单一体位后前联合入路治疗胸腰椎结核的临床观察

Combined posterior and anterior approach for thoracolumbar spinal tuberculosis in one position

目的探索单一体位行后路内固定、前路病灶清除植骨术治疗胸腰椎结核的可行性。方法自2008年1月至2009年12月对9例胸腰椎结核病人行单一体位前后联合病灶清除植骨内固定术。男6例,女3例,平均年龄42岁(27～61岁)。胸腰段2例,腰椎7例;累及2个节段8例,3个节段1例;5例伴有不同程度的脊髓和/或神经根受压的症状。所有病例均在抗结核治疗2～3周后行单一体位后路内固定、前路病灶清除植骨手术治疗。结果所有病例获得平均15个月随访(6～30月)。1例患者术后半年复发。8例均未出现复发和窦道形成,并于术后6个月复查时见植骨完全融合。5例术前伴有神经症状的患者术后完全恢复。结论单一体位下后路固定、前路病灶清除植骨术是一种治疗胸腰椎结核可行的方法。病变位于T12-L3为最佳部位,术者必须熟练掌握侧卧位的椎弓根钉植入技术。

Objective To explore the clinical value of combined posterior and anterior operation for thoracolumbar spinal tuberculosis in one position.Methods Data of 9 patients with thoracolumbar tuberculosis undergoing the operation of debridement and fusion with instrumentation in one position between Jan,2008 to Dec,2009 were documented retrospectively.There were 6 males and 3 females with the mean age of 42 years old （27~61 years old）.2 patients with thoracolumbar,and 7 patients with lumbar spinal tuberculosis;2 spinal segments were involved in 8 patients,3 segments in 1 patient.5 patients with different spinal cord or never root injury symptoms.Patients should be adopted anti-tuberculosis therapy for 2~3 weeks preoperatively,the combined operations,posterior spinal internal fixation and anterior lesion debridement and grafting fusion surgery in one position were performed in 9 cases.Results All patients were followed-up 6~30 months with the mean time of 15 months.one patient developed recurrence 6 months postoperatively.8 patients got bony fusion at the average of 6 months after operation.The neurological function recovered postoperatively.Conclusion The combined posterior and anterior operation for thoracolumbar tuberculosis in one position was a feasible method.T12 to L3 was the best lesion position for this operation.The surgeon should be familiar with the pedicle screw insertion technique in lateral position.