【摘 要】
：
背景：在脊柱结核后路稳定性重建手术中,常规方法是实行短节段或长节段固定或/和融合.这种方法牺牲了一个以上正常运动单元,限制了脊柱正常运动功能,并导致了相邻节段小关节的退变.如何减少融合、固定节段,最大限度地保留脊柱的运动功能,是脊柱结核手术治疗中亟待解决的问题之一.目的：探讨短椎弓根螺钉在脊柱结核单节段固定手术治疗中的可行性、适应证及疗效.方法：106例腰骶椎结核患者,随机分为二组,先进行后路矫形
【机 构】
：
宁夏医科大学附属总医院脊柱外科 750004
【出 处】
：
海峡两岸骨科专委会学术交流会、抗震救灾五周年学术研讨会暨第十届华西国际骨科论坛
论文部分内容阅读
背景：在脊柱结核后路稳定性重建手术中,常规方法是实行短节段或长节段固定或/和融合.这种方法牺牲了一个以上正常运动单元,限制了脊柱正常运动功能,并导致了相邻节段小关节的退变.如何减少融合、固定节段,最大限度地保留脊柱的运动功能,是脊柱结核手术治疗中亟待解决的问题之一.目的：探讨短椎弓根螺钉在脊柱结核单节段固定手术治疗中的可行性、适应证及疗效.方法：106例腰骶椎结核患者,随机分为二组,先进行后路矫形、内固定手术,同期或二期进行前路彻底病灶清除、植骨融合手术.其中单节段短椎弓根钉固定组54例,选用长20-35mm的短椎弓根钉置于病椎椎弓根.如其中病椎之一剩余骨质小于1/3,而另一病椎剩余骨质大于1/3时,则可行短钉、常规螺钉固定.短节段椎弓根钉固定组：常规椎弓根螺钉置于正常椎骨中,固定范围跨越病椎上、下各一个正常间隙.结果：两组患者术后平均随访58.09±17.01月.末次随访时,所有患者病灶治愈、植骨愈合、无内固定松动及断裂,术后3-5个月86例(81.13％) CT重建片示植骨块与椎体上下均骨性融合,随访时植骨均愈合.植骨平均愈合时间,短钉组4.35±1.04月,短节段组4.47±1.10月,Cobb角矫正度及丢失率两组分别为14.47±3.76°,7.22％和16.20±2.70°,6.37％,二组比较无统计学差异,P＞0.05,组内比较有统计学意义,P＜0.05.结论：单节段短椎弓根钉固定、矫形术在腰、骶椎结核中具有仅固定、融合病变节段,保留了相邻正常脊柱的运动单元,术后脊柱功能恢复好.
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