后路经椎弓根病灶清除、自体及同种异体骨植骨融合并节段性内固定治疗胸腰椎结核

Posterior transpedicular radical debridement, bone fusion and segmental fixation for the treatment of thoracic and lumbar tuberculosis

回顾性分析2006-01/2008-06中南大学湘雅医院脊柱外科收治的脊柱结核患者22例,男15例,女7例;年龄17～50岁。其中胸椎结核8例,胸腰段结核4例,腰椎结核10例。均以胸腰背部疼痛首诊,伴瘫痪症状者10例,Frankel分级B级3例,D级7例。影像学检查主要表现为椎体骨质破坏,椎间隙变窄或消失。椎旁脓肿形成者8例,14例患者有不同程度后凸畸形。入院时平均血沉55mm/h,术前平均血沉35mm/h。全部病例采用后路经椎弓根行病灶清除、自体骨和/或同种异体骨植骨融合、以及节段内固定术治疗,观察围手术期并发症;根据术前、术后1周,术后6个月侧位X射线平片测量融合节段Cobb角;评价植骨融合情况。本组无术中并发症,术后疼痛症状消失。术后1周平均血沉20mm/h,术后1～3个月全部降至正常范围。22例患者随访6～14个月,术后6个月均获骨性融合,至终末随访时均无感染和结核复发,无内固定失败,全部患者结核治愈。10例伴有神经功能损害者末次随访时FrankelB级3例均恢复到D级,D级7例均恢复到E级。术后1周后凸Cobb角较术前减小[（12.7±7.1）°,（31.2±10.6）°,P〈0.05],术后6个月与术后1周差异无显著性意义[（12.9±7.3）°,（12.7±7.1）°,P〉0.05]。提示后路经椎弓根病灶清除、植骨内固定术是治疗胸腰椎结核行之有效的方法。

A total of 22 patients with thoracic and lumbar tuberculosis treated in Department of Spinal Surgery, Xiangya Hospital of Central South University between January 2006 and June 2008, including 15 males and 7 females, aged from 17 to 50 years, were retrospectively analyzed. Of them, there were 8 cases of thoracic tuberculosis, 4 of thoracolumbar and 10 of lumbar. The primary symptom of all patients was back pain and 10 cases were accompanied by paralysis symptoms. There were 3 cases of grade B and 7 of grade D in Frankel grading. Imaging examination showed bone destruction and intervertebrat space narrowing or vanishing. In addition, there was abscess formation in 8 cases and kyphosis in 14 cases. The average erythrocyte sedimentation rate （ESR） on admission was 55 mm/h, and the average preoperative ESR was 35 mm/h. All patients received posterior transpedicular fixation, interbody fusion with autogenous bone and/or allogeneic bone and posterior segment fixation. Data evaluation included perioperative complications, degree of kyphosis on 1 week pre-, 1 week and 6 months post-operation and the state of fusion. No intraoperative complications were found, and pain vanished following operation. The ESR at one week postoperatively was 20 mm/h, and decreased to the normal range in 1-3 months postoperatively. All cases were followed-up for 6～14 months. There was a good bone fusion at 6 months, and no infection or recurrence was found at the final follow-up. The 3 cases of grade B recovered to grade D and 7 of grade D to grade E in Frankel grading. The average preoperative Cobb angle was improved one week postoperatively compared with before operation [（12.7±7.1 ）°, （31.2±10.6）°, P 〈 0.05], but no obvious changes were found at 6 months [（12.9±7.3）°, （12.7±7.1 ）°, P 〉 0.05]. The posterior transpedicular radical debridement, bone fusion and fixation has satisfactory clinical efficacy for the treatment of thoracic and lumbar tuberculosis.