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胸腰段脊柱结核伴截瘫的外科治疗

冯孟明 胡明 马远征 薛海滨 李大伟

中国骨伤2011,Vol.24Issue(4):323-326,4.
中国骨伤2011,Vol.24Issue(4):323-326,4.DOI:10.3969/j.issn.1003-0034.2011.04.017

胸腰段脊柱结核伴截瘫的外科治疗

Surgical treatment for the thoracolumbar spinal tuberculosis with paraplegia

冯孟明 1胡明 1马远征 1薛海滨 1李大伟1

作者信息

  • 1. 解放军309医院骨科,北京,100091
  • 折叠

摘要

Abstract

Objectives:To explore the long-term effects,operating opportunity, indication of anterior debridement and decompression and bone graft in treating thoracolumbar tuberculosis with paraplegia. Methods: From March 2006 to September 2008, the data of 56 patients with spinal tuberculosis were retrospectively analyzed. They were 36 cases male and 20 cases female, the age in ranging from 19 to 78 years with the mean of 42.5 years; course of disease in ranging from 3 months to 4 years.The lesion level was in T11-L2,including one stage in 6 cases,two stages in 42 cases,three stages in 7 cases,four stages in 1 case. According to the Frankel wade,grade A in 5 cases, B in 25,C in 21 ,D in 5. Preoperative Cobb angle had 30 cases under 30° ,24 cases in 30°-60°,2 cases more than 60°[averaged in (35.0±3. 3)°]. The mean VAS was 7.3±2.1 preoperatively. All patients had chemotherapy for 2-3 weeks. The clinical effects were evaluated by Cobb angle, VAS, condition of Frankel grade and fusion segments. Results:All patients were followed up from 12 to 38 months with an average of 24 months. All wound obtained primary healing. The Cobb angle was ( 19.0±5.5 )° immediately after operation, and lost ( 1 .8±0.7 )°at the follow up. The mean VAS was 1.4±0.3 postoperatively and 1 .3±0.4 at final follow up. The Cobb angle and VAS significant improved in postoperatively(P<0.05 ) ,and there was no statically difference between after operation and last follow up(P>O.05 ). At 1 year after operation ,all patients obstained successful bony fusion. Among 51 cases incomeplete paraplegia recovered partially or completely (over Frankel D ) through chemotherapy and rehabilitation training for 1-1.5 years;5 cases of complete paraplegia had partially recovered, 3 cases from Frankel A to C,2 cases from Frankel A to B. Conclusion:Base on the chemotherapeutic effect ,paraplegia reason and location ,total body condition to select different operative opportunity can effectively relieve spinal compression, stabilize spinal column, correct kyphosis and promote recovery of paraplegia.

关键词

脊柱结核/截瘫/外科手术/药物疗法,联合

Key words

Spinal tuberculosis/ Paraplegia/ Surgical procedures,operative/ Drug therapy,combination

引用本文复制引用

冯孟明,胡明,马远征,薛海滨,李大伟..胸腰段脊柱结核伴截瘫的外科治疗[J].中国骨伤,2011,24(4):323-326,4.

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