本文選題：脊柱結(jié)核 + 復(fù)發(fā)�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討胸腰椎結(jié)核一期前路病灶清除、植骨融合及內(nèi)固定術(shù)后復(fù)發(fā)的原因,并分析再手術(shù)的療效及策略。方法:對收治的15例胸腰椎結(jié)核前路術(shù)后復(fù)發(fā)合并竇道形成并經(jīng)過保守治療無效患者的相關(guān)資料進(jìn)行回顧性分析。15例均采取一期后路植骨內(nèi)固定、前路內(nèi)固定取出、病灶清除、植骨支撐即前后聯(lián)合的翻修術(shù)治療。結(jié)果:初次手術(shù)病灶清除不徹底10例,使用異體骨塊、人工骨、填裝異體骨粒的鈦籠植骨支撐9例,內(nèi)固定松動13例。15例翻修術(shù)后均獲得隨訪,時間12~48個月。術(shù)后結(jié)核桿菌培養(yǎng)陽性5例,其中3例存在不同程度的耐藥(2例耐異煙肼、利福平,1例耐異煙肼、利福平、對氨基水楊酸鈉)。神經(jīng)功能Frankel分級:1例C級恢復(fù)到D級;8例D級恢復(fù)到E級6例,2例無恢復(fù);6例E級仍為E級。術(shù)后14例獲得治愈,影像學(xué)顯示植骨融合,未發(fā)現(xiàn)內(nèi)固定物松動斷裂;1例再次復(fù)發(fā),再次復(fù)發(fā)率為6.67%(1/15),經(jīng)過抗結(jié)核及換藥4個月后治愈。術(shù)后1周后凸Cobb角為2°~3°(4.3°±2.5°),矯正率80.7%±8.0%,與術(shù)前比較差異有統(tǒng)計學(xué)意義(P0.001);末次隨訪為2°~3°(4.5°±2.6°),矯正率為79.6%±9.3%,與術(shù)后1周比較無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:胸腰椎結(jié)核一期前路術(shù)后復(fù)發(fā)的主要原因與病灶清除不徹底、耐藥性結(jié)核菌株出現(xiàn)、非活性異物過多放置、內(nèi)固定松動失效、長期營養(yǎng)不良及不正規(guī)化療有關(guān);前路病灶的徹底清除及良好的植骨支撐、后路堅強(qiáng)的內(nèi)固定結(jié)合有效的化療可明顯減少翻修術(shù)后結(jié)核的復(fù)發(fā)率。
[Abstract]:Objective: to investigate the causes of recurrence of thoracolumbar tuberculosis after primary anterior debridement, bone graft fusion and internal fixation, and to analyze the effect and strategy of reoperation. Methods: the data of 15 patients with anterior recurrence of thoracolumbar tuberculosis complicated with sinus formation after conservative treatment were retrospectively analyzed. 15 cases were treated with one stage posterior bone graft fixation, anterior internal fixation and debridement. Bone graft support is the combined anterior and posterior revision of the treatment. Results: in the first operation, 10 cases had incomplete debridement, 9 cases were supported by allograft bone, artificial bone, titanium cage with allogeneic bone grafts, 13 cases were loosened with internal fixation and 15 cases were followed up after revision, the time was 12 ~ 48 months. After operation, 5 cases were positive for mycobacterium tuberculosis culture, among which 3 cases were resistant to isoniazid in 2 cases, and 1 case to isoniazid, rifampicin and sodium aminosalicylate in 1 case. The neurological function was recovered from grade C to grade D in 1 case with Frankel's grade 1, from grade D to grade E in 8 cases, from grade D to grade E in 2 cases without recovery, and in 6 cases from grade E to grade E. After operation, 14 cases were cured, bone graft fusion was shown on imaging, and no recurrence of internal fixation loosening and fracture was found in 1 case. The recurrence rate was 6.67 / 1 / 15, and was cured after anti-tuberculosis and dressing change for 4 months. 1 week after operation, the Cobb angle of kyphosis was 2 擄/ 3 擄/ 4. 3 擄鹵2. 5 擄/ m, and the correction rate was 80.7% 鹵8.0%, which was significantly higher than that before operation (P 0.001), and the last follow-up was 2 擄3 擄(4.5 擄鹵2.6 擄), the correction rate was 79. 6% 鹵9. 3%, and there was no significant difference between the two groups at 1 week after operation (P 0. 05). Conclusion: the main causes of recurrence of thoracolumbar tuberculosis after primary anterior approach are related to incomplete debridement, emergence of drug-resistant tuberculous bacilli, excessive placement of inactive foreign bodies, loosening of internal fixation, long-term malnutrition and irregular chemotherapy. Complete removal of anterior lesions and good bone graft support, strong posterior internal fixation combined with effective chemotherapy can significantly reduce the recurrence rate of tuberculosis after revision.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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