病变椎体部分切除、髂骨植骨及内固定术治疗脊柱结核

Treatment of spinal tuberculosis with anterior partial vertebrectomy,iliac grafting and internal fixation

目的:探讨病变椎体部分切除、植骨、内固定手术治疗脊柱结核的临床效果.方法:对55例脊柱结核患者,术前抗痨治疗9～38d后采用前路病变椎体部分切除、大块髂骨支撑植骨、前路或后路器械内固定手术.融合2个椎间隙以下者行前路固定24例;融合3个椎间隙以上者行后路固定31例,其中前后路同期手术者14例,分两期手术者17例.术后负压引流3～5d.结果:随访24～70个月,平均38个月.24例伴脊柱畸形者后凸Cobb角由术前平均22°矫正至术后平均9°,随访时平均11°.19例伴神经功能障碍者均有不同程度恢复.术后半年87%的患者血沉达到正常,CRP 93%达到正常;1例出现并发症,经再次手术治愈.X线片复查见全部患者于术后3～6个月(平均5.5个月)植骨愈合,均恢复了正常生活与工作.结论:病变椎体部分切除、植骨、内固定术病灶清除彻底,病椎骨融合快,复发率低,患者卧床时间短,缩短了脊柱结核的疗程,是治疗脊柱结核的有效术式.

Objective:To discuss the clinical significance in treating the spinal tuberculosis with partial vertebrectomy,iliac grafting and internal fixation.Method:55 patients with spinal tuberculosis were treated by anterior partial vertebrectomy of the diseased vertebrae,iliac grafting and internal fixation from Dec.1998 to Oct.2002.24 patients needed one or two intervertebral-space fusion were offered internal fixation via anterior approach.31 patients requiring more than three intervertebral-space fusion were provided with internal fixation via posterior approach,of which 14 cases received one stage anterior operation and posterior internal fixation,while 17 patients were operated in two stages.The postoperative drainage was applied for 3~5 days.Result:During the follow-up period of an average 38 months,24 cases with kyphosis deformity corrected from the preoperatively 22° to preoperatively 9° were found to be 11° at follow-up.According to Frankel classification,the preoperative degrees of patients were 1 in Grade B,5 in Grade C,13 in Grade D and 36 in Grade E.While in the follow-up,1 in grade D and 54 in Grade E.Six month after the operation,87% of the total 55 patients′ ESR recovered to normal and 93% patients′ C-RP recovered to normal.Except one case that had the complication and was operated on for the second time,the others were cured just in one operation.The later X-ray showed the sound fusion of iliac grafting in all the 55 patients in 3~6 months(5.5 in average) after operation and all the cases resumed their normal daily activities.Conclusion:The partial vertebrectomy with iliac grafting and internal fixation is an effective therapy in curing the spinal tuberculosis.