一期前路病灶清除钛网植骨融合内固定治疗胸腰椎结核

One-stage anterior radical debridement,titanium mesh bone fusion and internal fixation for the treatment of thoracolumbar spinal tuberculosis

[目的]探讨一期前路病灶清除钛网植骨融合内固定治疗胸腰椎结核的疗效。[方法]回顾性分析2003年1月～2006年2月在本院接受治疗的胸腰椎结核患者22例。男12例,女10例;年龄19～76岁,平均36岁。病变部位为T9～L5,其中累及1个椎体1例,2个椎体17例,3个椎体3例,跳跃性1例,受累椎体数量的中位数M=2,四分位距Q=0*。所有患者均接受一期前路病灶清除钛网植骨融合内固定手术并配合规范抗痨化疗。对患者术后症状的改善情况、神经损害的恢复情况、脊柱后凸畸形的手术矫正程度以及远期随访中的植骨融合情况、角度丢失和钛网下沉情况进行随访观察和统计学比较。[结果]所有患者随访6～24个月,平均12.5个月,无复发。刀口均Ⅰ期愈合。术后全身症状及局部疼痛消失;神经症状有不同程度恢复(P<0.01);植骨融合时间3～6个月,平均4个月;后凸畸形手术矫正角度M=20.4°,Q=15.0°(P=0.0001),随访期间丢失角度的中位数M=1.85°,Q=3.6°(P=0.0001)。钛网上、下下沉率的M分别为11%、8%,Q分别为10.7%、9.0%,P均<0.0001。随访期间未见内固定松动及钛网明显移位。[结论]一期前路病灶清除钛网植骨融合内固定手术结合规范抗痨化疗治疗胸腰椎结核的临床疗效显著、可靠。

[ Objective] To evaluate the curative effect of the one-stage anterior radical debridement, titanium mesh cage bone fusion and inernal fixation for the treatment of thoraeolumbar spinal tuberculosis. [ Method ] Twenty-two thoraeolumbar spinal tuberculosis cases from January 2003 to February 2006 were analyzed retrospectively, among whom 12 were male and 10 were female, age ranging from 19 to 76 years with a mean of 36 years. T9 ~ L5 vertebrae were involved in, in detail 1 was involved in single vertebra, 17 were involved in 2 vertebrae, 3 were involved in 3 vertebrae, 1 was involved in the type of jumping style, M = 2, Q = 0. All cases received one-stage anerior radical debridement, titanium mesh cage bone fusion and internal fixation along with strict anti-tuberculosis chemical therapies. The improvement of symptoms and neurological function, angles reduced by the surgeries and bone fusion, angles lost as well as the subsidence of the titanium mesh during the long-term follow-up were observed and compared statistically. [ Result] No recurrence was found in the follow-up period extending from 6 months to 24 months with an averaging of 12. 5 months. All the incisions acquired primary healing. The systematic and local symptoms were released postoperatively. Neurological function recovered in different degrees （P 〈 0.01 ） ; The graft got fusion in 3 months to 6 months, averaging 4 months ; the median （M） of the reduced kyphosis Cobb＇s angle was 20.4° （ Q = 15°, P = 0. 0 001 ）, losing 1.85° （Q = 3.6°, P = 0. 0 001 ） in the follow-up. The medians of titanium mesh cage subsidence were 11.0% and 8. 0% proximally and distally, the quartiles were 10. 7% and 9. 0%, both P 〈0. 0 001. Neither internal fixation loosening nor obvious titanium mesh cage shifting was found. [ Conclusion] The curative effect of the one-stage anterior radical debridemem, titanium mesh cage bone fusion and internal fixation for the treatment of thoracic lumbar spinal tuberculosis is satisfactory and reliable.