单纯性脊柱结核,单纯性脊柱结核的症状,单纯性脊柱结核治疗【专业知识】.pdf

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1、本文极具参考价值，如若有用请打赏支持我们！不胜感激！单纯性脊柱结核,单纯性脊柱结核的症状,单纯性脊柱结核治疗【专业知识】疾病简介脊柱结核占全身骨关节结核的首位，其中以椎体结核占大多数，附件结核十分罕见。椎体以骨松质为主，负重大，承受应力高，而椎体的滋养动脉多为终末动脉，结核杆菌容易停留在椎体部位。在整个脊柱中，腰椎活动度最大，腰椎结核发生率也最高，胸椎次之，颈椎更次之，至于骶、尾椎结核则甚为罕见。本病以儿童患者多见，30 岁以上者的发病率明显下降。疾病病因一、发病原因病人咳嗽或打喷嚏时，可污染空气，可造成肺感染，污染的食物可造成胃肠感染，再经血循环可造成骨与关节的感染。二、发病机制1.分型 椎

2、体结核可分为中心型和边缘型两种。(1)中心型椎体结核：多见于10 岁以下的儿童，好发于胸椎。病变进展快，整个椎体被压缩成楔形。开始只侵犯一个椎体，病变进展时会穿透椎间盘而累及邻近椎体(图 1)。(2)边缘型椎体结核：多见于成人，腰椎为好发部位。病变局限于椎体的上、下缘，很快侵犯至椎间盘及相邻的椎体。椎间盘破坏是本病的特征，因而椎间隙很窄(图 2)。本文极具参考价值，如若有用请打赏支持我们！不胜感激！(3)椎体前型：亦可称之为骨膜下型，主要是由于腹膜或盆腔后结核病变直接侵及椎体前方，引起前方骨质边缘呈蚕蚀样破坏(图 3)。本型少见，但腰椎的发生率高。2.寒性脓肿椎体破坏后形成的寒性脓肿可以有两种

3、表现：(1)椎旁脓肿：脓液汇集在椎体旁，可在前方、后方或两侧，以积聚在两侧和前方者比较多见。脓液将骨膜掀起，还可以沿着韧带间隙向上和向下蔓延，使数个椎体的边缘都出现骨腐蚀。它还可以向后方进入椎管内，压迫脊髓和神经根。(2)流注脓肿：椎旁脓肿积聚至一定数量后，压力增高，会穿破骨膜的约束，沿着肌肉筋膜间隙向下方流动，在远离病灶的部位出现脓肿。3.脓肿流注方向各个节段的脊柱结核及寒性脓肿蔓延的方向如下：(1)颈椎：脓液穿破骨膜和前纵韧带的制约，聚集在颈长肌及颈前筋膜深面的疏松间隙内。第4 颈椎以上病变的脓肿多位于咽后壁，称为咽后壁脓肿;第 4 颈椎以下病变的脓肿积聚在食管的后方，称为食管后脓肿。巨大

4、咽后壁脓肿会影响呼吸与吞咽，患者夜间睡眠时鼾声大作。脓肿破向口腔或食管后会吐出脓液、干酪样物质和死骨。巨大椎旁脓肿会在颈部的一侧向外突出形成颈部包块。它沿着斜角肌表面流动至锁骨上窝。下颈椎病变的脓肿可沿着颈长肌间隙流动至纵隔内突出于纵隔的一侧或两侧，状如纵隔肿瘤。(2)胸椎：以椎旁脓肿为主，突出于脊柱的两旁，通常大小不对称。早期脓肿形状如球形;随着脓液的增多与上下蔓延，脓肿形如梭状;慢性病例的脓肿则往往成筒状，并有脓肿壁的钙化。椎旁脓肿可经肋骨横突间隙向背部蔓延，也可沿肋间血管神经束流向肋间隙的远端。脓肿穿破胸膜则成为脓胸。(3)腰椎：下胸椎及腰椎病变所致的椎旁脓肿穿破骨膜后，积聚在腰大肌鞘内

