经病椎置入短椎弓根螺钉后路内固定融合术治疗多椎体结核临床疗效观察

Treatment of Multi-vertebral Spinal Tuberculosis by Posterior Instrumented Fusion with Short Segment Pedicle Screws Fixed on Pathologic Vertebrae

目的探讨经病椎置人短椎弓根螺钉后路内固定融合术治疗多椎体结核的可行性。方法收集2010年7月至2012年7月首都医科大学附属北京胸科医院收治的2个及2个以上椎体骨质破坏并完成随访的全部32例患者，均行手术并术后明确诊断为脊柱结核。术前神经功能分级按美国脊柱损伤协会（ASIA）神经功能分级，其中A级2例、B级1例、C级7例、D级14例、E级8例。行经病椎短椎弓根螺钉内固定，比较术前、术后2周及术后18个月的Cobb角的变化；根据日本骨科协会（JOA）评分评价手术的优良率，观察其术前及术后的神经功能恢复情况及术后并发症。对术前、术后2周及术后18个月Cobb角及JOA评分采用配对资料t检验，以P〈0．05为差异有统计学意义。结果32例患者均完成至少2年期随访，2年随访期内结核均无复发，无脓液及窦道形成，无螺钉置入病椎相关的并发症。术后2周复查Cobb角明显变小，由术前的（19．8±6．1）°降至术后的（7．8±3．1）°（t=9．9，p=-0．00）；18个月时随访无明显丢失，Cobb角由术后2周的（7．8±3．1）°变为末次随访的（8．8±4．3）°（t=1．2，P=0．09）。JOA评分由术前的（8．7±6．3）分增加至18个月随访的（25．2±2．8）分，获得明显改善（t=13．6，P=0．00），末次JOA总优良率为75．0％（24／82）。术后ASIA分级D级7例，E级25例。结论经病椎置入短椎弓根螺钉固定不仅能够对治疗多椎体脊椎结核取得满意的效果，而且能减少患者术后Cobb角丢失，提高舒适度，值得推广。

Objective To evaluate the feasibility of treatment of multi-vertebral spinal tuberculosis by posterior instrumented fusion with short segment pedicle screws fixed on pathologic vertebrae. Methods Thirty-two patients with spinal tuberculosis of 2 or more vertebral body destruction, who were admitted in Beijing Chest Hospital, Capital Medical University from July 2010 to July 2012, confirmed by surgery and follow-up completed. According to the nerve function classification standard from American Spinal Injury Association （ASIA）, there were grade A ： 2 cases, grade B ： 1 case, grade C ： 7 cases, grade D ： 14 cases and grade E ： 8 cases. The Cobb angle were compared with pre-and postoperative short segment pedicle screws fixation at the end of the second and the eighteenth month. The excellent and good rate of operation was evaluated according to the marking standard from Japanese Orthopaedic Association （JOA）. The recovery of nerve function pre- and postoperation and postoperative complications were observed. Results All patients were followed-up completely at least 2 years and no patients were relapsed in this period. Meanwhile, no patients were observed with pus, sinus tract formation and complications associated with pedicle screw implantation.The Cobb angle became smaller obviously at the end of two weeks from （19.8 ± 6.1） degree preoperation to （7.8± 3.1） degree postoperation （t=9.9, P=0.00） and at the end of eighteenth month from （7.8 ± 3.1） degree postoperation to （8.8± 4.3） degree postoperation （t =1.2, P=0.09）. The score of JOA was improved obviously from （8.7 ± 6.3） to （25.2 ± 2.8） （t=1 3.6, P=0.00）. The improvement rate was 75.0% （24/82）. The ASIA classification was grade D 7 cases and grade E 25 cases after operation. Conclusion The short segment pedicle screws fixed on pathologic vertebrae to treat multi-vertebral spinal tuberculosis is not only satisfactory on efficacy, but also reduces Cobb angle loss and improves comfortableness. It is worth to extend application.