一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形

One-stage radical eradication and wedged vertebral osteotomy through a purely posterior procedure in treating thoracic and lumbar spine tuberculosis associated with kyphosis or scoliokyphosis demormity

目的探讨一期后路病灶清除、楔形截骨矫形及内固定治疗胸、腰椎结核并后凸或侧后凸畸形的可行性、应用指征及临床意义.方法对16例胸、腰椎结核并后凸或侧后凸畸形的患者采取一期后路病灶清除、楔形截骨矫形及内固定术.男性12例,女性4例,年龄17～53岁,平均37.1岁.术前后凸角为54°～138°,平均78.3°;2例合并侧凸,角度分别为31°和24°;1例伴随侧方移位.7例合并脊髓损害,2例为C级,5例为D级,2例表现为马尾及神经根损害.结果手术时间为215～325min,平均265 min,术中出血450～2200 ml,平均1100ml.术后结果满意,14例为优,2例为良,无严重并发症发生,脊髓神经功能损害均获显著改善.术后后凸角度为0°～67°,平均28.5°,矫正率63.6%,侧凸和侧方移位基本矫正.随访14～52个月,平均26.3个月.无内固定松动、断裂及明显矫正度丢失,融合良好.结论对胸、腰椎结核并后凸或侧后凸畸形的患者采取一期后路病灶清除、楔形截骨矫形及内固定术是一较为有效、可行的方法.与联合前、后路手术比较,该技术减少了创伤且有更好的畸形矫正效果.

Objective To investigate the feasibility,clinical indications and significance of one-stage radical eradication, wedged vertebral osteotomy and instrumentation in the treatment of tuberculosis of thoracic and lumbar spine associated with kyphosis or scoliokyphosis through a purely posterior procedure. Methods Sixteen cases with tuberculosis of thoracic and lumbar spine associated with kyphosis or scoliokyphosis were treated by one-stage radical eradication, wedged vertebral osteotomy and instrumentation fixation through posterior procedure.All patients included 12 males and 4 females, and the average age was 37.1 years(from 17 to 53 years). The preoperative average Cobb angle of kyphosis was 78.3°(range from 54°to 138°). There were 2 cases associated with scoliosis(the Cobb angle of scoliosis was 31°and 24°), and 1 case with lateral transition. Spinal cord compression were found in 7 cases. According to the Frankel′s classification, 2 cases belonged to C degree, and 5 cases to D degree. There were 2 cases with quadal equina or nerve root lesions. Results The average blood loss during the operation was 1100 ml (range from 450 to 2200 ml), and the average operation time was 265 min (range from 215 to 325 min).The postoperative results were satisfactory, 14 cases were excellent and 2 cases were good. Obvious improvement was obtained in 9 cases with neurological dysfunction. The postoperative average Cobb' angle was 28.5°(range from 0°to 67°), and the corrective rate was 63.6%. The followed-up was ranged from 14 to 52 months with an average of 26.3 months. There were no major complications related to the fixations, loss of correction and the fusion were achieved in all patients. Conclusions One-stage radical eradication, wedged vertebral osteotomy and instrumentation is a feasible and an effective procedure in the treatment of spinal tuberculosis associated with kyphosis or scoliokyphosis.Compared with combined anterior and posterior procedure, the surgical technique may decrease injuries and has better result.