一期后路病灶清除植骨融合内固定治疗胸腰椎结核

One-stage posterior debridement,bone grafting and internal fixation for thoracolumbar spinal tuberculosis

目的：探讨一期后路病灶清除植骨融合内固定治疗胸腰椎结核的临床疗效。方法回顾性分析2010年1月～2012年6月本院采用一期后路病灶清除植骨融合内固定治疗的28例胸腰椎结核患者的临床资料，对比研究患者手术前后患椎后凸Cobb角、红细胞沉降率（ erythrocyte sedimentation rate， ESR）、C 反应蛋白（ C-reaction protein， CRP）、植骨融合及美国脊髓损伤协会（ American Spinal Injury Association， ASIA）分级变化情况。结果28例获得随访，平均随访1．2年，术后Cobb角无明显丢失，后凸畸形平均纠正4．12°，平均矫正率24．5％。末次随访ESR、CRP恢复正常，植骨大部分骨性融合，融合时间平均为7．8个月，原有症状大部分消失，神经功能均有不同程度恢复。结论一期后路病灶清除植骨融合内固定治疗胸腰椎结核可有效完成病灶清除、减压、矫正后凸畸形、恢复生理曲度和重建脊柱稳定性，效果满意。

Objective To evaluate the clinical efficacy of one-stage posterior debridement, bone grafting and internal fixation for thoracolumbar spinal tuberculosis.Methods From January 2010 to June 2012,28 patients with thoracolumbar spinal tuberculosis undergoing one-stage posterior debridement, bone grafting and internal fixation procedure were reviewed retrospectively .All cases were followed up.The kyphosis Cobb’s angle, erythrocyte sedimentation rate （ESR）, C-reaction protein （CRP）, bone fusion and American Spinal Injury Association （ASIA） grade before and after surgery were reviewed and compared.Results The median peri-od of follow-up was 1.2 years.There was no significant loss of kyphosis Cobb’s angle after operation.The average kyphosis Cobb’s angle was corrected 4.12 °, the average correction rate was 24.5%.The ESR and CRP levels returned to normal at final follow-up. The majority of bony fusion was achieved within 7.8 months.Most of the original symptoms disappeared.According to ASIA grade, the neurological function was improved after operation.Conclusion Treatments with one-stage posterior debridement, bone grafting and internal fixation for thoracolumbar spinal tuberculosis can effectively achieve debridement, spinal cord decompression, correc-tion of spinal kyphosis, reconstruction of spinal stability.