后路病灶清除、椎体间融合及器械内固定术治疗胸腰椎结核性脊柱炎

目的探讨后路病灶清除、椎体间融合及器械内固定术治疗结核性脊柱炎的安全性和有效性。方法 17例胸腰椎结核患者接受后路病灶清除、椎体间融合和椎弓根钉固定术。采用Frankel神经功能分级和Kirkaldy-Willis标准来判断疗效,测量术前和术后Cobb角的变化。结果术后随访时间12～66个月。随访期内无结核症状加重及手术相关并发症。Frankel分级：术前C级4例恢复至E级2例、D级1例,1例无恢复;术前D级8例恢复至E级7例,1例无恢复。Kirkaldy-Willis标准：优9例,良5例,可3例,优良率为82.4%。后凸角术前3°～23°,末次随访时-6°～11°,差异有统计学意义（P〈0.05）。结论对病变局限的胸腰椎结核,一期后路病灶清除、椎体间融合后路内固定术能够同时完成病灶清除、稳定脊柱结构,防止矫正损失,是有效的手术方法。

Posterior focal clearence, fusion and instrumentation in tuberculous spondylitis of thoracic and lumbar spine

Objective To assess the safety and efficiency of posterior focal clearence, fusion and instrumentation in the surgical treatment of tuberculous spondylosis. Methods 17 patients with tuberculous spondylitis in the thoracic and lumbar spine underwent posterior focal clearence, fusion and pedicle screw fixation. The clinical outcome was assessed using the Frankel neurological classification and the Kirkaldy-Willis criteria. The radiologie aspects were eval- uated by comparing the pre- and postoperative Cobb＇ s angles. Results All cases were followed up for 12 - 66 months. No aggravation of infection and operation-related complications were observed ＇after the operation. On the Frankel classification, among 4 patients who had grade C before the operation, 2 patients improved to grade E, 1 im- proved to grade D, and 1 showed no change; among 8 patients who had grade D before the operation, 7 patients improved to grade E, 1 showed no change. The Kirkaldy-Willis functional outcome was classified as excellent in 9 pa- tients, good in 5, fair in 3, the rate of excellent and good was 82.4%. Preoperative kyphotic angle was 3° - 23° , at the final follow-up it was - 6° - 11 ° , the difference was statistically significant （P 〈 0. 05）. Conclusions Posterior focal clearence, fusion and instrumentation not only can remove the infection source, but also can stabilize the spinal structures to prevent correction loss. Therefore it is an effective surgical procedure for the patients with tuberculous spondylitis who have limited lesions in the thoracic and lumbar spine.