一期后路内固定并前路病灶清除植骨融合治疗胸腰椎结核

One-stage posterior internal fixation and anterior interbody fusion with focal cleaning and bone grafting for thoracic and lumbar tuberculosis

目的探讨采用一期后路椎弓根钉棒系统内固定并前路病灶清除植骨融合术治疗胸腰椎结核的临床疗效。方法回顾分析2005年1月～2008年12月收治的31例胸腰椎结核患者,先经后路行病变节段脊柱椎弓根钉棒系统内固定术,再经前路行病灶清除整块自体髂骨植骨融合术。结果全部病例术后切口均Ⅰ期愈合。除4例失访外,27例获得1～4年随访,平均2.1年。除复发病例2例外,其余病例椎体间植骨全部达到骨性融合,平均融合时间为6个月,治愈率达92.6%(25/27)。脊柱后凸畸形平均矫正21.3°,随访期内无明显丢失。7例有神经功能损害的患者均有一定程度恢复,平均恢复1.3级。结论本术式是目前治疗胸腰椎结核一种较好的手术方式,具有如下优势:内固定物不在病灶内,安全性更高,大大降低了复发的可能性;后路内固定可使病变节段获得即刻稳定,还可以有效纠正后凸畸形和防止后凸畸形加重;满足了脊柱的生物力学要求,可提高植骨融合率;同时具备前路手术病灶显露良好易于处理的优点。

Objective To evaluate the curative effect of one-stage posterior internal fixation and anterior interbody fusion with focal cleaning and bone grafting for thoracic and lumbar tuberculosis.Methods From January 2005 to December 2008,31 patients with thoracic and lumbar tuberculosis who were treated with one-stage posterior internal fixation and anterior interbody fusion with focal cleaning and bone grafting were analyzed retrospectively.Results The incision of all the cases were one-stage healing.Except for 4 patients who were lost during the follow-up,27 patients were followed up for 1-4 years（mean 2.1 years）.Relapses occurred in 2 cases,and the other 25 patients obtained bone fusion.Bone fusion occurred with a mean healing time of 6 months,and curative rate was 92.6%（25/27）.Malformation of kyphosis was corrected by 21.3° on average,and there were no significant loss during the follow-up stage.Neural function damage of 7 cases was recovered at some degree,and the mean value was 1.3 grade.Conclusion This technique is an effective method for treating thoracic and lumbar tuberculosis.It has the advantage of higher safety for internal fixation being away from the focus,segmental lesions obtaining instant stabilization,decreasing the possibility of relapse,correcting malformation of kyphosis,preventing malformation of kyphosis from aggravating.Posterior pedicle screw rod system is conformed to the biomechanism of spine,and it also has a higher fusion rate of implanted bone.Meanwhile,the lesion can reveal well to be handled in this technique as anterior operation.