前路内固定矫正结核性脊柱畸形

目的　总结前路病灶清除、椎体间植骨和前路内固定手术治疗结核性脊柱畸形的临床疗效 ,探讨前路内固定植入在脊柱结核外科治疗中的安全性和价值。　方法　 1997年 6月～ 2 0 0 1年5月 ,采用前路病灶清除、椎体间植骨和一期前路内固定手术治疗脊柱结核 18例 ,其中颈椎 1例 ,胸椎10例 ,胸腰段 2例 ,腰椎 5例。平均每例受累椎体 2 8个。脊柱后凸畸形角度 2 7 0°～ 75 5°,平均47 5°± 11 4°。均采用髂骨植骨。　结果　 18例病例均获得随访 ,平均随访时间 2 5个月。所有病例均未出现伤口深部感染或窦道形成 ,植骨均完全融合 ,平均融合时间为 3 6个月。后凸畸形矫正度数为 32 7°± 8 3°,后期矫正度丢失 3 2°± 2 8°。　结论　前路内固定手术在脊柱外科治疗中能有效地达到矫正后凸畸形、重建脊柱稳定性和促进椎体间植骨融合的目的 ,是一种安全和有效的治疗方法。

Anterior instrumentation for the treatment of tuberculotic spinal deformity

OBJECTIVES: To summarize the clinical results in the treatment of spinal tuberculosis with debridement, bone grafting and anterior fixation and to evaluate the safety and the value of this procedure. METHODS: From June 1997 to May 2001, 18 patients with spinal tuberculosis were treated using anterior debridement, autograft of bone and primary internal instrumentation. They were 8 men and 10 women, aged from 25 to 59 years (mean 41 years). The degree of kyphosis before surgery was 27.0 degrees to 75.5 degrees (mean 47.5 degrees +/- 11.4 degrees ). The involved spines included cervical spine (1 patient), thoracic spine (10), thoracic-lumbar spine (2), and lumbar spine (5). Average 2.8 intervertebral bodies in each patient were afflicted with tuberculosis disease. Spinal fusions were done with iliac bone grafts. RESULTS: All patients were followed up for an average of 25 months. No deep wound infection and sinus were observed after surgery. The grafted bones were fused in all patients with an average time of 3.6 months. The degree of spine kyphosis correction was 32.7 degrees +/- 8.3 degrees, and 3.2 degrees +/- 2.8 degrees was lost on average in the late stage. CONCLUSION: Anterior instrumentation for spinal tuberculosis could stabilize the spine, correct kyphosis and fuse the grafted bone.