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 instrumentations for treatment of thoracolumbar tuberculosis

目的分析一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核的临床效果。方法对60例胸腰椎结核患者行一期后路病灶清除、植骨融合内固定术。采用ASIA分级评估手术前后脊髓神经功能,根据影像学资料评价术后畸形矫正情况和植骨融合情况。结果患者均手术顺利,未发生脊髓及神经根损伤情况,切口均一期愈合。患者均获得随访,时间12~48个月。术后脊髓神经功能ASIA分级明显改善:术前A级4例,B级6例,C级10例,D级22例,E级18例;术后A级1例,B级3例,C级8例,D级18例,E级30例。患者植骨均达到骨性融合。术后3个月后凸Cobb角从术前的32.5°±13.2°改善至17.5°±12.3°,差异有统计学意义(P<0.05)。未出现内固定松动或断裂、假关节、骨不连等并发症。结论一期后路病灶清除、植骨融合内固定术治疗胸腰椎结核能有效纠正后凸畸形,并促进神经功能恢复,临床治疗效果好。

Objective To analyse the clinical effects of one stage debridement , bone graft and internal fixation in the treatment of thoracolumbar tuberculosis.Methods The 60 cases of thoracolumbar spinal tuberculosis were treated with one-stage debridement , bone grafting and internal fixation.ASIA classfication was used to evaluate the spinal cord nerve function before and after the operation , and the deformity correction and the bone graft fusion were evaluated according to the imaging data.Results The operation was successful and no spinal cord or nerve root injuries occurred.The incisions healed at one-stage.All patients were followed up for 12 ~48 months.Postoperative spinal nerve function of ASIA classification improved significantly：preoperative grade A 4 cases, grade B 6 cases, C 10 cases, D 22 cases, E 18 cases, postoperatively grade A 1 case, B 3 cases, C 8 cases, D 18 cases, E 30 cases.The bone grafts reached bony fusion.At 3 months of after operation , the Cobb angle was improved from 32.5°±13.2° before operation to 17.5°±12.3°,the difference was statistically significant （P〈0.05）.There were no complications such as loosening of internal fixation , fracture, pseudo joint and nonunion.Conclusions One-stage posterior debridement and bone graft fusion and internal fixation for thoracolumbar tuberculosis can effectively correct kyphosis and promote the recovery of neurological function , and the clinical effect is good.