后路病灶清除椎间植骨融合内固定治疗胸腰椎结核

目的探讨后路一期病灶清除、椎体间植骨融合内固定治疗脊柱结核的适应证及临床疗效。方法采用单纯后路病灶清除、植骨融合钉棒内固定治疗58例脊柱结核患者,其中单节段胸椎结核22例,多节段胸椎结核6例,单节段腰椎结核24例,多节段腰椎结核6例。分析复发率、并发症发生率,进行JOA评分,随访评估结核活动度、植骨融合和畸形矫正情况。结果手术时间平均(190±15.24)min,术中出血量平均(380±19.88)ml。术中无主要血管、神经损伤,无严重并发症发生。所有患者均安全度过围手术期。JOA评分:优39例,良11例,可7例,差1例,优良率为86.2%。后凸Cobb角矫正满意。1例术后结核脓肿复发,经再次清创、持续负压引流后治愈。患者均获随访,时间6~48(25.14±6.40)个月。无结核病变复发、内固定松动、断裂及明显矫正度丢失等严重并发症发生,58例植骨全部确定融合。结论对脊柱结核的患者采取一期后路病灶清除、椎体间植骨融合内固定治疗,可同时完成病灶清除、重建脊柱稳定,是治愈结核病灶有效可行的方法。

Posterior debridement and interbody fusion fixation in the treatment of thoracic and lumbar tuberculosis

Objective To investigate the clinical effect of posterior debridement, bone fusion and internal fixation for the treatment of spinal tuberculosis, as well as interbody indications and clinical efficacy. Methods Using a simple posterior debridement, bone fusion nail fixation rod, 58 cases of spinal tuberculosis patients were enrolled, including 22 single segment thoracic tuberculosis, 6 multi-segmental thoracic tuberculosis, and 24 single lumbar segment spinal tuberculosis, 6 multi-section lumbar spinal tuberculosis. Analysis of relapse rate, complication rate was conducted. JOA score, tuberculosis activity, fusion and deformity correction was recorded in follow-up. Results The mean op-eration time was （190 ± 15. 24）min, average blood loss was （380 ± 19. 88） ml. There were no major blood vessels, nerve damage and severe complications. Based on JOA score, the results were excellent in 39 cases, good in 11, fair in 7 and poor in 1,the excellent and good rate was 86. 2%. The kyphosis was corrected obviously. Recurrence of tu-berculosis abscess was found in one patient, after debridement and continuous negative pressure drainage, the abscess was cured. All patients were followed up for 6-48（25. 14 ± 6. 40）months. No recurrence of tuberculosis, loosening, fracture and significant loss of correction and other serious complications was found. All 58 cases achieved bone fu-sion. Conclusions Posterior primary debridement, interbody fusion and internal fixation can be performed in all pa-tients with spinal tuberculosis, debridement and reconstruction of spinal stability and cure of tuberculosis can be a-chieved simultaneously. It is an effective and feasible method.