多发性中下胸椎结核手术治疗的体会

Surgical treatment of multiple thoracic spinal tuberculosis

目的探讨多发性中下胸椎（胸6以下）结核手术治疗方法的临床效果。方法对42例多发性中下胸椎结核患者采用侧前方入路行病灶清除、植骨或行内固定，手术行钛网植骨5例，侧方椎体间单钉棒固定13例。术后随访治疗效果。结果随访4—36个月，平均18个月。症状完全缓解21例，治愈率50％；部分改善16例，好转率38％，合计恢复率为88％。无内固定失败、钛网明显沉降和矢状面矫正度丢失，均获得植骨融合。5例切口至术后2～6个月延期愈合，1例死亡。41例患者经手术治疗后病情稳定，生活自理，能够从事正常的日常工作。结论手术彻底清除病灶，可靠的植骨或加用内固定及加强手术后的制动及配合药物治疗，多发性中下胸椎结核可获得较好的疗效。

Objective To evaluate the clinical efficacy of surgical treatment for muhiple thoracic spinal tuberculosis （below the 6th thoracic vertebra）. Methods There were 42 patients in this group,including 29 males and 13 females,aged between 34 and 48 years （average age：70 y）. Disease course ranged from 10 months to 4 years with the average of 21 months. There were 14 patients involving two vertebrae lesions ,21 patients involving 3 vertebral patients, and 7 ones having more than 4 vertebral patients. All of the patients had low back pain. Spinal cord compression occurred in 20 patients and differ- ent degree of paralysis in 17. Lesion resection and bone grafting or internal fixation through anterolateral approach were performed. Among the patients,5 were subjected to reconstruction with titanium mesh cage, 13 to single bar fixation between lateral vertebras. Treatment effect was observed through postoperative fol- low - up. Results The follow - up lasted 4 to 36 months with an average of 18 months. Twenty - one pa- tients had completely remission of the symptoms and 16 patents had partial remission. Total recovery rate was 88%. No internal fixation failure, Titanium mesh settlement and loss of sagittal plane correction oc- curred and all cases achieved the bone fusion. The wound healing was delayed to 2 to 6 months after the operation in 5 cases and one patient died. The condition of 41 patients after the surgical treatment was sta- ble. They had self -care ability and could engage in daily work. Conclusion Radical elimination of the lesions, reliable bone grafting, internal fixation, immobility after the operation and medications are effective in treatment of multiple thoracic spinal tuberculosis.