颈椎结核合并四肢瘫的外科治疗

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1、颈椎结核合并四肢瘫的外科治疗作者：陈晓辉，豆贲，杨美芳作者单位：1•湖南省永州市蓝山县中医院骨科;2•湖南省郴州市第一人民医院脊柱外科，湖南永州425000【摘要】目的：探讨颈椎结核合并四肢瘫外科治疗的临床疗效与安全性。方法：对21例颈椎结核合并四肢瘫患者采用早期前路病灶清除、减压、植骨、内I古I定手术并行联合化疗。术前Frankel分级:B级12例,C级5例,D级4例。结果：术后随访4〜36个月，平均8个月，死亡2例，其中术后4个月死于突发肺部感染1例，1年后死于脑血管意外1例。所有患者术后脊髓

2、功能均有不同程度恢复，Frankel分级：D级12例,E级9例。3〜6个月X线片显示无骨质破坏复发，植骨处均已骨性融合，无内置物松动、脱落或断裂。结论：颈椎结核合并四肢瘫宜在联合化疗的基础上尽早外科干预;在细致的围手术期管理、止确熟练的手术操作技术下，颈前路病灶清除、减压、植骨、内固定治疗颈椎结核并四肢瘫是安全有效的。【关键词】颈椎;结核;脊柱/外科学;四肢麻痹SurgicaltreatmentforcervicaltuberculosiscomplicatedwithquadriplegiaCH

3、ENXiaohui,DOUBen,YANGMeifang(1.OrthopaedicDepartment,LanshanHosiptalofTCMYongzhou425000;2.SpinalSurgeryDepartment,the1stPeople'sHospitalinChenzhouChenzhou423000,China)Viewfromspecialist:Itiscreative,andofcertainscientificandeducationalvalue.[ABSTRACT]

4、Objective:Toexploretheeffectandsafetyofsurgicaltreatmentforpatientswithcervicaltuberculosiscomplicatedbyquadriplegia.Methods:Anteriorradiaclfocaldebridement,decompressiom,bonegraft,internalfixationcombinedwithchemotherapywereemployedfor21caseswithcerv

5、icaltuberculosisandquadriplegia・AccordingtoFrankelclassificationstandard,12caseswereatgradeB,5caseswereC,and4caseswereD.Results:Followingupof4~36months,averaged8monthsshowed2death:onediedofsuddenlunginfection4monthslateraftersurgery,andtheotherdiedofc

6、erebrovascularaccident1yearlate匚Allpatients*spinalfunctionhadrecoveryatdifferentdegreeaftersurgery,including12casesatD,9casesatE.Xrayat36monthslatershowedbonefusionatgraftspot,noreoccurrenceofbonedestruction,andnoloosening,sheddingorfractureinternalfi

7、xer.Conclusion:Combinedwithchemotherapy,surgicalinterventionshouldbeemployedassoonaspossibleforpatientswithcervicaltuberculosiscomplicatedandquadriplegia.Withcarefulperioperativetreatmentandaccurateoperation,thetreatmentincludinganteriorradicaldebridm

8、ent,decompression,bonegraft,andinternalfixationiseffectiveandsafefortreatingcervicaltuberculosiscomplicatedwithquadriplegia.[KEYWORDS]Cervicaltuberculosis;Spine/surgery;Quadriplegia颈椎结核多发于儿童，特别是肺结核复发患者,颈椎结核的发病率较高;一旦发病,长期卧床及四肢运动障碍带来的并发症严重影响患者的生