一期前路病灶清除椎体间植骨内固定治疗脊柱结核

Primary anterior debridement,interbody autografting and internal fixation for surgical management of spinal tuberculosis

目的 探讨脊柱结核手术治疗中一期前路病灶清除椎体间植骨融合同时内固定矫形固定的安全性、有效性。方法 总结28例脊柱结核患者,经术前抗痨后,采用一期前路病灶清除,椎体间自体骨植骨融合前路钛钢板或“AO”前路内固定器内固定治疗。结果 平均随访18个月,28例患者血沉恢复正常时间平均为术后1.6个月,无局部结核复发、窦道形成,植骨全部骨性融合,融合时间平均为术后3.6个月,后凸畸形矫正平均较术前纠正25°。神经功能Frankel分级全部得到显著改善。结论 脊柱结核内固定可有效纠正脊柱后凸畸形,早期重建脊柱稳定性,有助于植骨融合和减少结核复发,在结核病灶彻底清除的同时,植骨内固定是安全有效的。

Objective To explore the importance of reconstruction of spinal stability and to evaluate the safetyof anterior instrumentation in surgical management of spinal tuberculosis.Methods Eighteen cases of spinal tuberculosis were treated with primary anterior debridement,inetrbody autografting and internal fixation.Results All cases were followed-up for an average of 18 months.The 28 patients' ESR resuscitation time is 1.6 months on average after operation. Spinal tuberculosis do not have recrudescence in areas of tuberculaus focus. The autogenous bone graft was growing and the grafting bone interface was mixed together in 3.6 months after operation.Kyphosis was corrected for on average of 25°. Neurologic function of all cases improved by Frankel grade.Conclusion Interal fixation plays an important role in surgical treatment of spinal tuberculosis by early reconstructing spinal stability, correcting deformity, speeding bony fusion, and lessing arrest. And it is safe and effective to implant anterior titanium spinal instrument in tuberculosis foci.