病灶清除一期植骨内固定治疗脊柱结核

目的探讨脊柱结核病灶清除手术后内固定方式的选择。方法对35例脊柱结核患者采用3种不同术式：16例前路病灶清除、植骨,一期前路钢板或钉棒内固定;14例前路病灶清除、植骨,一期后路经弓根钉棒内固定;5例前路病灶清除、植骨,一期前路钢板、后路钉棒联合内固定。结果35例均获随访,时间18-24个月。X线显示病灶静止,植骨融合,内固定无松动断裂,后凸畸型改善,其中合并脊髓损害15例,按Frankel分级,C级3例、D级12例术后全部恢复到E级。结论病灶清除一期植骨内固定有利于重建脊柱稳定性,纠正和预防脊柱后凸畸形,可避免或减少结核复发。

Selections of internal fixation for surgical management of spinal tuberculosis in one stage procedure

Objective To explore one-stage operative method selection for the treatment of spinal tuberculosis.Methods 35 cases were treated with three different methods: 16 cases were treated with anterior focus elimination,bone grafting and one-stage anterior plate fixation;14 cases were treated with anterior focus elimination,bone grafting and one-stage posterior transpedicle instrumental fixation;5 cases were treated with one-stage combined anterior and posterior approach focus elimination and fusion with internal fixation.Results The follow-up for 18~24 months in 35 cases showed no internal fixators loosening,breakage or recurrence of tuberculosis.All got interbody fusion,deformity correction and back pain improvement.According to Frankel classification in 15 cases with partial spinal cord injury,the nervousness function of 3 cases with C grade and 12 cases with D grade were restored to E grade.Conclusions It is effective to treat spinal tuberculosis with focus debriding and bone autograft with internal fixation in one-stage to restore spinal stability,correct deformity of kyphosis,and avoid tuberculosis recurrence.