病灶清除植骨融合内固定治疗胸腰椎脊柱结核

Debridement, Bone Graft Fusion and Internal Fixation for the Treatment of Thoracolumbar Spinal Tuberculosis

[目的]探讨病灶清除植骨融合内固定治疗胸腰椎脊柱结核的手术策略及疗效分析.[方法]回顾性分析2006年7月至2010年3月期间接受一期病灶清除植骨融合联合内固定手术治疗并获得随访的58例脊柱结核患者的临床资料,其中对10例胸椎,11例胸腰段椎及5例腰椎结核患者行前路病灶清除、植骨融合内固定术,对9例胸腰段椎、9例腰椎、14例腰骶椎结核患者行一期后路椎弓根钉内固定后外侧植骨融合联合前路病灶清除、椎间植骨融合术.术后配合规范地抗痨治疗,观察术后及随访期间患者结核治愈情况及植骨融合情况.[结果]所有手术患者结核中毒症状明显缓解,98.3%（57/58）患者植骨融合满意（Bridwell标准骨性愈合）,治愈率为98.3%（57/58）.[结论]病灶清除植骨融合内固定治疗胸腰椎脊柱结核安全有效;术前术后的正规抗结核药物治疗营养支持治疗是脊椎结核手术治疗成功的保障;手术方式和病灶清除的范围应根据病情综合判断后选择.

[Objective]To explore the surgical strategies and efficacy of debridement, bone graft fusion and internal fixation for the treatment of thoracolumbar spinal tuberculosis. [Methods] The clinical data of 58 pa- tients with spinal tuberculosis undergoing one-stage debridement, bone graft fusion and internal fixation and followed up from July 2006 to March 2010 were analyzed retrospectively. Anterior debridement combined with bone graft fusion internal fixation was performed for 10 cases of thoracic spinal tuberculosis, 11 cases of thora- columbar spinal tuberculosis and 5 cases of lumbar spinal tuberculosis. One-stage posterior internal fixation with pedicle screw, lateral bone graft fusion, anterior debridement and intervertebral bone graft fusion was performed for 9 cases of thoracolumbar spinal tuberculosis, 9 cases of lumbar tuberculosis and cases of 14 lum- bosacral spinal tuberculosis. After the operation, the patients received routine antituberculosis therapy. The cure results and the fusion of grafted bone were observed after operation and during the follow up. [Results] Tuberculosis symptoms of all patients undergoing the operation were obviously relieved. The satisfaction rate of bone graft fusion（Bridwell standard bone fusion） was 98.3%（57/58）, and the curative rate was 98.3%（57/ 58）. [Conclusion] Debridement combined with bone graft fusion internal fixation for the treatment of thoraco- lumbar spinal tuberculosis is safe and effective. Regular antituberculosis therapy and nutritional support before and after surgery is the guarantee of the successful operation. Surgical method and the range of debridement should be chosen based on the comprehensive analysis of patients＇ condition.