一期前路病灶清除植骨融合内固定治疗胸腰椎结核

Anterior focus debridement with graft bone fusion and internal fixation in the treatment of thoracolumbar vertebra tuberculosis in one-stage

目的探讨胸腰椎结核前路病灶清除植骨内固定术的手术时机、手术方式及治疗效果。方法对52例胸腰椎结核采用一期前路病灶清除、椎体间植骨、内固定术后的患者随访。观察术后疼痛缓解、神经功能恢复、后凸畸形矫正及脊柱的稳定性。对手术时机、手术方式、治疗效果进行回顾性分析评价。结果随访12～24个月,平均18个月,52例病灶全部愈合,无复发;达到植骨融合标准49例,虽未达到标准3例,但疼痛消失,植骨内固定稳定,恢复日常生活。发生术后早期感染1例,经及时处理愈合;15例伴有脊髓神经受压症状患者术后3个月恢复14例,1例截瘫未恢复。术前脊柱后凸Cobb角0°～60.2°,平均30.4°,术后Cobb角-5°～35.2°,平均12.7°,较术前后平均矫正17.7°,术后1年Cobb角丢失0°～11°,平均丢失2.4°。结论一期前路病灶清除植骨融合内固定治疗胸腰椎结核,具有病灶清除彻底、直视下减压安全充分、复发率低、矫正后凸畸形满意、早期恢复脊柱稳定性等优点,临床效果满意。

Objective To evaluate the timing of operation, operative approach and clinical efficacy of anterior focus debridement with graft bone fusion and internal fixation in the treatment of thoracolumbar vertebra tuberculosis in one - stage . Methods 52 cases of thoracolumbar vertebra tuberculosis were treated with anterior focus debridement with graft bone fusion and internal fixation. All patients were followed-up for 12 - 24 months （ meanl8 months）. Relief of pain, progTess of the neurological function, kyphosis correction and spinal stability were evaluated. The operation time, method and clinical efficacy were analyzed retrospectively. Results All cases were healed withont recurrence, in which 49 cases achieved standard fusion of grafted bone, 3 cases experienced disappearance of pain and came back to daily life although the slandard recovery was not achieved, and 1 case got pest - operative infection, and recovered with timely treatment. In addition, 15 cases had the symptoms due to preoperatively compressed spinal cord and nerve, in which 14 cases recovered in 3 months after operation. The preoperative Cobb angle was 0° - - 60.2° （ mean 30.4°） and the postoperative Cobb angle was -5°- -35.2°（ mean 12.7°）. The mean correction Cobb angle was 17.7°. The loss of correction Cobb angle was 0° - - 11°in one year, （ mean 2.4°） . Conclusion The treatment of thoracolumbar vertebra tuberculosis by anterior focus debridement with graft bone fusion and internal fixation is effective because it can decrease the rate of recurrence, correct kyphosis deformity and stabilize the spinal junction in early stage.