术前短期化疗联合前路单钉棒系统治疗胸腰椎结核

Preoperative short-term chemotherapy and anterior single nail-stick system combined treatment of thoracolumbar spinal tuberculosis

背景:多数学者认为脊柱结核术前化疗至少需要4周,且大多选用接骨板或双钉棒系统作为前路手术的内固定材料。有关缩短术前化疗时间和选择更为简单内固定的研究甚少。目的:探讨术前短期化疗联合前路单钉棒系统治疗胸腰椎结核的临床疗效。方法:2007年6月至2009年12月,16例脊柱结核患者行HRES四联化疗1周后行前路单钉棒系统内固定术,术后常规抗结核治疗1年。观察术后和随访期间的一般情况及疼痛症状,记录Frankel脊髓损伤分级,通过X线片了解植骨融合及后凸畸形矫正情况。结果:术前抗结核治疗1周,患者一般状况无明显改善,自术后第3d起,患者一般状况开始改善。术后3例患者出现肋间神经痛,经治疗2周后2例缓解,其余患者均未出现明显的并发症。所有植骨均得到融合,融合时间为6～15个月,平均9个月;后凸畸形由15°～82°,平均42.0°±16.7°,矫正至3°～19°,平均9.7°±4.4°。术后2年随访后凸畸形为3°～23°,平均11.6°±5.3°。平均丢失1.9°。结论:术前短期化疗对手术疗效无明显影响,但能缩短患者术前承受痛苦的时间。前路单钉棒系统内固定治疗胸腰段脊柱结核可彻底清除病灶、充分减压,同时矫正畸形、有效重建脊柱稳定性,以防止神经损害进一步加重,可尝试应用于临床。

Background：Most scholars think that the preoperative chemotherapy for the spinal tuberculosis surgery should last for at least 4 weeks,and plates or double nail-stick systems are most often selected as the internal fixation materials for anterior surgery.There are few researches on the shortening of the preoperative chemotherapy and the selection of a easier way for internal fixation.Objective：To evaluate the clinical effects of the preoperative short-term chemotherapy and anterior single nail-stick system combined treatment of thoracolumbar spinal tuberculosis.Methods：From June 2007 to December 2009,16 cases of spinal tuberculosis received the HRES 4-drug chemotherapy for one week before the internal fixation surgery with anterior single nail-stick system.After the surgery,they received the routine anti-tuberculosis treatment for one year.The general conditions and the pain symptoms of the patients were observed after the operation and during the follow-up period,the spinal cord injury grades were recorded according to Frankel＇s classification,and the conditions of bone graft fusion and kyphosis deformity correction were evaluated through X-ray film.Results：The general situation of patients was not obviously improved during the one-week preoperative anti-tuberculosis treatment,but it started to improve on the 3 rd postoperative day.3 cases experienced intercostal neuralgia after the operation.The symptom was relieved after 2 week＇s treatment.No significant complications were found in other patients.Bone graft fusion was found in all the patients,the fusion time varied from 6 to 15 months,with an average of 9 months.The kyphosis deformity ranged from 15° to 82°,with an average of 42.0°±16.7°.It was corrected to 3° to 19°,with an average of 9.7°± 4.4°.This deformity became 3°-23° 2 year after the operation,averaged 11.6°±5.3°,an average of 1.9° was lost.Conclusions：Preoperative short-term chemotherapy has no obvious impact on the surgical effects,but can shorten the period of preoperative sufferings.And treating the thoracolumbar spinal tuberculosis with the internal fixation with anterior single nail-stick system can not only achieve complete clearance of lesions and sufficient decompression,but also can correct the deformity,reconstruct the spinal stability,and thus can avoid further damage of the nerves.It is worth trying in clinical practices.