病灶清除同期CD棒内固定治疗多节段脊柱结核

TREATMENT OF MULTI-SEGMENTAL SPINAL TUBERCULOSIS BY USING FOCAL DEBRIDEMENT AND INTERNAL FIXATION WITH CD ROD

目的 探讨病灶清除同期应用 CD棒内固定 ,在多节段脊柱结核治疗中的临床疗效。 方法 1999年7月～ 2 0 0 2年 11月对 16例多节段脊柱结核患者行病灶清除术的同期应用 CD棒内固定 ,其中男 9例 ,女 7例。年龄 2 1～5 9岁。病程 2～ 11个月。病变部位 :T6 ～ T1 1 11例 ,T1 0 ～ L2 5例。病变累及 3个椎体 13例 ,4个椎体以上 3例。其中脊髓功能不全损害 5例 ,按 Frankel分级 :C级 3例 ,D级 2例 ;脊柱后凸畸形 4例 ;侧方塌陷畸形 2例。病灶清除和内固定视具体情况采用同一切口或双切口施行。 结果 术后 16例获 6个月～ 3年随访 ,平均 11个月。脊柱结核均治愈 ,切口 期愈合。合并脑脊液漏 1例 ,无全身并发症。脊髓功能损害者于术后 6个月内完全恢复。植骨块均全部融合 ,后凸畸形部分矫正 ,未发现钉棒松动、脱位。 结论 多节段脊柱结核病灶清除术同期应用 CD棒内固定可加强脊柱稳定 ,预防和矫正畸形 ,提高脊柱结核治愈率和植骨融合率。

Objective To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multi-segmental spinal tuberculosis. Methods From July 1999 to November 2002, 16 patients with multi-segmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T 6-T 11 in 11 patients and T 10-L 2 in 5 patients. The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott's paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. Results All patients were followed up 11 months (6 months-3years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtained primary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. Conclusion Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity, and improve its curative ratio and fused ratio of grafted bone.