下腰椎结核侧后方入路病灶清除内固定在临床中的应用(1)
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[摘要] 目的 通过侧后方入路病灶清除、椎弓根钉棒系统内固定、植骨融合术治疗严重下腰椎结核，评估其治疗效果。 方法 回顾性分析2008年4月～2011年8月下腰椎结核行以上手术患者9例，术后随访6～12月观察其植骨融合率，症状缓解情况。主要评价标准包括：VAS评分、美国脊髓损伤神经学分类国际标准(2006)Asia损伤分级、血沉(ESR)。 结果 术后所有患者均显示骨性融合，术前疼痛活动受限症状术后均完全缓解，VAS评分均下降到0～2分，有神经损害表现者均恢复正常，Frankel分级恢复到D或E级，ESR均降至正常水平。 结论 通过对VAS评分、Frankel分级、血沉变化值进行统计分析，下腰椎结核采用Ⅰ期侧后方入路病灶清除植骨融合内固定手术，可改善症状, 稳定脊柱 ，该术式效果良好。
[关键词] 下腰椎；结核；侧后方入路；内固定
[中图分类号] R529.2 [文献标识码] A [文章编号] 1674-4721(2012)04(a)-0059-02
Application in the clinic on debridement and internal fixation through posterior-lateral approach in the lower lumbar spine tuberculosis
CHEN Shuilian LI Sen KE Baoyi QIN Bisong
Department of Spine Osteoarthropathy Surgery, the People′s Hospital of Guilin City in Guangxi Zhuang Autonomous Region, Guilin 541002, China
[Abstract] Objective To assess the effect on debridement through posterior-lateral approach, internal fixation with pedicle screw-rod system, bone graft and fusion in the treatment of serious lower lumbar spine tuberculosis. Methods Nine cases of patients with lower lumbar spine tuberculosis were retrospectively analyzed from April 2008 to August 2011, the bone graft fusion rate and symptom relief were observed on the postoperative follow-up in 6-12 months. Evaluation standard: VAS score, spinal cord injury classification standards of United States (2006) Asia injury grading, erythrocyte sedimentation rate (ESR). Results All patients had bone fusion after operation, the confined activity before operation and achiness were disappeared after operation, VAS scores dropped from 0 to 2 scores, the nerve damage had been recovered to normal, Frankel rating regained to D level or E level, ESR was reduced to the normal level. Conclusion Lower lumbar spine tuberculosis treated by one-stage operations which use of posterolateral fusion and fixation can improve the symptoms, and retain the stability of spine. It is confirmed that has a better operation effect judged by VAS scoring, Frankel classification, ESR changes.
[Key words] Lower lumbar; Tuberculosis; Posterior-lateral approach; Internal fixation
下腰椎结核手术既需要彻底清除病灶 ......
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