单纯后路双侧截骨并椎弓根钉置入矫形植骨融合内固定修复脊柱结核伴严重后凸畸形的生物力学特点

Biomechanical characteristics of posterior spine dual-plane osteotomy,debridement and fusion,pedicle screw fixation for spinal tuberculosis with severe kyphosis

背景:对于大于40°的脊柱结核畸形、脊髓或马尾、神经根受压及不稳定者行开放手术指征是明确的,经后路行切开病灶清除,植骨,矫形融合内固定是理想的治疗方法。目的:分析后路脊椎双平面截骨矫形、病灶清除植骨融合、椎弓根钉置入内固定治疗脊柱结核伴严重后凸畸形的临床结果及其生物力学特点。方法:回顾性分析2009-01/2010-01接受一期后路脊椎双侧截骨矫形、病灶清除植骨融合、椎弓根钉置入内固定治疗脊柱结核伴严重脊柱后凸畸形9例患者的临床资料。结果与结论:9例均安全渡过围手术期,获随访12(8～16)个月,未见结核复发,均骨性融合,末次随访Cobb角及疼痛目测类比VAS评分均较治疗前明显改善(P<0.01),植骨融合时间8.5(5～14)个月。说明后路脊椎双平面截骨矫形、病灶清除植骨融合、椎弓根钉置入内固定治疗脊柱结核伴严重后凸畸形配合正确的抗痨治疗,可取得优良的临床疗效及生物力学效果。

BACKGROUND： It is effective in the application of posterior incision debridement, bone graft and fixation on the patients with spinal tuberculosis deformity angle more than 40~, spinal cord or cauda equina, nerve root compression and unstable. OBJECTIVE： To analyze clinical results and biomechanical characteristics of the posterior spine dual-plane osteotomy debridement and fusion, pedicle screw fixation for the patients of spinal tuberculosis with severe kyphosis. METHODS： From January 2009 to January 2010, the clinical information of nine patients who accepted a bilateral posterior spinal osteotomy, debridement and fusion with pedicle screw fixation for the treatment of spinal tuberculosis with severe kyphosis was analyzed retrospectively. RESULTS AND CONCLUSION： All the patients were safe in the perioperative period, the term of followed up was 12 （8-16） months, without the cases recurrence of tuberculosis and were all bone fusion, Cobb angle of the last follow-up and visual analogue scale score compared with preoperative score improved significantly （P 〈 0.01 ）, fusion time was 8.5 （5-14） months. The clinical outcomes illustrated that the correct anti-tuberculosis treatment with the posterior spine dual-plane osteotomy, debridement and fusion, pedicle screw fixation for the treatment of spinal tuberculosis with severe kyphosis has better clinical and biomechanical effectiveness.