前路病灶清除植骨内固定术治疗胸腰椎结核

Anterior radical debridement with autograft bone fusion and internal fixation in treating of thoracic and lumbar spine tuberculosis

目的探讨一期前路病灶清除植骨内固定术治疗胸腰椎结核的临床疗效。方法全组15例,男9例,女6例,年龄25～66岁,平均36岁。4例伴有不全性瘫痪,神经功能按Frankel分级为D级。术前后凸角-4°～54°,平均29°。手术采用一期前路病灶清除椎间植骨前路钉板系统固定进行治疗。术后给予12～18个月抗结核治疗,随访观察术后症状改善,神经功能恢复,后凸畸形矫正,植骨融合及并发症情况。结果术后后凸畸形矫正至-6°～19°,平均9°。随访8～34个月,平均17个月,患者腰背部疼痛消失,4例术前有神经功能损害的,术后Frankel分级提高至E级。全组均获得骨性融合,植骨融合时间为3～6个月,平均4个月。终末随访时后凸角-5°～23°,平均11°。未见植入物断裂、结核复发和窦道形成等并发症。结论一期前路病灶清除植骨内固定术治疗胸腰椎结核能够矫正畸形,稳定脊柱,促进植骨融合。

Objective To investigate clinical efficacy of an anterior debridement with autograft bone fusion and internal fixation in treating thoracolumbar spine tuberculosis. Methods There were 15 cases included in this series, 9 males and 6 females. The age ranges from 25 to 66 years old（mean 36 years old）. With four cases of incomplete paralysis, nerve function was in grade D according to Frankel classification. The kyphosis angle was -4°-54° with a mean of 29° preoperatively. Patient was treated by an antenior radical debridement combined with autograft bone fusion and internal fixation screwplate. After 12 to 18 months of anti-tuberculosis chemotherapy, folllow-up observation of symptoms were improved, recovery of neurological function, correction of kyphosis, fusion and complications was obtained. Results The kyphosis correction was -6°-19°, with the average of 9°. The follow-up period was 8 to 34 months, with the average of 17 months, and low back pain of patients disappeared. There were four cases of preoperative neurological damage, with postoperative improvement of Frankel grade to E grade. Bony fusion was tbund in 3-6 months, with the average of 4 months. Kyphosis angle at the end of follow-up was -5°-23°, with the average of 11°. No complications such as implants rupture, tuberculosis recurrence and sinus formation was found. Conclusion The results of anterior radical debridement with autograft bone fusion and internal fixation to treat thoracolumbar spine tuberculosis is satisfactory, which possesses the advantages of correcting the kyphotic deformity, restorating the stability of spine and promoting bone fusion.