跳跃型脊柱结核的外科治疗

目的 探讨跳跃型脊柱结核的治疗方法 及临床效果.方法 回顾性分析2000年1月至2007年3月收治的资料完整的23例跳跃型脊柱结核患者的临床特点、治疗方法 及结果.患者年龄21～65岁,平均41.5岁.病灶位于颈椎+胸椎3例,胸椎+胸椎3例,胸椎+胸腰段6例,胸椎+腰椎4例,胸腰段+腰椎5例,颈椎+胸椎+胸腰段1例,颈椎+胸腰段+腰椎1例.术前后凸角度-5.0°～65.0°,平均30.6°.各处病灶根据病变特点、部位及椎体破坏程度选择行前路一期病灶清除、植骨内固定术,经肋横突入路病灶清除术、椎间植骨后路椎弓根系统内固定术,前路病灶清除植骨、后路椎弓根固定术,一期后路病灶清除、植骨内固定术,单纯病灶清除术或保守治疗.结果术后随访1.5～6.0年,平均3.2年.所有病灶均治愈,未再复发.术后6～12个月,行植骨者病灶X线片均显示植骨融合.术前11例合并截瘫者,7例完全恢复,4例部分恢复.末次随访时后凸角度改善至平均14.2°.术后9例次发生并发症,未造成机体残余损害.结论 跳跃型脊柱结核应根据各处病灶的部位、稳定性、畸形状况及神经损伤情况采取相应的治疗方法 .在有效的抗结核治疗和营养支持治疗前提下积极术前准备,对绝大多数跳跃型脊柱结核患者可一期行手术治疗.

Surgical treatment of multiple-level noncontiguous spinal tuberculosis

Objective To investigate the methods and results of surgical treatment of multiple-level noncontiguous spinal tuberculosis. Methods A retrospective review of 23 patients with multiple-level non-contiguous spinal tuberculosis who were surgically treated in our department from January 2000 to March 2007. The average age at the time of surgery was 41.5 years(range, 21-65 years). The sites of infection locat-ed at cervical and thoracic region in 3 cases, both at thoracic region in 3, thoracic and thoracolumbar in 6,thoracic and lumbar in 4, thoracolumbar and lumbar in 5, cervical, thoracic and thoracolumbar in 1, cervical, thoracolumbar and lumbar in 1. The mean preoperative angle of kyphotie deformity was 30.6° (range, -5.0°-65.0°). Eleven cases complicated with paraplegia. The surgical procedures of each site include: anterior de-bridement and bony grafting with anterior instrumentation fixation, anterior debridement and bony grafting with posterior fixation, posterolateral eostotransversectomy debridement and interbody fusion with posterior fixation, posterior debridement and posterior fixation,focus debridement only and conservative treatment. The patients were followed up for 1.5-6.0 years, with a mean period of 3.2 years. Results Tuberculous infection was controlled in all patients with no recurrence or reactivation occurred. Bony fusion was achieved in all patients who performed bony grafting. The mean angle of kyphotic deformity was reduced to 14.2 degrees at the final follow-up. Among 11 cases with paraplegia, 7 were completely recovered, 4 were partly improved. Conclusion The selection of the treatment of multiple-level noncontiguous spinal tuberculosis depends on the location, stability, deformity and neurologie status of each focus site. Under the condition of effective an-ti-tuberculosis chemotherapy, nutritional support and accurate preoperative management, all focus sites canbe treated in one-stage operation in most patients with multiple-level noncontiguous spinal tuberculosis.