成人颈椎结核外科治疗的术式选择

目的 探讨成人颈椎结核外科治疗的术式选择.方法 2例枢椎结核患者,行前路经颈部病灶清除、自体髂骨植骨融合并Halo架外固定,其中1例1个月后再次行后路枕颈融合术.13例下颈椎结核患者, 9例采用经前路一期病灶切除、自体骼骨植骨融合并前路钛合金钢板内固定术,4例采用前路病灶清除并自体髂骨植骨及Halo架外固定.15例均接受9～12个月的规范抗结核药物治疗.结果 所有患者切口均一期愈合,随访1～6年,局部无复发,植骨均融合,平均融合时间为3.9个月(3.5～4.5个月).6例脊髓损害患者中,4例恢复至E级,2例C级仅感觉改善,肌力无恢复.结论 颈椎结核应积极采用手术治疗.彻底病灶清除及有效稳定性重建是治疗颈椎结核的关键环节.

Surgical procedures for adult cervical spine tuberculosis

Objective To study the surgical procedures for adult cervical spine tuberculosis. Methods Fifteen eases of cervical spine tuberculosis were surgically treated ,affecting axis in two eases and subaxial cervical spine in thirteen eases. Anterior cervical debridement, autologous iliae grafting and Halo-vest fixation was carried out in two eases of axis tuberculosis, and one ease was added with posterior oeeipo-eervieal fusion one month later. For patients with subaxial cervical spine tuberculosis, the anterior debridement, autologous iliae grafting and anterior instrumentation were carried out in 9, and anterior debridement, and autologous iliac grafting and Halo-vest fixation in 4, respectively. All patients underwent regular antituberculous chemotherapy for nine to twelve months, and were followed up for one to six years. Results All cases healed without chronic sinus and recurrence during follow-up period. Bone fusion was founded in both cases with instrumentation and with Halo-vest fixation. Among six cases with preoperative neurological deficits,complete recovery to grade E was noted in four cases,and other two cases with grade C only had sensory improvement without obvious motor recovery. Conclusions Aggressive surgical management is strongly recommended in case of cervical spine tuberculosis. Complete debridement of tuberculous foci and effective reconstruction of spine stability remain the key steps for surgical management.