Ⅰ期病灶清除植骨内固定治疗胸腰椎结核

目的探讨病灶清除、Ⅰ期植骨内固定治疗脊柱结核的临床效果。方法2002年6月至2007年7月收治脊柱结核患者51例,其中胸椎10例、胸腰段16例、腰椎25例。胸椎、胸腰段结核采用I期病灶清除前路植骨钢板内固定,腰椎使用后路椎弓根钉系统内固定加前路病灶清除植骨。观察术后结核治愈率、植骨融合、畸形矫正和神经恢复情况。结果平均随访1年零3个月,所有病例切口均Ⅰ期愈合。1例术后2个月切口破溃,换药2个月愈合。2例多发结核复发,分别行保守和手术治愈,其余病例无复发现象。内固定无松动、断裂,植骨无移动、吸收。无后突畸形发生。结论I期病灶清除植骨内固定治疗脊柱结核能有效清除病灶、矫正后突畸形、早期重建脊柱稳定性及促进椎体间植骨的融合,是一种安全有效的治疗方法。

One-staged lesion debridement bone grafting with internal fixation for tuberculosis in thoracic and lumbar spine

Objective To evaluate the clinical result of one-staged lesion debridement, bone grafting with internal fixation for tuberculosis in thoracic and lumbar spine. Methods From June 2002 trhrough July 2007, 51 patients with spinal tuberculosis were admitted. The location of lesions distributed as follows: 10 in thoracic spine, 16 in thoracolumbar and 25 in lumbar. One-staged anterior lesion debridement, bone grafting and internal fixation were performed on the patients with the tuberculosis in thoracic or thoracolumbar spine. Combined anterior debridement and bone grafting with posterior transpedicular instrumentation were per-formed on patients with the tuberculosis in lumbar spine. The rate of bone-healing rate, cure of tuberculosis, correction of kyphosis, and recovery of neurological function was documented postoperatively. Results The average time of follow-up was 15 months. The wound primary healing achieved in all patients, except 1 patient whose wound ulcerated 2 months after surgery and healed 2 months later. Recurrence occurred in 2 patients with multiple involvement of the tuberculosis. The patients recovered after conservative and surgical treatment respectively. Conclusion The one-staged lesion debridement, bone grafting with internal fixation for spinal tuberculosis is effective in lesion debridement, correction of kyphotic deformity, restoration of spine stability and acceleration of bone healing.