5、，形成腰大肌脓肿。浅层的腰大肌脓肿可以穿越腰筋膜到腰三角，成为腰三角脓肿。腰三角是一个潜在的间隙，它的边缘是髂嵴后缘、骶棘肌的外缘与腹内斜肌的后缘。腰大肌脓肿还可沿腰大肌流窜至股骨小转子处，成为腹股沟处深部脓肿。它还能绕过股骨上端的后方，出现在大腿外侧，甚至沿阔筋膜下流至膝上文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A

6、4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3

7、文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:C

8、Z8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6

9、C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 H

10、N2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2

11、Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 Z

12、J7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3本文极具参考价值，如若有用请打赏支持我们！不胜感激！部位。(4)骶椎：脓肿积聚成为骶前脓肿。它可沿着梨状肌经坐骨大孔至臀部，或经骶管流至骶骨后方，也可下注到坐骨直肠窝及肛门附近。(5)尾椎：以肛旁脓肿形式出现。症状体征一、症状1、一般症状起病缓慢。有低热、疲倦、消瘦、盗汗、食欲不振与贫血等症状。儿童常有夜啼、呆滞或性情急躁等。2、疼痛 疼痛是最先出现的症状。通常为轻微疼痛，休息后症状减轻，劳累后则加重。早期疼痛不会影响睡眠，病程长者夜间也会有疼痛。3、颈椎结核的特点颈椎结核除有颈部疼痛外

13、，还有上肢麻木等神经根受刺激表现，咳嗽、喷嚏时会使疼痛与麻木加重。神经根受压时则疼痛剧烈。如果疼痛明显，患者常用双手撑住下颌，使头前倾、颈部缩短，姿势十分典型。咽后壁脓肿妨碍呼吸与吞咽，患者睡眠时有鼾声。后期时可在颈侧摸到冷脓肿所致的颈部肿块。4、胸椎结核的特点胸椎结核有背痛症状，必须注意，下胸椎病变的疼痛有时表现为腰骶部疼痛。脊柱后凸十分常见，粗心的家长直至偶然发现有胸椎后凸畸形才来就诊。5、腰椎结核的特点腰椎结核患者在站立与行走时，往往用双手托住腰部，头及躯干向后倾斜，使重心后移，尽量减轻体重对病变椎体的压力。患者从地上拾物时，不能弯腰，需挺腰屈膝屈髋下蹲才能取物，称拾物试验阳性。另一检查

14、方法为患儿俯卧，检查者用双手提起患儿双足，将两下肢及骨盆轻轻上提，如有腰椎病变，由于肌肉痉挛，腰部保持僵直，生理前凸消失。后期患者有腰大肌脓肿形成，可在腰三角、髂窝或腹股沟处看到或摸到脓肿。腰椎结核者脊柱后凸通常不严重，从胸椎到骶骨，沿着骶棘肌两侧，用手指顺序按摸，亦能发觉轻度后凸畸形。少数患者至发现寒性脓肿才来就诊。文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6

15、L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2

16、D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4

17、D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7

18、H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z

19、10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档

20、编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8

21、E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3本文极具参考价值，如若有用请打赏支持我们！不胜感激！寒性脓肿在有继发感染时会出现高热以及使毒血症症状加重。溃破后先流出大量稀薄液体，混有干酪样物，也可伴有少量死骨。破溃后往往形成慢性窦道，经久不愈。根据病史、临床表现、体征、X 线片、CT、MRI及实验室检查，临床确定诊断不难。用药治疗预防和护理一、治疗1.非手术疗法根据有无手术指征决定是否手术。即使对有手术指征者，也要进行24 周的非手术治疗以作为术前准备。非手术治疗包括全身抗结核药治疗与局部

22、制动。一般采用两种抗结核药物联合应用，36 个月后改为单种抗结核药物治疗，整个疗程应不少于2 年。局部制动采用石膏背心(胸椎及上腰椎结核)以及石膏腰围带一侧大腿(下腰椎结核)固定，固定期为 3 个月，固定期间应多卧床休息。对全身情况不好不能耐受石膏固定者，可以使其睡特制的石膏床3 个月。2.手术疗法手术有四种类型：(1)切开排脓：寒性脓肿广泛流注致患者出现继发性感染，全身中毒症状明显，不能耐受病灶清除术时可做切开排脓挽救生命。寒性脓肿被切开后，全身中毒症状可望得到控制，但切口极难愈合，并且这一问题往往经年累月不能解决。由于脓肿极深，大都在脓肿顶部切开，引流不畅。可每天以4%异烟肼溶液灌洗脓腔，

