人工椎体和椎间盘在胸腰椎结核中的疗效

Therapeutic effect of artificial vertebrae body and intercalated disc in the applied effect of thoracic and lumbar spinal tuberculosis

[目的]总结框架人工椎体和椎间盘在胸腰椎结核中应用的疗效。[方法]2002年4月～2006年7月收治具有24个月以上完整随访资料的脊柱结核33例,其中椎体置换28例,椎间盘5例。胸椎体结核T7～1213例,胸腰段T12L1、24例,腰椎体结核L1～516例。完全截瘫4例,不完全截瘫8例,有马尾神经综合征10例。20例有后凸畸形15°～45°,平均25.69°。并发浸润性肺结核23例,结核性胸膜炎和淋巴腺结核4例。一期彻底切除病灶,恢复病椎骨膜功能,营造病椎局部良好血运环境的基础上,撑开椎体、纠正脊柱后凸畸形、固定并维持脊柱稳定性、植骨重建缺损椎骨的骨性结构。术后定期X线和CT检查手术椎节稳定性、运动功能和融合情况。[结果]随访时间24～51个月,其中36个月以上21例,平均37个月。除1例病灶复发,2例完全截瘫患者未完全恢复外,余30例恢复。20例后凸畸形纠正角度15°～30°,平均纠正21.03°。其他病人最后一次复查骨重建理想、人工椎体稳定,血沉、血象等基本正常,骨结核治愈率96.97%。[结论]在全程、规律、足量、联合的抗结核化疗保护下,切除结核病灶,一期应用框架人工椎体或椎间盘治疗由胸腰椎结核引起的骨缺损及其并发症是可行的。

[Objective]To analyze the therapeutic effect of artificial vertebra body with framework（AVBF） and artificial intercalated disk with framework（AIDF） in thoracic and lumbar spinal tuberculosis（ST）.[Method]Thirty-three cases of spinal tuberculosis had been treated and followed up for 24 months from April 2002 to July 2006.Twenty-eight cases were replaced by AVBF and 5 cases were replaced by AIDF.There were 13 cases of T7～12 spinal tuberculosis,4 cases of T12.L1、2,16 cases of L1～5.There were 4 cases of complete paraplegia,8 cases of incomplete paraplegia and 10 cases of syndrome of coccygeal nervi.There were 20 cases of an angle of humpback from 15° to 45°,average 25.69°.There were 23 cases of complication of infiltrative pulmonary tuberculosis,4 cases of tuberculous pleurisy and 4 cases of scrofula.After the tubercular focus was resected entirely,the function of periosteum of sick vertebra was resumed and blood circulation was restored again in the location of ST.AVBF was braced between the survival vertebral bodies,redressed spinal backward malformation,maintained spinal stability and rebuilt skeletal structure by the bone grafting.The vertebrae post-operation were evaluated about the spinal stability,fusion of survival vertebrae and motor function of AVBF by X-ray and CT.[Result]All cases were followed up for 24 to 51 months,average 36 months and 21 cases of the total were followed up over 36 months.Except the 2 cases of complete paraplegia recovered partially and 1 case recrudesced,30 cases were recovered completely.Reconstruction and stability of the segments of spine,ESR and WBC were normal.Tuberculosis was cured with the rate 96.7%.The 20 cases with backward malformed were corrected by 15°～30°,average 21.03°.[Conclusion]Entirely excised tubercular focus and applied AVBF and AIDF based on full range,regularly,full dose and confederative anti-tuberculosis medicine treatment.