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find Keyword "脊柱结核" 20 results
  • Lower Anterior Cervical Approach Combined with Presternum-splitting Approach for Cervicothoracic Junction Spinal Tuberculosis

    【摘要】 目的 探讨低位下颈椎前方入路联合胸骨柄劈开术治疗颈胸段脊柱结核的手术方式及术后疗效。 方法 2002年3月-2009年7月收治颈胸段脊柱结核16例,男11例,女5例;年龄18~52岁,平均38岁。其中位于颈6-胸1者2例,颈7-胸1者5例,胸1-2者4例,胸2-3者3例,胸1-3者2例。神经功能Frankel分级为:B级4例,C级7例,D级3例,E级2例。手术行低位下颈椎前方入路联合胸骨柄劈开术,术中彻底清除结核肉芽组织、脓液、死骨并进行脊髓减压,取自体髂骨块植骨重建中前柱、前方钛板内固定。术后佩戴头颈胸支具6个月,正规抗痨18个月。术前后凸Cobb角为25~60°,平均为37.5°。 结果 全部患者均获得随访,随访时间2~8年,平均3年。均获得骨性融合,融合时间为5~8个月,无螺钉松动、脱落及钢板断裂等并发症发生。神经功能恢复按Frankel分级,平均改善3.6个级别;结核病变无复发,术后后凸Cobb角明显改善,为15~35°,平均22.6°,末次随访后凸角无明显丢失。1例术后出现暂时性声音嘶哑,术后1个月恢复。 结论 低位下颈椎前方入路联合胸骨柄劈开术治疗颈胸段脊柱结核,病灶显露充分,植骨内固定,重建脊柱稳定性,矫正后凸畸形可靠。【Abstract】 Objective To explore the clinical characteristics of cervico-thoracic junction spinal tuberculosis (CTJST) and to observe the therapeutic effect of lower anterior cervical approach combined with presternum-splitting approach on CTJST.  Methods The clinical data of 16 patients with cervicothoracic junction spinal tuberculosis from Match 2002 to July 2008 were retrospectively analyzed. According to the Frankel grades, four patients were in grade B, seven were in grade C, three were in grade D, and two were in grade E. There were 11 males and five females with a average age of 38 years ranging from 18 to 52 years. All patients underwent radical excision of epidural granulation tissue/abscess and necrotic bone, whilst a proper tricortical iliac crest autograft and anterior titanium plate were placed to reconstruct the anteromedian spinal column, followed by chemotherapy for 18 months and immobilization in a brace for six months. The mean Cobb angle was 37.5° (ranged from 25° to 60°) before surgery. Results All patients were followed up for two to eight years (three years on average), and got complete bone fusion within five to eight months postoperatively. There were no pull out and breakage of screws or plates.Spinal cord functional recovery improved on average 3.6 degree according Frankel standard, without recurrence of the disease or loss of Cobb angle till the last follow up. There was a statistically significant improvement in the Cobb angles from 22.6° to 37.5° (Plt;0.01) in average. However, two patients appeared transient hoarse voice after surgery, and the symptoms were alleviated one month after the operation. Conclusion Lower anterior cervical approach combined with presternum-splitting approach for CTJST may provide adequate exposure to the lesion, keep the bone graft with internal fixation and spinal stability, and correct the kyphosis.

    Release date:2016-08-26 02:21 Export PDF Favorites Scan
  • 一期经后路固定联合侧前方入路病灶清除植骨融合术治疗老年下腰椎结核

