一期病椎切除内固定治疗胸腰椎结核

目的探讨病变椎体部分切除、植骨融合、内固定治疗胸腰椎结核的临床效果。方法采用前路病变椎体部分切除、髂骨植骨融合、前路或后路内固定手术治疗23例胸腰椎结核。后路固定14例，前路固定9例。结果所有患者术后切口均一期愈合，早期无局部窦道形成。术后随访1年3个月-3年3个月，除1例术后8个月结核窦道形成行二次翻修外，余患者结核症状均消失，病灶全部愈合，无复发。9例有神经症状者，术后均有不同程度的恢复。16例后凸畸形术后平均矫正28．6°，随访期间丢失1°-5°。结论病变椎体部分切除、植骨融合、内固定手术复发率低，缩短了脊柱结核的疗程，是治疗脊柱结核的有效术式。

One-stage surgical treatment of thoracolumbar spinal tuberculosis with anterior partial vertebrectomy,iliac grafting and anterior or posterior internal fixation

Objective To explore the clinical significance in treating thoracolumbar spinal tuberculosis with partial vertebrectomy,iliac grafting and anterior or posterior internal fixation. Methods 23 patients with thoracolumbar spinal tuberculosis were treated by anterior partial vertebrectomy of the diseased vertebrae, iliac grafting and anterior or posterior internal fixation. The patients needed one or two intevertebral space fusion were offered internal fixation via anterior approach. 14 patients requiring more than three intevertebral-space fusion were provided with internal fixation via posterior approach. Results All these patients had their incision healed by first intention without chronic infection or sinus formation and no recurrence of spinal tuberculosis was noted in any patient during the follow-up early period. All patients were followed up with an average of 2. 3 years ranged 1.3 to 3.3 years. Recurrence was found in 1 case after first surgery in 8 months. Kyphosis deformity was corrected mean 28. 6° and 1° to 5° loss during followup. 9 cases with neurological deficits had an improvement of neurological function postoperatively. Conclusions The partial vertebrectomy with iliac grafting and internal fixation is an effective therapy in curing the spinal tuberculosis.