经后路一期手术病灶清除钉棒系统固定椎间支撑植骨治疗胸腰椎结核的疗效探讨

目的探讨胸腰椎结核一期后路病灶清除、椎间支撑植骨、后路经椎弓根螺钉内固定的临床疗效。方法选取2003-01~2010-06收治的46例胸腰椎结核患者,均采用一期后路病灶清除、椎间支撑植骨、后路经椎弓根螺钉内固定。根据术前、术后X片分析植骨融合情况以及脊柱后凸畸形矫正的效果。结果本组46例均获得随访,随访时间12~36个月,平均26个月。术后内固定无松动,1例病灶复发,经过第2次清创后,瘘口愈合,全部病例植骨愈合;愈合时间3~7个月;术前Cobb角平均35°,末次X片随访复查Cobb角平均16.5°。结论一期后路病灶清除、椎间支撑植骨、后路经椎弓根螺钉内固定治疗胸腰椎结核,既能彻底清除病灶,又能有效矫正脊柱后凸畸形,重建脊柱稳定,临床效果满意。

One stage posterior lesion clearence combined with internal fixation for thoraco-lumbar spinal tuberculosis

Objective To investigate the clinical effect of one stage posterior lesion clearence combined with posterior interveterbral supporting bone autograft and posterior pedical screw fixation in thoraco-lumbar spinal tuberculosis.Methods Forty-six patients with thoraco-lumbar spinal tuberculosis were sellected from Jan 2003 to Jun 2010.All the patients were treated with one stage lesion clearence combined with intervertebral supporting bone autograft and posterior pedical screw fixation.Then the conditions of bone graft fusion and the effect of correction of kyphosis were analyzed.Results All 46 patients were followed up for one to three years with an average of 26 months.There was no loosening of the internal fixation,all bone grafts were healed and no lesion recurred;The time of healing was 3 ~ 7 months;The latest X-ray follow-up revealed the average Cobb＇s angle was 16.5°compared to preoperative 35°.Conclusion The method of one-stage lesion clearence combined with intervertebral supporting bone autograft and posterior pedical screw fixation for the treatment of thoraco-lumbar spinal tuberculosis could not only completely clear the lesions but also correct the kyphosis effectively and reconstruct the stability of the vertebral column.