一期前路病灶清除植骨融合内固定治疗多椎体脊柱结核

One-staged anterior debridement,autograft bone fusion and spinal reconstruction for multi-segment tuberculosis

目的:总结一期前路病灶清除、自体骨植骨融合及前路内固定治疗多椎体脊柱结核的临床效果。方法:1998年5月～2008年5月收治多椎体脊柱结核(≥3个椎体,包括跳跃性病灶)患者41例,病灶分布为C4～S1,颈椎2例,胸椎14例,胸腰段19例,腰椎4例,腰骶椎2例。伴截瘫者7例,Frankel分级C级4例,B级2例,A级1例。伴后凸成角21例。均采用一期前路病灶清除、自体骨植骨融合及内固定术治疗,随访观察治疗效果。结果:随访12个月～10年,平均67个月。7例截瘫患者术后1年神经功能较术前均有恢复。后凸畸形术前平均Cobb角23.5°,术后平均11.5°,末次随访时平均丢失3.8°。内固定松动1例,伤口及植骨延迟愈合2例。所有患者均骨性融合,结核无复发。结论:多椎体脊柱结核患者采用一期前路病灶清除、自体骨植骨融合、前路内固定治疗可取得良好效果。

Objective：To investigate the outcome of one-staged anterior debridement,autograft bone fusion and spinal reconstruction for multi-segment tuberculosis.Method：A total of 41 cases suffering spine tuberculosis and with multisegments involvement（over 3 vertebrae） between May 1998 and May 2008 underwent one-staged anterior debridement,autograft bone fusion and spinal reconstruction.The lesion ranged from C4 to S1,with 2 in cervical spine,14 in thoracic,19 in thoracolumbar,4 in lumbar and 2 in lumbosacral.7 cases were complicated with paraplegia with 4 Frankel C,2 Frankel B and 1 Frankel A.Kyphosis was noted in 21 cases.The clinical outcome was reviewed retrospectively.Result：All cases were followed up for an average of 67 months（range,12-120 months）.7 cases recovered to some degree 1 year later.The postoperative kyphosis cobb angle decreased to 11.5° compared with preoperative 23.5°,with mean loss of correction of 3.8° at final follow-up.Instrument failure was noted in 1 case and delayed union of skin incision in 2 cases.All cases got bony union with no tuberculosis recurrence.Conclusion：One-staged anterior debridement,autograft bone fusion and spinal reconstruction for multi-segment tuberculosis is reliable.