不同手术方式治疗脊柱结核的临床疗效评价

The Clinical Efficacy of Different Surgical Treatment of Spinal Tuberculosis

目的根据脊柱稳定性的状况,探讨脊柱结核外科治疗的术式选择。方法总结回顾2006年8月至2013年12月手术治疗的脊柱结核患者共114例,所有病例分为A组(59例)一期单纯脊柱结核病灶清除治疗组,B组(55例)一期病灶清除、植骨融合并内固定治疗组。分别对比研究A及B手术时间、术中出血量、矫形率、神经功能恢复情况、植骨融合时间、并发症等。结果平均随访1年10个月,82例患者获访,两组患者脊柱结核均治愈,A组术后优良率84.5%,B组94.6%。有1例术后慢性窦道形成,其他患者切口愈合良好。53例有脊柱后凸畸形者,单纯病灶清除术病例中脊柱畸形无纠正,且一段时间后均有不同程度的矫正角度丢失。行病灶清除、植骨融合并内固定术病例中后凸畸形平均矫正25.8°,随访中平均丢失2.6°。37例有明显神经损害的患者手术后均获得改善。结论脊柱结核外科治疗可采用个体化治疗,在药物抗结核治疗的基础上,根据脊柱稳定性的不同选择合适的外科术式进行手术治疗,均可获得满意的临床疗效。

Objective According to the state of spinal stability, to discuss surgical treatment of spinal tuberculosis in operation choice. Methods Summary review in August 2006 to December 2013, A total of 114 patients with surgical treatment of spinal tuberculosis, all cases were divided into group A （59 cases） issue of pure spinal tuberculosis kitchen removal treatment group, group B （55 cases） issue of lesion clearance and bone graft fusion and internal ifxation in treatment group. Comparative study A and B respectively operation time, intraoperative blood loss, rate of orthopaedic, neural function recovery, the bone graft fusion time, complications, etc. Results A mean follow-up of 1 year 10 months, 82 patients received visit, two groups of patients with spinal tuberculosis were cured, postoperative was 84.5%in group A and group B 94.6%. With chronic sinus tract, 1 case of postoperative patients with other incisions healed well. 53 cases with protruding after spinal deformity, simple removal of lesion cases no correct spinal deformity, and after a period of time all have different degrees of lost corrective Angle. Line cases of lesion clearance and bone graft fusion and internal ifxation of the protruding after deformity correction average 25.8＆#176;, follow-up on average lost 2.6＆#176;. 37 cases of patients with obvious nerve damage after the operation, also get improved. Conclusion Surgical treatment of spinal tuberculosis can adopt individualized treatment, on the basis of drug anti-tuberculosis treatment, according to the spinal stability change to choose the appropriate surgery operation, all can obtain satisfactory clinical effect.