论文部分内容阅读
目的:总结分期后路融合内固定前路病灶清除椎间植骨治疗儿童腰椎结核伴后凸畸形的临床疗效。方法:2006年10月至2008年6月,我院收治15例腰椎结核伴后凸畸形患儿,男10例,女5例;年龄5～10岁。入院时血沉22～65mm/h,平均42mm/h。神经功能Frankel分级:B级2例,C级5例,D级8例。术前腰椎后凸Cobb角16°～48°,平均30.3°。均采用一期后路植骨融合内固定、二期前路病灶清除椎间植骨治疗,两次手术间隔6～10d。其中6例后凸Cobb角大于40°的患儿术前行Halo-股骨髁牵引2周左右;术前均采用异烟肼、利福平、乙胺丁醇抗结核治疗3～5周,术后继续抗结核治疗12～18个月。结果:手术时间200～320min,平均240min,术中出血量260～440ml,平均320ml。2例术后发生少量胸腔积液,加强抗炎及对症支持治疗2周后吸收。切口均一期愈合。术后后凸Cobb角2°～12°,平均6.9°,较术前明显改善(P<0.05)。随访25～44个月,平均36个月,术后3个月内血沉均恢复正常,末次随访时神经功能4例恢复2级,11例恢复1级;后凸角Cobb角为3°～14°,平均8.1°,较术后无明显丢失(P>0.05)。随访期间无内固定松动、断裂,植骨均融合,无结核复发。结论:在有效抗结核药物治疗的基础上,分期后路融合内固定前路病灶清除椎间植骨治疗小儿腰椎结核伴后凸畸形可取得较好效果。
Objective: To summarize the clinical effects of anterior posterior fusion and internal fixation of anterior debridement and interbody fusion in the treatment of lumbar tuberculosis with kyphosis. Methods: From October 2006 to June 2008, 15 cases of lumbar tuberculosis with kyphosis were treated in our hospital. There were 10 males and 5 females, aged 5 to 10 years old. Stroke admission 22 ~ 65mm / h, an average of 42mm / h. Frankel classification of neurological function: B grade in 2 cases, C grade in 5 cases, D grade in 8 cases. Preoperative lumbar kyphotic Cobb angle 16 ° ~ 48 °, an average of 30.3 °. All the patients were treated with anterior bone graft and internal fixation and two anterior debridement and intervertebral bone grafting. The interval of two operations was 6-10 days. Among them, 6 cases with kypic Cobb angle larger than 40 ° were treated with Halot-femoral condyle for about 2 weeks before operation. All patients were treated with isoniazid, rifampicin and ethambutol for 3 to 5 weeks before operation Continued anti-TB treatment after 12 to 18 months. Results: The operation time was 200-320 minutes with an average of 240 minutes. The intraoperative blood loss was 260-440ml, with an average of 320ml. A small amount of pleural effusion occurred in 2 cases, which was enhanced after 2 weeks of anti-inflammatory and symptomatic supportive treatment. All incisions healed. Postoperative kyphosis Cobb angle 2 ° ~ 12 °, an average of 6.9 °, significantly improved compared with preoperative (P <0.05). The follow-up ranged from 25 to 44 months, with an average of 36 months. The erythrocyte sedimentation rate returned to normal within 3 months after operation. In the last follow-up, 4 cases recovered to 2 grades and 11 cases recovered to 1 grade. The kurtosis Cobb angle was 3 ° to 14 ° °, an average of 8.1 °, no significant loss after surgery (P> 0.05). During follow-up no internal fixation loosening, fracture, bone graft were fusion, no tuberculosis recurrence. Conclusion: On the basis of effective anti-TB drug therapy, the treatment of pediatric lumbar tuberculosis with kyphosis by staging posterior fusion and internal fixation of anterior debridement can achieve better results.