一期后路内固定联合前路病灶清理治疗胸腰椎结核临床分析

Effect of surgical treatment on thoracolumbar tuberculosis by posterior internal fixation and ante-rior debridement at one - stage

目的探讨一期后路内固定联合前路病灶清理植骨融合治疗胸腰段脊柱结核的临床处理方法和疗效。方法2003年1月至2010年6月一期手术治疗多节段胸腰椎结核患者28例，均有脊柱后凸畸形，Cobb角16．2°～52．6°，平均32．1°，伴有神经功能损害症状20例。术前应用异烟肼、利福平、乙胺丁醇、链霉素四联药物抗结核并全身支持治疗2～3周，平均15d。手术采用后路椎弓根钉棒系统固定，前路病灶清理植骨融合。结果住院时间平均11d，切口均I期愈合，2例术后半年结核复发。脊柱后凸Cobb角恢复至9°～16°，平均12．2°。结论一期后路内固定联合前路病灶清理植骨治疗胸腰椎结核，安全有效，可以缩短病程，提高疗效，减轻患者的痛苦。

Objective To evaluate the clinical effects of posterior fixation and anterior debridement with bone graft fusion at one - stage. Methods There were 28 cases of thoracolumbar spinal tuberculosis with Kyphosis Cobb angle of 16.2° ～ 52.6° （ mean, 32. 1°）, in which 20 cases had nerve injury. They underwent posterior fixation and anterior debridement with bone graft fusion at one - stage. Before operation all the patients received antiphthisic treatment with isoniazid, rifampin, ethambutol and streptomycin,and support therapy for 2 ～3 weeks（ mean, 15 d）. The chemotherapy was continued for 12 to 18 months after operation. Results The symptoms of tuberculosis infection were alleviated in all cases. Average length of hospitalization was l 1 d. All cases had primary healing. There was no complication such as nerve injury and cerebrospinal fluid leakage. Recurrence occurred in 2 cases six months after operation. Kyphosis Cobb angle recovered to 9°～ 16°（mean, 12°）. Conclusion It is effective to improve the clinical symptoms and rebuild the stability of spine in patients with multiple - level lumbar spinal tuberculosis by posterior fixation and anterior debridement at one - stage.