病灶切除植骨与椎弓根固定治疗脊柱结核

目的：观察病灶切除植骨、经椎弓根内固定术治疗脊柱结核的临床疗效。方法：1996年10月至1998年11月,我院有34例胸腰椎结核患接受椎弓根器械固定、一期或二期病灶切除植骨手术,术后随访3-5年。结果：患者术后1周左右腰背部疼痛和结核中毒症状缓解,术后约4-6周时红细胞沉降率恢复正常,术后4-6个月椎间植骨全部融合,脊柱结核全部治愈。有12例患者术前脊魔柱后凸角度平均24度（10-32度）,术后平均9度（5-13度）。有9例患者术前合并脊髓功能损害（Frankel分级为C-D级）,术后1年内脊髓功能恢复正常。结论：病灶切除植骨椎弓根内固定治疗脊柱结核,术后能立即恢复脊柱稳定性,免除了患者长期卧床之苦。此外,经椎弓根内固定还能够促进病灶愈合和缩短术后抗结核疗程。

Transpedicular instrumentation and interbody fusion for spinal tuberculosis

OBJECTIVE: To evaluate the surgical outcomes of spinal tuberculosis treated with transpedicular instrumentation and interbody auto-grafting. METHODS: Thirty-four patients of thoracolumbar tuberculosis were treated with transpedicular instrumentation, radical focus resection and interbody auto-grafting, combined with 6- or 9-month antituberculous medication from October 1996 to November 1998. All patients were followed-up prospectively for 3 to 5 years postoperatively. RESULTS: The back pain and tuberculous symptoms were relieved about one week postoperatively. The erythrocyte sedimentation rate came back to normal level from 4 to 6 weeks postoperatively. The solid interbody arthodesis was achieved from 4 to 6 months postoperatively. All patients were cured of tuberculous lesions in spinal column or in other region, and there were no tuberculous recurrence. In 12 patients, average preoperative kyphosis angle was 24 degrees (range 10 degrees approximately 32 degrees ), and that was 9 degrees (range 5 degrees approximately 13 degrees ) immediately after surgery. The average correction of kyphotic deformity was 15 degrees and was maintained unchanged in follow-up period postoperatively. Nine patients who had type-C or type-D neurological lesions, according to Frankel gradation, had complete recovery one year postoperatively. CONCLUSION: In spinal tuberculous operation, transpedicular instrumentation and interbody fusion are essential in providing rigid stabilization of spinal column, correcting or preventing kyphotic deformity, accelerating focus healing up and shortening chemotherapy period. Transpedicular instrumentation is necessary in short segments fixation and preserving functional unit of spine.