胸、腰椎脊柱结核一期病灶清除前方钛网支撑矫形内固定

One-stage radical debridement,deformity correction,interbody fusion and internal fixation for the treatment of spinal tuberculosis

目的探讨胸、腰椎结核一期病灶清除、脊髓减压、前方畸形矫正、植骨融合内固定的疗效。方法本组19例,男11例,女8例;平均年龄43.3岁(15～66岁)。病变部位:胸椎8例,胸、腰椎7例,腰椎4例。2个椎体13例,3个椎体5例,4个椎体1例,无跳跃型。椎旁脓肿15例,髂窝流注性脓肿4例。本组患者皆伴有后凸畸形,平均Cobb角44.7°。术前血沉正常5例,其余为22～127mm/h。本组患者术前应用三联(异烟肼、利福平、链霉素)化疗2周,手术采用一期病灶清除、脊髓减压、前方钛网支撑畸形矫正、植骨融合内固定术。术后化疗持续10个月,定期进行脊柱影像学检查和血沉、肝功能检查。结果刀口皆为Ⅰ期愈合,无窦道。最先解除的症状是疼痛,随访8～29个月(平均17个月),畸形矫正、植骨融合满意,未见内固定失败;后凸角度平均矫正21.3°,脊髓功能皆有不同程度地恢复。3例胸、腰段结核术中出现胸膜破裂,1例术后气胸;4例出现神经根刺激症状,1例钛网位置欠佳。无脓胸发生和迟发性脊髓功能丧失。术后血沉恢复正常时间为2～8个月。结论胸、腰椎脊柱结核一期病灶清除、脊髓减压、植骨融合,同时前方钛网支撑畸形矫正和脊柱稳定性重建,在临床上取得了满意的疗效。未见使用在脊柱结核治疗过程中的支撑物和内固定物产生的不良反应。

Objective To observe the efficacy of one-stage radical debridement, spinal cord decompression, deformity correction, interbody fusion and stability reconstruction with cage for the spinal tuberculosis treatment.Methods There were 19 cases in the group, 11 males and 8 females with an average age of 43.3 years (range 15-66 years). The lesions were located at thoracic in 8 cases, thoracolumbar in 7 cases and lumbar in 4 cases. Two vertebraes were affected in 13 cases, three in 5 cases and four in 1 case. Fifteen cases had para-vertebral abscess, and 4 had psoas abscess. The cases were all associated with kyphosis deformity with an average Cobb angle of 44.7 degrees. The preoperative ESR was normal in 5 cases and ranged 22-127mm/h in the other cases. All the patients accepted 2-week chemotherapy, then underwent one-stage radical debridement, abscess drainage, spinal cord decompression, deformity correction, interbody fusion and stability reconstruction with cage through anterior approach. After the surgery, they accepted another 10-month chemotherapy and took image, ESR and the liver function examinations at intervals. Results All the patients acquired satisfactory incision healing. The pain was first relieved after surgery. Follow-up period extended from 8 months to 29 months (mean 17months). The graft got fusion in 3 months, and there was no internal fixation failure or recurrence. The mean angle of kyphosis correction was 21.3 degrees, and neurological function was improved in all patients in different degrees. Three cases of thoracolumbar tuberculosis had pleura rupture at surgery and pneumothorax occurred in 1 case after surgery. Four cases had nerve roots incitement symptom, and cage location was not so well in 1 case. There was no pyothorax or late neurological deficit. The postoperative ESR became normal 2-8 months later. ConclusionThe technique of one-stage radical debridement,deformity correction,interbody fusion with cage for the treatment of spinal tuberculosis acquires satisfactory curative effect. There is no complication caused by internal fixation in the tuberculosis spondylitis treatment.