Ⅰ期后路病灶清除植骨融合内固定治疗胸椎结核

目的:探讨Ⅰ期单纯后路病灶清除、椎弓根螺钉固定、植骨融合治疗胸椎结核的疗效及适应证。方法:2005年1月至2011年5月对12例胸椎结核患者行术前、术后常规抗痨治疗,Ⅰ期行单纯后路病灶清除植骨椎弓根螺钉内固定,其中男7例,女5例;平均年龄45岁,平均病程15个月。观察手术时间、出血量,术后植骨融合、局部后凸畸形矫正、神经功能恢复情况。结果:所有患者病灶清除彻底,植骨融合良好。手术时间120～210min,平均170min;术中出血量200～1000ml,平均510ml。后凸Cobb角术前平均(28.7±9.2)°,术后平均(8.2±3.5)°,差异具有统计学意义(P<0.05)。术后末次随访无内固定并发症,无后凸矫正丢失,无结核复发。神经功能Frankel分级均恢复为E级。结论:单纯Ⅰ期后路病灶清除并植骨融合、椎弓根螺钉固定治疗胸椎结核具有病灶清除彻底、手术时间短、出血量少、后凸畸形矫正明显、融合率高等优点。

Surgical treatment of thoracic tuberculosis with one stage posterior debridement and bone grafting fusion and internal fixation

Objective: To investigate the effect and indication of one stage posterior debridement and bone grafting fusion and internal fixation for thoracic tuberculosis.Methods: From January 2005 to May 2011,12 patients with thoracic tuberculosis were treated with one stage posterior debridement and pedicle screw fixation combined with regular anti-tuberculosis treatment before and after operation. There were 7 males and 5 females,with an average age of 45 years and average course of 15 months. Information of operative time,blood loss,bony fusion,local kyphosis and neurologic functional were evaluated.Results: All infective focus were thoroughly removed and bone graft obtained fusion. The mean of operative time and blood loss were 170 min (120-210 min) and 510 ml (200-1 000 ml),respectively. Cobb angle from (28.7±9.2)° preoperatively decreased to (8.2±3.5)° postoperatively(P<0.05). No kyphosis correction loss,tubercular recurrence or failure of internal fixation was found. According to Frankel grade to evaluate neurological function,all patients arrived to grade E.Conclusion: One stage posterior debridement and bone grafting fusion and internal fixation is an effective method in treating thoracic tuberculosis. It has advantages such as thorough debridement,short operative time,less blood loss,more kyphosis correction and higher bony fusion rate.