一期后路病灶清除椎体间非结构性植骨内固定治疗单节段胸椎结核

 目的 评价一期后路病灶清除椎体间非结构性植骨内固定治疗单节段胸椎结核的临床疗效及可行性。方法 回顾性分析2010年1月至2013年1月因单节段胸椎结核接受一期后路病灶清除椎体间非结构性植骨内固定术的患者27例，男16例，女11例；年龄23~69岁，平均40.3岁。合并脊髓功能障碍者22例，ASIA分级B级2例，C级8例，D级12例。术前CT和MRI提示胸椎病灶均存在明显的骨质破坏。术前给予规范抗结核药物（异烟肼、利福平、乙胺丁醇、链霉素）治疗2~3周。术中于后路清除病灶，椎体间植入局部减压获取的骨颗粒和自体髂后上棘松质骨颗粒，以椎弓根钉棒内固定。术后每3个月复查一次胸椎X线片及CT，评价植骨融合情况及胸椎生理曲度变化。结果 所有患者均获得随访，随访时间12~24个月，平均（21.7±2.3）个月。手术时间110~190 min，平均（167±35） min；术中出血量350~700 ml，平均（490±160） ml。椎体间植骨均获得骨性融合，平均融合时间（6.5±2.4）个月。神经功能均改善，改善1级19例、2级3例。术前、术后胸椎后凸Cobb角分别为47°±11°、41°±9°，末次随访时43°±10°。结论 在规范抗结核药物治疗和坚强固定的基础上，一期后路病灶清除椎体间非结构性植骨内固定治疗单节段胸椎结核有效、可行。

Treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting

Objective To evaluate the clinical efficacy and feasibility of treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting. Methods Retrospective study of patients with mono-segmental thoracic spine tuberculosis who underwent surgery in our hospital from January 2010 to January 2013 was conducted. 27 patients were involved in the study, including 16 male patients and 11 female patients. The age of patients is from 23 to 69 (average age 40.3). 22 patients suffered from combined spinal cord dysfunction. For the classification of ASIA, 2 cases were of Grade B, 8 cases were of Grade C and 12 cases were of Grade D. All patients had obvious bone destruction in thoracic spine shown on CT and MRI before the operation. All patients were given anti-tuberculosis drugs (Isoniazid, Rifampicin, Ethambutol, Streptomycin) for 2-3 weeks, preoperatively. And all patients underwent one-stage posterior focus debridement, and bone particles gained from partial decompression and spina iliaca posterior superior bone particles were planted among the centrum. Pedicle screw fixation was conducted internally. Thoracic vertebra X-ray film and CT were rechecked per 3 months after the operation. Bone grafting fusion and physiological curvature change of thoracic vertebra were evaluated. Results All patients were followed up for 12-24 months with the average time of 21.7±2.3 months. The operating time was 110-190 min (average time 167±35 min) and the bleeding amount during the surgery was 350-700 ml (490±160 ml on the average). The bone grafted in centrum achieved bone fusion with the average fusion time of 6.5±2.4 months. The neurological function was improved for all patients, including 19 cases (Grade 1 improvement) and 3 cases (Grade 2 improvement). The preoperative and postoperative Cobb angles of thoracic vertebra were 47°±11° and 41°±9°, respectively. And it was 43°±10° at the final follow-up period. Conclusion Based on the standardized treatment of anti-tuberculosis drugs and strong fixation with pedicle screw and rod, one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting are effective and feasible to treat mono-segmental thoracic spine tuberculosis.