钛网及植骨融合修复中重度脊柱后凸畸形

背景：有学者提出的经前路矫正脊柱结核后凸畸形和解除脊髓压迫的治疗方法，可能会有植骨块塌陷、吸收或断裂的并发症。研究证实，通过一期前后路联合内固定可增加对后凸畸形的矫正力量，避免出现植骨并发症、降低假关节的形成并有助于患者早期下地活动及功能恢复。目的：分析评价2个或多个节段受累伴中重度后凸畸形的脊柱结核患者，一期行前后路病灶清除、植骨融合内固定矫正后凸畸形的临床疗效。方法：回顾性分析20例脊柱胸腰段有2个或更多节段受累的结核患者，一期行后路内固定融合并前路病灶清除钛网融合内固定。所有患者内固定后持续9个月抗结核化疗，最初3个月采用四联抗结核药物，后6个月采用三联抗结核药物。随访时测量后凸角度，评价患者融合情况、神经病变和功能恢复状况。结果与结论：所有患者随访均超过37个月。所有患者均获得牢固节段融合重返工作岗位。内固定治疗后15例（75％）的患者仅残留局部轻度疼痛，3例（15％）活动受限明显。内固定前11例有神经功能障碍，内固定后9例神经功能完全恢复正常。后凸角度平均矫正了35．1。（84．8％）（P〈0．001），在随访期间矫正丢失差异无显著性意义（P〉0．05），未出现内固定及植骨相应并发症。结果表明，对于2个或更多节段受累伴有中重度后凸畸形的脊柱结核患者，应环形融合，即一期前后路联合内固定融合治疗。可获得更大矫正，有助于患者早期下地活动，稳定病变节段，而且可以长期有效地维持矫正效果。

Titanium mesh and interbody fusion repair medium and severe kyphosis deformity

BACKGROUND： Scholars have supposed that the treatment of spinal tuberculosis kyphosis with anterior approach and spinal cord decompression may lead to complications such as bone graft collapse, absorption or fracture. Studies have confirmed that one-stage anterior-posterior surgery combined with internal fixation can enhance the corrective effect to kyphosis, avoid bone graft complications, reduce the formation of false joints, help patients with early activities out of bed and promote the functional recovery. OBJECTIVE： To evaluate the clinical outcome for tuberculous spondylitis of thoracolumbar region with two or more affected segments treated with one-stage anterior-posterior debridement, interbody fusion and internal fixation. METHODS： We retrospectively studied 20 cases of tuberculous spondylitis of thoracolumbar region with two or more levels of involvement. All the patients underwent one-stage posterior fixation fusion and anterior debridement and titanium mesh fusion and internal fixation. All the patients received antituberculosis chemotherapy for 9 months after internal fixation. For the first 3 months, the patients were treated with quadruple antituberculosis drugs, and then treated with triple antituberculosis drugs in the later 6 months, The kyphosis angles were measured during follow-up to evaluate the fusion status, neuropathy and functional recovery. RESULTS AND CONCLUSION： All the patients were followed-up for more than 37 months. All patients returned to their previous occupation after firmly segment fusion; only 15 cases （75%） felt mild pain or no pain and three cases （15%） with major limitations in activities. There were 11 patients with neurological deficit before internal fixation, and nine cases of these achieved complete neurological recovery. The kyphosis angles were corrected for 35.1~ （84.8%） in average （P 〈 0.001）, and there was no significant difference in correction loss during the follow-up period （P 〈 0.05）. There were no grafts or fixation-related complications. Tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis should be treated with circumferential fusion, that is one-stage anterior-posterior fusion and fixation, which can obtain greater correction help the patients with early activities out of bed, stabilize the lesioned segments, and long-term maintain the correction effect.