不同术式治疗胸腰椎结核

Different operation methods for thoracolumbar spinal tuberculosis

目的:比较治疗胸腰椎结核传统手术方法与一期前路病灶清除、椎体间自体植骨并前路内固定方法的利弊,探讨其适应症。方法:收集1998年2月至2003年7月手术治疗的57例胸腰椎结核患者,其中内固定治疗组27例,病灶清除加植骨组8例,单纯病灶清除组22例,了解术后植骨融合、神经恢复、畸形矫正情况和治愈率。结果:57例患者经平均随访15.2月均治愈。其中3例胸椎、1例腰椎多椎体结核患者出现术后局部并发感染,经再次清创等处理后治愈。内固定组术后下床时间及畸形矫正角度好于另两组(P<0.05),但费用较另两组高。术中出血较另两组多(均P<0.05)。结论:治疗胸腰椎结核传统手术方法与一期前路病灶清除、椎体间自体植骨并前路内固定方法各有优缺点,三者互为补充,不可替代。

Objective To compare the advantages operative methods with the primary anterior debridement, and disadvantages among the conventional intercentrum auto grafting, and anterior internal fixation method for the thoracolumbar spinal tuberculosis, and to discuss the applying principle. Methods Twenty-seven patients with thoracolumbar spinal tuberculosis were treated by the primary anterior debridement, intercentrum auto grafting, and anterior internal fixation, 8 patients were treated by focus debridement and intercentrum auto grafting operations, and the other 22 patients were treated by focus debridement from Feburary 1998 to July 2003, and we analysed the status of the grafting bone fused, the neural function resumed, the malformation rectified and the whole cure ratio. Results All patients were cured after the follow-up of 15.2 months averagely. Three thoracic spinal and 1 lumbar spinal tuberculosis patients who suffered local infection were cured by debridement and other managements. The time of beginning active movement postoperatively was shortened, and the degrees of kyphosis correction had increased in the anterior internal fixation group compared with the other two groups （ P 〈 0.05 ）. But the cost and the bleeding resulted from operation had increased in the anterior internal fixation group compared with the other two groups （ P 〈 0.05 ）. Conclusion The conventional and the modern operation methods of thoracolumbar spinal tuberculosis have respective advantages and disadvantages, so that they can complement rather than replace each other.