一期前路病灶清除植骨内固定治疗胸腰椎结核

One-stage of anterior radical debridement and bone fusion and internal fixation in treatment of thoracic and lumbar tuberculosis

目的评价一期前路病灶清除植骨内固定治疗胸腰椎结核的临床疗效。方法2000年2月～2004年12月采用一期前路病灶清除植骨内固定治疗胸腰椎结核42例,42例患者均有不同程度的结核中毒症状和胸腰部疼痛,活动受限。15例伴截瘫(Frankel分级B级1例,C级6例,D级8例),30例患者有不同程度后凸畸形(15。～60。,平均30.6。),影像学显示单椎体破坏11例。双椎体破坏31例。结果切口一期愈合,无窦道形成。随访1.5～2.5年,平均1.8年。15例截瘫者除1例术前B级术后恢复至D级外,其余均恢复到E级。后凸Cobb角平均矫正21。。植骨愈合时间3～6个月,平均5个月,随访期内结核无复发。结论一期前路病灶清除植骨内固定治疗胸腰椎结核疗效确切,脊柱稳定性重建可靠,矫正后凸畸形较理想,是治疗胸腰椎结核的有效术式。

Objective To evaluate the clinical value in treating the thoracic and lumbar tuberculosis with one-stage of anterior radical debridement and bone fusion and internal fixation. Methods 42 patients with thoracic and lumbar tuberculosis were treated by one-stage of anterior radical debridement and bone fusion and internal fixation from 2000 to 2004. 15 patients had paraplegia and 30 patients suffered different spinal kyphosis deformity. Cobb＇s angle was ranged from 15° to 60° with an average of 30.6 °. Results All cases were followed up 1.5-2,5 years （mean 1.8 years）. 15 cases with incomplete paraplegia improved 2 grades in average with Frankel neurological classifications. All the 42 cases got solid fusion after 6 months. Kyphosis deformity was corrected mean 21°and without any recurrence. Conclusions The surgical debridement via anterior approach with bone grafting and internal fixation has significant advantages could quickly relief symptoms and rectify deformity and strengthen the spinal structure. It is an effective therapy in curing the thoracic and lumbar tuberculosis.