摘要
[目的]探讨椎体间多枚分网的异形钛网植骨技术应用于单纯一期后路手术治疗脊柱结核的可行性及疗效。[方法]自2008年7月-2010年6月,采用单纯一期后路多枚分网的异形钛网植骨新技术治疗的脊柱结核患者共48例,男27例,女21例;年龄16-78岁,平均（41.2±7.8）岁;其中胸段21例,胸腰段14例,腰段9例,腰骶段4例。ASIA分级：A级1例,B级9例,C级17例,D级10例,E级11例。术前血沉18-106 mm,平均（46.7±10.6）mm。胸腰椎结核后凸角度4°-62°,平均（26.6±9.2）°,腰骶段结核的腰骶角15°-31°,平均（23.5±5.7）°。所有患者术后继续抗痨治疗12-18个月。[结果]手术时间为90-180 min,平均（128±24）min,术中失血量100-800 ml,平均（310±125）ml。术后随访18-57个月,平均（37±8）个月。1例患者出现脑脊液漏,3例患者伤口延迟愈合。无窦道形成,无感染性脑脊髓膜炎发生,无结核复发,无钛网沉降。所有患者神经功能均有不同程度改善;术后6个月血沉均恢复正常;终末随访时胸腰椎后凸角度0°-18°,平均（7.2±2.2）°,腰骶段结核的腰骶角为23.8°-35.3°,平均（30.6±6.3）°,随访过程中无明显角度丢失;植骨融合时间为4-8个月,平均6个月。[结论]对于病灶较局限的脊柱结核,采用单纯一期后路多枚分网异形钛网植骨技术能达到满意的治疗效果。
[ Objective] To investigate the outcomes and feasibility of using multiple specially formed titanium mesh cages to treat spinal tuberculosis via the posterior approach. [ Methods] From July 2008 to June 2010, 48 patients （27 males and 21 females） with spinal tuberculosis were treated using the aforementioned new technique; the mean age of the patients was （41.2 ± 7.8 ） years, ranging from 16 to 78 years. There were 21, 14, 9, and 4 cases involving the thoracic, thoracolumbar, lumbar, and lumbosacral spine, respectively. Regarding the preoperative American Spinal Injury Association （ASIA） scores, 1, 9, 11, 10 and 11 cases were grade A, B, C, D and E, respectively. Mean preoperative ESR was （46. 7± 10. 6） mm, ranging from 18 to 106 mm. The mean preoperative thoracic and lumbar tuberculosis kyphosis angle was （26. 6 ±9. 2）°, ranging from 4° to 62 ° ; the mean preoperative lumbosacral angle was （23.5 ± 5.7 ） °, ranging from 15 o to 31 °. All patients received anti - tuberculosis treatment for 12 - 18 months. [ Results ] The mean operation time was （128±24） min, ranging from 90 to 180 min. The mean intraoperative blood loss was （ 310 ± 125 ） ml, ranging from 100 to 800 ml. The mean follow - up duration was （ 37 ±8 ） months, ranging from 18 to 57 months. Regarding complications, there was 1 case of cerebrospinal fluid leakage and 3 cases of delayed wound healing. There were no cases of sinus tract, cerebrospinal meningitis, tuberculosis recurrence, or titanium mesh subsidence. ASIA scores improved to varying extents. The mean thoracolumbar kyphosis angle at the final follow - up ex-amination was （7. 2± 2. 2）°, ranging from 0° to 18°; the mean lumbosacral angle was （ 30. 6 ± 6. 3 ） o, ranging from 23.8° to 35.3°, showing no significant decrease during the follow - up period. ESR recovered to normal levels 6 months postoperatively in all patients. Solid fusion was achieved in a mean 6 months, ranging from 4 to 8 months. [ Conclusion] Using multiple specially formed titanium mesh cages to treat spinal tuberculosis via theposterior approach can provide good results for circumscribed lesions.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2014年第15期1353-1358,共6页
Orthopedic Journal of China
基金
湖南省科技厅科技计划一般项目资助(项目编号:2009JT4011)
湖南省科技厅科技计划重点项目(项目编号:05SK2004)
湖南省"芙蓉学者项目"
关键词
异形钛网
多枚分网技术
脊柱结核
椎体间植骨
单纯后路
specially formed titanium mesh cage, multiple mesh cages technique, spinal tuberculosis, interbodybone graft, posterior approach
