单期后路清创加经椎弓根螺钉固定治疗腰背结核20例的前瞻性研究

A. Patidar, R. Mehta, Santosh R. Sharma, G. Vyas, Vivek Singh, Omprakash Ramchandra
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引用次数: 3

摘要

背景:印度的结核病负担最高,约占总负担的四分之一。在肌肉骨骼结核中,脊柱结核影响了一半的患者。AKT形式的药物治疗是治疗脊柱结核的主要手段,但在选定的病例中,手术作为AKT的辅助手段也有其自身的作用。文献中提到了各种手术方法和途径。我们研究了仅后路减压内固定治疗成人胸腰椎结核的疗效和安全性。材料和方法:在这项前瞻性随机对照研究中,我们对20例胸腰椎结核患者进行了单期仅后部清创、减压和经椎弓根螺钉固定治疗。比较术前和术后C反应蛋白(CRP)、血沉(ESR)、后凸角、视觉模拟量表(VAS)评分和Frankel神经分级、术中失血量和手术时间。评估了最后随访时后凸角度的矫正和后凸角度损失。结果:16名男性和4名女性患者接受了治疗,平均年龄37.9岁。平均随访14.95个月。13例患者有两级受累;其中7人为单级。平均手术时间为155分钟(标准差[SD]23.951)。术前ESR平均增加39.4毫米/小时(标准差9.046),术后3周平均增加24.15毫米/小时。术前3周平均CRP分别为15.7 mg/L(标准差5.398)和9.05 mg/L(标准偏差3.456)。术前平均后凸角度为24.7°(SD 6.822),术后平均矫正为10.1°(SD 3.932)。在最后的随访中,后凸角平均损失1.4°。平均失血量为722.75ml;平均手术时间为228.5分钟。疼痛VAS评分从7.05(SD 1.468)显著下降到3.9(SD 1.209)。最终随访时,VAS评分为1.7(SD 0.864)。除1例外,所有患者的神经系统恢复良好。结论:单期仅后路手术治疗胸腰椎结核是安全有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Single-stage posterior-only debridement and transpedicular screw fixation for dorsolumbar tuberculosis: A prospective study of twenty cases
BACKGROUND: India bears the highest burden of tuberculosis (TB), i.e., about one-fourth of the total burden. Of the musculoskeletal TB, spinal TB affects half of the patients. Pharmacological treatment in the form of AKT is the mainstay of treatment of spinal TB, but surgery has its own role to play as an adjunct to AKT in selected cases. Various surgical methods and approaches are mentioned in literature. We studied the efficacy and safety of posterior only approach for decompression and internal fixation in treating thoracic and lumbar spinal TB in adults. MATERIALS AND METHODS: In this prospective randomized control study, we treated twenty patients with thoracic-lumbar TB with single-stage posterior only debridement, decompression, and transpedicular screw fixation. Preoperative and postoperative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), kyphosis angle, visual analog scale (VAS) score and Frankel neurological grading, intraoperative blood loss, and duration of surgery were compared. Correction in kyphosis angle and loss of kyphosis angle at final follow-up was assessed. RESULTS: Sixteen male and four female patients with mean age 37.9 years were treated. Average follow-up was 14.95 months. Thirteen patients had two level involved; seven had single level. The average duration of surgery was 155 min (standard deviation [SD] 23.951). Preoperative average increase in ESR was 39.4 mm/h (SD 9.046) and 24.15 mm/h (SD 3.787) at 3 weeks. Average preoperative CRP was 15.7 mg/L (SD 5.398) and 9.05 mg/L (SD 3.456) at 3 weeks. Average preoperative kyphosis angle was 24.7° (SD 6.822) corrected to an average of 10.1° (SD 3.932) postoperative. At final follow-up, there was a mean loss of 1.4° of kyphosis angle. The average blood loss was 722.75 ml; the average duration of surgery was 228.5 min. The pain VAS dropped significantly from 7.05 (SD 1.468) to 3.9 (SD 1.209). At final follow-up, VAS was 1.7 (SD 0.864). All the patients had good neurological recovery except one. CONCLUSIONS: Single-stage posterior-only procedure is safe and effective for management of thoracolumbar spinal TB.
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