强直性脊柱炎合并多节段脊柱结核的外科治疗

Surgical treatment of ankylosing spondylitis complicated with multi-segmental spinal tuberculosis

目的探讨一期后路病灶清除植骨融合内固定治疗强直性脊柱炎(AS)合并多节段脊柱结核的临床疗效。方法对10例AS合并多节段脊柱结核患者行一期后路病灶清除植骨融合椎弓根螺钉内固定联合化疗治疗。结果 10例均获随访,时间6个月～3年。切口一期愈合,脊柱结核均治愈,无明显全身及局部并发症。在3～6个月均获得牢固愈合,患者全身状况良好。Frankel分级2例C级恢复至D级,4例D级恢复至E级。后凸畸形部分矫正,平均矫正8°±1°,未发现钉棒松动、脱位。结论 AS合并多节段脊柱结核采用后路病灶清除椎弓根螺钉内固定术联合化疗,可加强脊柱稳定,促进病灶吸收愈合,预防和矫正畸形,提高脊柱结核治愈率和植骨融合率。

Objective To evaluate the clinical efficacy of one stage posterior focal debridement and bone graft and internal fixation in the treatment of ankylosing spondylitis complicated with multi-segmental spinal tuberculosis. Meth- ods 10 patients with ankylosing spondylitis complicated with multi-segmental spinal tuberculosis were given onestage posterior focal debridement and bone graft and pedicle internal fixation and chemotherapy. Results All patients were followed up for 6 months to 3 years. Spinal tuberculosis was completely cured and all the incision were healed primarily. No significant systemic and local complication was found. All patients were in good condition. 2 patients in Frankel Grade C improved to Grade D ,4 patients in GradeC improved to Grade E. The kyphosis was corrected partly, the mean angle of kyphosis correction were 8o ± 1 o. No looseness and displacement of screws and rods was found. Conclusions Primary posterior focal debridement and pedicle internal fixation in treatment of ankylosing spondylitis complicated with multi-segmental spinal tuberculosis can stabilize the involved spinal segments, prevent and correct local deformity, and improve its curative ratio and fusion ratio of grafted bone.