一期前路病灶清除联合后路钉棒内固定治疗多节段下颈椎结核的临床体会

Clinical experience of one-stage anterior debridement and posterior internal fixation in treatment of multi-level lower cervical tuberculosis

目的总结一期颈椎前路病灶清除联合后路钉棒内固定治疗多节段下颈椎结核的临床体会。方法回顾性分析自2019-03—2021-03采用一期颈椎前路病灶清除联合后路钉棒内固定治疗的10例多节段下颈椎结核,根据结核病灶累及节段和破坏程度选择固定节段,常规置入合适长度的颈椎椎弓根钉或侧块螺钉,安装钛棒并矫正残留的颈椎后凸。根据结核病灶节段、脓肿部位、脓肿大小选择颈前左侧或右侧作纵向或横向切口,逐层显露病灶节段,彻底清除椎前脓肿、坏死组织及死骨组织。结果10例均获得随访,随访时间平均19.7(12~24)个月。术后所有患者临床症状均明显改善,未出现切口愈合不良及神经功能并发症。术后3个月疼痛VAS评分为0~3分,平均1.3分;NDI指数为25%~58%,平均43.2%;局部后凸Cobb角为-7.6°~3.1°,平均-2.7°;C2~7后凸Cobb角为-10.7°~1.8°,平均-3.2°。末次随访时疼痛VAS评分为0~3分,平均1.1分;NDI指数为4%~25%,平均11.6%;局部后凸Cobb角为-6.9°~2.0°,平均-2.6°;C2~7后凸Cobb角为-9.5°~2.7°,平均-3.3°。1例术后出现声音嘶哑,予以雾化、营养神经对症治疗,术后3个月症状缓解。末次随访时所有患者结核病灶椎体均获得骨性愈合,无内固定松动发生。结论一期颈椎前路结核病灶清除联合后路钉棒内固定治疗多节段下颈椎结核有利于恢复和维持颈椎曲度和颈椎序列的稳定性,促进病灶骨性愈合,为后期可能进行的前路内固定手术创造条件并缩短前方固定融合节段。

Objective To summarize the clinical experience of one-stage anterior debridement and posterior screw rod inter-nal fixation in the treatment of multi-level lower cervical tuberculosis.Methods Ten cases of multi-level lower cervical tuber-culosis treated with one-stage anterior cervical lesion clearance combined with posterior screw rod internal fixation from March 2019 to March 2021 were retrospectively analyzed.The fixation segment was selected according to the extent of involvement and destruction of the tuberculosis focus.Cervical pedicle screws or lateral mass screws of appropriate length were routinely insert-ed,titanium rods were installed,and residual cervical kyphosis was corrected.According to the tuberculosis focus segment,ab-scess location,and abscess size,the left or right side of the front neck for longitudinal or transverse incision was selected,the fo-cus segment layer by layer was exposed,and the prevertebral abscess,necrotic tissue,and dead bone tissue were thoroughly re-moved.Results All 10 cases were followed up,with an average follow-up time of 19.7(12-24)months.All patients showed significant improvement in clinical symptoms after surgery,and there were no signs of poor wound healing or neurological com-plications.The VAS score at 3 months after surgery was 0-3 points,with an average of 1.3 points;The NDI index ranged from 25%to 58%,with an average of 43.2%;The local convex Cobb angle was-7.6°-3.1°,with an average of-2.7°;The convex Cobb angle of C2-7 was-10.70-1.8°,with an average of-3.2°.At the last follow-up,the pain VAS score was 0-3 points,with an average of 1.1 points;The NDI index ranged from 4%to 25%,with an average of 11.6%;The local convex Cobb angle was-6.9°-2.0°,with an average of-2.6;The convex Cobb angle of C2-7 was-9.5°-2.7,with an average of-3.3°.One patient devel-oped hoarseness after surgery and received symptomatic treatment with nebulization and nutritional treatment for nerves.Symp-toms relieved 3 months after surgery.At the last follow-up,the vertebral bodies of all patients with tuberculosis were bony healed without loosening of internal fixation.Conclusion One stage anterior debridement of tuberculous lesions combined with posterior screw rod internal fixation for the treatment of multi-level lower cervical tuberculosis is conducive to restoring and maintaining the cervical curvature and the stability of cervical sequence,promoting the bone healing of tuberculosis foci,creating conditions for possible late anterior internal fixation and shortening the anterior fixation and fusion segments.