    目的 总结一期经后路固定联合侧前方入路病灶清除植骨融合术治疗老年下腰椎结核疗效。 方法 2006年1月-2009年3月,对13例老年下腰椎结核患者行一期后路固定联合侧前方入路病灶清除植骨融合术治疗。男7例,女6例;年龄60~80岁,平均67.8岁。累及节段:L3、 4 1例,L4 1例, L4、 5 7例,L3~5 3例,L5、S1 1例。病程2~10个月,平均6.8个月。6例伴硬膜外脓肿,1例伴髂腰肌脓肿;7例不完全性瘫痪,根据脊髓损伤神经功能分级标准(ASIA)分级:C级2例,D级5例。 结果术中硬膜撕裂1例,术后切口均Ⅰ期愈合。13例均获随访,随访时间1~4年,平均37个月。植骨均获骨性融合,融合时间6~9个月。未发生内固定相关并发症,无局部结核复发。术后腰椎局部前凸角及Oswestry功能障碍指数(ODI)均较术前明显改善(P lt; 0.05)。神经功能ASIA分级除1例由C级恢复为D级外,余均恢复为E级。 结论一期后路固定联合侧前方入路病灶清除植骨融合术治疗老年下腰椎结核是一种安全、有效的方法。

    Release date:2016-08-31 04:07 Export PDF Favorites Scan
  • 颈胸段脊柱结核术后并发食管胸腔瘘一例

    【摘 要】 目的 总结1例颈胸段脊柱结核术后并发食管胸腔瘘的治疗方法和效果。 方法 2009年4月收治1例42岁C7~T8脊柱结核患者,经规范抗结核治疗后,行经前路C7~T8脊柱结核病灶及脓肿清除、椎管减压、自体髂骨植骨融合、Antares内固定术。术后并发食管胸腔瘘,于内镜下植入全覆膜食管支架,同时予以充分引流,积极抗感染,肠内、外营养支持等综合治疗。 结果 经综合治疗患者食管瘘口愈合,逐步恢复正常饮食,治愈出院。 结论 脊柱结核术后并发食管胸腔瘘罕见,病死率极高,需高度重视,并采取积极治疗措施。

    Release date:2016-08-31 04:21 Export PDF Favorites Scan
  • FUNCTION RECONSTRUCTION OF ANTERIOR AND MIDDLE COLUMN IN THORACOLUMBAR SPINAL TUBERCULOSIS BY ONE-STAGE ANTERIOR RADICAL DEBRIDEMENT

    Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis. Methods From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T4-10), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L3-5). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinalcord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65° (41° on average). Results The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1 500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved heal ing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33° (24° on average), showing statistically significant difference (P lt; 0.05) when compared with preoperation. Conclusion Early reconstruction of load-bearing function and stabil ity of anterior and middle column in the treatment of spinal tuberculosis is great significant. The appl ication of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.

    Release date:2016-08-31 05:47 Export PDF Favorites Scan
  • SURGICAL TREATMENT OF SPINAL TUBERCULOSIS ASSOCIATED WITH DIABETES MELLITS

    Objective To investigate the perioperative management and the results of surgical treatment of spinal tuberculosis associated with diabetes mellitus. Methods The cl inical data were analysed retrospectively from 42 patients with spinal tuberculosis associated with type 2 diabetes mell itus who were surgically treated between July 2001 and January 2009.There were 22 males and 20 females with an average age of 56.5 years (range, 41-78 years). The disease duration was 4-18 months (mean, 7.5 months). The involved vertebrae included 2 cervical vertebrae, 13 thoracic vertebrae, 17 thoracolumbar vertebrae, and 10 lumbar vertebrae. Of them, 18 patients compl icated by paraplegia, and 25 patients had more than one of concomitant diseases. Anterior debridement and bony grafting with anterior instrumentation fixation were performed in 16 patients; anterior debridement and bony grafting with posterior instrumentation fixation in 4 patients; posterolateral costotransversectomy debridement and interbody fusion with posterior instrumentation fixation in 8 patients; posterior debridement and bony grafting with posterior fixation in 7 patients; sinus resectomy and focus debridement in 2 patients; anterior debridement and bony grafting in 3 patients; and CT guided percutaneous catheter drainage in 2 patients. Postoperative anti-tuberculosis treatment was given for 12-24 months. Results The patients were followed up 1.5-5.0 years, with a mean period of 3.5 years. One patient died of pulmonary infection after 1 week of operation; 1 patient died of myocardial infarction after 2 years of operation; and other patients survived without tuberculosis recurrence. Among 38 patients who received bony grafting, 34 patients achieved bony fusion, 3 suffered bony grafting failure without kyphotic deformity or instabil ity except 1 patient who died from pulmonary infection. Among 18 cases compl icated by paraplegia, nerve function improved to a certain extent. The intraoperative and postoperativecompl ications occured in 28 cases. The systemic compl ications mainly included heart insufficiency in 5, heart rrhythmia in 3, pulmonary infection in 2, urinary tract infection in 2, and stree ulcer in 1; they were cured after medical treatment. The local complications mainly included sinus tract formation in 5, pleural tear in 2, neurologic injury in 2, intraoperative tear of inferior vena cava in 2, and the loosening of transpedicular screws in 4; they all were cured effectively. Conclusion Surgical treatment of spinal tuberculosis associated with diabetes mell itus appears to be a beneficial procedure on the condition that the blood glucose is controlled and the associated disorders and postoperative complications are properly handled, and reasonably selection of surgical procedures is very important. Instrumentation fixation provides adequate stabil ity to allow early mobilization.

