老年脊柱结核46例外科治疗分析

The surgical treatment of spinal tuberculosis in older patients

目的：观察老年脊柱结核Ⅰ期病灶清除、脊髓减压、植骨融合内固定的疗效。方法：对46例老年脊柱结核并发脓肿、死骨形成及脊柱后凸畸形，平均Cobb角48．6。的患者，术前做内科处理和应用四联（异烟肼、利福平、乙胺丁醇、链霉素）化疗4周，采用Ⅰ期病灶清除、脊髓减压、植骨融合内固定，术后化疗持续9个月，定期进行影像学复查和血沉、肝功检查。结果：随访10～34月，平均23．2月。45例伤口Ⅰ期愈合，植骨融合满意，后凸畸形矫正，平均Cobb角13．3°，脊髓功能均有不同程度的恢复，1例术后4周窦道形成复发，再次病灶清除治愈，1例术后两月发生脑梗，余均未发生严重并症。结论：经积极合理的术前准备，老年脊柱结核l期病灶清除、脊髓减压、植骨融合内固定可取得满意的疗效。

Objective： To evaluate the outcome of one-stage radical debridement with spinal cord decompression and fusion with instrumentation. Methods： 46 patients were treated. The mean age was 68.2 years old（range 60-78）, They were all diagnosed with cold abscess, sequestrum formation and kyphosis. The mean Cobb angle was 48.6 degree. 92%patients were complicated with at least another disease. With preoperative medicine treatment and 4-drug chemotherapy （INH, Rifampicin, Ethambutol and Streptomycin） for 4 weeks, all patients underwent one-stage radical debridement with spinal cord decompression and fusion with instrumentation, then kept on chemotherapy for 9 months. The changes of radiographs, ESR and hepatic function were observed. Results： The follow-up period was 10 - 34 months, and the average was 23.2 months. In 45 patients, the injury healed primarily with satisfactory fusion and kyphosis restoration. The mean Cobb angle was 23.3 degree at last follow-up. The function of spinal cord improved variously. 1 patient was reoperated on for recurrence of sinus and 1 cerebral infarction occured. Conclusion： With active and reasonable preoperation preparation, the outcome of onestage radical debridement with spinal cord decompression and fusion with instrumentation is satisfactory, and the cure rate is improved.