患椎间手术治疗非连续性多椎体脊柱结核

目的：探讨经患椎间手术治疗非连续性多椎体脊柱结核的临床疗效。方法2000年1月～2008年1月手术治疗非连续性多椎体脊柱结核患者38例。38例共发生病变88处，平均每例2．3处；共累及190个椎体，平均每处2．1个椎体。病变相隔1个正常椎间者12例、相隔≥2个椎间者26例。术前有神经功能损害者15例。常规术前抗结核2～4周后手术，后路矫形、固定、前路病灶清除并植骨26例；前路病灶清除、矫形、植骨融合、器械内固定12例。结果38例均获随访，平均随访6年。术后后凸Cobb角为8．7°±6．1°，矫正率为71．3％；末次随访丢失率为7．8％。34例至术后平均4．9个月时血沉及C反应蛋白恢复正常。术后平均5．4个月植骨全部愈合。末次随访时神经功能Frankel分级均达到E级。。结论经患椎间彻底病灶清除、畸形矫正、植骨融合、器械内固定治疗非连续性多椎体脊柱结核是可行有效的。

Intervertebral focal surgery for treatment of non-contiguous multifocal spinal tuberculosis

Objective To assess the clinical efficacy of intervertebral focal surgery by complete debridement, deformity correction, bone grafting fusion, and internal fixation for patients with non-contiguous multifocal spinal tuberculosis.Methods A total of 38 cases with non-contiguous multifocal spinal tuberculosis were treated by intervertebral focal surgery from January 2000 to January 2008 .There were 88 foci in 38 cases, averaging 2.3 foci per case, and 190 affected vertebral bodies, avera-ging 2.1 vertebral bodies per focus.Twelve cases had 1 normal intervertebral disc between 2 foci, and the other 26 cases had≥2 normal intervertebral discs between 2 foci.Quadruple therapy, including Isoniazide, Rifampicin, Pyrazinamide and Streptomycin was given preoperatively.Anti-tuberculosis therapy was carried out for an average duration of 3 weeks.Twenty-six cases underwent posterior fixation, combined with anterior debridement, bone grafting and fusion.Anterior debridement, deformity correction,bone grafting fusion, and internal fixation were performed for 12 cases.Results All cases were followed-up for an average of 6 years.The kyphosis was with a mean correction rate of 71.3%after surgery.A mean loss rate of correc-tion of 7.8%was observed at the final follow-up.The levels of erythrocyte sedimentation rate and C-reactive protein returned to normal in 34 cases on average at 4.9 months and bone fusion could be observed at 5.4 months after surgery.Eleven cases with nerve damage recovered to grade E at the final follow-up.Conclusion Intervertebral focal surgery by complete debride-ment, deformity correction, bone graftiing, fusion, and internal fixation for patients with non-contiguous multifocal spinal tuberculosis is feasible and effective.