后路钉棒系统内固定联合前路病灶清除植骨融合治疗复杂性胸腰椎脊柱结核32例

32 Cases Clinical Study for Efficacy of Internal Fixation Combined with Anterior Lesion Removal of Bone Graft Fusion on Complicated Thoracolumbar Spinal Tuberculosis

目的:探讨后路钉棒系统内固定联合前路病灶清除植骨融合治疗复杂性胸腰椎脊柱结核的临床疗效。方法:回顾性分析2017年1月至2019年6月采用后路钉棒系统内固定联合前路病灶清除植骨融合治疗复杂性胸腰椎脊柱结核32例的临床资料。术前四联抗结核治疗2~6周后根据临床症状、体征、影像学结果拟定手术方案,统计分析术前、术后后凸角、侧凸角、血沉、VAS、ASIA,术后观察其手术并发症及植骨融合情况,采取个体化的联合抗结核治疗。结果:本组病例全部随访6~24个月,平均18个月,手术前后后凸角、侧凸角、血沉、VAS、ASIA差异有统计学意义(P<0.05),术后2周与末次随访时差异无统计学意义(P>0.05),末次随访时全部病例无结核复发,内固定无失效,骨性愈合时间为4~10个月,平均6.5个月。结论:后路钉棒系统内固定联合前路病灶清除植骨融合治疗复杂性胸腰椎脊柱结核是一种病灶清除彻底、植骨融合良好、内固定安全可靠、临床疗效良好的治疗方法。

Objective:To investigate the efficacy of posterior nail-stick system internal fixation combined with anterior debridement and graft fusion on the treatment of complex thoracolumbar spinal tuberculosis.Methods:A total of 32 cases with complex thoracolumbar spinal tuberculosis treated with posterior nail-stick system internal fixation combined with anterior debridement and graft fusion from January 2017 to June 2019 were respectively analyzed.After 2 to 6 weeks of preoperative quadruple anti-tuberculosis treatment, the operation plan was determined by clinical efficacy, symptoms and imaging results.The kyphosis convex angle, side angle, blood sedimentation, VAS and ASIA of pre-operation and post-operation were statistical analyzed.Postoperative observation of the surgical complications, bone graft fusion were performed and individual anti-tuberculosis therapy was taken.Results:The cases were followed up 6 to 24 months, with an average of 18 months.The convex angle, side angle, blood sedimentation, VAS,ASIA of pre-operation and post-operation had significant difference(P<0.05),and there was no difference in 2 weeks and at the final follow-up(P>0.05).All patients without recurrence of tuberculosis and internal fixation failure at the final follow-up.Bone graft fusion time was 4 to 10 months, with an average of 6.5 months.Conclusion:Posterior nail-stick system internal fixation combined with anterior debridement and fusion graft on the treatment of complex thoracolumbar spinal tuberculosis is a method with thorough debridement, good bone graft fusion, safe and reliable internal fixation and good clinical efficacy.