| 杨宗强,唐静,施建党,等.后路全脊椎截骨矫形联合钛网支撑治疗脊柱结核角状后凸畸形的临床疗效观察.骨科,2018,9(6): 451-457. |
| 后路全脊椎截骨矫形联合钛网支撑治疗脊柱结核角状后凸畸形的临床疗效观察 |
| Clinical efficacy of posterior total spinal osteotomy and titanium mesh support for the treatment of kyphosis spinal tuberculosis |
| 投稿时间：2017-07-19 |
| DOI：DOI：10.3969/j.issn.1674-8573.2018.06.007 |
| 中文关键词: 脊柱结核 脊柱后凸 截骨术 钛网支撑 |
| 英文关键词: Spinal tuberculosis Kyphosis Osteotomy Titanium mesh |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨后路全脊椎截骨矫形联合钛网支撑治疗脊柱结核角状后凸畸形的临床疗效及安全性。方法 回顾性分析2012年1月至2015年1月于我科采用后路全脊椎截骨矫形联合钛网支撑治疗的19例胸腰椎脊柱结核角状后凸畸形病人的临床资料，观察术前、术后及末次随访时病人的脊柱后凸Cobb角、矢状面平衡、Frankel分级、疼痛视觉模拟量表（visual analogue score, VAS）评分及并发症。结果 所有病人手术均顺利完成，术后随访24~36个月，平均32个月。术后Cobb角矫正至11.4°±4.4°（5°~20°）；末次随访时为11.8°±4.7°（6°~20°），均较术前显著改善，差异有统计学意义（P均＜0.05），但二者间比较，差异无统计学意义（P＞0.05）。术后VAS评分为（2.3±1.1）分（1~4分），末次随访时VAS评分为（2.5±1.3）分（1~5分），均较术前显著改善，差异有统计学意义（P均＜0.05），但二者间比较，差异无统计学意义（P＞0.05）。术后及末次随访的侧位片上C7铅垂线距S1后上缘的距离均为（9.0±4.2） mm，与术前相比有明显改善（P＜0.05）。术前Frankel B级2例，1例恢复到C级、1例恢复到D级；术前Frankel C级5例，4例恢复到E级、1例恢复到D级；术前Frankel D级12例，9例恢复到E级、3例仍为D级。后凸畸形及局部后背疼痛已明显好转，无其他并发症及病情恶化情况。所有病人在随访期间未见内固定及钛网松动和脱出现象。结论 后路全脊柱截骨术联合钛网支撑治疗脊柱结核角状后凸畸形具有良好的临床效果，但因畸形严重、手术难度高仍伴有神经并发症的风险。 |
| 英文摘要: |
| Objective To investigate the clinical effect and safety of posterior total vertebral osteotomy combined with titanium mesh treatment to spinal tuberculosis kyphosis angle. Methods From January 2012 to January 2015, 19 cases of spinal tuberculosis were cured by the posterior total vertebral osteotomy combined with titanium mesh. The preoperative, postoperative and follow-up kyphosis Cobb angle, sagittal balance, Frankel grade, visual analogue score (VAS) and complications of patients were observed. Results All patients were successfully given the surgery, and followed up for 24-36 months (average 32 months). Postoperative Cobb angle correction was 11.4°±4.4° (5°-20°), at the end of the follow-up, the convex Cobb angle was 11.8°±4.7° (6°-20°), both were improved significantly as compared with that preoperation (P＜0.05), but there was no significant difference between them (P＞0.05). The postoperative VAS score was 2.3±1.1 (1-4), at the end of the follow-up, the VAS score was 2.5°±1.3 (1-5), both were improved significantly as compared with that preoperation (P＜0.05), but there was no significant difference between them (P＞0.05). Postoperative side slice on the C7 plumb line spacing after S1 on edge distance was (9.0±4.2) mm and the last follow-up lateral slice on the C7 plumb line spacing after S1 on edge distance was still (9.0±4.2) mm, which were improved significantly as compared with those preoperation (P＜0.05). In 2 cases of preoperative Frankel grade B, 1 case recovered to the grade C, and 1 case recovered to grade D. In 5 cases of preoperative Frankel grade C, 4 recovered to grade E, and 1 case recovered to grade D. In 12 cases of preoperative Frankel D, 9 cases recovered to grade E, and 3 cases was still grade D. Kyphosis and local back pain was significantly alleviated, and all patients had no other complications and disease progression. The patients during the follow-up period had no internal fixation of titanium mesh loose and the backing out phenomenon. Conclusion Posterior total vertebral osteotomy combined with titanium mesh treatment to spinal tuberculosis kyphosis angle of orthopedic has good effect, and can avoid excessive spinal shortening caused by spinal cord wrinkle and improve surgical safety, but because of severe deformity and operation difficulty, the risk of neurological complications still exists. |
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