单切口椎体钉棒联合同侧椎弓根钉棒固定治疗胸腰椎结核

目的探讨病灶清除加单切口椎体钉棒联合同侧椎弓根钉棒固定植骨融合术治疗胸腰椎结核的疗效。方法 2008年1月-2010年10月,对22例胸腰椎结核患者行病灶清除加单切口椎体钉棒联合同侧椎弓根钉棒固定植骨融合术,术后继续行抗结核治疗。男14例,女8例;年龄18～66岁,平均42岁。病程2～16个月,平均6个月。双节段16例,其中T7、83例、T8、91例、T9、103例、T11、122例、L1、24例、L3、43例;三节段6例,其中T7～92例、T11～L11例、L2～43例。术前疼痛视觉模拟评分(VAS)为(7.50±0.63)分;神经功能按美国脊髓损伤学会(ASIA)修订的Frankel分级:B级2例,C级4例,D级9例,E级7例。结果术后22例均获随访,随访时间15～36个月,平均25.2个月。1例于术后1个半月发生切口感染,经相应处理后愈合;其余患者切口均Ⅰ期愈合。未发现内固定物松动、断裂,无脊髓损伤加重及脑积液漏等并发症发生。X线片及CT示患者椎间隙均达骨性融合,融合时间3～6个月,平均5.2个月。患者术后红细胞沉降率较术前明显降低,差异有统计学意义(P<0.05)。术后2周及末次随访时VAS评分分别为(2.90±1.00)分及(2.60±0.81)分,均较术前显著改善(P<0.05)。末次随访时患者神经功能Frankel分级为C级2例,D级5例,E级15例。结论单切口椎体钉棒联合同侧椎弓根钉棒固定治疗胸腰椎结核创伤小,能有效恢复脊柱稳定,但远期疗效需进一步观察。

TREATMENT OF SINGLE-INCISION VERTEBRAL SCREW-ROD FIXATION COMBINED WITH PEDICLE SCREWROD FIXATION FOR THORACOLUMBAR TUBERCULOSIS

Objective To investigate the effectiveness of debridement and single-incision vertebral screwrodfixation combined with pedicle screw-rod fixation and autograft bone fusion in treatment of thoracolumbartuberculosis.Methods Between January 2008 and October 2010,22 patients with thoracolumbar tuberculosis were treatedby debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bonefusion,and were given anti-tuberculosis therapy after operation.Of 22 patients,14 were male and 8 were female with an averageage of 42 years(range,18-66 years).The disease duration was 2-16 months(mean,6 months).Sixteen double-segment lesionsincluded T7,8 in 3 cases,T8,9 in 1 case,T9,10 in 3 cases,T11,12 in 2 cases,L1,2 in 4 cases,and L3,4 in 3 cases;6 three-segment lesionsincluded T7-9 in 2 cases,T11-L1 in 1 case,and L2-4 in 3 cases.Preoperative visual analogue scale(VAS) score was 7.50 ± 0.63.According to Frankel classification of America Spinal Injury Association(ASIA),2 cases were rated as grade B,4 cases as gradeC,9 cases as grade D,and 7 cases as grade E.Results Twenty-two patients were followed up 15-36 months(mean,25.2months).Wound infection occurred in 1 case and was cured after corresponding treatment;incision healed by first intention inother patients.No loosening or breakage of internal fixator was found;the patients had no deteriorations in spinal cord injury orcerebrospinal fluid leakage.X-ray films and CT showed obvious bone fusion in the intervertebral space.The time of bone fusionwas 3-6 months(mean,5.2 months).The erythrocyte sedimentation rate after operation was significantly lower than that beforeoperation(P < 0.05).The VAS scores were significantly improved to 2.90 ± 1.00 at 2 weeks after operation and 2.60 ± 0.81 at lastfollow-up(P < 0.05).At last follow-up,nerve function was significantly improved.According to Frankel classification,2 caseswere rated as grade C,5 cases as grade D,and 15 cases as grade E.Conclusion Single-incision vertebral screw-rod fixationcombined with pedicle screw-rod fixation for thoracolumbar tuberculosis is a stable and minimally invasive method.However,the long-term effectiveness need further follow-up.