多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究

王成; 罗飞; 张泽华; 侯天勇; 汪正东; 刘勋; 荣志刚; 许建中

doi:10.16016/j.1000-5404.201707047

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多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究

临床医学 | 更新时间：2026-01-09

- 多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究
- One-stage anterior internal fixation with multidirectional self-locking plate in treatment of lumbosacral tuberculosis: report of 35 cases
- 第三军医大学学报 2017年39卷第21期页码：2093-2098
- 作者机构：
  
  400038 重庆，第三军医大学西南医院骨科，全军矫形外科中心
- 作者简介：
  
  [许建中，E-mail: xjzswl@163.comXU Jianzhong, E-mail: xjzswl@163.com
- 基金信息：
  
  第三军医大学临床创新基金(SWH2011015)
- DOI：10.16016/j.1000-5404.201707047
  中图分类号： R529.2;R681.57;R687.32
- 收稿：2017-07-07，
  
  修回：2017-07-24，
  
  纸质出版：2017-11-15
- 稿件说明：
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王成, 罗飞, 张泽华, 等. 多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究[J]. 第三军医大学学报, 2017,39(21):2093-2098.

Cheng WANG, Fei LUO, Zehua ZHANG, et al. One-stage anterior internal fixation with multidirectional self-locking plate in treatment of lumbosacral tuberculosis: report of 35 cases[J]. Journal of Third Military Medical University, 2017, 39(21): 2093-2098.
王成, 罗飞, 张泽华, 等. 多向自锁钛板内固定一期前路治疗腰骶段结核的临床研究[J]. 第三军医大学学报, 2017,39(21):2093-2098. DOI： 10.16016/j.1000-5404.201707047.

Cheng WANG, Fei LUO, Zehua ZHANG, et al. One-stage anterior internal fixation with multidirectional self-locking plate in treatment of lumbosacral tuberculosis: report of 35 cases[J]. Journal of Third Military Medical University, 2017, 39(21): 2093-2098. DOI： 10.16016/j.1000-5404.201707047.

摘要

目的

探讨采用自主研发的多向自锁钛板内固定行一期前路病灶清除、植骨融合术治疗腰骶段结核的安全性和有效性。

方法

2010-2015年我科采用一期前路病灶清除、植骨融合与多向自锁钛板内固定术治疗腰骶段结核共35例。术前常规支持及抗结核治疗，采用CT血管造影技术评估髂血管走行与腰骶段结核病灶的关系及骨质破坏情况。术中采用多向自锁钛板选择骨质结构相对完整的区域进行固定。术后定期随访，评估结核活动、植骨融合、矫形维持、神经功能恢复及并发症等情况。

结果

35例患者均获随访，随访时间18~36(26.06±6.16)个月。手术时间(148.57±17.68)min，术中失血量(257.14±29.66)mL。术中无大血管、神经及输尿管损伤。术后腰腿痛症状均获明显缓解，无结核复发、下肢深静脉血栓、逆行射精及勃起功能障碍等并发症，术后12个月椎间植骨均达Ⅰ级骨愈合。术前、末次随访红细胞沉降率分别为(32.14±9.87)、(5.34±2.30)mm/h，术前、末次随访C反应蛋白分别为(23.66±9.98)、(1.26±0.55)mg/L，术前、末次随访平均VAS评分分别为(4.80±1.02)、(0.83±0.71)分，术前、末次随访平均ODI评分分别为(27.47±6.79)%、(4.31±1.49)%，术前、术后及末次随访平均腰骶角分别为(23.09±3.21)°、(29.21±1.16)°和(26.71±1.57)°。

结论

一期前路结核病灶清除、植骨融合与多向自锁钛板内固定术治疗腰骶段结核安全且有效，多向自锁钛板是适合腰骶段结核前路手术的有效内固定装置。

Abstract

Objective

To explore the clinical safety and efficacy of one-stage anterior debridement

bone grafting and internal fixation for the treatment of lumbosacral tuberculosis (TB) with the self-developed multidirectional self-locking plate system.

Methods

A total of 35 cases of lumbosacral tuberculosis who were treated with above approach between 2010 and 2015 were enrolled in this study. Preoperative routine support and anti-TB treatment

and CT angiography was used to assess the relationship between iliac vascular access and lumbosacral TB lesions and the bone destruction. During the operation

relatively complete regions of bone structure were chosen to place the multidirectional self-locking plate. Postoperative regular follow-up was carried out for assessment of tuberculosis activities

neurological recovery

bone graft fusion

orthopedic maintenance and complications.

Results

All patients were followed up for a mean period of 26.06±6.16 (ranging from 18 to 36) months. The average operation time was 148.57±17.68 min

and the average intraoperative blood loss was 257.14±29.66 mL. No injury of blood vessel

cauda equina or ureter occurred during surgery. After surgery

the lumbocrural pain was relieved significantly

and no TB recurrence or complications

such as venous thrombosis

impotence

retrograde ejaculation or recurrence was observed in all of these patients. The intervertebral bone grafts reached grade Ⅰ at 12 months after surgery. The average preoperative erythrocyte sedimentation rate (ESR)

C-reactive protein (CRP)

visual analogue scale (VAS) score

and Oswestry disability index (ODI) were 32.14±9.87 mm/h

23.66±9.98 mg/L

4.80±1.02

and (27.47±6.79)%

respectively

while the above indicators were 5.34±2.30 mm/h

1.26±0.55 mg/L

0.83±0.71

and (4.31±1.49)% postoperatively. The average lumbosacral angle was (23.09±3.21)°

(29.21±1.16)°

and (26.71°±1.57)°

pre-

intra-and post-operatively.

Conclusion

One-stage anterior debridement

bone grafting and multidirectional self-locking plate internal fixation is safe and effective in treatment of lumbosacral TB. Our self-made multidirectional self-locking plate is an effective internal fixation system for anterior approach for lumbosacral TB.

关键词

Keywords

references

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