钛网植骨侧前路钉棒系统内固定治疗脊柱结核伴截瘫

Operation of latero-anterior internal fixation by nail-stick and titanium mesh and bone graft for treatment of spinal tuberculosis with paraplegia

[目的]探讨钛网植骨侧前路钉棒系统内固定治疗脊柱结核伴截瘫的疗效。[方法]自2002年1月～2004年9月对58例脊柱结核伴不同程度截瘫病人行钛网植骨侧前路钉棒系统内固定术，男32例，女26例；年龄28～68岁，平均38．5岁。术前均有不同程度的结核全身症状并局部疼痛，叩压痛，活动受限。影像学显示1～2个椎体破坏塌陷42例，≥3个椎体16例，均不同程度的后凸畸形；Cobb＇s角18°～50°，平均36°。术前抗结核治疗2～4周。侧前路彻底切除病灶，撑开矫正后凸畸形，行钛网植骨侧前路钉棒系统内固定，术后继续应用抗结核药物治疗至少1年。[结果]58例截瘫患者随访20～48个月，平均28个月。症状完全缓解34例，治愈率58．62％；部分改善19例。好转率32．76％，合计恢复率为91．38％。所有切口均为一期愈合，术后后凸畸形平均矫正30．4°，最终一次随访后凸角度平均矫正28．4。，后凸角度平均丢失2°。[结论]钛网植骨侧前路钉棒系统内固定治疗脊柱结核伴截瘫，既能彻底切除病灶防止复发，又能矫正畸形、重建脊柱稳定性，恢复脊柱支撑功能，防止晚发神经损害。

[ Objective] To evaluate the effectiveness of the operation of latero-anterior internal fixation by nail-stick system and titanium mesh and bone graft for treatment of spinal tuberculosis with paraplegia. [Method] Fifty eight patients with spinal tuberculosis were treated by the operation of one-stage latero-anterior debridement, spinal cord decompression, titanium mesh and bone graft and internal fixation by nail-stick system, from Jan 2002 to Sep 2004. There were 32 males and 26 females and mean age was 78.5 years old （28 to 68 years old）. All these tuberelosis patients had different symptoms and accompanied with local pain and spinal kyphosis deformity with Cobb＇s angles of the thoracolumbar spine were ranged from 18° to 50° （ average of 36° ）. All patients received anti-tubercolosis chemotherapy for 2 to 4 weeks before operation. 58 patients were constructed with titanium mesh and bone graft and internal fixation by nail-stick system. Anti-tuberculosis chemotherapy regularly was given for over 1 year after surgery. [ Result] All patients were followed-up for 20 -48 months （ average 28 months） . Among 58 cases, 34 were completely recovered （ cure rate 58.62% ）, 19 were partly recovered （ cure rate 32. 76% ）, total recovery rate was 91.38%. All patients showed successful autograft bone graft fusion. The average immediate postoperative correction of kyphosis angle was 30. 4° , the average correction of kyphosis angle at the time of last follow-, up was 28.4°, the average loss of correction was only 2°. [Conclusion] Operation of anterior internal fixation by nail-stick and titanium mesh and bone graft for treatment of spinal tuberculosis with paraplegia can cure tuberculosis without recurrence and can also correct deformity, strengthen the spinal structure to prevent secondary paraplegia.