    Release date:2016-09-01 09:04 Export PDF Favorites Scan
  • COMBINED ANTERIOR AND POSTERIOR SURGERIES FOR LUMBARSACRAL JUNCTION TUBERCULOSIS

    To explore the advantage and indication of combined anterior and posterior surgeries for lumbarsacral junction tuberculosis. Methods Eleven cases of the lumbarsacral junction tuberculosis were treated with combined anterior (radical debridement and autograft) and posterior (instrumentation and fusion) surgeries in one stage between January 2002 and December 2006. There were 9 males and 2 females with the age of 20-56 years old. The courseof disease was 4 to 15 months, 6 months on average. The lessons were located at L5, S1 in 7 patients, at L4,5, S1 in 2 patients and at L5, S2 in 2 patients. The involved vertebral bodies were at 2 segments in 7 patients; and 3 segments in 5 patients. The preoperative kyphosis was 5 to 8° with an average 9°. The sinus was associated in 3 patients, 3 patients had radiculopathy; 4 had paeumonophthisis and 9 had abscess. Results The followed-up period was from 6 months to 3 years, 18 months on average. According to Chen score, among the 11 cases, there were excellent in 9, good in 2. All incisions were healed up primarily. After operation, spinal fusion was achieved in 10 cases within 5 months to 7 months, 6 months on average, and pseudoarthrosis in 1 case was found by the CT examination. The postoperative kyphosis was 0 to 4° with the mean of 2° and the radiculopathy in 3 cases all got nerve function recovery. Conclusion Lumbarsacral junction tuberculosis treated with this surgical technique can achieve a high satisfactory rate with restoring the spinal stabil ity, arresting the disease early, providing early fusion, correcting the kyphosis and preventing progression of kyphosis particularly if lumbosacral spine tuberculosis is associated with sinus or preoperative diagnosis cannot exclude suppurative spondyl itis.

    Release date:2016-09-01 09:12 Export PDF Favorites Scan
  • 一期前路病灶清除植骨及内固定术治疗颈椎及颈胸段脊柱结核

