胸腰椎结核病灶清除脊柱重建方法的研究

Spinal reconstruction after clearance of focal infection and spondylectomy in thoracolumbar tuberculosis

目的 探讨胸腰椎TB脊椎切除术后脊柱稳定性重建方式.方法 通过回顾性分析1998～20D6年收治的胸腰椎TB行脊椎切除、髂骨取骨植入内固定,重建脊柱稳定性患者91例,其中Z-Plate 26例、Kaneda 32例,CDH懈系统28例,All Fix5例.观察术前、术后即刻及随访时矢状面Cobb角度变化,植骨融合情况,有无植骨块下沉、内固定物松动等并发症.手术前后脊髓功能评级情况.结果 随访86例,时间6个月～8年,平均3.6年,手术均获得成功,所有病灶均顺利愈合,植骨融合,无明显移位和塌陷,内固定物无松动和折断,矢状面Cobb角平均矫正15℃,手术前神经功能症状大部分消失,Frankel评分平均改善1.6级,绝大部分患者恢复日常生活与工作.结论 胸腰椎113脊椎切除、髂骨取骨植入、前路钉-板、钉-棒系统内固定可取得脊椎即刻稳定,而且有助于防止植骨块脱出、塌陷、骨不愈合的发生,对恢复脊柱、脊髓的功能有良好的效果,对多节段患者同时行后路椎弓根钉棒系统内固定效果更佳.

Objective To explore the modality of spinal reeonstruetlon for the en bloc spondyleetomy in the thoraeolumbel tuberculosis. Methods From 1998 to 2006, 91 thoraeolumbal tuberculosis eases operated with en bloc spondyleetomy, bone graft and embeddinged the internal fixation were analyzed retrospectively. The parameters of the change of cobb angle, the state of the grafting bone fused or subsided, the cinch of internal fixation and the recovery of neural function were observed. Results The 86 cases was followed up from 6 months to 8 years, averagely 3.6 years. All the foci of infection were healed. The cobb＇ s angle of vertical plane were eorreeted averagely 15°. Frankle score was improved averagely 1.6 grade. Conclusion En bloc spondylectomy, autograft and embeddinging the internal fixation are helpful for reconstructing the stability of the spine in the thoracolumbal tuberculosis. It is also helpful for preventing the eollapse and disunion of bone graft. There are satisfactory effect on the recovery of neural function. Posterior fixation with transpedicular rod - screw system in the mult - segment thoracolumbal tuberculosis is better.