侧前方病灶清除椎弓根内固定治疗胸椎结核后凸畸形

目的观察侧前方病灶清除椎间植骨经椎弓根内固定术治疗脊柱结核并后凸畸形的疗效。方法胸椎结核并后凸畸形患者17例,男11例,女6例;年龄23～56岁,平均36.4岁。结核病损位于下胸椎,累及两或三个椎体。后凸成角15°～34°,平均25°。5例患者合并脊髓损伤,Frankel分级为C级2例、D级3例。手术方法为一期侧前方病灶清除椎间植骨经椎弓根内固定,抗结核药物治疗9个月。结果术后随访2~4年,切口一期愈合,椎间植骨全部融合,脊柱结核全部治愈,脊髓功能损害患者术后1年内完全恢复。术后后凸成角平均为7°,平均矫正18°,随访期间畸形矫正无明显丢失。结论侧前方病灶清除椎弓根内固定术治疗脊柱结核并后凸畸形,能够一期完成病灶清除、脊髓减压、脊柱稳定性重建和后凸畸形矫正。坚强的内固定可促进病椎植骨融合,有助于缩短术后药物治疗时间和提高脊柱结核治愈率。

Anterolateral interbody fusion combined with transpedicle fixation for kyphosis due to thoracic spinal tuberculosis

Objective To evaluate the result of anterolateral interbody fusion combined with transpedicle fixation for patients with kyphosis due to tuberculosis of the thoracic spine. Methods There were totally 17 patients, 11 male and 6 female in this study. The average age was 36.4 years, ranging from 23 to 56 years old. All tuberculous lesions were located in low thoracic spine, two vertebral bodies were involved in 9 patients and three vertebral bodies involved in 8 patients. The average kyphosis angle was 25 degrees, ranging from 15 to 34 degrees. Mild neurological function deficiency (Frankel Grade C or D) were present in 5 patients. All patients were treated with one stage posterior transpedicle fixation and anterolateral interbody fusion combined with 9 month antituberculous medication. Results All patients were followed up for 2 to 4 years postoperatively. All incisions were healed up primarily. Interbody fusion was achieved in all patients from 4 to 6 months after operation. All patients were cured and there was no recurrence within follow up period. The average kyphosic angle was 7 degree postoperatively, and the average correction of kyphosis angle was 18 degree, which was maintained well within follow up period. Patients with neurological function deficiency achieved complete recovery one year after operation. Conclusion Anterolateral interbody fusion combined with transpedicle fixation provides rigid fixation and good stability for early fusion and facilitates tuberculous kyphosis correction. This one stage procedure is effective in decreasing duration of antituberculous medication and increasing curing rate of spinal tuberculosis.