钉棒内固定技术在脊柱结核治疗中的应用

目的:探讨钉棒内固定技术在脊柱结核治疗中的应用效果。方法:2003年5月～2009年5月,30例脊柱结核采用钉棒内固定技术,其中男21例,女9例。年龄9～75岁,平均37岁。颈椎结核2例,胸椎结核6例,腰椎结核9例,胸腰段结核11例,骶椎结核2例。术前ASIA评分:A级2例,B级5例,C级10例,D级12例,E级1例;后凸角度:10°～64°,平均28.4°。经前路钉棒内固定15例、经后路11例,前后路联合固定4例。随访时予ASIA评分、测量后凸角度及评估植骨融合状况。结果:术后均随访4个月～6年,平均2.3年。最后1次随访ASIA评分:B级1例,C级3例,D级6例,E级20例;后凸角度5°～45°,平均18°,平均角度丢失4°。植骨融合平均时间为6个月。结论:钉棒内固定系统治疗脊柱结核具有良好的临床效果,使病灶彻底清除后的脊柱稳定性恢复及后凸畸形矫正,并为脊髓神经功能的恢复提供良好的条件。

The Application of Nail-stick Internal Fixation Technique for the Treatment of Spinal Tuberculosis

Objective:To investigate the efficacy of Nail-stick Internal Fixation Technique in Spinal Tuberculosis Treatment.Methods:From May 2003 to May 2009,30 cases with spinal tuberculosis were treated by nail-stick internal fixation,including 21 males and 9 females.The age ranged from 9 to 75 years,average 37 years.And there were 2 cases of cervical vertebral tuberculosis,6 cases of thoracal vertebral tuberculosis,9 cases of lumbar vertebral tuberculosis,11 cases of thoracal thoro-columbar vertebral tuberculosis and 2 cases of sacral vertebral tuberculosis.The preoperative scales of ASIA were 2cases with grade A,5 cases with grade B,10 cases with grade C,12cases with grade D and 1 case with grade E;the preoperative kyphosis angle ranged from 10 degrees to 64 degrees,averaging 28.4°.15 cases were fixed from the anterior approach by nail-stick instrument,11cases were from the posterior and the last were from both the anterior and the posterior.After the operations,We evaluated them with the scales of ASIA,measured the kyphosis angle and assessed the bone fusion when they were followed-up.Results:All cases were followed-up for an average of 2.3 years(range 4 months-6years).At final follow-up,the neurological recovery on the scale of ASIA were 1 case with grade B,3 cases with grade C,6 cases with grade D and 20 cases with grade E ;the average postoperative kyphosis was 18 degrees(range 5-45 degrees)and with an average loss of correction of 4 degrees.The average of bone fusion was 6 months.Conclusions:The Nail-stick Internal Fixation system has a good efficacy in the treatment of spinal tuberculosis,rebuilding the stability of the spine and remedy the kyphosis deformity after complete radical debridement,then supply a good situation for the neurological recovery.