单纯一期后路病灶清除椎体间植骨融合内固定治疗胸椎结核的临床研究

目的]评价一期后路病灶清除、椎体间植骨、钉棒系统内固定治疗胸椎结核的临床疗效及可行性.方法]回顾性分析60例单节段胸椎结核患者,男34例,女26例；平均年龄37.5岁.合并脊髓功能障碍者24例,合并明显脊柱后凸畸形(SI＞15°)者38例.CT或MRI显示所有患者病灶有明显的骨质破坏和不同程度脓肿形成,无巨大脓肿的患者.术前给予2周以上的抗结核化疗.研究观察的指标包括手术情况(手术时间、出血量、卧床时间)、并发症、神经功能的恢复、成角畸形的矫正及植骨融合率等.结果]所有病例均得到随访,平均随访时间27.5个月.平均手术时间251 min,平均失血量780 ml.后凸畸形矫正率79％,矫正角度平均25°,末次随访矫正角度丢失1.2°.神经功能改善率90.1％.术后3个月内ESR及CRP恢复至正常水平.植骨融合率100％,治愈率为100％.无脊髓功能损伤,无严重并发症发生.结论]该术式能满意地清除病灶,安全地进行椎体间植骨,脊柱稳定性能得到有效重建,临床效果良好,是一种值得推广的手术方式.

A clinical study of internal fixation,debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach

Objective]To evaluate the clinical efficacy and feasibility of one stage posterior internal fixation,debridement and interbody thoracic fusion in the treatment of thoracic tuberculosis.Methods]Sixty adult patients with monosegment thoracic tuberculosis were studied retrospectively,including 34 males and 26 females with an average age of 37.5 years.Twenty-four patients suffered from neurological impairment.And 38 cases suffered from obvious kyphosis(SI>15°).All patients had obvious bone destruction and different degree of abscess on CT or MRI examination.The study did not involve patients with giant abscess.All patients were given chemotherapy for more than 2 weeks before operation.Some items were observed in our study,including operating time,blood loss,time in bed,complications,neurological function,the rate of deformity correction,and the rate of interbody fusion.Results]All cases were followed up for 27.5 months on average.The mean operating time was 251 minutes and the blood loss during operation was 780ml on average.The average rate of kyphosis correction was 79%.The angels of kyphosis were corrected by 25°on average.The average loss of corrected angel was 1.2°.The neurological function was improved by 90.1%.The ESR or CRP returned to normal levels in 3 months after operation.The rate of bone fusion was 100%,with a 100% cure rate.No severe complication or spinal cord injury occurred.Conclusion]This approach can satisfactorily remove focus of tuberculosis,and safely complete interbody fusion.It can effectively reconstruct the stability of the spine.