前后路内固定手术治疗胸腰段脊柱结核的对比研究

目的探讨胸腰段脊柱结核理想的手术治疗方案。方法回顾总结2000年1月~2005年6月期间行病灶清除植骨融合内固定术的胸腰段脊柱结核患者51例。所有病例分为:A组(24例)一期前路病灶清除植骨融合钉-板(棒)矫形内固定术治疗组,B组(27例)一期后路钉-棒矫形内固定前路病灶清除植骨融合术治疗组;每个组又分为累及单个椎体组(A1,B1)及累及多个椎体组(A2,B2)。分别对比研究A1、B1及A2、B2手术时间、术中出血量、矫形率、神经功能恢复情况、植骨融合时间、并发症等。结果A1组手术时间、术中出血量明显低于B1;B2组矫形率、稳定性及并发症发生率优于A2组。结论胸腰段脊柱结核累及单个椎体时一期前路病灶清除植骨融合钉-板(棒)矫形内固定术是较佳的选择;累及多个椎体尤其脊柱后凸角度偏大时一期后路钉-棒矫形内固定前路病灶清除植骨融合术更为理想。

Comparison of anterior and posterior internal fixation for thoracolumbar tuberculosis

ObjectiveTo explore the ideal surgical treatment for thoracolumbar tuberculosis. Methods Fifty-one cases of thoracolumbar tuberculosis treated by focus clearance, bone graft fusion and internal fixation from January 2000 to June 2005 were retrospectively studied. All the cases were divided into two groups: 24 cases in Group A underwent one-stage anterior focus clearance, bone graft fusion and anterior internal fixation by screw-rod system, and 27 cases in Group B underwent one-stage posterior internal fixation by screw-rod system, anterior focus clearance and bone graft fusion. The two groups included four subsets: one level involved (A_ 1 , B_ 1 ), multi-level involved (A_ 2 ,B_ 2 ). The operation time, blood loss, correction rate, recovery of neurological function, fused time and complications were respectively compared between A_ 1 and B_ 1 , and between A_ 2 and B_ 2 . Results The operation time and blood loss of Group A_ 1 were both obviously less than those of Group B_ 1 ; Group B_ 2 had more advantages such as in correction rate, stability and complications than Group A_ 2 . ConclusionWhen one level involved, the surgical procedure of one-stage anterior focus clearance, bone graft fusion and anterior internal fixation by screw-rod system is a better choice for thoracolumbar tuberculosis; whereas, the procedure of one-stage posterior internal fixation by screw-rod system, anterior focus clearance and bone graft fusion is better when multi-level involved especially with larger kyphosis angle.