脊柱结核一期手术治疗的围手术期处理

Perioperative management of one-stage surgical treatment for spinal tuberculosis

目的 探讨一期手术治疗脊柱结核的围手术期处理问题。方法 采用一期手术治疗胸、腰椎脊柱结核患者 5 7例 ,其中经前路病灶清除、椎体间植骨并内固定 35例 ,经后路病灶清除并内固定16例 ,后路内固定并前路病灶清除、椎体间植骨 6例。采用钛合金材料内植入物 38例 ,不锈钢材料内植入物 19例。围手术期处理主要包括规则化疗、支具保护及有效监测。结果 5 7例患者切口均一期愈合 ,无窦道形成。除 3例失访外 ,5 4例获得随访 ,随访时间 1～ 5年 (平均 2 2年 ) ,结核无局部复发 ,后凸畸形平均矫正 2 1 6°。随访期内 ,有 2°～ 4°角度丢失。植骨界面骨性融合时间平均 3 8个月。 10例出现化疗相关的并发症 ,需要调整化疗方案及接受治疗。结论 一期手术治疗可以完成脊柱结核外科治疗的基本环节 ,具有明显的优越性。

Objective To evaluate the perioperative management of one stage surgical treatment for spinal tuberculosis. Methods 57 cases of thoracic, thoracolumbar or lumbar spinal tuberculosis were treated surgically by a single stage procedure in our department, including anterior resection,interbody autografting and anterior instrumentation in 35 cases, posterior debridement and posterior instrumentation in 16 cases,and posterior instrumentation and anterior resection with interbody autografting in 6 cases. Titanium alloy spinal implants were used in 38 cases and stainless steel implants in 19 cases. Perioperative management included chemotherapy, orthosis support, and effective monitoring. Except for 3 patients, 54 patients were followed up for one to five years (mean 2 2 years). Results All these patients were healed without chronic infection or sinus formation, and no recurrence of spinal tuberculosis was noted during the follow up period. Kyphosis correction were achieved by mean 21.6°postoperatively. There was a mild loss (2°～4°) of kyphosis correction during follow-up period. Spinal solid fusion at the interface between graft and adjacent vertebral bodies was shown radiologically in mean 3 8 months. 10 cases with complications due to chemotherapy had to be given regime adjustment and other treatments. Conclusions One stage surgical management has more advantages in that it can complete all aspects of surgical treatment for spinal tuberculosis. The role of perioperative management cannot be underestimated for clinical efficacy of this procedure.