腰椎结核术式及血沉对手术疗效的探讨(1)
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【摘要】 目的 探讨腰椎结核术式及血沉对手术疗效的影响。方法 回顾性分析21例侧前方入路清除病灶、后路内固定以及植骨融合手术，联合药物治疗对腰椎结核患者后凸Cobbs角和神经系统功能Frankel分级的影响；探讨不同血沉对手术疗效的影响。结果 所有患者手术切口均一期愈合，血沉2周内恢复正常，植骨于6~9个月融合。术后腰椎后凸Cobbs角(8.3 ± 2.4)°较术前(21.3 ± 4.6)°明显减小(P<0.01)，神经系统功能Frankel分级明显改善。血沉60 mm/h组与血沉60~85 mm/h组在手术时间、术中出血量、术后引流量及Cobbs角等方面均差异无统计学意义(P>0.05)。结论 侧前方入路清除病灶、后路内固定以及植骨融合术是治疗腰椎结核的有效方法；血沉85 mm/h不是手术绝对禁忌证。
【关键词】 腰椎结核；后前路联合；植骨；内固定；血沉
Effects of blood sedimentation rate (BSR)-associated operation methods on lumbar vertebra tuberculosis
LIU Yan-Xiong, LI Mei, GUO Long, et al.Department of Orthopedics, Affiliated Hospital of Yanan University; Centreal Hospital for Staff of Yanchang Petroleum, Yanan 716000, China
【Abstract】 Objective To explore the operation methods of lumbar vertebra tuberculosis, and to investigate the effects of blood sedimentation rate (BSR) on operative effect. Methods Twenty-one patients with lumbar vertebra tuberculosis received operation of anterior debridement, bone grafting and internal fixation in addition to drug administration. Cobbs angle and Frankel grade system for evaluate the neurological deficits were compared between pre-operation and post-operation. Additionally, operative effect on patients with different BSR was studied. Results Operative incisions of 21 cases were primary healing, BSR was normalized within 2 weeks, and grafting bones were fused within 6~9 months. The Cobbs angle was significantly reduced, and the Frankel grade was generally improved after operation compared with pre-operation[Cobbs angle: post-operation (8.3 ± 2.4)°, VS. pre-operation (21.3 ± 4.6)°, P<0.05]. No difference of operation time, blood lose, postoperative drainage, or Cobbs angle could be detected between BSR 60 mm/h group and BSR 60~85 mm/h group (P>0.05). Conclusion Lumbar vertebratuberculosis treated with operation methods of anterior debridement, bone grafting and internal fixation contribute to spinal stability. Patients with BSR at 85 mm/h can not be excluded from operation.
【Key words】 Lumbar vertebra tuberculosis; Anterior and posterior operation; Bone grafting; Internal fixation; Blood sedimentation rate ......
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