前路病灶清除植骨钛板内固定治疗下颈椎结核

Anterior debridement and autograft with internal fixation for tuberculosis lesion of the lower cervical spine

[目的]探讨前路一期病灶清除、植骨内固定治疗下颈椎结核的手术方法及效果。[方法]30例下颈椎结核患者，术前四联抗痨治疗至少3周后，采用前路行一期病灶清除、前路减压及植骨内固定融合术。男22例，女8例；平均年龄为37岁。术前检查病变累及2个椎体者21例，3个椎体者9例。按Frankel分级：B级5例，C级5例，D级13例，E级7例。术前颈椎平均后凸角为12°。[结果]所有患者都能很好的耐受手术，术中显露清楚，病灶清除彻底。手术时间为70～100min，出血量为50～150ml。无手术并发症发生。所有患者均得到随访，随访时间24～36个月，平均30个月。末次随访中，23例合并有神经系统症状患者中，5例B级恢复到D级，3例C级恢复到D级，2例C级恢复到E级，13例D级恢复到E级。随访中结核病灶无复发，无断钉及内固定失效发生。椎间植骨均获骨性融合，融合平均时间为6．5个月。[结论]经前方人路一期病灶清除、植骨钛板内固定手术是治疗下颈椎结核的有效方法。

[ Objective ] To assess the efficacy of autograft fusion and anterior spinal stabilization as an alternative treatment for tuberculosis lesion of the lower cervical spine. [ Methods ] Thirty patients with tuberculosis of the lower cervical spine underwent anterior decompression and fusion. There were 22 male and 8 female with the age from 24 to 58 years （ mean age, 37 years） . The involved area included 2 vertebral bodies in 21 patients, 3 vertebral bodies in 9 patients . Combined chemotherapy was delivered to each patient for at least three weeks preoperatively. There were 5 patients with Frankel Grade B, 5 with Grade C, 13 with Grade D and 7 with Grade E. The mean kyphosis angle were 12°. [Results] The patiets stood surgery well. The operation time was 70 - 100 min and the bleeding during operation was 50 - 150ml. There was no postoperative complication. All patients were followed up for 24 - 36 months. At the last follow - up visit, 5 cases with Frankel Grade B improved to Grade D, 3 cases with Grade C improved to Grade D, 2 cases with Grade C improved to Grade E, 13 cases with Grade D improved to Grade E. There was no breakage of nails or failure of the internal fixation during the follow up. Stable bone union was observed in all cases and the average time required for fusion were 6. 5 months. [ Conclusion] Anterior debridement and autograft with internal fixation is a safe and effective method for treatment of the lower cervical tuberculosis.