脊柱结核的一期手术治疗

目的：评价一期手术治疗脊柱结核的临床疗效。方法：1996年1月至2001年1月间采用一期手术治疗胸、腰椎脊柱结核患者57例,其中经前路病灶切除、椎体间植骨并内固定35例,经后路病灶清除并内固定16例,后路内固定并前路前路病灶切除、椎体间植骨6例。采用钛合金材料内植入物38例,不锈钢材料内植入物19例。结果：所有57例患者切口均一期愈合,无慢性窦道形成。除3例失访外,其余54例获得随访,随访时间1-5年（平均2.2年）,结核无局部复发,后凸畸形平均矫正21.6度。随访期内,有2-4度的角度丢失。植骨界面骨性融合时间平均3.8个月。结论：一斯手术治疗可以完成脊柱结核外科治疗的基本环节,具有明显的优越性。采用钛合金或不锈钢材料内植入物进行一期内固定均安全,但需根据患者具体情况选择合适术式。

One-stage surgical management for spinal tuberculosis

OBJECTIVE: To evaluate the clinical efficacy of one-stage surgical management for spinal tuberculosis. METHODS: Fifty-seven patients with thoracic, thoracolumbar and lumbar spinal tuberculosis were treated surgically by a single stage procedure from Jan 1996 to Jan 2001, including anterior resection, interbody outografting and anterior instrumentation in 35 cases, posterior debridement and posterior instrumentation in 16 cases, and posterior instrumentation and anterior resection plus interbody autografting in 6 cases. Titanium-alloy spinal implants were used in 38 cases and stainless steel implants in other 19 cases. Except for three patients, other 54 patients were followed up for one to five years (mean 2.2 years). RESULTS: All these patients had their incision healed by first intention without chronic infection or sinus formation, and no recurrence of spinal tuberculosis was noted in any patient during the follow-up period. Kyphosis correction were achieved by 21.6 degrees on the average postoperatively. There was a mild loss (2 degrees - 4 degrees) of kyphosis correction during follow-up period. Spinal solid fusion at the interface between the graft and adjacent vertebral bodies was shown radiologically in 3.8 months on the average. CONCLUSION: One-stage surgical management has more advantages in that it can completes all the aspects of surgical treatment for spinal tuberculosis. Anterior or posterior instrumentation with titanium-alloy or stainless steel spinal implants is safe, The selection of one-stage surgical procedure should be planed individually.