一期病灶清除植骨融合前后路联合内固定治疗复发性胸腰椎结核

One stage debridement and bone graft fusion with combined anterior and posterior fixation in treatment of recurrent thoracolumbar tuberculosis

目的探讨一期病灶清除植骨融合前后路联合内固定治疗复发性胸腰椎结核的临床疗效。方法回顾性分析自2011-09—2014-09一期病灶清除植骨融合前后路联合内固定术治疗的46例复发性胸腰椎结核。比较术前、术后2周、末次随访时VAS评分、ODI指数、Cobb角、C7矢状位铅垂线(SVA值)。按Brantigan标准评价植骨融合情况。结果 46例均获得(29.7±5.1)个月随访。术后抗结核药物治疗(21.8±3.4)个月。按Brantigan标准,46例植骨融合时间(8.5±2.4)个月,其中D级21例,E级25例。术后2周VAS评分明显低于术前,差异有统计学意义(P<0.05);末次随访与术后2周的VAS评分差异无统计学意义(P>0.05)。术后2周ODI指数明显低于术前,且末次随访ODI指数明显低于术后2周,差异有统计学意义(P<0.05)。术后2周SVA值、Cobb角均较术前改善,差异有统计学意义(P<0.05),且末次随访时均未丢失。结论一期病灶清除植骨融合前后路联合内固定治疗复发性胸腰椎结核不但可以有效缓解胸腰背部疼痛、恢复患者自主生活能力并使脊柱结核达到临床治愈标准,还可以矫正后凸畸形、恢复脊柱矢状面平衡并重建脊柱稳定性。

Objective To evaluate therapeutic effects of one stage debridement and bone graft fusion with combined anterior and posterior fixation for recurrent thoracolumbar tuberculosis. Methods From Sept. 2011 to Sept. 2014, 46 patients with recurrent thoracolumbar tuberculosis were treated by one stage debridement and bone graft fusion with combined anterior and posterior fixation. The average VAS, ODI index, Cobb angle and C7 sagittal plumb （SVA） of all the patients were evaluated before surgery, 2 weeks after surgery＂ and at the last follow-up. The fusion of intervertebral bone graft was evaluated by the Brantigan-standard. Results The average period of follow-up was （29.7±5.1）months. The average period of postoperative anti-tuberculosis treatment was （21.8±3.4）months. The average fusion time of intervertebral bone graft was （8.5±2.4）months by the Brantigan-standard. The average VAS, ODI index, Cobb angle, and SVA of all the patients were significantly improved 2 weeks after surgery. Comparing the 2 weeks after surgery and at the last follow-up, the difference of ODI index was also significant statistically （P 〈0.05）; but the VAS, Cobb angle and SVA were not significant statistically （P 〉0.05）, Conclusion One stage debridement and bone graft fusion with combined anterior and posterior fixation for recurrent thoracolumbar tuberculosis can not only effectively alleviate the pain of the back, restore the ability of self-living and make the spinal tuberculosis reach the standard of clinical cure, but also correct the kyphosis, restore the balance of the spinal column and rebuild the stability of the spine.