前路病灶清除、钛网植骨融合及内固定治疗胸腰椎结核

Anterior radical debridement?titanium mesh bone fusion and fixation for the treatment of thoracic and lumbar tuberculosis

目的:探讨应用钛网前路重建技术治疗胸腰椎结核的临床价值。方法:对69例胸腰椎结核患者采用前路结核病灶清除、钛网重建植骨融合及前路或后路节段内固定手术,观察围手术期并发症、融合节段后凸角度和椎间平均高度、钛网沉降率及植骨融合情况。结果:本组无术中并发症,术后伤口感染2例、腰椎结核复发合并窦道形成1例,并发症发生率4.3%,融合节段后凸角术前21.5°±2.5°,术后6.5°±2.4°(与术前比较P<0.05)。融合节段椎体间高度术前109.4±4.2mm,术后121.2±3.6mm(与术前比较P<0.05)。随访12个月～3年,平均24个月,无内固定失败,钛网在头侧和尾侧终板平均沉降率分别为27%和31%。66例钛网椎间植骨融合,3例无明显融合征象。结论:胸腰椎结核前路彻底病灶清除后应用钛网进行重建结合节段性内固定可以避免取骨区并发症和有效维持脊柱矢状位排列,但骨融合有待进一步提高。

Objective:To evaluate the clinical value of reconstructive technique with titanium mesh cage for the treatment of thoracic and lumbar tuberculosis.Method:Retrospective analyzed 69 cases of thoracic and lumbar spine tuberculosis from March 2001 to March 2003.Operative methods including:anterior radical debridement?bone fusion with titanium mesh cages(TMCs) combined anterior fixation alone or combined posterior segment fixation.Data evaluation included perioperative complications,degree of kyphosis,intervertebral averaging height,TMCs subsidence pre and postoperatively and bone fusion.Result:No intraoperative complications.Postoperative complications including:2 cases with wound infection,1 case appeared recurrence of lumbar spinal tuberculosis,total complications occupied 4.3%.The preoperative averaging kyphosis angle 21.5°±2.5° was reduced to 6.5°±2.4° postoperatively(angle of kyphosis compared between pre and postoperation P<0.05).The preoperative intervertebral averaging height 109.4±4.2mm,a mean of 121.2±3.6mm in postoperation(intervertebral height compared between pre and postoperation P<0.05).Cage subsidence averaged 27% and 31% at the cephalad and caudal endplates.Followed up from 12 months to 3 years,with an averaging of 24 months,there were no TMCs and fixation failure.66 cases occurred intervertebral TMCs bone fusion at final follow-up.No obvious bone fusion were found 3 cases.Conclusion:The anterior radical debridement?reconstruction with titanium mesh cages combined fixation is an effective method in the treatment of thoracic and lumbar tuberculosis.It can avoid the complications of autograft iliac bone fusion and maintaining spinal sagittal plane alignment.But further research for bone fusion are needed.