一期前路病灶清除植骨内固定治疗胸腰椎结核

One Stage Anterior Radical Debridement, Bone Fusion and Internal Fixation for the 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—01／2005—12采用一期前路病灶清除植骨内固定治疗胸腰椎结核44例，44铡患者均有不同程度的结核中毒症状和胸膛部疼痛，活动受限。16例伴截瘫（Frankel分级B级1例，C级7例，D级8例），31例患者有不同程度后凸畸形（14°～55°，平均28．5°），影像学显示单椎体破坏9例。双椎体破坏35例。结果切口一期愈合，无窦道形成。随访1．5～6年．平均2.4年。16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18°。植骨愈合时间4～6月，平均4、8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 anterior radical debridement, bone fusion and internal fixation. Methods A total of 44 patients with thoracic and lumbar tuberculosis were treated by one stage anterior radical debridement, bone fusicn and internal fixation from 2000 to 2005. All the patients suffered different tuberculosis symptoms, accompanied with local ache and had no sinus. 16 patients had paraplegia. 31 patients suffered different spinal kyphosis deformity. Cobb＇s angle was ranged from 14°to 55° with an average of 28.5°. Results A total of 44 cases were visited regularly after operation for 1.56 years （ average 2.4 years）. 16 cases with incomplete paraplegia improved 2 grades in average with Frankel neurological classifications. All the 44 cases got solid fusion after 4. 8 months. Kyphosis deformity was corrected 18° in average without any recurrence. Conclusions The surgerical debridement via anterior approach, with bone grafting and internal fixation has significant advantages, such as quickly relief of symptom, rectify deformity, strengthen the spinal structure, which is an effective therapy in curing the thoracic and lumbar tuberculosis.