Ⅰ期前路病灶清除植骨内固定治疗胸腰椎结核

Stage Ⅰ anterior approach focus clearance and fusion with internal fixation to treat thoracic and lumbar tuberculosis

目的探讨采用Ⅰ期前路手术治疗胸腰椎结核的临床疗效。方法采用Ⅰ期前路病灶清除、植骨、内固定治疗胸腰结核19例，术后抗结核治疗。术前Frankel分级：c级4例，D级12例。结果切口均Ⅰ期愈合，无窦道形成。本组患者均获随访16～78个月，植骨块均在4～6个月融合，无植骨块松动移位发生，病灶无复发。神经功能c级4例中2例恢复至D级；2例恢复至E级；D级12例均恢复至E级。结论采用Ⅰ期前路病灶清除植骨内固定治疗胸腰椎结核疗效确切，脊柱稳定性重建可靠，促进骨性融合和病灶愈合，有利于早期适度活动，是治疗胸腰椎结核的可靠手术方法。

Objective To study the clinical results of the stage Ⅰ anterior approach operation treatment for thoracic and lumbar tuberculosis. Methods 19 patients with thoracic and lumbar tuberculosis were treated by stage Ⅰ anterior debridement and fusion, internal fixation, and antituberculosis therapy after operation. The Frankel grading：4 eases were grade C, 12 cases grade D. Results All patients were follow - up regularly after operation for 16 - 78 months. The incisions healed primarily without sinus formation. The graft fused in 4 - 6 months. There was no looseness and migration of bone graft material . The neurological status： in 4 cases with grade C, 2 cases recovered to grade D, 2 cases recovered to grade E. All 12 cases with grade D recovered to grade E. Conclusion The stage Ⅰ anterior approach focus clearance and fusing with internal fixation to treat thoracic and lumbar tuberculosis is a satisfactory and reliable technique. This treatment can reconstruct the stability of the spine in thoracic and lumbar tuberculosis, enhance the bone graft fusion, facilitate the early ambulation of the patients.