【2017年整理】多节段脊柱结核的诊断与治疗方法探讨.docVIP

PAGE PAGE 10 多节段脊柱结核的诊断与治疗方法探讨 王清1 田泽高1 徐杨博1 侯宗亮1 韩福刚2 兰永树2 （1泸州医学院附属医院骨科 2放射科 646000） 【摘要】 目的 对多节段脊柱结核的诊治方法行前瞻性研究。方法 分析19例多节段脊柱结核患者的临床资料，将多节段脊柱结核分为中心病灶和卫星病灶，比较同位素扫描、X线、CT、MRI对中心病灶和卫星病灶的检出效果。采用经胸胸膜外脊柱前方入路行病灶清除、脊髓减压、后凸畸形矫正、长节段内固定处理中心病灶，对部分卫星病灶行脓肿引流、病灶搔刮、自体髂骨或肋骨块植骨。随访观察此类患者的临床疗效。结果 上述四种检测方法发现中心病灶19例19处，卫星病灶19例34处。X片发现卫星病灶2例2处，CT片13例28处，同位素扫描14例38处（其中12处为脊柱外病灶），MRI片19例39处（其中5处信号异常，诊断为非结核所致）。术中行中心病灶清除19例19处，卫星病灶清除5例9处，未处理14例25处。15例患者获1~6年随访，平均2.2年。所有患者病情静止。血沉正常。慢性腰背痛3例。复查X片，脊柱后凸畸形3例，无钢板、螺钉松动、断裂，无慢性窦道形成。复查MRI示中心病灶静止、骨性融合15例15处，卫星病灶消失9例15处（包括行卫星病灶清除2例4处，未行卫星病灶清除7例11处），卫星病灶明显缩小4例4处（包括行卫星病灶清除1例1处，未行卫星病灶清除3例3处），无明显变化2例2处（均未行卫星病灶清除）。脊髓功能完全恢复11例，部分恢复2例。结论 MRI对多节段脊柱结核的诊断、治疗和预后监测具有重要临床意义。根据MRI和CT扫描将多节段脊柱结核区分为中心病灶和卫星病灶，重点处理中心病灶，而对卫星病灶酌情处理，有助于减少组织器官的暴露，减轻手术创伤。跨越多节段的或/和跨越正常椎间盘的长节段内固定对于稳定脊柱，保护脊髓有帮助。 【关键词】脊柱结核；内固定；中心病灶；卫星病灶；多节段 The treatment experiences of multisegmental tuberculosis of the spine WANG Qing, TIAN Ze-gao, XU Yang-bo, et al. Orthopaedic Department, The Affiliated Hospital of Luzhou Medical College, Luzhou 646000, China 第一作者简介：男（1964-），副主任医师，医学硕士。研究方向：脊柱外科。电话：0830-2392712-6063【Abstruct】 Objective To discuss the method of diagnosis and management about multisegmental spinal tuberculosis prospectively. Method Clinical material and material of ECT、X-ray、CT、MRI are studied for 19 cases who have sustained multisegmental spinal tuberculosis from 1998 to 2004. Multisegmental spinal tuberculosis was divided into central focus and satellite focus according to full spinal MRI. The data about central focuses and satellite focuses which was discovered in ECT、X-ray、CT、MRI was compared. All central focuses that included more than two vertebrate or discs was excised by anterior thoracol approach, meanwhile there was focus excision, spinal cord decompression, kyphosis correction and long-segmental interfixation. Apart of satellite focuses was treated by abscess draining, focus scraping and self-grafting. Clinical result was followed about anterior focus excision and