一期前路病灶清除后路椎弓根螺钉内固定治疗胸腰椎结核

Treatment of Thoracolumbar Spinal Tuberculosis by One Stage Focus Clearance,Anterior and Posterior Approach Internal Fixation

【目的】探讨一期前路病灶清除、钛网植骨、后路经椎弓根螺钉内固定治疗胸腰椎结核的临床疗效。【方法】自2002年1月至2006年6月收治46例胸腰椎结核患者,采用一期前路病灶清除、钛网植骨、后路经椎弓根螺钉内固定。根据术前、术后X线片分析植骨融合情况以及脊柱后凸畸形矫正的效果。【结果】本组46例均获得随访,随访时间1～3年,平均26个月。术后内固定无松动,植骨愈合,病灶无复发;愈合时间3～7个月;术前Cobb角平均35°,末次X线片随访复查Cobb角平均16.5°。【结论】一期前路病灶清除、钛网植骨、后路经椎弓根螺钉内固定治疗胸腰椎结核,既能彻底清除病灶,又能有效矫正脊柱后凸畸形,重建脊柱稳定,临床效果满意。

[Objective] To evaluate the clinical efficacy of anterior focus clearance and bone graft with titanium mesh cage and posterior approach pedicle internal fixation in thoracolumbar tuberculosis. [Methods] A total of 46 patients with thoracolumbar tuberculosis were treated with anterior focus clearance and bone graft with titanium mash cage and posterior approach pedicle internal fixation. The efficacy of bone graft fusion and kyphosis deformity were analyzed according to X-ray before and after operation. [Results] All cases were followed up from 1 to 3 years （mean 26 months） postoperatively. All the cases got solid fusion in 3-7 months without any recurrence. The average Cobb＇s angle was corrected from 35 degree preoperatively to 16.5 degree postoperatively. [Conclusion] Patients with thoracolumbar tuberculosis can be successfully treated by anterior focus clearance, bone graft with titanium mesh cage and posterior approach pedical internal fixation which allows thorough clearance of focus, effective correction of kyphosis deformity, the stability of spinal reconstruction and solid graft fusion. Its clinical efficacy is satisfactory.