颈椎结核的外科治疗策略与疗效评价

Evaluation of the effect and strategy of surgical treatment of cervical spine tuberculosis

目的探讨颈椎结核的外科治疗策略并对临床疗效进行评价。方法24例颈椎结核患者均行颈椎前路病灶清除术,其中3例同期行后路病灶清除术,钛网植骨及颈前路钢板内固定,后路钉棒系统内固定。术后继续抗结核治疗12～18个月。结果平均出血量(225±30)ml。24例均获得随访,时间8～44个月,随访期间均未见结核复发。脊髓及神经根压迫症状均有不同程度的改善。JOA评分由6.4～14.3(11.5±1.3)分提高到8.2～18.6(16.3±0.7)分。无颈椎塌陷和内固定失败发生。结论外科综合治疗颈椎结核可获得满意的临床疗效。

Objective To study the strategy of surgical treatment of cervical spine tuberculosis and to evaluate curative effect.Methods 24 patients suffered from cervical tuberculosis had been treated with anterior debridement,bone graft with titanium cage and plate fixation,and 3 of which were undergone posterior debridement simultaneously.The involved site included 14 cases of C3 to C4 and 10 cases of C5 to C7.The average JOA score was 6.4～14.3（11.5±1.3） before surgery.All cases were treated with regular antituberculosis drugs from 12 to 18 months.Results The average follow-up range was 27 months（from 8 to 44 months）.There was no recurrence of spine tuberculosis.Average bleeding volume was（225±30） ml in the operation.Compression symptom of spinal cord and nerve root was relieved in some degree,and the average JOA score was 8.2～18.6（16.3±6.7） after the operation.There were no cervical spine collapse and internal fixation failure.Conclusions The strategy of combined surgical treatment was a better method for the cervical tuberculosis.