胸腰椎脊柱结核前后路内固定手术的选择

Selection of Internal Fixation of Combined Anterior or Posterior Approach in Treatment of Thoracic and Lumbar Spinal Tuberculosis

目的:探讨治疗不同病变节段及病变程度胸腰椎脊柱结核手术方法的选择。方法:对23例患者中,10例行前路病灶清除、植骨、内固定,13例行后路内固定、前路病灶清除植骨。其中2例分二期手术,21例一期手术。结果:术后随访6个月～3年,平均23个月。23例均一期愈合、无复发。X线片显示骨性愈合,植骨平均融合时间为8个月,后凸畸形平均纠正29°,随访期间丢失2°。瘫痪均恢复,Frankel神经功能达E级。结论:前路内固定适宜于病变节段1～2个椎体且破坏严重,后凸畸形明显,结核处于静止期,无混合感染,寒性脓肿较大及脊髓压迫伴截瘫患者;后路内固定适宜于多椎体长节段病变,尤其跳跃性脊柱结核,病灶主要位于后方,局限于单侧椎体破坏形成寒性脓肿或伴有混合感染,年龄大、体质较弱的患者。

Objective To explore the surgical procedures selection of internal fixation in the treatment of thoracic and lumbar spinal tuberculosis at different segments and with different degrees. Methods There were twenty-three patients. Ten cases were treated with anterior debridement and fusion with internal fixation, 13 cases were treated with posterior fixation combined with anterior debridement and fusion. Two cases were treated in two stages and 11 cases in one stage according to the systemic condition of the patients. Twenty-three patients of spinal tuberculosis healed by one stage without recurrence by follow-up for 6 months to 3 years. The bone healed as shown by X-ray examination and the bone grafting fusion in average 8 months. Postoperative kyphosis was corrected by 29°averagely and 2°was lost during follow-up. In all patients the paraplegia recovered. The Frankel nerve function achieved at level E. Conclusion The method of anterior internal fixation was appropriately indicated in patients with focus segments of 1～2 vertrebrae which were destroyed heavily, with obvious kyphosis deformity, static tuberculosis, no composite infection, bigger cold abscess and spinal compression accompanied by paraplegia. The method of posterior internal fixation was appropriately indicated in patients with focus segments of multiple vertebrae especially discontinuous spinal tuberculosis located posteriorly, with cold abscess by limited vertebral destroyment of single lateral, composite infection, and those of old age, had systemic condition.