2015,28(1):82-84.
[11] 王勍,李敬朝,王传庆,等.手术并超短程化疗治疗脊柱结核的临床研究[G].临床医学专集,2015,2501-2502.
[13] 颜福金.腰椎结核寒性脓肿合并混合感染的手术探讨[J].航空航天医学杂志,2014,25(4):488-489.
[14] 张岱阳,罗政.微创术与病灶清除术在脊柱结核治疗中的疗效比较[J].实用临床医药杂志,2016,20(3):114-115.
[15] 程春,曾勇,杨超,等.脊柱结核的MRI表现特点及诊断价值分析[J].磁共振成像,2016,7(5):371-375.
[16] Ran B,Xie YL,Yan L,et al.One-stage surgical treatment for thoracic and lumbar Spinal tuberculosis by transpedicular fixation,debridement,and combined interbody and posterior fusion via a posterior-only approach[J].J Huazhong Univ Sci Technolog Med Sci,2016,36(4):541-547.
[17] 杨宗强,施建党,何胤,等.脊柱结核治疗失败、复发的原因及防治措施[J].骨科,2015,6(5):277-280.
[18] Lee SH,Sung JK,Park YM.Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis:a retrospective case series[J].J Spinal Disord Tech,2006,19(8):595-602.
[19] Lagios K,Karaolanis G,Perdikides T,et al.Thoracic Aortic Injury:Embolization of the Tenth Intercostal Artery and Endovascular Treatment in a Young Woman after Posterior Spinal Instrumentation[J].Case Rep Vasc Med,2015,2015:531201.
[12] 梅刚.腰骶段及跳跃性脊柱结核治疗方式选择及临床回顾研究[D].重庆:第三军医大学,2015.

更新日期/Last Update: 2017-07-15