17例颈椎结核外科手术治疗分析

目的探讨颈椎结橱外科手术治疗的手术方法及其疗效。方法本组17例，平均31岁。其中C1～2 4例，C2～3 3例，C2-5 5例，C5-6 3例，C6～7 1例，C7T1 1例。一期清除结核病灶，自体髂骨植骨内固定15例，应用Orion内固定4例，Zephir 4例，Codman3例；Slim-loc 2例，Apofix 1例，枕颈融合1例。2例C1-2经颈前路病灶清除后未行内固定。所有病例术后均采用颈围或头颈胸石膏外固定3个月，抗结核治疗12～18个月。结果平均随访21个月，结核病灶愈合；颈椎后凸畸形得以矫正，颈椎生理弧度得以恢复，术后随访未见矫正角度明显丢失；神经功能恢复良好；术后3～6个月植骨融合，无内固定器械断裂，无结核病灶层部复发。结论在抗痨治疗的基础上，一期病灶清除植骨内固定治疗颈椎结核，可恢复病椎高度、矫正后凸畸形、解除脊髓压迫重建颈椎即刻稳定性，有利于结核病灶的愈合。

Surgical treatment of cervical vertebra tuberculosis

Objective To evaluate the clinical efficacy and surgical method in management of cervical vertebra tuberculosis.Methods There were 17 cases in this series.The mean age was 31 years.Among this patients,C_(1~2) 4 cases,C_(2~3) 3 cases,C_(4~5) 5cases,C_(5~6) 3cases,C_(6~7) 1cases,C_7 T_1 1 cases.All of the patients were radical focus debrided and 15 cases were grafted with iliac bone and fixed with plate.Four cases were fixed with Orion plate,4 cases with Zephir plate,3 cases with Codman plate,2 cases with Slim-loc plate and 1 case with Apofix.One case with occipital-cervical fusion.The brace was needed for 3 months after surgery.Results The period of follow-up lasted for 21 months.All patients achieved satisfactory results,and showed successful interboby fusion within 3-6 months.The kyphosis deformity was corrected and the normal cervical lordoisis were maintained without associated complication.The neural symptoms were improved. All patients had no recurrence of tuberculosis.There were no plates and screws complications.Conclusion It is safe and effective to treat cervical vertebra tuberculosis by anterior radical debridement with primary autograft and internal fixation,and it is a good treatment option with high correction rate in local kyphosis deformity,high fusion,and low complication rate.