一期后路病灶清除植骨选择性病椎置钉内固定术在相邻多个胸腰椎结核中的应用

Application of one-stage posterior debridement bone graft and selective nail-stick internal fixation for adjacent multiple thoracolumbar tuberculosis

目的探讨一期后路病灶清除植骨选择性病椎置钉内固定术治疗相邻多个胸腰椎结核的疗效。方法回顾性分析2008年1月至2011年1月行一期后路病灶清除选择性病椎置钉内固定同期植骨融合术的胸腰椎结核患者18例,其中男10例,女8例;年龄18-62岁,平均37.5岁。选择钛合金为内固定材料,术前后凸成角10°-65°,平均26°。CT或磁共振成像(MRI)检查显示所有患者病灶有明显的偏侧骨质破坏和不同程度脓肿形成,无巨大脓肿。随访时间1～4年,平均1.5年。结果 18例患者均得到随访,均未引起炎症扩散,植骨块和内固定物均无松动、移位和脱出,植骨全部骨性愈合,无复发和后凸畸形形成。结论一期后路病灶清除选择性病椎置钉内固定术治疗相邻多个胸腰椎结核能有效重建脊柱稳定性,在病椎局部植入钛质内固定材料对疗效无明显影响,是治疗胸腰椎结核的有效方法。

Objective To investigate the effect of one-stage posterior debridement bone graft and selective nail-stick internal fixation in treating adjacent multiple thoracolumbar tuberculosis.Methods 18 cases of thoracolumbar tuberculosis performing one-stage posterior debridement bone graft and selective nail-stick internal fixation from January 2008 to January 2011 were retrospectively analyzed,including 10 males and 8 females,aged from 18-62 years was mean age of 37.5 years.The material for selective internal fixation was titanium alloy.The preoperative kyphosis angle was 10°-65°,mean 26°.CT or MRI results showed that all patients had obvious unilateral bone destruction and varying degrees of abscess formation without gaint abscesses.The duration of follow-up was 1-4 years,mean 1.5 years.Results 18 cases were all followed up.There was no inflammation diffusion,and the bone graft and the internal fixator were not loosed,shifted,and prolapsed.Bone union was observed in all cases,and there were no relapse and no formation of kyphosis.Conclusion One-stage posterior debridement bone graft and selective nail-stick internal fixation can effectively reconstruct the stability of spine in treating adjacent multiple thoracolumbar tuberculo sis,implanting the titanium alloy material at the local part of injured vertebra has no obvious influence on the curative effect,which is an effective treatment method for thoracolumbar tuberculosis.