前路病灶清除椎体间植骨内固定治疗脊柱结核

目的：探讨前路病灶清除椎体间植骨内固定治疗脊柱结核的临床效果及存在问题。方法：1996年1月～2005年12月,对78例脊柱结核患者行前路病灶切除椎体间植骨内固定治疗。术前行异胭肼、利福平、吡嗪酰胺、左氧氟沙星等抗结核治疗,平均2～4周,术后继续常规抗结核治疗2年左右。结果：随访70例,随访时间24～38个月,优38例,良25例,一般7例。椎体间植骨3～6个月融合,平均4个月。30例合并截瘫患者术前Frankel分级A级5例,B级10例,C级11例,D级4例,E级0例,术后：A级3例,B级3例,C级2例,D级11例,E级11例,术前脊柱后凸（38.80±3.50）°,术后（12.30±2.40）°,均有显著改善（P〈0.05）。结论：前路病灶清除椎体间植骨内固定治疗脊柱结核,既能彻底切除病灶防止复发,重建脊柱稳定性,恢复脊柱支撑功能,又能提高植骨融合率,矫正和预防后凸畸形,防止晚发神经损害。

Anterior debridement and intervertebral fusion with instrumentation in the treatment of spinal tuberculosis

Objective：To discuss the effect in the treatment of spinal tuberculosis Anterior debridement and intervertebral fusion with instrumentation.Methods：Between Jan 1996 and Dec 2005,78 patients with spinal tuberculosis were treated with anterior debridement and intervertebral fusion with instrumentation.Treating tuberculosis for 2-4weeks before operation.Results： All patients were visited regularly after operation for 24-38 months, about 29 months in avarage, their focus was eliminated complatdy, the cut became healed for the firse stage,anterior interbody fusion fused 4 months later.The function of paraplegia pre-operative were （Frankel criteria）：A 5 cases,B lOcases,C 11 cases,D 4 cases and E 0 case while that of the post-operative were：A 3 cases,B 3cases,C 2 cases,D 11 cases and E 11 cases.The average kyphosis pre-opera- tive were 38.80±3.50 degrees while that of post-operative were 12.30±2.40 degrees.There was a significant difference （P〈 0.05）.Conclusion：Anterior debridement and intervertebral fusion with instrumentation in the treatment of spinal tuberculosis can cure tuberculosis without recurrence and can also correct deformity, strengthen the spinal structure to prevent secondary paraplegia,correcting the kyphosis and preventing progression of kyphsis.