前路病灶清除植骨内固定治疗下颈椎结核的中期随访研究

Mid-term follow up after anterior debridement and primary interbody bone grafting with internal fixation in treatment of tuberculosis of lower cervical vertebra

目的探讨前路一期病灶清除、植骨、内固定治疗下颈椎结核的效果。方法 2005年1月～2009年12月,行前路病灶清除、自体髂骨植骨或钛网填充异体骨植入、钛板内固定手术治疗下颈椎结核病例29例,病变节段为C3～7,其中14例患者有不全瘫症状,Frankel神经功能分级B级3例、C级3例、D级8例。术前常规行颈椎X线、MRI检查和/或CT三维重建检查,均显示为颈椎曲度变化、局部寒性脓肿或死骨形成等。结果所有病例随访1～5年,平均3.1年。手术时间为60～120 min,出血量为50～150 mL,所有患者都能耐受。无术中及术后并发症发生。末次随访时14例合并有神经系统症状患者,3例B级患者恢复到D级,1例C级患者恢复到D级,2例C级患者恢复到E级,8例D级患者恢复到E级。结核病灶无复发,术后随访未见矫正角度的明显丢失。椎间植骨均获骨性融合。结论经前方入路一期病灶清除、植骨、钛板内固定手术治疗下颈椎结核安全可靠,效果良好。

Objective To investigate clinical outcomes of anterior debridement and primary bone grafting with internal fixation in treatment of lower cervical vertebra tuberculosis.Methods From January 2005 to December 2009,29 patients with tuberculosis of lower cervical spine underwent surgical treatment,including anterior debridement,primary autogenous or allogeneic bone grafting and internal fixation.The injured segment ranged C3-7.There were partial paralysis symptoms in 14 patients.According to Frankel classification,there were 3 cases in Grade B,3 cases in Grade C and 8 cases in Grade D.Preoperative X-ray,MRI and/ or CT 3D reconstruction showed cervical curvature changes,local cold abscess or sequestrum formation.Results All the patients were followed up for 1-5 years（mean 3.1 years）.The operation time was 60-120 min and the blood loss was 50-150 mL.The procedure was tolerable for all the patients.No complications happened.At the final follow-up,3 cases in Frankel Grade B improved to Grade D,1 case in Grade C improved to Grade D,2 cases in Grade C improved to Grade E,and 8 cases in Grade D improved to Grade E.There was no recurrence in all cases.There was no obvious angle loss at the final follow-up.Stable bone union was observed in all cases.Conclusion It is safe and effective to treat cervical vertebra tuberculosis by anterior debridement and primary bone grafting with titanium-plate internal fixation.