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[1]杨生森,袁海峰,杨春瑞,等.外科治疗腰椎布鲁菌性脊柱炎的术式选择[J].宁夏医科大学学报,2017,(11):1314-1318.[doi:10.16050/j.cnki.issn1674-6309.2017.11.019]
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外科治疗腰椎布鲁菌性脊柱炎的术式选择(PDF)
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《宁夏医科大学学报》[ISSN:1005-8486/CN:64-1029/R]

卷:
期数:
2017年11期
页码:
1314-1318
栏目:
经验交流
出版日期:
2017-11-30

文章信息/Info

Title:
-
作者:
杨生森1袁海峰1杨春瑞2马小民1丁惠强1
1.宁夏医科大学总医院,银川 750004; 2.解放军第三医院,宝鸡 721000
Author(s):
-
关键词:
布鲁菌性脊柱炎腰椎手术方式
Keywords:
-
分类号:
R516.7
DOI:
10.16050/j.cnki.issn1674-6309.2017.11.019
文献标志码:
B
摘要:
目的 回顾性分析一期前路病灶清除、植骨融合联合后路内固定术与后路病灶清除、植骨融合内固定术治疗 腰椎布鲁菌性脊柱炎的治疗效果。方法 对37例腰椎布鲁菌性脊柱炎患者根据不同疾病状态和适应症分别采用一期 前路病灶清除、植骨融合联合后路内固定术(后前路联合组)和后路内固定、病灶清除、后外侧植骨融合术(单 纯后路组)。记录两组患者手术时间、术中失血量、卧床时间、手术前后疼痛视觉模拟量表(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及神经功能改善情况,以红细胞沉 降率(ESR)、C-反应蛋白(CRP)及影像学来判定治疗效果。结果 单纯后路组手术时间 130~200min(150± 28.8min),失血量300~500mL(410±180.3mL),卧床时间 14~21d(16±5.7d);后前路联合组手术时间190 ~320min(260.6±28.8min),失血量550~1200mL(990.1±150.0mL),卧床时间 18~26d(21±4.5d)。所有 患者术后6个月和末次随访时腰痛VAS评分、ODI、ESR、CRP均较术前下降,两组患者疗效达到优的病例分别为 93.3%和90.1%,单纯后路组中2例出现肝损,后前路联合组中3例出现肝损,加用保肝药后肝功恢复正常。末次随 访时两组患者病灶均愈合,植骨均融合。结论 单纯后路手术治疗以椎间隙破坏为主,无脓肿形成或较小椎旁脓肿 或椎管内脓肿可以获得良好的疗效;病灶主要位于前中柱,病损主要以骨破坏为主,且伴有较大的椎旁脓肿、腰 大肌脓肿;椎体骨质破坏严重,椎体矢状面高度严重破坏的患者应采用后前联合入路手术,可以彻底清除骨破坏 病灶和脓肿,并可恢复脊柱前中柱高度。
Abstract:
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备注/Memo

备注/Memo:
收稿日期:2017-06-10
基金项目:宁夏医科大学科学研究基金资助项目(XY2017151)
作者简介:杨生森(1984-),男,主治医师,硕士,研究方向:脊柱骨科。
通信作者:丁惠强,男,主任医师,硕士研究生导师。 E-mail:Dinghuiqiang-nx@163.com
更新日期/Last Update: 1900-01-01