病灶清除植骨内固定治疗相邻多椎体脊柱结核

目的:探讨病灶清除、植骨及内固定术治疗相邻多椎体脊柱结核的疗效.方法:1999年1月～2007年1月手术治疗27例相邻多椎体脊柱结核患者.病变累及3个椎体15例,4个椎体7例,5个及以上椎体5例,病变单纯累及胸椎者5例,单纯累及腰椎者7例,累及胸腰椎者11例,累及腰骶椎者4例.术前有神经功能损害者11例,Frankel分级B级1例,C级2例,D级8例.后凸Cobb角26°～43°,平均35°±7°.术前均采用口服异烟胼(H)、利福平(R)、乙胺丁醇(E)并肌注链霉素(S)四联药物方案(HRES)抗结核治疗3周,一期后路内固定、前路病灶清除植骨16例,前路病灶清除植骨融合内固定11例.术后继续HRES扰结核治疗3个月,然后口服HRE三联药物方案抗结核治疗9个月.采用吴启秋骨结核治愈标准对疗效进行评估.结果:手术时间150～300min,平均240min;术中出血量600～1400ml,平均1000ml.术后无神经功能障碍加重及脑脊液漏等并发症.1例术后伤口出现寞道Ⅱ期愈合,其余均Ⅰ期愈合.脊柱后凸Cobb角恢复至120～20°,平均15°±5°.27例均获随访,随访时间14～48个月,平均18个月,有神经功能损害者于术后8个月内恢复至正常;植骨伞部融合,融合时间5～14个月,平均7个月.随访期间内固定无松动及折断.末次随访时所有患者均获临床治愈.结论:在有效抗结核药物治疗的基础上,多椎体脊柱结核采用彻底病灶清除、植骨融合及内固定术加强脊柱稳定,可提高植骨融合率和治愈率.获得满意的疗效.

Debridement and fusion with bone grafting and instrumentation in the treatment of multiple-level contiguous spinal tuberculosis

Objective:To investigate the results of surgical treatment for multi-level spinal tuberculosis with focal debridement,bone grafting and primary internal fixation.Method:27 cases of multi-level spinal tuberculosis treated by operation from January 1999 to January 2007 were reviewed retrospectively.3 vertebral bodies involved in 15 cases,4 vertebral bodies involved in 7 cases,5 vertebral bodies involved at least in 5 cases.Of these,there were 5 cases in thoracic vertebra,7 cases in lumbar vertebra,11 cases in...