一期前后路联合手术治疗胸腰椎结核的疗效观察

Combined posterior instrumentation internal fixation and anterior debridement in the treatment of thoracolumbar spinal tuberculosis with spondylitis in one stage

目的探讨前后路联合手术治疗胸腰椎结核的疗效。方法 2000年1月～2010年1月采用后路器械固定、前路彻底病灶清除植骨的方法治疗胸腰椎结核25例。术前后凸角20°～51°,平均27.3°±2.6°;所有患者均伴有不同程度的椎旁脓肿及椎管内死骨形成,25例伴有不同程度的脊髓和(或)神经根受压症状,Frankel分级B级5例,C级10例,D级10例。结果本组25例随访16月～48月,平均(14.5±2.3)月。术后伤口全部一期愈合,后凸畸形均明显改善。患者平均Frankel分级上升(1.3±0.2)级,神经根刺激症状全部得到缓解。无围手术期并发症及随访期并发症发生。所有患者最终均获得了良好的骨性融合,无结核复发的病例。结论前后路联合手术治疗腰骶脊柱结核有利于恢复脊柱的稳定性、提高植骨融合率、纠正和预防后凸畸形,提高临床治愈率。

Objective To explore the clinical value and efficacy of combined posterior instrumentation internal fixation and anterior debridement in the treatment of thoracolumbar spinal tuberculosis with spondylitis in one stage. Methods Twenty five patients suffered from thoraeolumbar spinal tuberculosis with spondylitis were treated by combined posterior instrumentation internal fixation and anterior debridement in one stage between January 2000 and January 2010. The mean pre - operative kyphotic angle was 27.3° ± 2.6° （range： 20° to 51°}. They all had different degree of kyphosis. According to the Frankel＇ s scoring system, there were 5 patients with Frankel Grade B, 10 with Grade C, and 10 with Grade D. Sphincter disturbance was observed in 14 patients and 11 patients had nerve root irritation. All patients underwent single stage posterior instrumentation, and anterior debridement, de- compression and fusion. Results All the patients were followed up for 16 months to 3 years with an average of 14.5± 2.3 months. All incisions were healed up primarily, and kyphotic angle was decreased obviously. Neuro-logic deficits were improved by 1.3 ± 0.2 level according to Frankel grade system. All 19 patients with nerve root irritation completely released. There was no complication in perioperative and followup duration. All patients showed evidence of successful bone fusion. No recurrence of the tuberculosis happened in all the cases at final follow- up. Conclusion It is a good way combined posterior instrumentation internal fixation and anterior debridement in the treatment of thoracolumbar spinal tuberculosis with spondylitis in one stage