前路病灶清除植骨融合内固定治疗下颈椎结核

目的：评估颈前路病灶清除联合植骨融合内固定治疗下颈椎结核的临床疗效。方法：对2010年6月至2018年12月接受Ⅰ期颈前路病灶清除植骨融合内固定治疗的15例下颈椎结核患者进行回顾分析，其中男9例，女6例；年龄39~72（54.67±10.75）岁；病灶节段为C₄-C₆。应用ASIA分级评估术后神经功能恢复情况，手术前后拍摄颈椎正侧位X线片，定期复查CT以评估植骨融合情况。结果：15例患者均成功手术，术中未出现神经、血管损伤，且所有患者获完整随访，时间18~52个月，随访期间患者临床症状明显改善。CT显示植骨融合良好。其中1例术后3年病情复发，强化抗结核方案后，随访治愈。结论：针对椎体破坏、颈椎稳定性丧失的下颈椎结核患者，Ⅰ期颈前路病灶清除联合植骨融合内固定手术方案疗效确切，在术前规范抗结核治疗的基础上，术后长期、规范的抗结核治疗是确保下颈椎结核治愈的关键。

Debridement and bone grafting with internal fixation via anterior approach for the treatment of tuberculosis of lower cervical vertebrae

Objective: To evaluate the clinical effects of debridement and bone grafting with internal fixation via anterior approach in treatment of tuberculosis of lower cervical vertebrae.Methods: The clinical data of 15 patients with tuberculosis of lower cervical vertebrae who accepted the treatment of one-stage debridement and bone grafting with internal fixation from June 2010 to December 2018 were retrospectively analyzed. There were 9 males and 6 females,aged from 39 to 72 years with an average of (54.67±10.75) years. The lesion segment was C₄ to C₆. Pre-and post-operative neurologic functions were evaluated by ASIA grade. All the patients underwent the X-ray films of positive and lateral of cervical spine before and after the operation and accepted the periodic review of CT to evaluate the bone grafting.Results: All the 15 operations were successful,no neurological or vascular injury occurred during the operation,and all patients were followed up for 18 to 52 months. The clinical symptoms improved significantly during the follow-up period and CT showed good bone grafting fusion. One patient suffered a relapse of the illness 3 years later,but was healed during the follow-up visit by strengthening the anti tuberculosis therapy.Conclusion: For the patients with vertebral destruction and loss of cervical stability,one-stage debridement and bone grafting with internal fixation via anterior approach has definite curative effects. On the basis of standard anti-tuberculosis treatment before operation,the long-term standard anti-tuberculosis treatment after operation is the key to healing the tuberculosis of lower cervical vertebrae.