手术治疗胸腰椎结核79例临床分析

目的探讨胸腰椎结核一期病灶清除、植骨融合、内固定治疗的临床疗效。方法回顾分析自2002年9月至2008年7月我院手术治疗并获得随访的79例胸腰椎结核患者,病变范围为T5～S1,病灶累及1～2个椎体72例,大于等于3个椎体7例,其中跳跃性脊柱结核4例。手术方法：a）经前路病灶清除,椎体间植骨融合并内固定术;b）后路椎弓根固定术并前路病灶清除、椎体间植骨融合术。术后佩戴支具3～6个月,抗结核药物治疗12～18个月。定期门诊随访,进行实验室检查和影像学观察。结果该组患者随访2～9年,均获临床治愈。79例前路植骨病例,界面骨性融合时间平均4.7个月,后凸畸形平均矫正18.7°,随访期内丢失2°。合并截瘫29例,术后神经症状均得到明显改善。结论一期结核病灶清除、植骨融合内固定术是治疗脊柱结核的重要手段,有效的抗结核化疗是脊柱结核治愈的基础。

Clinical Analysis of 79 Cases of Surgical Management for Thoracolumbar Spinal Tuberculosis

Objective To explore the clinical efficacy of onestage debridement,bone graft fusion and internal fixation in thoracolumbar spinal tuberculosis.Methods Seventy-nine patients with thoracolumbar spinal tuberculosis were treated surgically by a single stage procedure in our department from Sep 2002 to Jul 2008,there are 1～2 vertebral body lesions involved in 72 cases,≥3 vertebrae in 7 cases,leap spinal tuberculosis in 4 cases.The surgical procedures included:a)anterior debridement,fusion with autograft and internal fixation.b)posterior pedicle fixation and anterior debridement,interbody fusion.All patients wore the brace for 3～6 months,12～18 months anti-TB drugs postoperatively.Regular outpatient follow-up,laboratory tests and imaging observations.Results All patients were followed up for 2～9 years,were clinically cured.Spinal solid fusion at the interface between graft and adjacent vertebral bodies was shown radiologically in mean 4.7 months.There was a kyphosis correction of 18.70° after operation.There was a 2° loss of kyphosis correction during follow-up period.Symptoms of 29 paraplegia cases were significantly improved.Conclusion One-stage debridement,bone graft fusion and internal fixation is an important treatment of spinal tuberculosis.Effective anti-TB chemotherapy is the basis for cure of spinal tuberculosis.