前后路联合Ⅰ期手术治疗胸腰椎结核

Anterior and posterior combined operation for treatment of thoracic and lumbar tuberculosis

目的探讨前后路联合Ⅰ期手术治疗胸腰椎结核的临床疗效。方法采用Ⅰ期后路椎弓根系统内固定同时前路病灶清除、椎体间植骨治疗胸腰椎结核患者28例。在X线片上测量术前、术后后凸角度（Cobb角），观察植骨融合情况，应用Frankel分级评分评估神经恢复情况。结果随访12～23个月，术后12～培个月所有患者均显示骨性融合。12例有神经症状的患者，术后均有一定程度的恢复，后凸畸形未见加重，无结核复发及切口感染。结论前后路联合Ⅰ期手术治疗胸腰椎结核，可以促进植骨融合和神经功能恢复，防止后凸畸形，临床疗效满意。

Objective To evaluate the clinical effect of anterior and posterior combined operation for treatment of thoracic and lumbar tuberculosis. Methods Posterior pedicle screw system internal fixation and anterior radical debridement with interbody fusion procedures were used in 28 patients suffering from thoracic and lumbar spinal tuberculosis. The degree of the kyphosis（Cobb angle） were measured and the interbody fusion were observed preoperatively and postoperatively. The Frankel grading system was used to assess the neurological status. Results All cases were followed up for 12 -23 months. All patients showed sucessful interbody fusion in 12 - 18 months. 12 cases of paraplegia were recovered in certain degree. Kyphosis angle was not progressed. No recurrence or wound infection was found. Conclusions Anterior and posterior combined operation for treatment of thoracic and lumbar tuberculosis can enhance the stability of spine in thoracic and lumbar spinal tuberculosis, which is beneficial for successful interbody fusion and recovery of paraplegia, and preventing progression of kyphosis.