摘要
目的分析小儿脊柱结核临床症状及手术治疗的效果。方法选取山西大医院2012年10月至2017年10月收治的脊柱结核儿童60例,其中男性患儿31例,女性患29例;所有患儿年龄(7.92±2.93)岁;颈椎病变患儿4例,颈胸交界区病变患儿3例,胸椎病变患儿23例,腰椎病变患儿28例,腰骶椎病变患儿2例。有27例患儿合并有神经损害,其中有2例患儿Frankel分级为A级,有4例患儿为B级,有7例患儿为C级,有14例患儿为D级。所有入选患儿均给予手术治疗,并且在术前和术后均进行站立位全脊柱X线片拍摄,测量患儿的躯干矢状偏移距离和矢状面Cobb角,记录所有患儿的脊柱融合情况和融合固定节段。结果有52例(86.67%)患儿的临床症状以病变部位的疼痛或是放射痛为主要表现,有45例(75.00%)患儿表现为局部可触及包块,有7例(11.67%)患儿表现为可触及椎旁或腹部包块,有37例(61.67%)患儿合并有后凸畸形并且病变部位可见脊柱不同程度的隆起;有11例(18.33%)患儿表现为感觉异常、肢体麻木,有11例(18.33%)患儿存在行走困难。60例脊柱结核患儿均存在X线异常表现,其主要表现为患儿病变区的生理曲度异常或出现后凸畸形,患儿的椎间隙变窄,并且椎体边缘模糊不清,存在增宽、变扁或者是楔形样改变。所有患儿手术时间(184.29±23.28)min;术中出血量(475.39±30.28)mL;融合固定节段为6~16节椎体;患儿术前的平均矢状面Cobb角为106.7°,术后矫正为31.3°,矫正率达到76.21%;患儿术前平均胸椎后凸为76.7°,术后矫正为15.7°,平均矫正了55.9°;患儿术前平均躯干矢状偏移距离为-15.42 mm,术后矫正为0.63 mm,平均矫正了20.68 mm。结论疼痛是小儿脊柱结核的首发症状,大多数会合并有严重的后凸畸形;对脊柱结核患儿采用外科手术治疗能够取得较好的临床效果,值得在临床上加以推广,其中对手术入路和融合范围的选择则是治疗过程的关键。
Objective To analyze the clinical symptoms of spinal tuberculosis in children and the effect of surgical treatment. Methods From October 2012 to October 2017, 60 cases of spinal tuberculosis admitted to Shanxi Dayi Hospital were selected, including 31 male children and 29 female children.The age of the children was (7.92±2.93)years old;4 children with cervical vertebra lesions, 3 children with cervical thoracic junction lesions, 23 children with thoracic vertebra lesions, 28 children with lumbar vertebra lesions, and 2 children with lumbar sacral vertebra lesions.There were 27 children with neurological damage.Among them, 2 children with Frankel classification of A, 4 children with B, 7 children with C, and 14 children with D. All children were treated by surgery, and standing full spine X-rays were taken before and after operation.The sagittal deviation distance and sagittal Cobb angle of the children's trunk were measured, and spinal fusion and fixation of all children were recorded. Results In 52 cases (86.67%), the main symptoms were pain or radiation pain, 45 cases (75.00%) showed local palpable mass, and 7 cases (11.67%) had palpable paraspinal or abdominal mass.There were 37 cases (61.67%) with kyphosis and different degrees of spinal bulge, 11 cases (18.33%) showed abnormal sensation and limb numbness.There were 11 cases (18.33%) with walking difficulty.All 60 cases of spinal tuberculosis had abnormal X-ray manifestations.There were abnormal physiological curvature or kyphosis in the diseased area of children, the intervertebral space of children became narrow, and the edge of vertebral body was blurred, there were widening, flattening or wedge-like changes.The operative time was (184.29±23.28)min, and the intraoperative bleeding was (475.39±30.28)mL.The fusion fixation segment was (10.27±1.92) and the sagittal plane was (10.27±1.92). Cobb angle was 106.7°, postoperative correction was 31.3°, the correction rate was 76.21%, the mean preoperative correction of thoracic kyphosis was 76.7°, postoperative correction was 15.7 °, the average correction was 55.9°, the mean sagittal deviation distance of trunk was -15.42 mm, postoperative correction was 0.63 mm, and the average correction was 20.68 mm. Conclusion Pain is the first symptom of spinal tuberculosis in children, most of them will be complicated with severe kyphosis.Surgical treatment of children with spinal tuberculosis can get better clinical results, and it is worthy of popularizing in clinic.The choice of surgical approach and fusion range is the key to the treatment process.
作者
张泓毅
陈晨
李强
Zhang Hongyi;Chen Chen;Li Qiang(Department of Orthopedics, Shanxi Dayi Hospital, Taiyuan, Shanxi 030001, China)
出处
《中国基层医药》
CAS
2019年第10期1229-1232,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
结核
脊柱
疼痛
疾病特征
外科手术
治疗结果
儿童
Tuberculosis, spinal
Pain
Disease attributes
Surgical procedures, operative
Treatmert outcome
Child
