胸椎稳定性重建中应用椎间植骨与AO Ventrofix内固定系统联合治疗的特点

AO Ventrofix system plus bone graft in the treatment of thoracic vertebrae tuberculosis

目的:探讨AO Ventrofix系统在胸椎结核病灶清除植骨应用的临床效果及胸椎稳定性评价。方法:自2004-10/2006-12河南省人民医院骨科采用手术治疗胸椎结核患者30例,平均年龄34岁。经术前正规抗结核药物化疗后行病椎死骨刮除,周边脓肿、死骨、肉芽组织及干酪样物质等结核病灶清除,椎间大块自体骨植骨或钛网植入自体骨粒植骨,一期行前路内固定术,术后继续抗结核治疗1～1.5年。结果:术后3个月随访1例,6个月随访5例,12个月随访14例,16个月随访5例,18个月随访3例,24个月随访2例。经影像学观察,无结核复发,螺钉松动,内固定物断裂;全部病例植骨呈现骨性融合;其中10例脊髓功能障碍的患者中有7例得到明显改善;术后2例出现肺不张。结论:胸椎结核治疗行病灶清除,植骨融合,内固定系统的联合应用效果确切,脊柱前路固定系统Ventrofix具有固定性强、生物力学稳定及生物相容性良好的特点,在胸椎结核前路手术中有较好的临床疗效。

AIM： To explore the clinical value and thoracic vertebrae stability of AO Ventrofix system and bone graft in the treatment of thoracic vertebrae tuberculosis. METHODS： From October 2004 to December 2006, 30 patients with thoracic vertebrae tuberculosis, who were surgically treated in Department of Orthopedics, Henan People＇s Hospital, were selected with average age of 34 years. After routine antituberculosis chemotherapy, the patients were treated by dead bone erasion and tuberculose focus removal of abscess, dead bone, granulation tissue and cheese-like substance, intervertebral body fusion with bone graft and Ventrofix system. The antituberculosis chemotherapy was carried out for 1 to 1.5 years postoperatively. RESULTS： One patient was followed up for 3 months postoperatively, 5 for 6 months, 14 for 12 months, 5 for 16 months, 3 for 18 months and 2 for 24 months. Imaging examination showed that no tuberculosis recurrence, screw loosening, or breakage of internal fixator. All patients achieved solid fusion. Seven patients of 10 with neurologic deficits were improved after operation, and 2 cases were found pulmonary closure. CONCLUSION： The combination of focus clearance, bone granule grafting, and internal fixation presents positive effect on thoracic vertebrae tuberculosis. Ventrofix system is of reliable fixation, high biomechanical stability and good biology compatibility. It is a good way to treat thoracic vertebrae tuberculosis with anterior approach.