经后路病灶清除RF矫形固定植骨治疗脊柱结核

Treatment of vertebral tuberculosis by RF rectification, fixation and grafting bones through posterior approach focus clearance

目的 探讨治疗脊柱结核一期完成病灶清除、矫正脊柱后凸畸形、前后同时植骨融合的效果。方法 俯卧位 ,以病椎为中心作后正中切口 ,从病椎左右椎弓根骨膜下分离病灶 (在胸椎段 ,先切取左右肋骨后段 ) ,椎弓根短节段固定器 (RF系统 )矫正脊柱后凸畸形和椎体间高度 ,彻底清除结核病灶 ,前后同时植骨。结果 15例患者结核病灶清除彻底 ,脊柱畸形矫正角由术前 18°～ 45°矫正到术后 3 4° ,椎体间高度由术前 62 6 %恢复到术后 98 2 % ,植骨块无移位。结论 该手术入路简捷 ,病灶清除彻底 ,畸形矫正满意 ,三柱固定植骨融合 ,后期脊柱稳定 ,缩短了卧床时间 ,减少了相应的并发症。

Objective To evaluate the results of vertebral tuberculosis by complete focus clearance, rectifying deformed back raised vertebrae and successively grafting bones at the front and the back of involved vertebrae meanwhile. Methods The patient kept prone position. A back middle incision was taken on the involved vertebrae as the center. Showing the vertebral focus by separating underneath pedicle of vertebral arch bone membrane of the left and right vertebrae from the sick one(for thoracic vertebral tuberculosis, cutting left and right rib hind ends). Rectifying deformed back raised vertebrae and the level by setting the pedicle of vertebral arch short section fixators(RF system). Completely cleaning tuberculosis focus. Meanwhile grafting bones at the front and the back of involved vertebrae. Results\ Of 15 cases,tuberculosis focus was completely cleared and the Cobb angle of the deformed vertebrae column was rectified to 3 4° from preoperative 18°～45°,the level of vertebra to 98 2% from preoperative 62 6%. Position of the grafted bone kept stable.Conclusion The approach of the surgery is both simple and direct,as well as complete clearance of focus and satisfactory correction of deformity. Bone graft by fixing the three columns together merges well,the verbebral column is stable at the late stage. Therefore,the time for patients to stay in bed is shortened and the corresponding complications are reduced.