前后入路一期病灶清除植骨融合内固定治疗胸腰椎脊柱结核

目的探讨胸腰椎脊柱结核通过前后手术入路行病灶清除一期椎间植骨融合、内固定的治疗疗效。方法回顾性分析2006年1月至2011年1月,采用前后路手术入路行病灶清除一期椎间自体髂骨植骨融合、内固定的手术方式治疗胸腰椎脊柱结核患者32例。术前正规抗结核治疗3～5周,其中术中彻底清除病灶组织,对骨质破坏缺损采用自体髂骨植骨同时行前路钉板或钉棒系统内固定21例。采用前路病灶清除自体髂骨植骨后路椎弓内固定系统内固定11例。术后卧床6～8周,继续正规抗结核治疗9～18个月。结果本组32例患者均获得随访,随访时间6～24个月,1例患者出现切口不愈合,其他患者手术切口均一期愈合。术后摄X线片提示植骨及内固定位置良好,Cobb′s角平均14.30°。均获骨性融合,融合时间4～7个月。无内固定松动、脱落、断裂,愈合后Cobb′s角平均15.2°,无明显矫正角度丢失。术前、术后后凸角度的差异有统计学意义(P<0.05),脊髓功能恢复良好。其中合并神经损害20例,按Frankel分级,C级3例中有1例恢复至D级,1例恢复至E级,1例分级无明显变化,D级17例中有12例恢复至E级,5例分级无明显变化。无复发病例。结论前后手术入路病灶清除一期植骨融合、内固定治疗胸腰椎脊柱结核,椎体前方病灶清除、椎管减压彻底,植骨量大,结合有效内固定避免植骨块松动、脱出,植骨融合率高并有效矫正脊柱后凸畸形。

Anterior One Stage Debridement Bone Grafting and Internal Fixation for Thoracolumbar Spinal Tuberculosis

Objective To assess the efficacy of thoracolumbar spinal tuberculosis by anterior one-stage debridement,bone grafting fusion and anterior or posterior internal fixation.Methods From January 2006 to March 2011,32 cases with thoracolumbar spinal tuberculosis were treated by anterior one-stage debridement,bone grafting fusion and anterior or posterior internal fixation.All the cases received regular anti-TB chemotherapy for 3 weeks~5 weeks pre-operatively and the lesions were completely cleared up intraoperatively.In 21 cases who had bone defect,autogenous iliac were used to support graft repair and anterior screw plate or screw rod system fixation was applied.11 cases treated anterior one-stage debridement and posterior internal fixation with screw rod.All the cases stayed in bed for 4~6 weeks,and the regular chemotherapy was continued for 9 months to 18 months.Results All the cases were followed up for 6 months to 24 months.All the incision were one-stage healed except one.Average cobb′s angel was 14.3 degree.Tuberculosis was successful healed and graft was stable and fused.Tere was no internal fixation loose.The cobb′s angel was 15.2 degree at the end of follow-up.Compare with before surgery,the angel of kyphosis after surgery is significant improved(P<0.05).The function of spinal recovered well.20 cases in 33 cases were accompany with spinal injure.There were 3 cases of grade C according to Frankel classification.1 recovered to D grade.1 recovered to E grade and 1 of them had no improvement.There 17 cases of grade D.12 of them recovered to E grade,and 5 of them had on change.Conclusion Treatment of thoracolumbar spinal tuberculosis by anterior one stage debridement,bone grafting fusion and anterior or posterior internal fixation can effectively reconstruct spinal stability,correct and prevent kyphosis,obtain good grafting fusion and have a reliable clinical efficacy.