结核病与肺部健康杂志 ›› 2017, Vol. 6 ›› Issue (3): 218-221.doi: 10.3969/j.issn.2095-3755.2017.03.000

• 论著 • 上一篇    下一篇

经皮椎间孔镜下治疗腰椎结核的初步报告

唐国柯1,李大伟2,胡凯1,袁野1,马远征2   

  1. 1412000湖南省株洲市中心医院脊柱微创外科;2解放军第三〇九医院全军骨科中心
  • 收稿日期:2017-06-07 出版日期:2017-09-30 发布日期:2017-09-30
  • 作者简介:马远征

A preliminary report on the treatment of lumbar tuberculosis by percutaneous endoscopic lumbar discectomy

TANG Guo-ke1, LI Da-wei2, HU Kai1, YUAN Ye1, MA Yuan-zheng2   

  1. 1Zhuzhou Central Hospital of Hunan Province, Zhuzhou 412000, China
  • Received:2017-06-07 Online:2017-09-30 Published:2017-09-30

摘要: 目的探讨椎间孔镜下治疗脊柱结核的临床应用价值。 方法 回顾性分析2012年4月至2015年4月株洲市中心医院(3例)及解放军第三〇九医院(16例)共收治的采用椎间孔镜治疗的腰椎结核患者19例。19例患者在正规抗结核药物治疗的同时,均应用椎间孔镜进行病灶清除及局部抗结核药物放置,对19例患者术前和术后的疼痛视觉模拟评分及血红细胞沉降率进行比较。 结果 19例患者均在术后得到18~24个月的随访,患者疼痛视觉模拟评分从术前的(7.8±1.3)分降低到术后1周的(3.2±1.6)分,差异有统计学意义(t=2.91,P<0.05);血红细胞沉降率从术前的(55.0±32.0)mm/1 h降低到术后1个月的(23.0±7.0)mm/1 h,差异有统计学意义(t=2.69,P<0.05);随访期间未见明显症状加重或者复发患者。19例患者中,临床治愈18例,治愈率为94.7%;1例在治疗期间出现胃肠道结核,转解放军第三〇九医院全军结核病研究所继续进行治疗。 结论 椎间孔镜可辅助传统开放脊柱结核手术的治疗,具有良好的临床应用价值。

Abstract: Objective To evaluate the clinical value of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of spinal tuberculosis. Methods Nineteen patients with lumbar tuberculosis who conducted PELD from April 2012 to April 2015 were retrospectively analyzed, including 3 patients in Zhuzhou Central Hospital of Hunan Province and 16 patients in The 309th Hospital of Chinese People’s Liberation Army. During the regular anti-tuberculosis treatment, PELD was performed for lesion clearance and local anti-tuberculosis drug placement. The visual analog scale (VAS) score and erythrocyte sedimentation rate before and after surgery were compared. Results Nineteen patients were followed up from 18 to 48 months after surgery. The VAS score was reduced from 7.8 ± 1.3 before surgery to 3.2 ± 1.6 points one week after surgery; the difference was statistically significant (t=2.91, P<0.05). Laboratory erythrocyte sedimentation rate significantly declined from 55.0 ± 32.0 mm / 1h before surgery to 23.0 ± 7.0 mm / 1h one week after surgery (t=2.69, P<0.05). During the follow-up period, there were no cases with obvious symptom deterioration or recurrence cases. Out of 19 patients, 18 were cured, resulting in a cure rate of 94.7%. The remaining one case developed tuberculosis of gastrointestinal tract, and was transferred to The 309th Hospital of Chinese People’s Liberation Army for further treatment. Conclusion PELD treatment for spinal tuberculosis is an important supplement to the traditional open surgery, having good clinical efficacy.