前路病灶清除植骨Ⅰ期前路内固定治疗脊柱结核

Anterior debridement combined with interbody bone graft and internal fixation for the treatment of spinal tuberculosis on first stage

目的评估不同节段脊柱结核前路内固定的疗效和安全性。方法46例患者平均年龄45．58岁，测量术前、术后及最终的后凸畸形的角度及病椎的融合率。在有神经系统症状的患者中，随访其神经功能恢复情况。所有患者最少随访2年，平均随访39个月。结果前路内固定能有效地纠正后凸畸形，平均矫正角度（18．58°±4．37°），有利于脊柱融合，平均丢失角度（1．72°±1．56°）。有神经症状的44例患者中27例（61．3％）全部恢复，17例（38．7％）部分恢复。所有病例没有假关节形成，无内固定失败。所有患者都临床愈合，无未愈及复发病例。结论前路病灶清除植骨内固定由于手术方法相对简单，融合节段短，能够为脊柱融合提供可靠的稳定性，融合率高，是一种治疗脊柱结核的安全有效方法。

Objective To investigate the effectiveness and safety of anterior instrumentation for different sites of involvement. Methods We measured preoperative, postoperative and final kyphosis deformities radiographically and fusion rate of vertbra in 46 tuberculous spondylitis patients （mean age, 45.58 ± 16.69）. Patients had a minimum follow up of 2 years （ average 39 months）. Results Addition of anterior instrumentation was effective in the correction of kyphosis deformity （ 18.58° ±4. 37°） and facilitated solid fusion, with an average loss of 1.72° ±1.56°. Of the 44 patients with neurologic symptoms, 27（58.69% ） achieved full and 17 （36. 95% ） achieved partial recovery. There were no formation of pseudoarthrosis and implant failures. All patients demonstrated clinical healing of tuberculosis without recurrence and reactivation. Conclusion Anterior instrumentation represents a safe and effective method for the treatment of tuberculosis spondylitis, and it may be the ideal stabilization method as a result of less segment fusion, single approach and obviating the need for external immobilization.