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1、不同手术方式选择治疗胸腰椎结核并严重后凸畸形及重度截瘫作者:王浩,塔依尔江·举来提,袁宏【摘要】[目的]选择不同手术方式治疗不同发病节段伴有严重后凸畸形和重度截瘫的胸腰椎结核疗效探讨。[方法]2003年5月~2007年12月,共收住23例患者,男16例,女7例;年龄12~56岁,平均25岁。病变节段:T1~44例、T5~104例,胸腰段9例,腰椎6例,累及2个椎体8例,3个椎体12例。手术方式:4例选择经胸骨颈胸联合入路,5例选择单一后路椎体去松质骨截骨术,14例选择前后路联合的手术方式,根据患者全
2、身情况,2例分期,12例一期手术。术后观察植骨融合时间,畸形矫正度和截瘫恢复程度。[结果]植骨平均融合时间为7个月,融合率100%。后凸畸形平均纠正49°,随访时矫正度丢失<2°。所有患者截瘫都完全恢复,最长的10个月时间内Frankel神经功能达到E级。本组脊柱结核均治愈,无大的手术并发症。[结论]根据胸腰椎发病节段及后凸畸形和截瘫程度,选择单一前路、后路或前后联合的手术方式能获得有效的根治,可行彻底的病灶清除、植骨融合并畸形矫正后内固定获得脊柱前后方的稳定性,能完全恢复脊髓神经功能,改善患
3、者的生活质量。【关键词】胸腰椎结核;后凸畸形并截瘫;内固定13Selectiveofdifferentsurgicalprocedureintreatmentofthoracicandlumbarspinetuberculosiswithseverekyphosisandparaplegia∥WANGHao,TAYIERJIANGJulaiti,YUANHong.DepartmentofOrthopaedics,thePeople’sHospitalofXinjiangUygurAutonoumyR
4、egion,Urumqi830001,ChinaAbstract:[Objective]Toevaluatetheclinicalresultsofthepatientswithseverekyphosisandparaplegiaindifferntspinesegmentduetotuberculosisofthoracicandlumbarwhichhadbeentreatedbydifferentsurgicalprocedure.[Methods]Therewereatotalof23pa
5、tients,16maleand7femaleinthisstuady.Theaverageagewere25years,rangingfrom12~56yearsold.Tuberculosislesionwerelocatedindifferentspinesegment(T1~4)fourcases,(T5~10)fourcases,(T11~L2)ninecases,(L3~5)sixcases,twovertebralbodieswereinvolvedin8patientsandthre
6、evertebralbodiesinvolvedin12patients.Surgicalprocedure:fourpatientstreatedthroughmodifiedanteriorcervico-thoracicapproach.Fivepatientstreatedthroughonestageposteriortotalvertebralosteotomy,otherpatientscombinedwithanterior-posteriorapproach,accordingto
7、thepatient'ssurgicalsituation,twelvepatientsacceptedanteriorandposteriorcombinedoperation,twopatientswere13treatedbytwostages.Theperiodofbonegraftingfusion,kyphosisdeformitycorrectiondegree,andneurologicalfunctionrecoveryrecordwereinvestigatedpostopera
8、tively.[Results]Allpatientsgotsolidfusioninaaverageofsevenmonths.Thekyphosisdeformitywascorrected49°inaverage,whichwasmaintainedwellwithinfollow-upperiod.Patientsneurologicalfunctiondeficiencyachievedcompletelyrecovery,thelongesttimebei