一期后路病灶清除植骨融合内固定治疗儿童胸腰段结核伴后凸畸形

目的探讨一期后路病灶清除植骨融合内固定治疗儿童胸腰段结核伴后凸畸形的效果。方法对12例胸腰段结核伴后凸畸形的患儿采用一期后路结核病灶清除、钛笼重建、后路钉棒系统内固定术。术后定期复查X线片了解后凸Cobb角变化和植骨融合情况，采用ASIA分级评定术后脊髓功能恢复情况，采用Bird—well分级评价术后植骨融合情况。结果术中无周围脏器、血管及脊髓损伤。12例均获随访，时间18—32（23±3．6）个月。患儿胸腰段疼痛均消失，结核症状消失无复发，无切口感染、窦道形成或内固定失败等并发症，复查血沉均正常。术后1年x线片提示植骨均获骨性融合，Birdwell分级：I级9例、Ⅱ级3例。内固定位置均正常。末次随访Cobb角：13°～28°（15．5°±1．8°）。末次随访ASIA分级：术前B级3例均恢复至C级，C级5例均恢复至D级，D级4例恢复至E级3例、1例无恢复。结论一期后路清除胸腰段结核病灶彻底，椎管减压可靠，矫形效果显著，钛笼重建、钉棒系统内固定可有效重建胸腰段脊柱的稳定性。

One-stage debridement and bone grafting with internal fixation via posterior approach for treatment of children thoracolumbar spine tuberculosis

Objective To investigate the outcome of the children patients with thoracolumbar spine tuberculosis who underwent radical debridement, reconstruction with bone autograft or allograft and internal fixation via posterior ap- proach. Methods Twelve patients with thoracolumbar tuberculosis and kyphosis deformity underwent a standard one- stage operation via posterior approach. Radical debridement was performed, then iliac crest bone autograft or allograft was placed and transpedicular screw system internal fixation was done to reconstruct the spinal column. The change of kyphosis angle and fusion of bone grafting were reexamined by X-ray regularly. The neurological function was evalua- ted according to ASIA classification. Results There was no injury of blood vessel or spinal cord during the surgery. The follow-up period was range 18 -32 （23 -＋ 3.6 ） months. The tuberculosis symptoms disappeared after surgery and there was no tuberculosis recurrence, incision infection, sinus formation and internal fixation failure in any of these patients. ESR reexamination recovered normally. Bony fusion was obtained in all patients and Birdwell classification was as follows： 9 at grade I , 3 at grade ]I. The internal fixation position was normal. The kyphosis angle ranged from 13~ ~ 28~（ 15.5~ _＋ 1.8~） at final follow up. The function of spinal cord improved postoperatively, the function of spinal cord recovered at different degrees： 3 at grade C （preoperative at B） , 6 at grade D（ preoperative 5 at C and 1 at D） , and 3 at grade E（preoperative at D）. Conclusions The one-stage posterior approach can provide direct and safe access to the lesion. The effect of vertebral canal decompression and kyphosis deformity correction were sig- nificantly. The structural iliae crest autograft or allograft and posterior transpedicular screw system can work effective- ly to stabilize the thoracic junction.