后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核

目的探讨后路Ⅰ期病灶清除植骨内固定治疗胸椎、胸腰段脊柱结核的临床效果。方法自2006年1月～2009年1月共治疗胸椎及胸腰段脊柱结核37例,对其中椎体破坏较严重、有明显后凸及侧弯畸形的17例患者采用后路Ⅰ期病灶清除植骨内固定矫正畸形。术前神经功能评价按Frankel分级标准:B级1例,C级8例,D级7例,E级1例。结果随访12～36个月,平均18个月。局部疼痛和下肢放射性麻痛症状均缓解,术后Frankel分级明显改善(C级1例,D级5例,E级11例),植骨均达骨性融合标准。脊柱后凸Cobb角从术前的(36.8±9.0)°降至术后的(17.5±3.5)°,差异具有统计学意义(P0.05);随访1年未见明显矫正丢失(与术后比较,P0.05)。结论后路Ⅰ期病灶清除植骨内固定能够彻底清除病灶,矫正后凸畸形,可用于治疗部分重度胸椎、胸腰段脊柱结核。

One-stage posterior approach for thoracic or thoracolumbar spinal tuberculosis by debridement as well as internal fixation and fusion

Objective To investigate clinical effects of one-stage posterior approach for thoracic or thoracolumbar spinal tuberculosis by debridement,internal fixation and fusion.Methods Among 37 patients with thoracic or thoracolumbar tuberculosis treated from January 2006 to January 2009,17 cases whose focus of infection destroyed the centrum severely and resulted in kyphotic deformity and lateral curvature deformity were treated by one-stage posterior debridement with internal fixation and fusion.According to Frankel classification,the pre-operative neural functions were assessed with degree B in 1 case,degree C in 8 cases,degree D in 7 cases and degree E in 1 case.Results The patients were followed up for an average of 18 months （range from 12 to 36 months）,tuberculosis symptoms and emissive leg numbness and pain relieved,postoperative neural functions were improved with degree C in 1 cases,degree D in 5 cases and degree E in 11 cases.Bone graft in all patients showed the standard of fusion.The preoperative Cobb angles were （36.8 ± 9.0）° and the postoperative results were （17.5 ± 3.5）°,which improved significantly （P〈0.05）.No significant correction loss occurred after one year （compared with postoperative results （P〈0.05）.Conclusion One-stage posterior debridement as well as internal fixation and fusion can be used to remove the infectious focus completely and correct kyphosis effectively for selected serious thoracic and thoracolumbar spinal tuberculosis.