Ⅰ期前路病灶清除植骨内固定治疗胸腰椎结核

目的:探讨Ⅰ期前路病灶清除植骨内固定治疗胸腰椎结核的可行性、指征及临床意义。方法:采用前路病灶清除植骨内固定治疗成人胸腰椎结核38例,17例有椎管内压迫,16例有神经功能损害,后凸畸形Cobb角9°～30°。术前ASIA分级:B级1例,C级5例,D级9例;术前VAS评分5～10分,平均7.6分。椎体间植骨病例均采用自体骨。术后继续四联标准疗程抗结核药,随访患者临床症状、实验室及影像学检查指标的变化。结果:所有患者切口均一期愈合。术后获得12～48个月的随访,椎体间植骨病例6个月随访时均获得融合,后凸畸形Cobb角矫正至2°～10°,随访丢失1°～2°,无内固定松动、断裂等并发症。神经功能损害术后获得不同程度改善,ASIA分级:1例B级恢复至D级;1例C级恢复至D级,4例C级恢复至E级;D级共11例,10例恢复至E级,1例无改变。末次随访时VAS评分1～3分,平均1.5分,VAS评分改善平均6.1分。结论:选择正确的适应证和手术时机,Ⅰ期前路病灶清除植骨内固定治疗胸腰椎结核可达到椎管内减压、脊柱矫形、融合和脊柱恢复稳定的目的,手术效果满意。

The One Stage Anterior Operation of Debridement and Fusion with Internal Fixation for the Thoracolumbar Spinal Tuberculosis

Objective:To approach the clinic indicatio and effect and its possibility of anterior operation of debridement and fusion with internal fixation for the thoracolumbar spinal tuberculosis in one stage.Methods:38 cases sufering from the thoracolumbar spinal tuberculosis accepted the treat by anterior operation of debridement and fusion with internal fixation in one stage.of which 21were male and 17 female,age from 21 to 69,mean age 47.5 years old,whose Meta-protruding deformation Cobb Ang between 9°and 30°.There were 17 cases get canalis vertebralis oppression and 16 patients suffering from nerves functional lesion.Preoperative nerves functionating were graded by ASIA grade,and get 1 case of B grade,5 case C grade,9 case D grade.VAS score was used before the operation and arrive at 5 to 10 score,average 7.6.Autogenous bone was used for fusion in all cases.Standard course of treatment of tetragenus antituberculosis drugs were kept on after the operation.We observed the clinical symptom and the serology indicatrix and imageology check were investigated in follow-up visit.Results:All cuts get heal in time,and follow-up went on 12 to 48 months.The mean VAS score was only 1.5,coming from the score from 1 to 3,and get 6.1 scores improve.All the patients suffering from nerves functional lesion have gain raise.There was 1 case of ASIA grade B and 1 case of grade C reached to grade D,4 cases of grade C reached to grade E.And the grade D patients add up to 11 cases,of which 10 cases return to grade E.jiust 1 case have no elevate.After the operation 6 months later,all the bone graft have get fusion,without internal fixation cinch or break.The Meta-protruding deformation Cobb Ang correct to 2°to 10°,and lose 1°to 2°during the follow-up.Conclusion:With correct indication and opportunity,it is a satisfated approach that anterior operation of debridement and fusion with internal fixation to treat the thoracolumbar spinal tuberculosis in one stage,because the decompression of the canalis vertebralis and spinal orthopedic well be get after the operation with good fusion and convalescence of spinal stability.