胸腰椎结核前路术后复发的原因及再手术治疗

Anterior approach operation for thoracic and lumbar spinal tuberculosis: the cause of recurrence and revision

目的探讨胸腰椎结核一期前路病灶清除、植骨融合及内固定术后复发的原因及再手术治疗的策略。方法对136例胸腰椎结核患者行一期经前路术病灶清除、植骨融合及内固定,对其中15例术后复发合并窦道形成并经过保守治疗无效患者的复发原因进行分析,并均采取一期前路病灶清除、内固定取出、植骨融合、后路植骨融合内固定的翻修术治疗。结果 15例均获得随访,时间12~48个月。14例治愈,影像学检查显示植骨融合;1例再次复发,再次复发率为6.67%（1/15）,经抗结核及换药4个月治愈。结论胸腰椎结核一期前路术后复发的主要原因与病灶清除不彻底、耐药性结核菌株出现、非活性异物过多放置、内固定松动失效、长期营养不良及不正规化疗有关;前路病灶的彻底清除及良好的植骨支撑、后路坚强的内固定结合有效的化疗可明显减少翻修术后结核的复发率。

Objective To investigate the recurrent cause of thoracic and lumbar spinal tuberculosis treated by onestaged anterior debridement,bone fusion and spinal reconstruction,and strategies of revision. Methods 136 patients with thoracic and lumbar spinal tuberculosis were undergone one-staged anterior debridement,bone fusion and spinal reconstruction. It was analyzed that the cause of the 15 patients among them with recurrent spinal tuberculosis and sinus tract and conservative treatment were not cured. 15 patients had undergone one-stage anterior sinus clearing and debridement,instrument removal,bone graft and internal fixation by posterior approach. Results All cases were followed up for 12 ~ 48 months. 14 patients got cured,the imaging examination showed bone graft fusion. 1 patient got recurrence with the rate of 6. 67%（ 1 /15）,cured by anti-tuberculosis treatment for 4 months. Conclusions The recurrent cause of thoracic and lumbar spinal tuberculosis treated by one-staged anterior operation include uncompleted debridement,drug-resistant strains of tuberculosis,redundant inactive foreign body,loosening of instrumentation,chronic malnutrition and irregular chemotherapy. It can reduce the recurrence rate of spinal tuberculosis by revision include anterior radical debridement and satisfactory bone graft,posterior stable internal fixation,which must combine with effective chemotherapy.