一期前路病灶清除植骨内固定治疗胸腰椎结核的疗效

Anterior radical debridement and bone grafting with one-stage instrumentation anteriorly or pesterioriy for the treatment of thoracic and lumbar spinal tuberculosis

目的总结一期前路病灶清除植骨内固定治疗胸腰椎结核的临床效果。方法白2001年1月至2006年2月采用一期前路病灶清除、椎间自体髂骨或钛笼植入、前路或后路内固定治疗胸、腰椎结核68例，男39例，女29例。年龄28—76岁，平均36．8岁。病程3个月至1．5年，平均8个月。随访观察植骨融合、脊柱后凸畸形的矫正效果以及神经功能恢复情况。结果随访1．5至5年，平均36个月。3例患者术后出现窦道，经换药后伤口均愈合。术后平均3．2个月ESR下降到正常。28例不全性截瘫患者中，27例于术后24h至3个月感觉、肌力及括约肌功能逐渐恢复，末次随访时美国脊髓损伤协会（ASIA）分级提高；仅1例术后神经功能无明显改善，末次随访时ASIA分级无变化。植骨均获骨性融合，愈合时间3—15个月，平均4．8个月。内固定物无松动、脱出及断裂。术前平均脊柱后凸度数Cobb角为41．2°，术后1周平均Cobb角为13．6°，平均矫正27．6°；末次随访平均Cobb角为15．8°，平均丢失2．2°。无脊柱结核复发。结论一期前路病灶清除植骨内固定治疗胸腰椎结核可以获得满意的临床效果。

Objective To evaluate the clinical outcomes of anterior radical debridement and autologons ilium or titanium cage interbody autografting with one-stage instrumentation anteriorly or posteriorly for the treatment of thoracic and lumbar tuberculosis. Methods Sixty-eight cases of thoracic and lumbar tuberculosis were surgically treated with anterior radical debridement and autologous ilium or titanium cage interbody autografting with one-stage instrumentation anteriorly or posteriorly from Jan 2001 to Feb 2006. Thirty-nine were male and 29 were female age ranged from 28 to 76 years, （ average 36. 8 years. The course of illness was from 3 months to 1.5 years average 8 months）. Fifty-five of them underwent anterior instrumentations, and the remaining underwent posterior instrumentations. All patients were followed up to determine the stages of intervertebral bony fusion and the corrections of spinal kyphosis and the restoration of neurological deficit. Results The follow-up period ranged from 1.5 years to 5 years （ mean 36 months）. Sinus formation occurred in 3 cases and healed after continuous dressing changes. The ESR of these patients decreased to normal levels after an average of 3.2 months postoperatively. The functions of feeling, motion and sphincter in 27 cases among all 28 paraplegia cases gradually recovered 24 h to 3 months postoperatively and ASIA grades increased at least one grade at the final follow-up. Only 1 case did not recover at all and ASIA grade did not increase at the final follow-up. Intervertebral bony fusions were all achieved for a mean of 4. 8 months （ranged from 3 to 15 months） postoperatively. No internal fixation devices were loose, extracted or broken Average Cobb angle of kyphotic deformities was 41.2 degree preoperatively and decreased to 13.6 degree at 1 week postoperatively. The average correction was 27.6 degree. The average Cobb angle was 15.8 degree at the final follow-up and the average loss of correction was only 2. 2 degree. There were no recto＇fences in all cases. Conclusion The method of anterior radical debridement and interbody grafting with one-stage instrumentation anteriorly or posteriorly was effective for the treatment of thoracic and lumbar spinal tuberculosis.