有限減壓及椎板重建在單節段胸椎結核手術治療中的應用_《中國修復重建外科雜志》

作者：

羅一 , 鄧展生 , 陳靜 , 郭超峰

中南大學湘雅醫院脊柱外科（長沙，410008）;

關鍵詞：

單節段胸椎結核有限減壓可吸收性止血綾椎板重建

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目的探討在一期后路病灶清除、植骨融合內固定基礎上，采用有限減壓、硬膜囊外可吸收性止血綾覆蓋及椎板重建治療單節段胸椎結核的療效。方法回顧分析2005年9月－2010年3月收治的90例單節段胸椎結核患者臨床資料，其中對照組46例采取一期后路病灶清除、植骨融合內固定治療，治療組44例在此基礎上聯合有限減壓、硬膜囊外可吸收性止血綾覆蓋及椎板重建治療。兩組患者性別、年齡、病程、病變節段、術前Cobb角、Frankel分級、紅細胞沉降率（erythrocyte sedimentation rate，ESR）、Oswestry功能障礙指數（ODI）等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。結果術后患者切口均Ⅰ期愈合。90例均獲隨訪，隨訪時間24～44個月，平均38個月。術后1周及3個月兩組ESR比較差異均無統計學意義（P gt; 0.05）。影像學檢查示，治療組植骨均融合，硬膜外未見明顯瘢痕組織，無內固定失效，對照組出現3例內固定失效，兩組比較差異有統計學意義（P=0.032）。兩組術后Cobb角均較術前顯著改善（P lt; 0.05）；治療組術后2年及末次隨訪時Cobb角及其矯正丟失度均優于對照組（P lt; 0.05）。末次隨訪時兩組ODI均較術前顯著改善（P lt; 0.05），且治療組ODI及其改善率均優于對照組（P lt; 0.05）。末次隨訪時兩組Frankel分級均較術前顯著改善（P lt; 0.05），且治療組優于對照組（Uc=4.368，P=0.000）。結論與傳統手術方法比較，一期后路有限減壓、病灶清除、植骨融合內固定聯合硬膜囊外可吸收性止血綾覆蓋及椎板重建，具有創傷小、并發癥少及患者術后功能恢復佳等特點，是治療單節段胸椎結核的一種有效手術方法。

引用本文： 羅一,鄧展生,陳靜,郭超峰. 有限減壓及椎板重建在單節段胸椎結核手術治療中的應用. 中國修復重建外科雜志, 2012, 26(12): 1409-1414. doi: 復制

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2.	Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop, 2012, 46(2): 165-170.
3.	王自立. 對徹底治愈脊柱結核病灶及其相關問題的管見. 中國脊柱脊髓雜志, 2008, 18(8): 568-570.
4.	Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J, 2011, 20(3): 475-481.
5.	劉進, 劉浩, 李濤, 等. 單節段Coflex棘突間動力重建與后路360°植骨融合治療腰椎退變性疾病的對比研究. 中國修復重建外科雜志, 2011, 25(6): 693-698.
6.	Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Unfallchirurg, 2009, 112(1): 294-316.
7.	文永強, 詹偉彥, 何開正, 等. 有限潛行減壓術治療多節段腰椎間盤突出癥療效分析. 中國修復重建外科雜志, 2006, 20(4): 407-409.
8.	Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
9.	Wurgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
10.	Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
11.	Xie JM, Li T, Wang YS, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
12.	Hsu WH, Lui TN, Chang CN, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12): 1645-1650.
13.	Bokov A, Istrelov A, Skorodumov A, et al. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician, 2011, 14(6): 545-557.
14.	Chandler K, Cappello R. Laminectomy membrane formation in dogs: Is the answer still elusive? Vet J, 2006, 172(1): 1-2.
15.	Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population. Spine (Phila Pa 1976), 2011, 36(24): 2076-2083.
16.	張宇, 周初松, 蔣剛彪, 等. 殼聚糖/聚乙二醇琥珀酸酯/絲裂霉素C釋藥系統預防椎板切除術后硬脊膜外瘢痕粘連的實驗研究. 中國修復重建外科雜志, 2008, 22(10): 1222-1226.
17.	龐祖才, 許漢權, 謝偉堅, 等. 預防椎板切除術后硬膜外粘連的實驗研究. 中國修復重建外科雜志, 2006, 20 (12): 1176-1179.
18.	黃俊俊, 宋躍明, 劉立岷, 等. 聚乳酸薄膜預防腰椎間盤突出癥術后硬膜外粘連的臨床研究. 中國修復重建外科雜志, 2004, 18(1): 21-24.
19.	Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J, 2009, 18(8): 1202-1212.
20.	劉華春. 椎板切除術應用泰綾預防硬膜外瘢痕粘連. 中國當代醫藥, 2011, 18(21): 187, 190.
21.	唐欣, 楊述華, 李寶興, 等. 同種異體骨板覆蓋預防硬膜外瘢痕粘連的實驗研究. 中國修復重建外科雜志, 2006, 20(8): 816-819.
22.	Wee JH, Lee CH, Rhee CS, et al. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol, 2012, 269(3): 897-903.
23.	Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.

1. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine—A classification based on the selection of surgical strategies. J Bone Joint Surg (Br), 2001, 83(6): 859-863.
2. Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop, 2012, 46(2): 165-170.
3. 王自立. 對徹底治愈脊柱結核病灶及其相關問題的管見. 中國脊柱脊髓雜志, 2008, 18(8): 568-570.
4. Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J, 2011, 20(3): 475-481.
5. 劉進, 劉浩, 李濤, 等. 單節段Coflex棘突間動力重建與后路360°植骨融合治療腰椎退變性疾病的對比研究. 中國修復重建外科雜志, 2011, 25(6): 693-698.
6. Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Unfallchirurg, 2009, 112(1): 294-316.
7. 文永強, 詹偉彥, 何開正, 等. 有限潛行減壓術治療多節段腰椎間盤突出癥療效分析. 中國修復重建外科雜志, 2006, 20(4): 407-409.
8. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
9. Wurgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
10. Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
11. Xie JM, Li T, Wang YS, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
12. Hsu WH, Lui TN, Chang CN, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12): 1645-1650.
13. Bokov A, Istrelov A, Skorodumov A, et al. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician, 2011, 14(6): 545-557.
14. Chandler K, Cappello R. Laminectomy membrane formation in dogs: Is the answer still elusive? Vet J, 2006, 172(1): 1-2.
15. Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population. Spine (Phila Pa 1976), 2011, 36(24): 2076-2083.
16. 張宇, 周初松, 蔣剛彪, 等. 殼聚糖/聚乙二醇琥珀酸酯/絲裂霉素C釋藥系統預防椎板切除術后硬脊膜外瘢痕粘連的實驗研究. 中國修復重建外科雜志, 2008, 22(10): 1222-1226.
17. 龐祖才, 許漢權, 謝偉堅, 等. 預防椎板切除術后硬膜外粘連的實驗研究. 中國修復重建外科雜志, 2006, 20 (12): 1176-1179.
18. 黃俊俊, 宋躍明, 劉立岷, 等. 聚乳酸薄膜預防腰椎間盤突出癥術后硬膜外粘連的臨床研究. 中國修復重建外科雜志, 2004, 18(1): 21-24.
19. Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J, 2009, 18(8): 1202-1212.
20. 劉華春. 椎板切除術應用泰綾預防硬膜外瘢痕粘連. 中國當代醫藥, 2011, 18(21): 187, 190.
21. 唐欣, 楊述華, 李寶興, 等. 同種異體骨板覆蓋預防硬膜外瘢痕粘連的實驗研究. 中國修復重建外科雜志, 2006, 20(8): 816-819.
22. Wee JH, Lee CH, Rhee CS, et al. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol, 2012, 269(3): 897-903.
23. Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.

《中國修復重建外科雜志》

有限減壓及椎板重建在單節段胸椎結核手術治療中的應用

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《中國修復重建外科雜志》

有限減壓及椎板重建在單節段胸椎結核手術治療中的應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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