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1、钛网支撑治疗胸腰椎结核30例分析作者:土克军,李照文,廖全明,王志贵,王宜山单位:胸椎;腰椎;脊柱结核;钛网支撑;内固定[摘要]目的探讨胸、腰椎结核一期病灶淸除加植件融合内固定的疗效。方法本组30例,男16例,女14例;平均年龄32.4岁(17〜55岁)。病变部位:胸椎9例,胸、腰段6例,腰椎15例。2个椎体21例,3个椎体7例,4个椎体1例,跳跃型1例。椎旁脓肿24例,骼窝流注性脓肿6例。木组患者伴有后凸畸形26例,平均Cobb角42.8°o术前血沉介于34〜142mm/h。木组患者术前常规抗密(异烟册、利福平、乙胺丁醇、链霉索)1〜2周,手术方式为一期
2、病灶淸除、脊髓减压、前方钛网支撐畸形矫止、口体翳骨(或肋骨)植骨融合内固定术。术后继续抗癘治疗12个月,定期复查胸腰椎止侧位片、血沉、肝肾功能等。结果切口皆一期愈合,无窦道形成。随访6〜36个月(平均12个月),畸形矫正、植骨融合满意,未见内固定失败,疼痛等症状消失,脊髓功能皆明显恢复。2例出现神经根刺激症状,3例感伤口区麻木。术后血沉恢复正常时间平均为3〜11个月。结论胸、腰椎结核行一期病灶清除、脊髄减压、植骨融合,同时前方钛网支撑畸形矫正和内固定治疗,在临床上取得了满意的疗效且不良反应少。[关键词]胸椎;腰椎;脊柱结核;钛网支撑;内固定Operativesur
3、gicalprocedursestreatmentspinaltuberculosis30casesWnagkejun,lizhaowen,liaominquanetal.DepartmentoforthopedicJinzhoucenterhospital[Abstract]ObjectiveToobservetheefficacyofone-stageradicaldebridement,defornitycorrection,interbodyfusionandstabilityreconstructionwithcageforthespinaltuberc
4、ulosistreatment.MethodsTherewere30casesinthegroup,16malesand14femaleswithanaverageageof32.4years(17-55years).Thelesionswerelocatedatthoracicin9cases,thoracolunbarin6casesandlumbarin15cases・Twovertebraswereaffectedin21cases,threein7casesandfourin1case.24caseshadpara・vertebralabscess,an
5、d6hadpsoasabscess.ThecaseswereallassociatedwithkyphosisdeformitywithanaverageCObbangleof42.8degrees・ThepreoperativeESRwasranged34-142mm/h.Allthepatientsaccepted1・2weeksAnti-TBtherapy,thenunderwentone-stageradicaldebridement,abscessdrainage,spinalcorddecompression,deformitycorrection,i
6、nterbodyandstabilityreconstructionwithcagethroughanteriorapproach.Afterthesurgery,theyacceptedanother12-monthAnti-TBtherapyandtookimage,ESRandtheliverfunctionexaminationsatintervals.ResultsAllthepatientsacquiredsatisfactoryincisionhealing.Follow-upperiodextendedfrom6monthsto36months(m
7、ean12months).Thegraftgotfusionandtherewasnointernalfixationfailureorrecurrence・Paingotdissapearedandneurologicalfunctionwasimprovedinallpatientsindifferentdegrees・Twocaseshadnerverootsincitementsymptom,andthreecasesfeltanaesthesiaattheareaofopration.Therewasnopyothoraxorlateneurologic
8、aldef