23、并保持窦道口敞开。可以插入一段粗橡皮管以扩张窦道口，或用双套管引流，注意不要使皮管、棉花球等异物落入脓腔内。千万不要对没有继发感染的寒性脓肿施行切开排脓手术。已形成的窦道因周围有广泛的瘢痕组织形成，并有炎性浸润，解剖结构不清，因此不宜贸然施行瘘管切除术，以免损伤邻近血管、神经或重要脏器。亦不主张对寒性脓肿施行分层穿刺排脓及注射抗结核药物。(2)病灶清除术：20 世纪 4050 年代起，由于抗结核药物的成功合成和提取，为实施病灶清除术提供了条件。有前路和后路手术两种。后路手术通常用于胸椎结核，从寒性脓肿明显的一侧入路。患者取侧卧位，手术侧向上。做棘突旁切口，推开骶棘肌，显露病变脊椎的一侧肋横突，

24、按病变范文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档

25、编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8

26、E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6

27、L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2

28、D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4

29、D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7

30、H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3本文极具参考价值，如若有用请打赏支持我们！不胜感激！围需切除 13 个肋横突及部分肋骨头。推开胸膜，进入病灶做彻底的清创术，可以清除脓液、结核性肉芽组织、干酪样

31、坏死物质和死骨。应该掏尽椎间隙内一切病变组织，直至进入对侧寒性脓肿。颈椎结核则多从前路进行病灶清除术，术后予以石膏固定34 个月，复查后酌情拆除石膏或继续固定(图 6)。(3)后路脊柱融合术：这是古老的手术，现已很少使用。那么后路椎弓根螺钉系统与前路病灶清除术联合应用是否可取呢?联合手术可以加强脊柱稳定性，并可使患者早期下床活动，不必用石膏背心固定;但必须考虑到手术创伤大的问题，如果脊柱结核病例久卧病床，一般情况比较差，则不能耐受此联合手术。(4)矫形手术：主要是纠正脊柱后凸畸形。已有临床报道对陈旧性胸椎结核有后凸畸形者采用Halo牵引，再施行脊柱矫形并后路安放内固定物取得成功。二、预后一般经

32、术前术后的抗结核治疗及手术病灶清除，能获得良好结果。一、护理无相关资料。并发病症一、并发病症胸椎椎旁肿脓穿破胸膜后可并发脓胸。饮食保健一、饮食a 相关药品结核丸9gx10 丸/盒国药准字 Z20093602￥30.10异烟肼片 0.1gx100 片/瓶国药准字文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档

33、编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8

34、E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6

35、L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2

36、D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4

37、D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7

38、H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z

39、10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3本文极具参考价值，如若有用请打赏支持我们！不胜感激！H14020123￥9.41异烟肼片 0.1gx100 片/瓶国药准字 H41022341￥10.10异烟肼片 50mgx100片/瓶国药准字 H20073577￥5.46“身体是革命的本钱”。身体健康是人最基本的，也是很难达到的目标。今天，你能开口说话，能用眼睛、耳朵、鼻子去感知身边的一切事物，能正常地用双腿行走，无病无痛这些看起来是很轻而易举的，但是你是否想过这些却是极度重要且来之不易的，如果某一天你失去了，怎么办?看到街上那些失明失聪、断手少腿的

40、残疾人，你是否在想：幸好我没有像他们那样，你错了，生命充满意外，谁能保证你明天不会成为他们中的一员呢?那你又是否因此更加懂得珍惜健康呢?那就请不要透支自己的身体健康，赶快行动起来，锻炼身体，让身心健康吧!要清楚意识到自己目前的健康状况是稍纵即逝的，明确健康是我们做任何事情的本钱，要懂得珍惜健康!以上内容仅供参考，必要时请及时去医院咨询更专业的医生咨询。文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z1

41、0X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编

42、码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E

43、5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L

44、4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D

45、1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D

46、5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3文档编码:CZ8E5F6C6L4 HN2D1Q2Z4D5 ZJ7H10A4Z10X3