一期前方入路病灶清除植骨融合内固定治疗下颈椎结核

One-stage debridement and bone grafting with internal fixation via anterior approach in treatment of tuberculosis of lower cervical vertebrae

目的探讨一期前方入路结核病灶清除髂骨移植内固定治疗下颈椎结核的疗效。方法本组均采用一期前方入路行病灶清除、植骨融合和内固定术。结果术中无大血管、脊髓或喉返神经损伤,术后随访所有患者结核症状消失,无结核复发、切口感染、窦道形成或内固定失败等并发症,复查血沉结果正常。结论一期前方入路显露下颈椎结核病灶安全可靠,椎管减压效果显著,病灶清除后行自体或同种异体髂骨植骨,钢板内固定可有效重建颈椎的稳定性。

Objective To investigate the outcome of the patients with tuberculosis of lower cervical vertebrae who underwent one-stage radical debridement,reconstruction with bone autograft or allograft and internal fixation via anterior approach.Methods All the patients underwent one-stage anterior approach,which was combined with radical debridement,tricortical iliac crest bone autograft or allograft and internal fixation.The change of Cobb angle and fusion of bone grafting were reexamined by X-ray regularly.The clinical symptom and the neurological function were evaluated according to NDI score（neck disability index） and Frankel classification.Results There was no injury of blood vessel,spinal cord or recurrent nerve during the surgery.There was no tuberculosis recurrence,incision infection,sinus formation and internal fixation failure in any of these patients.ESR reexamination recovered normally.Conclusion The anterior approach can provide direct and safe access to the lesion.The decompression effect of vertebral canal was significantly.The structural iliac crest autograft or allograft and anterior instrumentation could work effectively to stabilize the cervical vertebrae.