前路病灶清除椎管减压及一期椎间植骨内固定治疗胸、腰椎结核

One stage anterior debridment,decompression and internal fixation with autograft of bone for the treatment of thoracolumbar tuberculosis

目的分析前路病灶清除椎管减压一期椎间植骨内固定治疗胸腰椎结核的疗效。方法回顾2002年3月以后的病例中对17例胸腰段、腰椎结核病者,行前路病灶清除椎管减压一期椎间植骨钛质钉-板、钉-棒系统内固定治疗。本组患者术前均有椎旁或腰大肌脓肿,椎体破坏塌陷,椎管内占位,脊柱畸形,不同程度神经功能受损。结果术中无脊髓、神经及大血管损伤;术后随访1～3年,脊髓神经功能恢复良好。椎间植骨全部融合,脊柱畸形被矫正,无病灶复发。结论前路病灶清除椎管减压一期椎间植骨内固治疗胸、腰椎结核具有安全,疗效可靠、恢复快,卧床时间短,护理简单等优点。

Objective To investigate the curative effects on the focal cleaning,vertebral canal decompression and interspinal bone grafting plus internal fixation for treating tuberculosis of thoracolumbar spine in one stage. Methods From April 2002 to July 2005,17 cases with tuberculosis of thoracolumbar spine received anterior approach focal cleaning,vertebral canal decompression and interspinal bone grafting plus internal fixation with titanic nail-plate,nail-clavate system were analyzed retrospectively.All cases had paravertebral abscess or psoas abscess ,destruction and collapse of vertebral body, occupying lesion of intravertebral canal, deformity of vertebral body, occupying lesion of intravertebral canal, deformity of spinal column and neural function impairment of different degree before operation. Results No injury of spinal cord, major nerve and blood vessels were happened during operation.In this group,the patients were followed-up from 1 to 3 years after operation.The recovery of spinal nervous function was good.Interspinal bone grafting was fused completely and deformity of spinal column was improved.No focal recurrence was found during follow-up period. Conclusion This surgical prompt recovery,shortening time of bed rest tuberculosis of thoracolumbar spine.