一期前路植骨融合固定重建相邻多椎体结核脊柱稳定性

CLINICAL OBSERVATION OF ANTERIOR BONE GRAFT FUSION AND INTERNAL FIXATION TO TREAT ADJACENT MULTIVERTEBRAL TUBERCULOSIS IN ONE-STAGE

目的观察一期前路病灶清除、植骨融合并单钉棒内固定重建相邻多椎体结核脊柱稳定性的临床疗效。方法 2007年3月-2009年9月,收治8例胸腰椎相邻多椎体结核患者。其中男6例,女2例;年龄20～42岁,平均32岁。病程8～14个月,平均10.2个月。病变累及5个椎体4例,6个椎体3例,8个椎体1例;胸椎35个,腰椎11个。脊髓功能Frankel分级为C级2例,D级4例,E级2例。术前后凸Cobb角为(25.1±6.6)°。术前强化抗结核治疗4～6周,术中彻底清除病灶,同时行自体髂骨、肋骨及腓骨植骨及椎体侧前方单钉棒固定重建脊柱稳定性,术后抗结核治疗18个月。结果术后切口均Ⅰ期愈合。8例均获随访,随访时间18～48个月,平均29个月。参照金大地的脊柱结核治愈标准,7例1次治愈;1例于术后3个月复发伴窦道形成,经再次病灶清除后治愈。术后7 d及末次随访时融合节段后凸Cobb角分别为(19.5±4.2)°和(22.3±3.6)°,与术前比较差异均有统计学意义(P<0.05),术后7 d及末次随访时比较差异无统计学意义(P>0.05)。术后12个月神经功能Frankel分级均为E级。采用Lee等植骨融合标准,术后6～8个月均达骨性融合。随访期间未发生植骨块或内固定物松动、移位。结论一期前路病灶清除、植骨融合并单钉棒内固定能有效矫正后凸畸形并重建脊柱稳定性,为相邻多椎体结核的外科治疗提供了选择。

Objective To evaluate the method and effectiveness of anterior focus clearance with autograft bone fusion and internal fixation in treating of adjacent multivertebral tuberculosis in one-stage.Methods Between March 2007 and September 2009,8 cases of thoracic vertebra tuberculosis were treated.Of 8 cases,6 were male and 2 were female,aged 32 years on average（range,20-42 years）.The disease duration ranged from 8 to 14 months（mean,10.2 months）.Affected vertebrae included thoracic vertebrae in 35 cases and lumbar vertebrae in 11 cases;5 vertebrae were involved in 4 cases,6 vertebrae in 3 cases,and 8 vertebrae in 1 case.According to Frankel classification,there were 2 cases of grade C,4 cases of grade D,and 2 cases of grade E.All patients had different kyphosis with the Cobb angle of（25.1 ± 6.6）°.All patients received antituberculous therapy 4-6 weeks preoperatively;after complete clearance lesions,autograft bone fusion and internal fixation were performed,and then antituberculous therapy was given for 18 months.Results All incisions healed by first intention.Eight patients were followed up 18-48 months（mean,29 months）.According to JIN Dadi et al.criterion,7 cases recovered after first operation,1 case of relapsed tuberculosis with sious was cured after re-focus clearance.The Cobb angle was（19.5 ± 4.2）° at 7 days after operation and was（22.3 ± 3.6）° at last follow-up,showing significant differences when compared with the preoperative value（P〈 0.05）.The nerve function of all cases were classified as Frankel grade E.CT scan showed bone graft fusion at 6-8 months after operation.No loosening or displacement of grafted bone and internal fixation occurred during follow-up.Conclusion The treatment of adjacent multivertebral tuberculosis by anterior focus clearance,intervertebral autograft,and internal fixation in one-stage is effective.Anterior bone fusion and internal fixation in one-stage can correct kyphosis effectively and rebuild spinal stability,so it is a good choice for surgical treatment of adjacent multivertebral tuberculosis.