病灶清除植骨融合联合内固定治疗脊柱结核

目的：探讨不同节段脊柱结核外科治疗的手术策略及内固定适应证的选择。方法：回顾性分析2000年1月至2003年9月期间接受病灶清除、植骨融合及内固定手术治疗并获得随访的39例脊柱结核患者的临床资料．其中16例颈椎、胸椎和胸腰椎及2例腰椎结核患者接受前路-期病灶清除、植骨融合、内固定术，21例腰椎和腰骶椎结核患者接受后路经椎弓根固定、后外侧植骨融合联合前路病灶清除、椎间植骨融合术。观察术后和随访期间患者结核中毒症状和神经功能的改善情况、植骨融合情况及治愈率。结果：术后结核中毒症状明显缓解，神经功能明显改善，22个月时94．9％（37／39）植骨融合，治愈率为94．9％。结论：脊柱结核手术治疗中内固定的应用是安全、有效的；手术策略的制定和内固定的选择应根据病变节段、脓肿大小、范围等综合判断。

Debridement and fusion with instrumentation in the treatment of spinal tuberculosis

Objective: To explore the operative strategy for different segments of spinal tuberculosis and the appropriate choice of internal fixation in the course of surgical intervention.Method:Data of 39 patients with spinal tuberculosis undergoing the operation of debridement and fusion with instrumentation between Jan,2000 to Sep,2003 were documented retrospectively.16 patients with cervical,thoracic or thoracolumbar spinal tuberculosis and 2 patients with lumbar spinal tuberculosis underwent the operation of one-stage anterior surgery,and the other 21 patients with lumbar or lumbosacral spinal tuberculosis underwent the operation of one-stage anterior debridement and fusion followed by posterior instrumention and fusion.Result:The toxic symptom of tuberculosis alleviated greatly and neurological function improved postoperatively.37 of 39 patients(94.9%) got bony fusion and healed at 22 months after operation.Conclusion:The application of internal fixation in the operative treatment of spinal tuberculosis was safe and effective.The design of operative strategy and the selection of internal fixation should be based on the segments of spine involved,the range of abscess and so on.