胸、腰椎结核经前路手术病灶清除一期植骨融合内固定失败的原因分析

Thoracic and Lumbar Tuberculosis by One-stage Anterior Debridement and a Fusion Fixation Failure Analysis

目的探讨分析胸、腰椎结核经前路手术病灶清除一期植骨融合内固定失败的原因。方法回顾2006年1月～2011年1月11例胸腰椎结核经前路病灶清除一期植骨融合内固定失败来自笔者医院就诊和复治的患者,其中7例在笔者医院二次手术翻修,并经后路椎弓根系统内固定重建脊柱稳定性。结果二次胸、腰段脊柱手术翻修和重建的7例患者全部临床康复,随访6个月～2年无结核复发、窦道形成和内固定再次失败等。结论胸腰椎结核经前路手术病灶清除一期植骨融合内固定有一定失败率(笔者医院统计为3.7%),内固定手术的成功与失败与术者操作技术有明确相关性,此类高难度手术应由经过严格训练的资深医师完成,内固定失败后应及时翻修,二次脊柱稳定性重建选择后路经椎弓根固定具有明显优越性。

Objective Of analysis of thoracic and lumbar tuberculosis by one - stage anterior debridement and a fusion fixation failure. Methods From January 2006 to January 2011,11 cases of thoracic and lumbar tuberculosis by anterior debridemcnt and a fusion with fixation failure to our hospital and retreated patients, including 7 cases of secondary surgery in our hospital renovation and posterior pcdiclc screw system fixation reconstruction of spinal stability. Results After the second thoracic and lumbar spine surgery renovation and reconstruction of the 7 patients with full clinical recovery, follow - up of 6 months to 2 years, no recurrence of tuberculosis, sinus formation and fixation failed again and so on. Conclusion Thoracic and lumbar tuberculosis by anterior debridement and a fusion with internal fixation have a failure rate （3.7% , our hospital statistics）. There is a clear correlation between success or failure of internal fixation and Surgeon＇s techniques. Such a difficult surgery should be highly trained senior doctors to complete. The failure of internal fixation should be promptly renovated, and pedicle screw fixation has obvious advantages in the second reconstruction of spinal stability.