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1、实用骨科杂志第16卷,第1期,2010年1月·11·文章编号:1008-5572(2010)01-0011-05颈椎结核的手术适应证选择与疗效评价钱邦平,邱勇,王斌,俞杨,朱泽章,马薇薇,黄爱兵,曹兴斌,刘文军(江苏省南京鼓楼医院脊柱外科,江苏南京210008)摘要:目的探讨颈椎结核的手术适应证选择并分析其疗效。方法本组11例颈椎结核患者,男8例,女3例,平均年龄50岁。2例为寰枢椎结核,9例为下颈椎结核。神经功能:2例寰枢椎结核,FrankelD级、E级各1例。9例下颈椎结核,FrankelC级2例,D级2例,E级5例。采用两种
2、手术方式:a)行前路病灶清除内固定植骨融合术7例;b)行后路内固定植骨融合、前路病灶清除植骨融合术4例。结果平均随访24个月,影像学检查示所有结核病灶均骨性融合,无局部病灶复发。神经功能:1例为FrankelD级的寰枢椎结核,末次随访时为FrankelE级。下颈椎结核中,2例FrankelC级,2例D级,末次随访时均为E级。结论颈椎结核手术适应证选择恰当,可实现治愈结核、维持颈椎稳定性及恢复神经功能。关键词:脊柱结核;颈椎;适应证;疗效中图分类号:R529.2文献标识码:BTheSurgicalIndicationsandEval
3、uationofClinicalResultsforCervicalSpineTuberculosisQIANBang2ping,QIUYong,WANGBin,etal(DepartmentofSpineSurgery,GulouHospitalofNanjingUniversityMedicalSchool,Nanjing210008,China)Abstract:ObjectiveThepurposeofthisstudyistoexplorethesurgicalindicationsandevaluateclinical
4、resultsofpatientswithtuberculosisofthecervicalspine.MethodsTherewere8maleand3femalepatients,withameanageof50yearsatpresentation(range,21～75years).Therewere2patientswithtuberculosisoftheatlanto2axialspine,and9withthelowercervicalspine.Ofthetwopatientswithtuberculosisof
5、theatlanto2axialspine,neurologicaldeficitwereFrankelDinone,FrankelEinanother.Oftheninepatientswithsubcervicaltuberculosis,neurologicalstatuswasFrankelCintwo,FrankelDintwo,FrankelEinfive.Ofthe11patients,twosurgicalstrategieswereadopted,7patientsweretreatedbyanteriordeb
6、ridementandfusion,and4patientsunderwentposteriorfixationandfusioninone2stage,anteriordebridementandfusioninsecond2stage.ResultsTheaveragedurationoffollow2upwas24months.Allcaseshadbonyfusion.Therewasnorelapseofthediseaseinanyofourpatients.Onepatientwithtuberculosisofat
7、lanto2axialspinewithFrankelDhadcompleterecoveryatfinalfollow2up.TwopatientswithFrankelCandtwowithFrankelDofthelowercervicalspinehadcompleterecoveryatfinalfollow2up.ConclusionWithappropriateindication,surgicaltreatmentofcervicalspinetuberculosiscanachievecuredisease;ma
8、intaincervicalstability,andrecoverneurologicalfunction.Keywords:spinaltuberculosis;cervicalspine;indications;clinicalresults
