本文關鍵詞： 胸腰椎 結核 骨水泥 椎弓根 內固定　出處：《皖南醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：目的探討一期后路病灶清除、生物骨水泥復合抗結核藥物填充聯(lián)合后路經椎弓根內固定術治療胸腰椎結核的臨床處理方法和療效,為臨床應用提供依據。方法總結2011年6月至2014年10月30例采用一期后路病灶清除、生物骨水泥復合抗結核藥物填充聯(lián)合后路經椎弓根內固定術治療胸腰椎結核患者資料,男20例,女10例;年齡25~75歲,平均45.5歲。病灶部位:T9結核2例,T10結核2例,T11結核2例,T12結核5例,L1結核8例,L2結核5例,L3結核2例,L4結核4例。14例存在不同程度的脊髓神經功能障礙,脊髓損傷按Frankle分級,B級1例,C級4例,D級6例,E級3例。記錄患者手術時間、神經功能(Frankel分級)、后凸Cobb角、脊柱生活質量量表評分、疼痛視覺模擬評分、Oswestry功能障礙指數(shù)、血沉、C反應蛋白及結核復發(fā)等情況來進行療效評價。結果術后1例患者出現(xiàn)手術切口延遲愈合,其余患者手術切口愈合良好,未見切口感染,均獲得骨性融合。所有患者均獲得隨訪,隨訪時間12-30個月,平均20.5個月�；颊咝g后日常生活質量明顯改善。14例術前存在神經功能障礙的患者神經功能有不同程度的改善。與術前比較,術后疼痛視覺模擬評分、Oswestry功能障礙指數(shù)及脊柱后凸Cobb角明顯改善(P0.05)。血沉、C反應蛋白在術后約2周明顯下降,在2-4個月內基本恢復正常。術后未發(fā)現(xiàn)一例患者出現(xiàn)結核復發(fā)情況。結論采用一期后路病灶清除、生物骨水泥復合抗結核藥物填充聯(lián)合后路經椎弓根內固定術治療胸腰椎結核療效良好,它能夠有效矯正脊柱后凸畸形,改善神經功能以及維持脊柱的穩(wěn)定性。在嚴格掌握相關手術適應證的條件下,后路病灶清除、生物骨水泥復合抗結核藥物填充聯(lián)合后路經椎弓根內固定術是治療胸腰椎結核的一個較好選擇。
[Abstract]:Objective to investigate the clinical treatment of thoracolumbar tuberculosis with posterior debridement, bone cement and antituberculous drug implantation combined with posterior transpedicular internal fixation in the treatment of thoracolumbar tuberculosis. Methods from June 2011 to October 30th 2014, the clinical data of patients with thoracolumbar tuberculosis treated by posterior debridement, biomedical bone cement combined with antituberculous drugs and posterior transpedicular internal fixation were summarized. There were 20 males and 10 females, aged 2575, The mean age was 45.5 years old. The lesion site was divided into T9 tuberculosis (n = 2), T10 (n = 2), T11 (n = 2), T12 (n = 5), L1 (n = 8), L2 (n = 5), L3 (n = 2), L4 (n = 4), and L4 (n = 14). Spinal cord injury was classified according to Frankle grade B (n = 1), C (n = 4), D (n = 6) and E (n = 3). The time of operation, nerve function Frankel grade, kyphosis Cobb angle, spinal quality of life scale, visual analogue of pain and visual analogue score were recorded. Results one patient had delayed wound healing, the other patients had good wound healing and no wound infection. All patients were followed up for 12-30 months. The average time was 20.5 months. The quality of daily life was significantly improved after operation. 14 patients with neurological dysfunction had different degrees of improvement compared with those before operation. Postoperative pain visual analogue score, Oswestry dysfunction index and Cobb angle of kyphosis were significantly improved (P 0.05). ESR C reactive protein decreased significantly about 2 weeks after operation. No recurrence of tuberculosis was found in one patient after operation. Conclusion one stage posterior debridement is used. The treatment of thoracolumbar tuberculosis with biological bone cement combined with antituberculous drugs and posterior transpedicular internal fixation is effective in correcting kyphosis deformity. Improve neurological function and maintain spinal stability. Under the condition of strict operation indication, the posterior approach focus is cleared. Biological bone cement combined with antituberculous drugs combined with posterior transpedicular internal fixation is a good choice for the treatment of thoracolumbar tuberculosis.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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