经胸前路一期病灶清除椎间钛网植骨内固定治疗胸椎结核15例

目的探讨经胸前路一期病灶清除椎间钛网植骨内固定治疗胸椎结核的手术方法和临床效果。方法选取2006年~2012年我院收治的15例胸椎结核患者,术前行正规抗结核化疗2~3周,一期行经胸前路结核病灶清除,切除病变椎体,减压椎管,钛网椎体间植骨,并在椎体侧方采用钉棒内固定系统重建脊柱稳定性。病人术后卧床2~8周,并继续正规化疗12~18个月。观察术后腰背部疼痛缓解程度、脊髓神经功能恢复、植骨融合愈合率及结核有无复发。结果随访时间为24~36个月,平均29个月,无病例失访。14例患者手术切口一期愈合,1例术后伤口感染,经换药后完全愈合;腰背痛均得到有效缓解;术前伴有脊髓功能障碍的7例患者术后神经功能均基本恢复;所有患者植骨均融合,未见内固定失效,脊柱后凸畸形获得明显矫正且矫形得到了保持,无一例病例复发。结论经胸前路一期病灶清除椎间钛网植骨内固定治疗胸椎结核能彻底清除病灶,解除病灶对脊髓压迫,重建脊柱稳定性,取得较满意的临床疗效,是安全、确切、有效的胸椎结核手术方法。

Treatment of15 casesofthoracic tuberculosis with anterior debridement and bone grafting with titanium mesh

Abstract] Objective To investigate the surgical method and clinical effects of the treatment of thoracic tuberculosis by anterior debridement and internal fixation of Titaniummesh with bone graft. Methods A total of 15 cases of thoracic spinal tuberculosis patients were selected in our hospital from 2006 to 2012. All patients were given regular preoperative anti tuberculosis chemotherapy for 2 to 3 weeks. The surgical procedure was as follows: anterior debridement of tuberculosis foucs, vertebral body resection, spinal canal decompression, titanium mesh with bone graft and screws internal fixationinby thelateral of the vertebral body.Postoperativepatientsliedon the bed for 2-8 weeks, and continued taking theanti tuberculosischemotherapy for 12 to 18 months. The evaluationsincludedpain degree release, nerve function recovery, vertebral fusion rate and tuberculosisrecurrence. Results Follow-up periods ranged from 24 to 36 months with an average of 29 months. All patients achieved total healing of the surgery incision except 1 patientwith infection, whichfinally healed after dressing. Among all the patients with spinal cord dysfunction before the surgery, there were 7 cases whose nerve function recovered afetr the surgery; andtherewas nointerbody nonfusion and failure of internal fixation; spinal kyphosis was obviously corrected and orthopedic shape had been maintained, and no case recurrented among the follow-up days. Conclusion The treatment of thoracic tuberculosis with anterior debridement and internal fixation of Titaniummesh with bone graft could completely remove the tuberculosis focus, relieve the compression of the spinal cord, reconstruct the spinal stability, and obtain satisfactory clinical effect.