一期前路病灶清除钛网植骨内固定治疗胸腰椎结核疗效观察

目的探讨一期前路病灶清除钛网支撑植骨融合加内固定治疗胸腰椎结核的临床疗效。方法回顾性分析2006年2月至2009年3月在新乡医学院第一附属医院接受治疗的胸腰椎结核患者45例,男23例,女22例,年龄21～69岁,平均45.5岁。所有患者均采用一期前路病灶清除、钛网支撑植骨融合加前路内固定术,其间观察围手术期并发症,测定融合节段后突角度、椎间平均高度、钛网沉降率及植骨融合情况。结果全部病例随访20～48个月,平均26个月,除1例出现肋间神经痛,其余44例均无术后并发症。随访期间未发现结核病灶残留或复发,术后融合节段后凸角为（8.0±2.1）,°终末随访时矫正角度丢失（3.9±1.3）°,椎间高度丢失（2.3±0.2）mm,所有患者终末随访均达到骨性愈合。结论一期前路病灶清除钛网支撑植骨融合加内固定治疗胸腰椎结核的临床疗效显著,具有重建可靠,减压彻底和复发率低等优点。

Treatment of Thoracolumbar Spinal Tuberculosis With Anterior Debridement Titanium Meshes Bone Grafting and Internal Fixation

Objective To study the clinical outcome in treating the thoracolumbar spinal tuberculosis with debridement titanium meshes bone grafting and internal fixation.Methods Totally 45 patients with thoracolumbar spinal tuberculosis were treated by anterior debridement of the diseased vertebrae,bone grafting and internal fixation from Feb 2007 to Mar 2009.There were 23 males and 22 females and mean age was 45.5 years old（21～69 years old）.All patients received anterior debridement,Titanium meshes bone grafting and internal fixation.We noted the spinal kyphosis deformity with Cobb＇s angles of the thoracolumbar spine and the bone infusion rate after operation.Results All patients were followed up for 20～48months（average 26 months）.All patients had no complications except one patient with intercostal nerve ache.Their lesion was eliminated completely.The graft fused perfectly.The kyphosis were corrected partly,and lose with average of（3.9±1.3）°.Conclusion For patien t with thoracolumbar spinal tuberculosis,anterior debridement with iliac grafting and internal fixation appears to be effective in correcting spinal kyphosis,reconstructing the stability of spine and improving clinical outcome.