一期后路病灶清除椎间植骨内固定术治疗老年胸椎结核

One-stage posterior debridement,bone grafting and internal fixation for the thoracic vertebrae tuberculosis in the elders

[目的]对比观察～期后路椎管减压、病灶清除、植骨融合内固定与分期前后路联合手术针对老年胸椎结核的疗效。[方法]对26例老年胸椎结核并发脓肿、死骨形成的患者进行回顾性分析（2006年1月-2009年12月）。平均年龄65．6岁，其中男性17例，女性9例，病变累及单节段者4例（15．4％），2～3个节段14例（53．8％），3个节段以上8例（30．8％）。所有患者均伴有不同程度的后凸畸形。26例患者中21例有1种以上合并症。其中10例患者接受一期后路椎管减压、病灶清除、植骨融合内固定术（A组），16例接受一期后路内固定和二期前路病灶清除、植骨融合术（B组）。术后持续化疗11．5（9～12）个月，定期复查血沉及肝功能。对比两组患者愈后情况。[结果]随访12～36个月，平均25个月，两组患者术后植骨块融合满意，脊髓功能均有不同程度的恢复，未出现内固定引起的持续或继发感染。两组患者术后后凸畸形矫正率及影像学未见明显区别。[结论]一期后路病灶清除椎管减压椎间植骨融合内固定术联合术后规范化疗对于老年胸椎结核有确切疗效，与分期前后路术式相比具有创伤小等优势，可作为老年患者一种多样化治疗的选择。

[ Objective] To evaluate the outcome of one- stage posterior radical debridement with spinal cord decompression and fusion with instrumentation in aged thoracic vertebrae tuberculosis patients compared with anterior radical surgery and posterior instrumentation. [ Methods] From January 2006 to December 2009, 10 patients （group A） who had less bone destruction were treated with one - stage radical debridement with spinal cord decompression and fusion with instrumentation that was supplemented with posterolateral bone fusion and chemotherapy. Sixteen patients （group B） who had greater bone destruc- tion were treated with anterior decompression, bone fusion, and posterior instrumentation. The outcome was compared between the two groups. [Results] All patients were followed up for average 25 months （12 to 36 months ） . Spinal tuberculosis was completely cured and the grafted bones were fused in all 26 patients. The kyphosis and Frankel grade improved in all cases. There was no persistence or recurrence of infection possibly related to the instrumentation. There were no differences in the radio- logical results in both groups. The kyphosis was significantly corrected after surgical management. However, the loss of correction also occurred considerably in both groups. [ Conclusion] The single stage radical debridement with spinal cord decompression and fusion can be an alternative treatment method for thoracic vertebrae tuberculosis, especially for elderly patients in early phase of bone destruction and/or mild and moderate kyphosis.