CT引导下经皮穿刺置管灌洗治疗小儿腰骶段结核

Percutaneous intubation and irrigation under CT guidance for lumbosacral tuberculosis in children

中文关键词:  脊柱结核  腰骶段  小儿  经皮穿刺置管  微创治疗

英文关键词:Ｌumbosacral tuberculosis  Percutaneous catheter drainage  Children  Surgical procedures  Minimally invasive

中文摘要:

  【摘要】 目的：评价CT引导下经皮穿刺置管（percutaneous catheter drainage，PCD）灌洗治疗儿童腰骶段脊柱结核的疗效。方法：2006年1月~2011年2月我科采用CT引导下PCD灌洗治疗9例腰骶段脊柱结核患儿，其中男6例，女3例，年龄2岁2个月~7岁，平均5.4岁。术前血沉25~57mm/h，平均39mm/h，C反应蛋白22.9~40mg/L，平均29mg/L。术前4例有神经功能障碍，Frankel分级D级3例，C级1例。所有患儿在全身抗结核药物治疗的同时，在CT引导下经皮穿刺置管、异烟肼溶液灌洗病灶，同时行TLSO支具外固定保护。结果：9例患者全身抗结核药物治疗9~12个月，病灶局部灌洗10~12周，TLSO支具外固定6~18个月。随访12~36个月,平均24个月， 术后1~3个月ESR、CRP恢复到正常。8例治愈，1例因过早停用抗结核药物致病灶复发，改行开放手术治疗。置管处均无窦道形成，3例Frankel D级患者恢复到E级，1例C级恢复到D级。末次随访时患者临床症状完全消失，影像学检查示结核病灶均愈合，无复发病例。结论：在全身抗结核药物治疗和术后TLSO支具外固定保护下，CT引导下PCD灌洗治疗儿童腰骶段脊柱结核是一种微创、简单、安全、有效的方法。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical efficacy of percutaneous intubation and irrigation under CT guidance for lumbosacral tuberculosis in children. Methods: 9 children suffering from lower lumbar spinal tuberculosis in our institute between January 2006 and February 2011 were reviewed retrospectively. There were 6 males and 3 females with a mean age at surgery of 5.4 years old(range, 2.2 to 7 years). Preoperative ESR and CRP ranged from 25 to 57mm/h(average 39mm/h) and 22.9 to 40mg/L(average 29mg/L) respectively. Preoperative neurological deficits were noted in 4 cases, with 1 Frankel C and 3 Frankel D. All patients underwent routine chemotherapy which consisted of rifampin, isoniazid and ethambutol. 9 children underwent percutaneous intubation, irrigation and continuous focal distillation of isoniazid under CT guidance, after that, all cases had thoracolumbar sacralorthosis(TLSO). Results: All patients received chemotherapy for 9-12 months, PCD for 10-12 weeks and thoracolumbar sacralorthosis(TLSO) for 6-18 months. All cases were followed up for 12-36 months(average, 24 months). 8 children had defect healed completely, tuberculosis recurrence was noted in 1 case due to early cease of chemotherapy, and this case received surgery. No sinus formation was detected, ESR and CRP decreased to normal after an average of 1 and a half months(range, 1 to 3 months). The clinical symptoms completely disappeared and the defect healed. 3 cases with Frankel D recovered to E and 1 from Franke C to D. There was no recurrence after final follow-up． Conclusions： Percutaneous intubation and irrigation under CT guidance is an easy, safe, efficient and less invasive method for lumbosacral vertebral tuberculosis in children on the presence of chemotherapy and thoracolumbar sacralorthosis.