胸椎结核内固定手术治疗的术式选择

目的：探讨胸椎结核内固定手术治疗的术式选择。方法：选择1999年1月至2003年12月采用内固定手术治疗胸椎结核34例，采用不同的手术治疗方式。（1）前路病灶清除植骨、同期钢板内固定；（2）经肋横突切除入路行病灶清除植骨、同期椎弓根系统内固定；（3）后方入路行病灶清除、植骨融合和椎弓根系统内固定；（4）前路病灶清除植骨、后路椎弓根系统内固定。结果：随访1～3年（平均1．5年），无结核复发、螺钉松动、钢板断裂，17例有明显神经损害的患者术后均获得明显改善。四种术式在手术时间、出血量、后凸畸形矫正度和矫正丢失等方面存在差异。结论：脊柱稳定性在脊柱结核外科治疗中具有重要意义，根据胸椎稳定性改变选择合适的外科治疗术式，均可获得满意的临床疗效。

Selection of Operative Method for Internal Fixation of Thoracicspinal Tuberculosis

To evaluate the value of internal fixation and applicative method in thoracicspinal tnberculosis.Methods:Thirty-four cases were treated with four different methods between January 1999 and December 2003:(1)Anterior debridement fusion with graft and same-stage anterior plate fixation;(2)Lateral debridement posterior fusion and pedicle screwfixation.(3)posterior debridement fusion and pedicle screwfixation.4.Anterior debridement and posterior fusion and pedicle screwfixation.Results: All cases were followed up for 12 to 36 months.There were no recurrence of tuberculosis,screw loosening or breakage of plate Fixation.17 cases with neurological deficits had an improvement of neurological function postoperatively.There were significant differences in average operation time,blood loss,correction of kyphotic deformity and postoperation losing among the four groups.Conclusion: The maintenance of segmental stability has significant effect on the surgical treatment of thoracicspinal tuberculosis and satisfactory clinical results can be achieved by proper selection of the surgical procedure according to the location and degree of the soliotic deformity.