一期前路病灶清除植骨内固定治疗胸腰椎结核(英文)

Anterior radical debridement and interbody bone grafting with onestage anterior or posterior instrumentation for treatments 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。方法自2001年1月～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。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1.5～5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个月红细胞沉降率(ESR)下降到正常。全部28例不全性截瘫患者中有27例于术后24h～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1例脊柱结核复发。结论一期前路或后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 interbody bone grafting with one-stage anterior or posterior instrumentation for the treatment of thoracic and lumbar tuberculosis. [Methods] 68 cases of thoracic and lumbar tuberculosis were surgically treated by anterior radical debridement and autogenous ilium or titanium cage interbody bone grafting with one-stage anterior or posterior instrumentation from Jan. 2001 to Feb. 2006. They were followed up to determine the effectiveness of intervertebral bony fusion, corrections of spinal kyphosis and restorations of neurological deficit. [Results] The follow-up period ranged from 1.5 years to 5 years （mean 36 months）. Sinus tract formation occurred postoperatively only in 3 cases and healed after continuous dressing changes. These patients＇ erythrocyte sedimentation rates （ESR） decreased to normal level after an average of 3.2 months after operation. Among all the 28 paraplegia patients, there were 27 patients whose feeling, motion and sphincter functions gradually recovered 24 hours to 3 months after operation and ASIA grades increased at least one grade at final follow-up. Only 1 patient did not recover at all and his ASIA grade did not increase at final follow-up. All the patients achieved complete intervertebral bony fusion 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 deformity was 41.2° preoperatively and decreased to 13.6° in 1 week postoperatively. The angle maintained 15.8° at final follow-up and average loss of correction was only 2.2°. There were no recurrences in all the eases. [Conclusions] The method of anterior radical debridement and interbody bone grafting with one-stage anterior or posterior instrumentation is effective for the treatment of thoracic and lumbar spinal tuberculosis.