前路经病椎短节段有限固定融合治疗胸腰椎结核的近期临床疗效观察

Observation on short term effect of anterior trans-injured vertebral short segment limited fixation and fusion in treating thoracic and lumbar spinal tuberculosis

目的探讨前路经病椎短节段有限固定融合治疗胸腰椎结核的近期临床疗效。方法 2010~2012年103例脊柱结核患者经前路（第12胸椎以上经胸,第1腰椎以下经腹膜后）结核病灶清除和椎管减压术,椎间结构植骨,残余患椎短节段内固定。结果结核患者接受手术后,神经功能得到有效改善,影像学结果显示病灶平均后凸角明显下降（P〈0.05）。术后随访发现,半年后植骨已融合,局部的后凸平均角度为13°,与术后相比无明显改变。此外,1年后患者内固定位置并无松动断裂,植骨无位移脱落,四肢活动正常,局部无叩、压痛。结论前路经病椎短节段有限固定融合治疗胸腰椎结核的近期临床疗效满意。

Objective To investigate the anterior trans-injured vertebral short segment limited fixation and fusion in treating thoracic and lumbar spinal tuberculosis. Methods One hundred and three patients with spinal tuberculosis from 2010 to 2012 were operated by trans-anterior approach（trans-thoracic above thoracic spine 12, trans-retroperitoneal below waist spine 1） tuberculosis focus clearance and spinal canal decompression,intervertebral bone graft of vertebral structure,and short segment internal fixation for residual disease spine. Results The nerve function of the patients was effectively improved after surgery, and the imaging re- sults showed that the average lesion kyphosis angle was significantly decreased（P〈0.05）. The postoperative follow-up found that the bone graft was fused after half a year, and the average local kyphosis angle was still 13%, which had no obvious change compared with that after operation. In addition,the internal fixation position had no looseness and fracture,the grafted bone had no displace ment and detachment,the four limbs movement was normal without local percussion pain or tenderness. Conclusion The anterior trans-injured vertebral short segment limited fixation and fusion has the satisfactory short term clinical efficacy in the treatment of thoracic and lumbar spinal tuberculosis.