一期病灶清除植骨后路内固定治疗胸腰椎结核

First Remove Bone Lesions in the Posterior Internal Fixation Treatment of Thoracic and Lumbar Vertebrae Tuberculosis

目的:探讨一期病灶清除植骨后路内固定治疗胸腰椎结核的临床疗效。方法:用一期前路病灶清除后路钉捧内固定治疗胸腰椎结核24例。术前均行X线片、CT、MR检查,抗结核2～4周。13例伴有驰缓性瘫痪者术前后采用Frankel分级标准评定神经功能的恢复。结果:全部病例获得随访,随访时间1.5～4年(平均2.6年),切口均一期愈合,病灶全部愈合,1例窦道形成。18例后凸畸形(C0bb角)术前1°～42°(平均29°),术后4°～13°(平均10.2°),终末随访时畸形矫正角度丢失平均1.7°,植骨平均融合时间5.7个月,至终末随访时无1例内固定失败。结论:一期前路病灶清除植骨后路内固定治疗胸腰椎结核,彻底清除病灶、椎管减压,矫正后凸畸形,重建脊柱稳定性,缩短病程,但创伤大。

Objective：To investigate first thase removeal abone lesions in the posterior internal fixation treatment of thoracic and lumbar vertebrae tuberculosis clinical curative effect. Methods：we use an anterior debridement and posterior screw-rod internal fixation to treat 24 cases of thoracolumbar tuberculosis. In the Preoperative, did X-ray,CT,MRI examination and Anti-tuberculosis 2-4 weeks. 13 patients with delayed sex paralytic evaluation nerve function recovery according to Frankel grading standards in preoperative and postoperative. Results ：All cases were obtained ,follow-up time 1.5-4 years （average 2.6years）, All incisions were I healed, all lesions healed, 1 case of sinus come into being. 18 cases of kyphosis （cobb angle）is 100-420 in the preoperative ,and 40-130（average 10.20）.At the final follow-up , angle of deformity correction lost an average 1.70,13 cases of paraplegia after operation recovery according to Frankel classification standard： B class is 4 cases ,and 2 cases back to C class ,1 case back to D class; C class is 5 cases ,and 4 cases back to D class, 1 case back to E class; D class is 3 case and all back to E class. All healing bone graft, the average fusion time of 5.7 months. No failure of internal fixation was found dur- ing follow-up. Conclusion：Treatment of thoracolumbar spinal tuberculosis with an anterior debridement and posterior bone graft internal fixation could complete removal of lesions, decompression, correction of deformity after reconstruction of spinal stability, shorten the course of disease ,but prove to have major trauma.