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植骨内固定治疗胸腰椎结核的疗效。方法23例胸腰椎结核患者采用一期前路或侧前方入路病灶清除、植骨,后路椎弓根螺钉固定、椎板间植骨融合。根据术前、术后X线片和MRI分析脊柱后凸畸形的矫正、植骨融合以及脊髓损害的恢复情况。结果23例均获得随访,时间12～24个月,患者均未出现结核播散,植骨全部融合,在3～6个月均获得牢固愈合,后凸畸形得到矫正,无侧弯畸形,Cobb角术前平均为(37±11)°,术后为(17±5)°。患者全身状况良好,受损神经均有不同程度的恢复。结论对有明显椎体破坏及脊髓受损的胸腰椎结核患者行一期前路病灶清除植骨内固定术,能有效防止远期手术矫正脊柱后凸畸形不理想以及早期阻止脊髓的不可逆损害,为脊柱融合提供一个稳定的力学环境。

Objective To evaluate the clinical application of anterior focus clearance and bone graft and posterior approach pedicle internal fixation thoracolumbar tuberculosis. Methods A total of 23 patients with thoracolumbar tuberculosis were treated with anterior focus clearance and bone graft and posterior approach pedicle internal fixation. The efficacy of bone graft fusion and reformation of spinal injury were analyzed according to X-ray and MRI before and after operation. Results All cases were followed up for 12 -24 months postoperatively. All cases got solid fusion in 3 -6 months without tuberculosis dissemination and recurrence after operation. The average Cobb＇s angle was corrected from 37 degree preoperatively to 17.5 degree postoperatively. All cases got recovery of neural function in certain degree. Conclusions Patients with thoracolumbar tuberculosis can be successfully treated by anterior focus clearance,bone graft and posterior approach pedicle internal fixation which corrects kyphosis deformity effectively and precludes failure of kyphosis deformity correction later and irreversible neural injury, and provides a stable mechanics condition for spinal fusion.