一期前路病灶清除椎体间钛笼植骨钢板内固定治疗胸椎结核(附31例报告)

Primary anterior debridement, T-annoy cage interbody autografting and anterior plate internal fixation for the surgical management of thoracolumbar spinal tuberculosis

目的探讨一期前路病灶清除、椎体间钛笼植骨钢板内固定治疗胸椎结核的安全性及其价值。方法采用一期前路病灶清除、椎体间钛笼植骨钢板内固定治疗胸腰椎结核31例。结果本组患者均获得10～43个月随访,平均随访时间18个月。本组中30例患者均未出现椎旁脓肿或窦道形成等结核复发情况,内固定物无松动,植骨融合,平均融合时间4.5个月;后凸畸形矫正度数为31.6°±7.5°,后期校正度数丢失2.7°±1.5°。本组中仅1例9个月后手术对侧出现腰大肌脓肿,经再次病灶清除手术后,随访11个月,无复发迹象。结论一期前路病灶清除椎体间钛笼植骨钢板内固定治疗胸腰椎结核,能达到彻底清除病灶、脊柱即时稳定、促进植骨融合、校正后凸畸形的目的,是一种安全、有效的治疗方法。

Objective To discuss the safety and value of primary anterior debridement, T-annoy cage interbody autografting anterior plate internal fixation for the surgical management of thoracolumbar tuberculosis. Methods 31 patients who had primary anterior debridement T-annoy cage interbody autografting and anterior plat internal fixation for the surgical management of thoracolumber spinal tuberculosis were enrolled. Results All patients were followed up for an average of 18 months. After 9 months from the first operation, 1 patient was discovered to have contralateral psoas abscess, A second anterior debridement operation were performed for this patients and without recurrence during the 11 months follow-up. Among the other 30 patients, no deep wound infection and sinus was found after surgery, no loose of internal fixation was discovered and the grafted bones were fused in all patient within an average time of 4.5 months. The degree of spine kyphosis correction was 31.6°±7.5°,and 2.7°±1.5°was lost on average in the late stage. Conclusions Primary anterior debridement T-annoy autografting anterior plate internal fixation for the surgical management of thoracolumbar spinal tuberculosis can debride, stabilize spine immediatly after the operstion, fuse the grafted bone and correct kyphosis. This treatment is safty and effective.