一期后路内固定联合前路病灶清除并取髂骨植骨融合治疗胸腰椎结核

One-stage posterior approach plating,anterior approach focus clearance and bone grafting between spine for tuberculosis of thoracic and lumbar spine

目的评价一期后路内固定、前路病灶清除并取髂骨植骨融合治疗胸腰椎结核的临床疗效。方法采用一期后路内固定、前路病灶清除并取髂骨植骨融合手术治疗胸、腰椎结核患者34例,按照Frankel分级评定患者手术前后的神经功能,根据X线片评价植骨融合时间,测量手术前及手术后脊柱后突角度及随访期内的角度丢失。结果34例中,优25例,良9例。34例患者结核病灶清除彻底,手术切口均一期愈合,无窦道形成,结核治愈无复发。后凸畸形角度平均纠正19.8°±3.7,°X线片显示所植髂骨骨性融合时间平均(4.5±1.4)个月。结论一期后路内固定、前路病灶清除并取髂骨植骨融合治疗胸腰椎结核的临床疗效确切,是治疗胸腰椎结核的有效方法。

Objective To evaluate the clinical efficacy of one-stage posterior transpedicle internal fixation,anterior debridement and bone grafting between spine for the treatment of thoracic and lumbar spinal tuberculosis. Methods 34 patients with thoracic and lumbar spinal tuberculosis were treated by one-stage posterior approach plating, anterior approach focus clearance and bone grafting between spine. Evaluation including neurologic function assessment according to Frankel grade, time of bone fusion, correction of deformity and complication was carried out. Results Among 34 cases, 25 cases were excellent, nine cases were good. All the tuberculose focus were cleared completely ,the operative incisions were primary healing without sinus formation and recurrence of spinal tuberculosis. Kyphosis correction were achieved by 19.8°± 3.7°on average postoperatively ,spinal solid fusion between the spine was shown radiologically in （4.5 ± 1.4） months on average. Conclusion One-stage posterior transpedicle internal fixation ,anterior debridement and bone grafting between spine for the treatment of thoracic and lumbar spinal tuberculosis has significant effect, which is a very effective option for treatment of thoracic and lumbar spinal tuberculosis.