单钉-棒固定在胸腰椎结核前路手术中的应用

Application of single rod-screw fixation in anterior approach for thoracic and lumbar tuberculosis

目的探讨脊柱结核手术内固定的有效方式。方法2002年6月～2004年6月，在手术前有效抗结核化疗的基础上，采用前路病灶清除、植骨融合及单钉-棒内固定的手术方式治疗胸、腰椎结核患者54例。术中在保证彻底清创的基础上注意保留病椎有血供的部分和无明显破坏的椎间盘，以减少切除范围和融合的节段，有神经症状者注意行椎管前侧减压。骨缺损采用自体髂骨、异体髂骨＋自体碎骨、或钛网＋自体碎骨的方法修复，安置单钉-棒时注意对移植骨块适当加压。患者术后卧床10d左右，然后在支具的保护下下床活动。本组共有41例患者获得随访，手术后随访的时间7—31个月，平均18个月。结果患者所有的结核病灶均顺利愈合，植骨稳定，无明显移位和塌陷，内固定器无松脱和折断，其中37例达到骨性愈合标准；脊柱后凸角平均矫正达23°，患者术前伴有的神经症状也大部分消失，绝大部分患者恢复日常生活、工作。结论前路单钉-棒内固定不仅能够维持胸、腰椎结核手术后脊柱的稳定，防止移植骨块的脱位、塌陷和骨不愈合的发生，而且可以最大范围地减少融合节段，减少术中创伤，故是手术治疗胸、腰椎结核的可靠固定方式。

Objective To investigate the effective fixation method for spinal tuberculosis. Methods From June 2002 to June 2004, 54 patients of thoracic and lumbar tuberculosis were treated by anterior focus clearance, bone graft and single rodscrew fixation combined with the administration of pre- and post-operative antituberculosis therapy. The blood-supplied part of the involved vertebrae and the mainly-uninvolved intervertebral disc were carefully reserved in the procedure of radical debridement and vertebral canal decompression, in order to reduce the resected and fused segment of the spine. The bone defects were reconstructed with autograft or allograft （ iliac strut）, or titanic mesh with autogenic morselized bone. The single rodscrew was fixed to compress and stabilize the graft. The patients lay in bed for about 10 days after operation, and then got up with the assistance of braces. There were 41 patients who were followed up for 7-31 months （mean 18 months）. Results All the tuberculosis focuses were completely cured and solid bone fusion was obtained in total 37 patients. There were no obvious shift or collapse and no instrument loosened or broken. The average kyphosis angle was corrected by 23 degrees. The accompanied neurological symptom disappeared mostly after operation, and most patients reverted their daily lives and work. Conclusion Anterior single rod-screw fixation is an effective fixation method for thoracic and lumbar tuberculosis. It not only can stabilize the ruined segment, but also can reduce the fused segment and simplify the fixation procedure.