病变治愈型脊柱结核脊柱后凸畸形及脊髓压迫的外科治疗

目的]探讨胸腰段病变治愈型脊柱结核合并脊柱后凸畸形及脊髓压迫的外科治疗方法。方法]对17例胸腰段病变治愈型脊柱结核分别采用单纯后路植骨融合3例，后路椎弓根螺丝钉固定及后路植骨融合术8例，椎体侧前方椎管减压6例，其中行单纯椎体侧方植骨融合术3例，辅以椎体侧方钢板内固定3例。结果]术后随访时间9个月～7a6个月，平均4．2a。后路植骨平均骨融合时间为2．8个月，椎体侧方植骨平均骨性融合时间为3．3个月，椎管侧前方减压6例中1例神经根刺激症状完全消失，3例大部分改善，2例症状加重并伴单侧下肢肌力1～2级减退。结论]胸腰段病变治愈型脊柱结核合并脊柱后凸畸形临床上有时并不合并严重的脊髓压迫症状，外科治疗目的在于防止脊柱后凸畸形进一步加重及避免继发性截瘫，而过分强调椎管完全减压及脊柱后凸畸形矫正会导致严重的脊髓功能受损。

Spinal tuberculosis with focus-healed kyphosis and compression of spinal cord in thoracolumbar region

Objective] To explore the treatment method of Spinal tuberculosis with focus-healed kyphosis and compression of spinal cord in thoracolumbar region. Method] Seventeen cases were treated surgerically by single stage procedure, including posterior fusion, posterior instrumentation, decompression of spinal canal and interbody autografting. Result] All patients were followed up from 9 months to 7 years postoperatively. The solid fusion was showed radiologically in 2. 8 months at posterior autografting and in 3. 3 months at interbody autografting on the average. The anteriolateral decompression of spinal canal was performed on 6 cases, completely recovered in 1 case, partially recovered in 3 cases and bad result in 2 cases. Conclusion ] Spinal tuberculosis with focus-healed kyphosis and compression of spinal cord in thoracolumbar region may show little spinal symptom clinically. The purpose of treatment is to provide rigid fixation and good stability of spine.