    目的 总结一期前路病灶清除、椎体间植骨及前路内固定治疗颈椎及颈胸段脊柱结核的临床疗效,探讨重建脊柱稳定性的必要性和安全性。 方法 2002 年4 月- 2006 年3 月,采用一期前路病灶清除、椎体间植骨及前路内固定治疗13 例颈椎及颈胸段脊柱结核患者。男8 例,女5 例;年龄21 ~ 58 岁。病程1 ~ 7 个月,平均4 个月。颈椎结核10 例,颈胸段结核3 例。术前X 线片、CT、MRI 检查示病变部位为:C3、4 1 例,C5 2 例,C5、6 3 例,C6、7 4 例,C7、T12 例,C7 ~ T2 1 例。后凸Cobb 角为20 ~ 50°,平均35.7°。神经功能ASIA 分级:B 级1 例,C 级4 例,D 级6 例,E 级2 例。术前血沉34 ~ 78 mm/h,平均42 mm/h。 结果 术后患者均获随访,随访时间9 ~ 34 个月,平均14 个月。均未出现伤口深部感染或窦道形成,平均1.5 个月血沉降至20 mm/h 以下。患者植骨均完全融合,融合时间3 ~ 5 个月,平均3.4 个月。术后后凸Cobb 角17 ~ 39°,平均29.3°;随访14 个月时为9 ~ 21°,平均14.5°。神经功能除1 例B 级恢复至D 级外,余均达E级。 结论 一期前路病灶清除同期植骨内固定治疗颈椎及颈胸段脊柱结核能彻底清除病灶、防止复发、矫正畸形、重建脊柱稳定性,促进脊柱植骨融合,提高脊柱结核的治愈率。

    Release date:2016-09-01 09:17 Export PDF Favorites Scan
  • TREATMENT OF MULTI-SEGMENTAL SPINAL TUBERCULOSIS BY USING FOCAL DEBRIDEMENT ANDINTERNAL FIXATION WITH CD ROD

    Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multisegmental spinaltuberculosis.Methods From July 1999 to November 2002, 16 patients with multisegmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6T 11 in 11 patients and T 10 -L2 in 5 patients.The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott’s paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtainedprimary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity,and improve its curative ratio and fused ratio of grafted bone.

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  • FAILURE AND PREVENTION OF RECONSTRUCTION IN ANTERIOR STABILITY OF SPINE BY DUAL BLADE PLATE

    Abstract Dual-blade plate is widely used in reconstruction of anterior stability of spine. Two hundred and ninety-eight cases were followed up since 1984. Among them, 181 cases were fractureof thoracolumbar spine; 63 cases were tuberculosis of thoracolumbar spine; 43 cases were tumor of thoracolumbar spine; 5 cases were spondylisthesis of lumbar spine; 2 cases were ankylosing spondylitis accompanied with gibbosity; 2 cases were adolescent vertebral epiphysis; I case was hemivertebra; I case was dysplasia of the first lumbar vertebra acompanied with gibbosity. Most cases were successful following operation, but in some cases, the results were unsuccessful, mainly due to the position of the dualblade plate in the vertebral body was not satisfactory. The mistakes most commonly occurred were one or two blades, or a part of the blade going into the intervertebral space, and less commonly seen was deviation of the dual -blade plate from itscorrect orientation or a little side-bent of the blade. Split of the vertebra and fall off of the dual-blade plate were happened in few cases. The causeswere analyzed and ways of prevention were provided in this article.

    Release date:2016-09-01 11:11 Export PDF Favorites Scan
  • Posteriol Fixation and Fusion for Treatment of Tuberculosis of Spine

    目的:探讨后路内固定治疗脊柱结核的必要性及适应证。方法:2002年1月~2008年12月采用后路器械固定、融合结合前路彻底病灶清除、植骨治疗脊柱结核17例。病变位于胸椎3例,胸腰段2例,腰椎4例,腰骶椎8例;累及2个节段7例,3个节段7例,4个节段3例;有3例伴窦道形成;9例伴不同程度的脊髓和(或)神经根受压症状;术前后凸成角10°~72°,平均31°。所有患者均一期手术。结果:术后随访6个月~5年,平均3.1年,术后切口均Ⅰ期愈合,后凸成角7°~58°,平均16°,椎间植骨平均在5个月融合,植骨融合率95.6%,优良率达89.6%,无一例复发。结论:后路器械固定结合前路彻底病灶清除、植骨治疗脊柱结核主要适用于多个节段受累、腰骶段及伴窦道者,利于恢复脊柱的稳定性、提高植骨融合率、纠正和预防后凸畸形。

    Release date:2016-09-08 09:56 Export PDF Favorites Scan
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