应用异体骨移植、前方内固定治疗颈胸段结核的初步报道

The outcome of allografts and anterior instrumentation in cervicothoracic junction spinal tuberculosis

目的探讨颈胸段结核病灶彻底清除后同期异体髂骨块移植、内固定治疗的疗效.方法对C7～T3椎体结核采用标准颈椎前方入路联合胸骨柄劈开暴露病灶,彻底清除病灶进行脊髓减压,次全切除相应椎体,同期植入异体髂骨块重建前中柱、前方钢板内固定,术后佩戴头颈胸支具3个月,正规抗痨12个月.结果随访18～39个月,平均28个月,切口均Ⅰ期愈合,6例均获Ⅰ级骨性愈合,骨愈合时间9～12个月,后凸角无明显丢失.结论尽管异体髂骨块移植达到骨性愈合的时间与自体骨相比较长,但当与前路内固定器械结合应用时,可有效维持畸形的矫正,使脊柱拥有良好的稳定性,具有较好的近期、远期疗效.

Objective To investigate the outcomes in patients with cervicothoracic junction spinal tuberculosis who underwent radical debridement and reconstruction using tricortical iliac allograft plus anterior fixation devices through modified anterior approach.Methods A standard cervical approach was combined with a partial median sternotomy and transverse osteotomy through the synostosis between the manubrium and body of the sternum to expose the lesion adequately, then perform radical excision of epidural granulation tissue/abscess and necrotic bone ,place a proper tricortical iliac allograft and anterior fixation devices to reconstruct the anterior spinal column, followed by chemotherapy for 12 months and immobilization in a brace for 3 months.Results The mean follow-up period was 28 months (range 18-39 months). Bony fusion was obtained in all patients (9-12 months). There was no recurrence of the disease or loss of Cobb angulation.Conclusion Although the incorporation and remodeling of anterior structural bone allograft occurred late when compared with allograft, it works effectively in the long term to maintain correction of the kyphosis, if combined with instrumentation.