单纯后路病灶清除钛网椎间植骨融合内固定治疗合并椎管脓肿的胸腰段脊柱结核

Posterior approach debridement, internal fixation, and interbody fusion using titanium mesh in treatment of thoracolumbar tuberculosis with intraspinal abscess

目的探讨单纯后路病灶清除、钛网椎间植骨融合内固定治疗合并椎管脓肿的胸腰段脊柱结核的可行性及临床疗效。方法回顾性分析自2008-01-2012-01采用单纯后路病灶清除、钛网椎间植骨融合内固定治疗的27例合并椎管脓肿的胸腰段脊柱结核。比较手术前后血沉、疼痛VAS评分、病变节段后凸Cobb角。结果 27例均获得随访,随访时间平均78.5(60~110)个月。随访期间无内固定失败及假关节形成,植骨融合时间平均6.5(4~9)个月。术后神经功能获得不同程度恢复,术前1例B级恢复至D级;9例C级中,3例恢复至D级,6例恢复至E级;11例D级中,2例未改善,9例恢复至E级。术后3 d病变节段后凸Cobb角较术前明显减小,术后2周疼痛VAS评分较术前明显降低,术后6个月血沉较术前明显降低,差异有统计学意义(P <0.05)。结论对于合并椎管内脓肿的胸腰段脊柱结核,单纯后路病灶清除、钛网椎间植骨融合内固定术可充分减压、清除病灶,并且提供可靠的脊柱重建和骨性融合。

Objective To investigate the clinical efficacy and feasibility of posterior approach debridement, internal fixation,and interbody fusion using titanium mesh for the treatment of thoracolumbar tuberculosis(TB) with intraspinal abscess.Methods From January 2008 to January 2012, 27 patients diagnosed as thoracolumbar spine TB with intraspinal abscess were enrolled in this retrospective study. The patients were treated by the posterior-only approach debridement, internal fixation, and interbody fusion using titanium mesh. The erythrocyte sedimentation rate(ESR), visual analog scale(VAS) and Cobb angle of segmental kyphosis were observed and compared before and after operation. Results All 27 patients were followed up with an average of 78.5(60-110) months. All patients obtained bony fusions without internal fixation failure and pseudarthrosis during follow-up. The mean of the bone graft fusion time was 6.5(4-9) months. Postoperative neurological function was restored to varying degrees, 1 case improved from grade B to D, 3 cases from grade C to D, 6 cases from grade C to E, 9 cases from grade D to E, only 2 cases of grade D did not improve. The segmental kyphosis Cobb angle 3 days after operation and VAS scores 2 weeks postoperative, ESR 6 months follow-up were significantly decreased than those before operation(P <0.05). Conclusion For thoracolumbar TB patients with intraspinal abscess, posterior approach debridement,internal fixation, and interbody fusion using titanium mesh can enable surgeon to perform full decompression and debridement with solid spinal reconstruction and bone fusion.