曹 奇,唐晓军,唐国军,陈亮元,廖 雄,杨铁军,陈小明,颜学亮.一期病灶清除经椎弓根截骨内固定治疗腰骶段陈旧结核伴后凸畸形[J].中国脊柱脊髓杂志,2011,(10):825-829. |
一期病灶清除经椎弓根截骨内固定治疗腰骶段陈旧结核伴后凸畸形 |
中文关键词: 腰骶椎结核 结核后凸畸形 经椎弓根截骨 髂骨钉固定 |
中文摘要: |
【摘要】 目的:探讨一期病灶清除经椎弓根截骨(pedicle subtraction osteotomy,PSO)内固定治疗腰骶段陈旧结核伴后凸畸形的临床疗效。方法:2002年2月~2010年6月我院采取一期病灶清除、PSO技术联合椎弓根螺钉及髂骨钉内固定治疗14例腰骶段陈旧结核伴后凸畸形患者,男5例、女9例,平均年龄45.2岁。术前及术后分别测量脊柱腰椎前凸角、腰骶角、后凸Cobb角及躯干矢状偏移距离,并行神经功能Frankel分级、疼痛视觉模拟评分(visual analogue scale,VAS)测定,随访观察治疗效果。结果:手术时间平均5.4h,术中出血平均2045ml。随访6个月~3年,平均23.4个月。术前腰椎前凸角、腰骶角、后凸Cobb角及躯干矢状面偏移距离分别为17.0°±8.4°、10.0°±6.1°、11.0°±4.7°、5.3±0.5cm,末次随访时分别为28.0°±7.9°、25.0°±7.6°、4.1°±3.5°、-3.2±0.8cm,矫正率分别为(52.0±4.2)%、(61.3±5.7)%、(68.3±3.6)%、(58.0±1.4)%。术前合并神经功能障碍Frankel C及D级各2例,末次随访时1例C级恢复到D级,其余均恢复至E级。术前VAS评分平均8.75分,末次随访时平均2.52分,疼痛改善率71.2%。所有病例均未出现死亡或神经损伤并发症,2例窦道形成、1例血肿形成,对症治疗后愈合;平均7.3个月植骨节段骨性融合。结论:一期病灶清除PSO内固定可安全有效地用于清除脊柱结核病灶,并同期完成后凸畸形矫正,可重建腰骶段稳定、恢复躯体矢状面平衡。 |
Single-stage focal debridement and pedicle subtraction osteotomy for lumbosacral tuberculosis complicated with kyphosis deformity |
英文关键词:Lumbosacral tuberculosis Post-tubercular kyphosis Transpedicular osteotomy Iliac screw fixation |
英文摘要: |
【Abstract】 Objective:To evaluate the clinical efficacy of single-stage focal debridement and pedicle subtraction osteotomy(PSO) for lumbosacral tuberculosis complicated with kyphosis deformity.Method:A total of 14 cases(5 males and 9 females) suffering from lumborsacral tuberculosis complicated with kyphotic deformity between 2002 and 2010 underwent one-stage focal debridement,PSO and pedicle-illiac screw fixation.The average age at surgery was 45.2 years(range,31-53 years).Radiologic index including lumbar lordosis,lumbosacral angle,kyphotic Cobb angle,sagittal trunk shift as well as neurologic status using the modified Frankel grade and visual analogue scale(VAS) were evaluated before and after surgery.Result:The mean duration of surgery was 5.4h,and the average intraoperative blood loss was 2045ml.All patients were followed up for 6 to 36 months with an average of 23.4 months.At final follow-up,the lumbar lordosis increased from 17.0±8.4 degrees to 28.0±7.9 degrees.Lumbosacral angle increased from 10.0±6.1 degrees to 25.0±7.6 degrees.The average preoperative kyphosis was 11.0±4.7 degrees,which decreased to 4.1±3.5 degrees after operation.Sagittal trunk shift improved from 5.3±0.5cm to -3.2±0.8cm.The rate of correction for the four procedures mentioned above was (52.0±4.2)%,(61.3±5.7)%,(68.3±3.6)% and (58.0±1.4)% respectively.Three of four cases with Frankel′s C and D each had neurofunction improved to grade E after operation except for one grade C to grade D at final follow-up.The mean preoperative VAS score was 8.75 and 2.52 for final follow-up,and back pain relief reached 71.2%.No death or nerve injury was found.Two cases developed fistula formation and one had hematoma formation after operation.All patients showed bony union with an average of 7.3 months.Conclusion:Single-stage focal debridement and PSO is safe and reliable for debridement,deformity correction, stability reconstruction and maintaining sagittal alignment. |
投稿时间:2011-07-25 修订日期:2011-08-13 |
DOI:10.3969/j.issn.1004-406X.2011.10.825.4 |
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