脊柱结核病灶部分切除术的切除范围

Resectable range of anterior partial vertebrectomy for spinal tuberculosis

目的:探讨实施脊柱结核病灶切除术的有效切除范围.方法:20例脊柱结核患者,施行病灶部分切除、髂骨植骨、前路或后路内固定手术,术后将切除的大块病灶骨用MMA包埋、不脱钙骨切片、甲苯胺蓝染色,观察结核特征性病灶在整块骨中的分布情况.用统计学可信区间得出手术的有效切除范围.结果:脊柱结核大病灶至微小病灶的最小距离为2.5mm,最大距离为4mm.结论:欲彻底切除脊柱结核病灶,需切除距明显病灶4mm的包括硬化骨、结核肉芽组织、坏死物质在内的所有骨质.

AIM： To observe the distribution of tubercular infectious focus in diseased vertebral body for providing theoretic evidence to partial vertebrectomy of vertebral body with spinal tuberculosis. METHODS： Twenty pationts with spinal tuberculosis were treated by anterior partial vertebrcctomy of the diseased vertebrae, iliac grafting and internal fixation via anterior of posterior approach. Using MMA embedding, undecalcified bone sections and toluidine blue staining, the distribution of infectious focus in diseased vertebral body was observed, then the confines of resectable bone in partial vertebrectomy were obtained by statistic methods. RESULTS： The distance from the bigger tubercular infectious focus to the smaller is 2.5 mm to 4 mm. CONCLUSION： The partial vertebrectomy of vertebral body with spinal tuberculosis should involve all the unconspicuous tubercular infectious bone that is 4 mm apart to the distinct infectious focus, including the vertebral osteosclerosis, granulation tissue and necrotic tissne.