儿童脊柱结核再次手术原因分析

Reasons of re-operation for pediatric spinal tuberculosis

中文关键词:  脊柱结核  再次手术  儿童

英文关键词:Spine tuberculosis  Re-operation  Pediatric

中文摘要:

  【摘要】 目的：探讨儿童脊柱结核再手术原因。方法：2002年6月~2013年6月行手术治疗的儿童脊柱结核患者123例，其中男59例，女64例；年龄6.9±4.8岁（1~14岁）。其中76例患者行前路手术，26例行后路手术，21例行前后路联合手术。分析再手术原因。结果：其中27例患者再次手术治疗，男15例，女12例；年龄8.2±4.1岁（2~13岁）。其中，脊柱结核迁延不愈或复发5例，脊柱后凸畸形14例，术后内固定断裂或脱出4例，脊柱结核复发同时伴内固定螺钉断裂、内固定棒断裂1例，脊柱结核迁延不愈伴脊柱后凸畸形2例，术后内固定棒断裂伴脊柱后凸畸形1例。再次手术患者中，初次行前路手术者19例，后路手术者4例，前后路联合手术者4例。初次行前路、后路和前后路联合手术后因脊柱后凸畸形再手术的百分率比较差异有统计学意义（P＜0.05），因术后脊柱结核迁延不愈或复发再手术的百分率比较差异无统计学意义（P＞0.05），术后因内固定断裂或脱出再手术的百分率比较差异有统计学意义（P＜0.05）。结论：儿童脊柱结核再次手术的原因复杂，主要有术后脊柱后凸畸形、术后脊柱结核的迁延不愈或复发、术后内固定断裂或脱出。儿童脊柱结核行前路手术后因脊柱后凸畸形而再次手术的百分率比后路或前后路联合手术高。

英文摘要:

  【Abstract】 Objectives: To summarize the reasons of re-operation for pediatric spinal tuberculosis. Methods: A retrospective analysis of 123 cases with pediatric spinal tuberculosis from June 2002 to June 2013 and undergoing surgical treatment was reviewed. Among them, there were 59 males and 64 females; age ranged from 1 to 14 years(mean 6.9 years). There were 76 cases undergoing anterior operation, 26 cases undergoing posterior operation and 21 cases with combined anterior and posterior operation. The reasons of re-operation were reviewed retrospectively. Results: Among 123 cases with pediatric spinal tuberculosis, 27 patients underwent re-operation, there were 15 males and 12 females; age ranged from 2 to 13 years(mean 8.2 years). Delayed healing of spinal tuberculosis was noted in 5 cases, kyphosis was noted in 14 patients, instrument failure was noted in 4 cases, recurrence of spinal tuberculosis accompanied by instrument failure was noted in 1 case, delayed healing of spinal tuberculosis accompanied by kyphosis was noted in 2 cases, postoperative instrument failure accompanied by kyphosis in 1 case. Anterior re-operation was performed in 19 cases, posterior re-operation in 4 cases, combined anteropsterior re-operation in 4 cases. Incidence of postoperative kyphosis showed significant difference among three groups(P<0.05), postoperative re-operation, delayed healing and recurrence rate showed no significant difference among three groups(P>0.05). The difference was satistically significant with respect to the instrument failure after operation(P＜0.05). Conclusions: Postoperative kyphosis, delayed healing, recurrence and instrument failure are the main causes of re-operation for pediatric spinal tuberculosis. Anterior approach has higher rate of re-operation than posterior and combined anteroposterior approach.