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目的探讨后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核的临床疗效分析。方法 2011年6月-2015年10月期间于本院采用后路内固定联合前路病灶清除植骨融合治疗小儿脊柱结核患者18例,男性11例、女7例,年龄3~11岁,平均5.8岁。对所有患者术后进行定期随访,现对其临床数据进行回顾性分析。根据后凸畸形Cobb角及脊髓功能Frankle分级评价临床疗效。结果手术时间150~240 min,平均196 min。术中出血量200~480 mL,平均328 mL。随访时间1~3年,平均2.18年。Cobb角由术前48.4°矫正至术后10.8°,矫正率为78%(P<0.05)。1例患者出现植骨块骨折,返修术后治愈。末次随访,根据Frankle分级,所有患者神经功能均恢复正常(P<0.05)。Cobb角平均丢失3.4°。随访中未发现结核复发及内固定失败。结论后路内固定联合前路病灶清除植骨融合是治疗小儿脊柱结核有效、安全的手术方式,该技术能够较理想地维持后凸畸形的矫正率。
Objective To investigate the clinical efficacy of posterior fixation and anterior debridement and fusion in the treatment of pediatric spinal tuberculosis. Methods From June 2011 to October 2015, 18 cases of pediatric patients with spinal tuberculosis were treated with posterior fixation and anterior debridement combined with anterior fixation in our hospital from June 2011 to October 2015. There were 11 males and 7 females, aged 3 to 11 years, with an average of 5.8 years old. All patients were followed up regularly, and their clinical data are retrospectively analyzed. The clinical efficacy was evaluated according to Cobb angle of kyphosis and Frankle grade of spinal cord function. Results The operation time was 150 ~ 240 min with an average of 196 min. Intraoperative blood loss of 200 ~ 480 mL, an average of 328 mL. Follow-up time of 1 to 3 years, an average of 2.18 years. The Cobb angle was corrected from 48.4 ° preoperatively to 10.8 ° postoperatively, with a correction rate of 78% (P <0.05). One patient had a bone graft fracture and was cured after the repair. At the final follow-up, neurological function returned to normal in all patients according to the Frankle classification (P <0.05). The Cobb angle lost an average of 3.4 °. No follow-up of tuberculosis recurrence and internal fixation failed. Conclusion posterior fixation with anterior debridement and fusion is an effective and safe surgical treatment of pediatric spinal tuberculosis. This technique can be more ideal to maintain the correction rate of kyphosis.