一期前后联合入路手术治疗胸腰椎脊柱结核

目的探讨胸、腰椎结核的手术治疗方式。方法42例胸、腰椎结核患者，男24例，女18例；年龄为22～73岁，平均38．2岁。其中胸椎结核11例，胸腰段结核14例，L2以下腰椎结核17例。术前采用四至六联正规抗结核治疗至少3周，所有患者均采用后路椎弓根螺钉系统矫形内固定、椎板间植骨（人工骨），同期行前路病灶清除联合自体髂骨植骨术。前路手术切口根据病变节段分别采用经胸腔入路、胸膜外腹膜外入路、经腹膜外肾切口、经腹直肌旁腹膜外切口及腹正中腹膜外入路。平均手术时间为230min，术中平均出血量为550ml。术后继续抗结核治疗，术后4周下地行走。结果所有患者均获得8～46个月随访，平均24．3个月。全部患者植骨融合，腰背痛症状缓解，神经功能明显恢复，复查血沉及CRP均正常。结论对于非手术治疗效果不佳的胸、腰椎结核患者，采用后路矫形内固定、前路病灶清除植骨的一期手术方式可获得满意的疗效。

Anterior debridement and bone grafting with posterior instrument in surgical treatment of thoracolumbar spinal tuberculosis

Objective To evaluate the surgical methods of thoracolumbar spinal tuberculosis. Methods The surgical results of 42 patients treated by anterior debridement and bone grafting and additional posterior instrumentation were analyzed retrospectively. There were 24 males and 18 females with an average age of 38.2 years in this series. The lesions involved 11 cases in thoracic segments , 14 cases in thoracolumbar segments and 17 cases in lumbar. All these patients were treated with routine antituberculous medication for at least 3 weeks pre-operatively. Then they were underwent posterior transpedical interfixation and anterior radical focus resection plus bone grafting. The anterior approach included thoracotomy, thoracoabdominal incision, pararectal retroperitoneal and midline rectus split with retroperitoneal approach respectively. Average duration of surgery was 230 min, and the mean blood loss was 550ml. Anti-tuberculosis chemotherapy was used for 18 months. Results All patients were followed up with an average 24.3 months (range from 8 to 46 months). Bony fusion was obtained in all patients. The back pain and neurological deficits showed obvious improvement in most patients. There was no recurrence of the disease. Conclusions Anterior debridement and bone grafting with one-stage posterior instrument can achieve satisfactory results in the treatment of thoracolumbar spinal tuberculosis.