前后路联合手术治疗胸腰椎结核的临床探索

目的探讨前后路联合手术治疗胸腰椎脊柱结核的临床可行性及疗效。方法1998年1月至2005年l2月间采用后路器械固定、前路彻底病灶清除植骨的方法治疗胸腰椎脊柱结核27例。其中胸椎6例,胸腰段10例,腰椎11例;累及2个节段17例,3个节段7例,4个节段3例;所有患者均伴有不同程度的椎旁脓肿,6例伴流注脓肿形成;15例伴有不同程度的脊髓和(或)神经根受压症状;所有患者均采用全身抗结核2周后手术,手术方式为先行后路脊柱内固定,后行结核病灶清除、植骨治疗。术中放置引流管和局部注药管。结果平均随访4年,除术后复发2例外,余25例患者平均术后6个月获得椎体间植骨融合,植骨融合率为92.6%。17例患者于术后1～4年行内固定取出术。结论前后路联合手术治疗胸腰椎结核有利于恢复脊柱的稳定性、提高植骨融合率、纠正和预防后凸畸形,提高临床治愈率。为尽量保留脊柱的运动单位应及时取出内固定。术中放置引流管并不会增加窦道的发生,术中置管化疗有利于局部病灶的控制。

Combined anterior-posterior surgeries in the treatment of spinal tuberculosis

Objective To explore the clinical value of combined anterior and posterior operation for thoracic and lumbar spinal tuberculosis. Methods Data of 27 patients with spinal tuberculosis undergoing the operation of debridement and fusion with instrumentation between January 1998 to December 2005 were documented retrospectively. Six cases were located in thoracic spine,10 in thoracolumbar and 11 in lumbar spine. Two vertebrae were involved in 17 patients,three vertebrae in 7 patients,four vertebrae in 3 patients. All patients had different abscess. Fifteen patients had different spinal cord or never root injury symptoms. Patients adopted anti-tuberculosis therapy for two weeks preoperatively. The combined operations,posterior spinal internal fixation and anterior lesion debridement and grafting fusion,were performed in 27 cases. Two tubes were placed in the lesion during operation. Results The toxic symptom of tuberculosis alleviated greatly and neurological function improved postoperatively. 25 of 27 patients(92.6%) got bony fusion at the average of 6 months after operation. Conclusions The application of combined operation in the treatment of spinal tuberculosis was in favor of recovering spinal stability,increasing bony fusion rate,correcting and preventing kyphosis deformity. It was necessary to dislodging internal fixation devices for remaining spinal movement unit. The use of drainage tube would not cause development of sinus tract. It was in favor of improving local control with local chemotherapy.