患椎間短椎弓根螺釘在單節段腰骶椎結核穩定性重建中的臨床研究

·臨床研究·

患椎間短椎弓根螺釘在單節段腰骶椎結核穩定性重建中的臨床研究

王騫，金衛東，王自立，朱禧，張家林

共同第一作者：金衛東(1966— )，碩士，主任醫師

作者單位：33612佛羅里達州，美國南佛羅里達大學藥學院(王騫)；寧夏醫科大學總醫院脊柱外科(金衛東，王自立，朱禧，張家林)

通信作者：王自立wangzlnx@126.com

【摘要】目的證明后路患椎間短椎弓根螺釘固定治療單節段腰骶椎結核的可行性，并探討其適應證及療效。 方法204例診斷明確、脊柱后凸畸形<35°，符合納入標準的單節段腰、骶椎結核患者，隨機分為2組，均先進行后路矯形、內固定手術，同期或二期進行前路徹底病灶清除、椎體間自體髂骨支撐植骨融合術。其中短釘組104例，選用長20～35 mm的短椎弓根釘置于患椎椎弓根。如1個患椎剩余骨質<1/3，而另1個患椎剩余骨質>1/3，則行短釘、常規螺釘固定。長釘組：常規椎弓根螺釘置于患椎相鄰的正常椎骨中，固定范圍跨越患椎上、下各1個正常間隙。所有患者均采用四聯化療方案。 結果2組患者平均隨訪62.1個月。術后均無嚴重并發癥發生，末次隨訪時，所有患者均治愈，無內固定松動及斷裂現象。植骨平均愈合時間，短釘組4.3個月，長釘組4.6個月，Cobb角矯正度及丟失率2組分別為13.26°±3.76°,6.22%和16.35°±2.63°，5.24%，2組比較差異無統計學意義(P>0.05),組內術前術后比較差異有統計學意義(P<0.05)。血沉與C反應蛋白的術前術后差異無統計學意義。2組患者術后2年生活、工作基本恢復正常。短釘組患者術后功能恢復較長釘組好。結論腰、骶椎結核后路患椎間短椎弓根釘固定、前路病灶徹底清除術具有僅融合、固定病變節段，保留相鄰正常的脊柱運動單元功能，術后脊柱功能恢復好等優點,具有很高的臨床應用價值。

【關鍵詞】結核, 脊柱; 骨移植; 清創術; 脊柱融合術; 內固定

作者簡介：王騫(1984— )，博士，主治醫師

【中圖分類號】R 529.2【文獻標志碼】 A

DOI【】

收稿日期：(2014-06-05)

Clinical comparative study of short pedicle screws in treatment of single-segment lumbar and sacral vertebral lesion by posterior fixation surgeryWANGQian*,JINWei-dong,WANGZi-li,ZHUXi,ZHANGJia-lin.*Collegeofpharmacy,UniversityofSouthFlorida, 33612Florida,USA

Abstract【】ObjectiveTo confirm the feasibility of short pedicle screws in treatment of single-segment lumbar and sacral vertebral lesion by posterior fixation surgery, and discuss the indications and curative effect.MethodsA total of 204 patients diagnosed definitely with Cobb’s angle <35° and accord with the standard single segmental lumbosacral vertebral tuberculosis were randomly divided into 2 groups. After posterior correction and internal fixation, all patients underwent anterior radical debridement and interbody fusion with bone grafting. The short screw fixation group 104 cases, with 20-35 mm pedicle screw in disease of vertebral pedicle. As one of the disease of vertebral bone remained <1/3, while the other disease vertebral bone remained>1/3, the short nails and conventional screw fixation was used. The long screw fixation group: normal vertebral pedicle screws were used in normal adjacent vertebrae, and across a normal clearance. All of the patients adopted quadruple therapy. The mean postoperative follow-up period was 62.1months. There was no serious postoperative complications. At the final follow-up, all patients were cured, and there was no internal fixation loosening and fracture phenomenon. The average bone graft healing time was 4.3 months in the short screw fixation group and 4.6 months in the long screw fixation group.ResultsThe correction of the Cobb’s angle was 13.26° ± 3.76° and the loss rate was 6.22 %, and in the short-segment group, correction of the Cobb’s angle was 16.35°±2.63° and the loss rate was 5.24%. There was no statistical difference between the 2 groups (P>0.05), but there was statistical difference between pre- and post-operation within group(P<0.05). Changes of the erythrocyte sedimentation rate and C-reactive protein had no statistical differences. All patients returned to normal life and work. Patients in the short screw group got better postoperative functional recovery compared with the long screw group.ConclusionSingle-segment pedicle screw fixation and correction surgery can fix and fuse the diseased segment in lumbar and sacral tuberculosis, retain normal movement in the adjacent spinal column, and promote functional recovery of the spinal column postoperatively. It can be regarded as a cost-effective means of treatment with lumbar and sacral tuberculosis.

【Key words】Tuberculosis, spinal; Bone transplantation; Debridement; Spinal fusion; Internal fixators

J Spinal Surg, 2015,13(1):1-6

目前對于脊柱結核的手術治療，由于顧及感染擴散及患椎剩余骨質較少，內固定的椎體釘或椎弓根螺釘常?？缭秸Ｗ甸g隙,固定或/和融合>1個脊柱正常運動單元[1-4]。此種方法擴大了手術顯露范圍；剝離了過多的軟組織導致患者術后腰背部肌肉失神經支配、腰背肌僵硬，肌萎縮，進而發生腰骶部疼痛、活動受限等功能障礙發生[3,5]；同時也……