中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (53): 8567-8572.doi: 10.3969/j.issn.2095-4344.2015.53.007

• 脊柱植入物 spinal implant • 上一篇    下一篇

胸腰椎结核伴重度后凸畸形：矫形内固定与植骨融合后的脊柱稳定性

邓 强1，帕尔哈提·热西提1，张亚楼2，盛伟斌1   

  1. 1新疆医科大学一附院脊柱外科，新疆维吾尔自治区乌鲁木齐市 830011；2新疆医科大学基础医学院组织胚胎学教研室，新疆维吾尔自治区乌鲁木齐市 830054
  • 收稿日期:2015-11-01 出版日期:2015-12-24 发布日期:2015-12-24
  • 通讯作者: 张亚楼，博士，副教授，新疆医科大学基础医学院组织胚胎学教研室，新疆维吾尔自治区乌鲁木齐市 830011
  • 作者简介:邓强，男，1974年生，湖南省益阳市人，汉族，2004年新疆医科大学毕业，博士，副主任医师，主要从事脊柱外科方面的研究。
  • 基金资助:

    国家自然科学基金资助项目(81460481)

     

Thoracolumbar tuberculosis complicated with severe kyphosis: spinal stability after orthopedic fixation and bone grafting fusion

Deng Qiang1, Paerhati•Rexiti1, Zhang Ya-lou2, Sheng Wei-bin1   

  1. 1Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China; 2Department of Histology and Embryology, School of Basic Medicine, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • Received:2015-11-01 Online:2015-12-24 Published:2015-12-24
  • Contact: Zhang Ya-lou, M.D., Associated professor, Department of Histology and Embryology, School of Basic Medicine, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
  • About author:Deng Qiang, M.D., Associate chief physician, Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81460481

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摘要：

背景：目前对于胸腰椎结核重度后凸畸形(>90°)的疗效尚缺乏报道，对严重脊柱结核性后凸畸形，影响心肺功能且伴有神经功能障碍的患者，选择手术治疗是必要的选择。
目的：回顾性分析一期后路截骨矫形内固定、二期前路病灶清除椎间植骨融合对胸腰椎结核伴重度后凸畸形的修复效果。
方法：纳入53例脊柱结核伴严重脊柱后凸畸形患者，一期行后路截骨矫形内固定，二期行前路病灶清除椎间植骨融合治疗。治疗前后分别行X射线、CT、MRI等影像学检查，并对比分析治疗前后的血沉、C-反应蛋白、疼痛目测类比评分、后凸角及ASIA脊髓损伤分级用于临床疗效评价。
结果与结论：患者均顺利完成手术，手术时间290(195-420) min，出血量1 800(1 100-3 300) mL，人均固定节段11.8(9-16)个。53例患者均获随访，随访时间26-48个月。患者治疗后血沉及C-反应蛋白均逐渐恢复正常，至末次随访均恢复到正常水平。末次随访矢状面Cobb角平均矫正77.92°，矫正率达74.6%。至末次随访，矫正角度丢失平均1.35°。患者腰背部疼痛及功能受限在治疗后均得到不同程度的缓解。末次随访目测类比评分显著低于治疗前(t=19.219，P < 0.001)。ASIA脊髓损伤评分逐渐提高，患者均不同程度的恢复生活及工作能力。提示一期后路截骨矫形内固定、二期前路病灶清除椎间植骨融合是修复胸腰椎结核伴后凸畸形的有效方法。文中纳入的胸腰椎结核伴重度后凸畸形患者病变涉及多个椎体，骨缺损长，常常需要长节段异体骨植骨，植骨块融合时间较长，所以行后路关节突间植骨融合以增加植骨稳定性。 

关键词: 骨科植入物, 脊柱植入物, 脊柱结核, 后凸畸形, 截骨矫形, 椎间植骨, 临床疗效, 国家自然科学基金

Abstract:

BACKGROUND: At present, there was lack of reports on the efficacy of thoracolumbar tuberculosis complicated with severe kyphosis (> 90°). Choice of surgical treatment is necessary for patients with severe spinal tuberculosis kyphosis, affected heart and lung function and neurological disorders.
OBJECTIVE: To retrospectively analyze the repair effect of I-stage posterior osteotomy orthopedic fixation and II-stage anterior debridement interbody bone grafting fusion in repair of patients with thoracolumbar tuberculosis complicated with severe kyphosis.
METHODS: Totally 53 patients with spinal tuberculosis complicated with severe kyphosis were enrolled. Patients underwent posterior osteotomy orthopedic fixation in the first stage, and underwent anterior debridement interbody bone grafting fusion in the second stage. X-ray, CT, MRI and other imaging examinations were conducted before and after the treatment. Erythrocyte sedimentation rate, C-reactive protein, pain visual analog scale scores, kyphosis and ASIA spinal cord injury classification before and after the treatment were compared and analyzed for clinical evaluation of efficacy.
RESULTS AND CONCLUSION: All patients had a successful surgery. The operative time was 290 (195-420) minutes, and the intra-operative amount of blood loss was 1800 (1 100-3 300) mL, the average number of fixed segments were 11.8 (9-16). All these 53 patients were followed up for 26-28 months. The erythrocyte sedimentation rate and C-reactive protein of patients after treatment gradually recovered to normal, and recovered to normal levels at the final follow-up. The mean correction of sagittal Cobb angle was 77.92°, the correction rate reached to 74.6% at the final follow-up. Till the final follow-up, the average loss of corrective angle was 1.35°. The lower back pain and limitation of function obtained varying degrees of alleviating after treatment. The visual analog scale scores in the final follow-up were significantly lower than those before treatment (t=19.219, P < 0.001). ASIA spinal cord injury scores gradually increased. Patients recovered the ability to live and work in varying degrees. These results suggest that I-stage posterior osteotomy orthopedic fixation combined with II-stage anterior debridement interbody bone graft fusion is an effective methods for repair of thoracolumbar tuberculosis complicated with severe kyphosis. The lesions of patients with thoracolumbar tuberculosis complicated with severe kyphosis who were enrolled in this study involve multiple vertebral body, long bone defect, and often need long segmental allograft bone grafting, with long-time of bone grafting fusion, therefore, zygapophyseal bone grafting fusion should be conducted to increase the stability of posterior bone grafting. 

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