胸腰椎结核伴截瘫39例治疗分析【精品论文】

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1、胸腰椎结核伴截瘫39例治疗分析—作者：小小小作者：程新平，李坤，王志刚，穆哈买捉【摘要】目的探讨胸腰段多椎体脊柱结核伴瘫痪一期前方病灶清除植肯融合和/或内固定治疗的疗效。方法回顾我院2004年3月至2006年8月，应用一期前方病灶清除、植骨加/或内固定植骨治疗39例胸腰椎结核伴截瘫患者。男20例，女19例，年龄3〜74岁,平均38.7岁。病程3个月至12年。病变节段为：T2〜L5,累及椎体数目：1个椎体2例，2个椎体20例，3个椎体4例，4个椎体8例，5个椎体4例，8个椎体1例。6例伴完全截瘫。所有病例术前均进

2、行适当的抗疥治疗。术后39例随访12〜41个月，平均24个月。结果术后伤口全部一期愈合，胸椎后凸畸形均明显改善，随访时无加重，随访1年时均获骨性融合。33例不完全性截瘫患者，Frankel分级平均恢复1・36级，6例完全截瘫患者有3例部分恢复，3例无恢复。结论活动性胸腰椎结核伴截瘫的一期椎体间自体骨植骨稳定并全部融合，内固定治疗可行、有效，减少了脊柱后凸畸形，促进截瘫恢复。【关键词】结核;脊柱;截瘫；内固定Abstract：ObjectiveTopredicttheprognosisofPottfsparapl

3、egicpatientsthatwerereviewedretrospectivelyafterbeingtreatedwithanteriordecompressivesurgeryandchemotherapyand/orinterfixed.MethodsAllcasesweretreatedindepartmentoforthopedicsurgerythefirstaffiliatedhospitalofxinjiangmedicaluniversityfrom2004to2006.Inthisstu

4、dy,therewere39patients(twentymaleandnineteenfemale)rangingfrom3to74yearsage.(average,38.7years)Theydevelopedspinaltuberculosisattheageoftwoyears(range,3monthstotwelveyears),atlesionlevelofT2—L5,includinglesionstage：onestagehastwocases;twostageshavetwentycase

5、s;threestageshavefourcases;fourstageshaveeightcases;fivestageshavefourcases;eightstageshaveonecases.Therearesixpatientssufferedentirelyparaplegia.Allpatientshadtriplechemotherapyfortwoweekstosixmonths.Thefollowupwasrangedfrom15to41months,average24months.Resu

6、ltsAl1patientswerehealed,thoracicvertebrakyphosobviouslybecamelittle.Thereweisnosignificontprogressionofkyphosis.Atthefinalfollowup,alloftheresultsshowedsuccessfulinterbodyfusion.Among33casesincompleteparaplegiaimproved1.36gradesinaveragewithFrankelneurologi

7、calclassification,Allof6cases,ofwhomcompleteparaplegiawaspartiallyrecoveredin3cases,hadnochangein3.ConclusionItconeludedthatinternalfixationanterior/posteriorandautograftbonefusionprocedureswerefoundtobehelpfulinstrengtheningthestabilityandprovidingsuccessfu

8、lrecoveryofAtypePottzsparaplegia,andeffectivefixationcancorrectthekpyhosisanddecreaseprogressionofkpyhosis.Keywords：tuberculosis;spinal;paraplegia;internalfixation近I•年来我国结核病人增加，其屮胸腰椎结核好发，发病年龄以儿童