单纯后路开放手术治疗儿童胸、腰椎结核的临床疗效

何晋月; 方青; 罗飞; 许建中; 张泽华

doi:10.16016/j.2097-0927.202202114

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单纯后路开放手术治疗儿童胸、腰椎结核的临床疗效

临床医学 | 更新时间：2026-01-09

- 单纯后路开放手术治疗儿童胸、腰椎结核的临床疗效
- Clinical efficacy of posterior approach to surgical treatment for thoracic and lumbar tuberculosis in children
- 陆军军医大学学报 2022年44卷第17期页码：1752-1756
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院骨科
- 作者简介：
  
  [张泽华，E-mail：zhangzehuatmmu@163.comZHANG Zehua, E-mail: zhangzehuatmmu@163.com
- 基金信息：
  
  重庆市科卫联合重点项目(2018ZDXM002)
- DOI：10.16016/j.2097-0927.202202114
  中图分类号： R529.2;R681.5;R687.3
- 收稿：2022-02-21，
  
  修回：2022-04-18，
  
  纸质出版：2022-09-15
- 稿件说明：
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何晋月, 方青, 罗飞, 等. 单纯后路开放手术治疗儿童胸、腰椎结核的临床疗效[J]. 陆军军医大学学报, 2022,44(17):1752-1756.

Jinyue HE, Qing FANG, Fei LUO, et al. Clinical efficacy of posterior approach to surgical treatment for thoracic and lumbar tuberculosis in children[J]. Journal of Army Medical University, 2022, 44(17): 1752-1756.
何晋月, 方青, 罗飞, 等. 单纯后路开放手术治疗儿童胸、腰椎结核的临床疗效[J]. 陆军军医大学学报, 2022,44(17):1752-1756. DOI： 10.16016/j.2097-0927.202202114.

Jinyue HE, Qing FANG, Fei LUO, et al. Clinical efficacy of posterior approach to surgical treatment for thoracic and lumbar tuberculosis in children[J]. Journal of Army Medical University, 2022, 44(17): 1752-1756. DOI： 10.16016/j.2097-0927.202202114.

摘要

目的

探讨单纯后路开放手术治疗儿童胸、腰椎结核的临床疗效。

方法

收集2013年1月至2021年6月我科收治行单纯后路开放手术的胸、腰椎结核患儿的病例资料，总结分析手术时间、出血量、住院时间等指标以及术后、随访时的一般状况；X线与CT明确后凸畸形矫正情况；采用疼痛视觉模拟量表(visual analogue score，VAS)、Oswestry功能障碍评分(Oswestry disability index，ODI)以及脊髓损伤分级Frankel评分评估术后疼痛、神经功能恢复等情况。

结果

共收集9例病例，年龄(6.4±3.3)岁，其中男性5例，女性4例；胸椎结核4例，胸腰段结核2例，腰椎结核3例。术前Frankel瘫痪分级C级2例，D级3例，E级4例。随访时间(29.2±8.6)个月，9例患儿行单纯后路手术后无神经功能损害加重，Frankel等级提高1级以上，VAS评分从术前(3.2±2.0)分降至末次随访的(1.0±0.5)分，ODI评分从术前(31.3±21.3)分降至末次随访(13.7±8.7)分，脊柱后凸Cobb角从术前(46.2±23.8)°降至术后(22.6±16.9)°，术后1年以上随访9例均达到骨性融合，其中结核复发1例并行二次手术。手术时间(398.2±203.7)min，出血量(550.0±355.3)mL，住院时间(20.0±8.4)d。

结论

单纯后路手术辅以围手术期规律全程结核治疗，对治疗儿童胸、腰椎结核同时避免术后后凸畸形发生可取得良好临床疗效。

Abstract

Objective

To investigate the clinical efficacy of posterior surgery for children with thoracic and lumbar tuberculosis.

Methods

Clinical data of 9 children with vertebral tuberculosis who underwent posterior surgery in our department from January 2013 to June 2021 were collected and retrospectively analyzed. The operation time

blood loss

length of hospital stay and other indicators

as well as the general condition after operation and during follow-up were summarized and analyzed. Kyphosis correction was evaluated with the results of X-ray filming and CT scanning. Visual analogue score (VAS)

Oswestry disability index (ODI) and Frankel scores were used to evaluate the recovery of neurological function.

Results

For the 9 children

there were 5 males and 4 females

at a mean age of 6.4±3.3 years

and there were 4 cases of thoracic

2 of thoracolumbar and 3 of lumbar tuberculosis. Preoperative Frankel scores showed that there were 2 cases in Grade C

3 in Grade D

and 4 in Grade E for neural status. The mean follow-up time was 29.2±8.6 months. All patients had attained neurological improvements with Frankel grade increasing by more than 1 grade. At the final follow-up

the VAS score decreased from 3.2±2.0 to 1.0±0.5

while ODI score from 31.3±21.3 to 13.7±8.7. The Cobb angle of kyphosis was decreased from (46.2±23.8)° preoperatively to (22.6±16.9)° postoperatively. All patients achieved satisfactory osseous fusion in 1 year after surgery. Only 1 patient had tuberculosis recurrence and received a second operation. The mean operation time was 398.2±203.7 min

mean blood loss was 550.0±355.3 mL

and mean hospital stay was 20.0±8.4 d.

Conclusion

Posterior approach can achieve satisfactory outcomes and avoid the occurrence of kyphosis in the treatment of thoracic and lumbar tuberculosis in children.

关键词

Keywords

references

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