进展期结核性脊柱后凸的外科治疗

Deformity correction for kyphosis resulting from progressive spinal tuberculosis

目的探讨进展期结核性脊柱后凸后路手术矫形的临床效果。方法回顾性分析1998年10月～2006年10月25例采用后路手术治疗进展期结核性脊柱后凸患者的病例资料。男10例,女15例。平均年龄36.1岁(12～62岁)。病程平均4年3个月(2年7个月～11年)。病变累及椎体平均2.2节段(1～4节段),病变部位T7～L3°术后抗结核治疗时间平均9.4个月(7～23个月),随访时间平均24.3个月(9～59个月)。其中后凸21例,侧后凸4例,术前脊柱后凸角平均60.3°(19°～130°)。结果21例患者行一期后路结核病灶清除、椎管减压及椎体截骨、Luque棒结合节段椎弓根螺钉系统固定及植骨矫正,4例进行了二期前路椎间植骨。除2例患者失去随访外,其他患者随访时X线片均显示截骨区骨融合良好,25例患者术后脊柱后凸角度平均17.3°(-10°～60°),后凸矫正率平均71.3%(53.9%～152.6%)。19例随访患者的后凸矫正丢失率平均5.8%(3.6%～9.3%)。结论进展期结核性脊柱后凸患者可采用一期后路病灶清除、椎体截骨、椎管减压及Luque棒结合节段椎弓根螺钉系统固定手术。对部分多节段椎体破坏严重的患者,需同期或二期行前路椎间植骨,以免融合及内固定失败。

Objective To study the clinical outcome of deformity correction for kyphosis during progressive phase of spinal tuberculosis through one-staged posterior approach. Methods From 1998. Oct to 2006. Oct, 25 patients with kyphosis deformity caused by progressive spinal tuberculosis underwent corrective operation through posterior approach in our hospital. Ten of them were male, and 15 were female, with the average age of 36.1 years. The course of disease ranged from 31 months to 11 years. The average number of affected vertebrae was 2.2 segments （1 to 4 segments）, and the site of onset located between T7 and L3. The average time of chemotherapy and the follow-up were 9.4 months （7 to 23 months） and 24.3 months （9 to 59months） respectively. Twenty-one patients sustained kyphosis defomity, and 4 sustained kyphoscoliosis. The average pre-operative kyphotic angle was 60.3° （19° to 130°）. Twenty-one patients underwent posterior debridment and decompression, kyphectomy, transpedicular instrumentation and chemotherapy, and 4 under- went second stage anterior interbody infusion. Results At follow-up, plain radiograph indicated good grafted bone fusion masses in the area of kyphectomy in all patients. No patient had relapse of tuberculosis. The average kyphotic angle was reduced to 17.3 ° （- 10° to 60°）, and the rate of kyphosis correction was 71.3% （53.9% - 152.6%）. The average correction loss was 5.8% at follow-up. Conclusion The one-staged posterior debridment and decompression with transpedicular instrumentation is effective for the progressive kyphosis of spinal tuberculosis .However, for these patients who sustain multiple segmental involvement, an additional anterior fusion is necessary.