前后联合入路治疗腰椎结核

Anterior and posterior combined operation for treatment of lumbar tuberculosis

[目的]探讨一期后路椎弓根钉系统矫形固定、前路病灶清除加钛网植骨支撑治疗腰椎结核的疗效。[方法]回顾性分析一期后路椎弓根系统矫形固定、前路病灶清除加钛网支撑治疗腰椎结核43例,按照美国脊髓损伤协会(ASIA)2000年的脊髓损伤分级方法评定患者的神经功能,根据X线片或者CT评价植骨融合时间、术后及随访期内矫正角度及椎体高度变化情况。[结果]41例病人获得随访,时间24～36个月(平均28.3个月)。所有病人都获得骨性融合,平均融合时间为4.7个月;神经功能皆有不同程度的恢复;后凸畸形平均矫正21.3°,丢失1.4°;椎体高度平均恢复10.2mm,平均丢失2.4mm;随访期内结核无复发。[结论]一期后路椎弓根钉系统复位固定、前路病灶清除加钛网植骨支撑是治疗腰椎结核的一种安全有效方法。

[ Objective] To determine the efficacy of one - stage posterior deformity correction with transpedicular screw system and anterior radical debridement following reconstuction with titanium mesh cage for treatment of lumbar tuberculosis. [Methods] Forty- three patients with lumbar tuberculosis were treated operatively through anterior and posterior combined ap- proach. The postoperative neurologic status （ASIA, 2000） , graft fusion, deformity correction and complications were observed and analyzed respectively. [ Results ] Forty - one patients were followed up for a duration of 24 ~ 36 months （ mean 28.3 months） . A solid fusion was achived in all cases. The neurologic function was improved in all patients in different grades. The mean kyphotic angle was corrected by 21.3 degrees, the angle loss was 1° -3° , the mean vertebral height was restored by 10. 2 mm, the mean height loss was 2. 4 mm. There was no recurrence of the tuberculosis infection. [ Conclusion ] One - stage posterior deformity correction with transpedicular screw system and anterior radical debridement following reconstuction with titanium mesh cage is a safe and effective method in the surgical management of lumbar tuberculosis.