一期后路病灶清除椎间植骨融合内固定术治疗跳跃型胸腰椎结核的临床研究

目的探讨一期后路病灶清除椎间植骨融合内固定术治疗跳跃型胸腰椎结核的临床疗效及安全性。方法选择我院2006年5月～2011年11月收治的脊柱结核患者50例进行回顾性分析,手术前、后检查X线片测量椎间隙高度、畸形矫正等情况。术后所有病例均常规佩戴腰围严格限制腰椎活动3个月、抗结核治疗9～18个月。观察临床疗效及椎间融合情况。结果术后随访12～32个月,平均18个月。患者手术切口一期愈合44例,4例术后1～3个月结核窦道形成,2例复发,术前平均后凸角11.8°,术后平均后凸角2.4°,平均矫正8.4°。除1例窦道形成继续换药、2例复发行侧前路病灶清除术外,其余47例6个月内均达结核愈合标准,治愈率为94%。结论一期后路病灶清除联合单节段椎间植骨融合内固定手术,疗效明确,是治疗下腰椎结核可行的方法之一。

Clinical study of single-stage posterior debridement,interbody bone grafting,internal fixation in treatment of thoracic and lunmbar multilevel noncontiguous spinal tuberculosis.

Objective To explore the clinical effectiveness and safety of surgical management single-stage posterior debridement,interbody bone grafting,internal fixation in treatment of throracic and lunmbar multilevel noncontiguous spinal tubercylosis.Methods A consecuing series of 50 cases of spinal tubercylosis from May 2006 to November 2011 were studied retrospectively.The height of vertebrae interval and deformity were measured before and after the surgery by X-ray.All the cases normally wore waist bellyband to strictly limited lumbar activity for 3 months and had been antituberculosis therapy for 9-18 months.Lumbar interbody fusion and the effectiveness were observed.Results All the cases had been followed for 12-32 months postoperatively,the average follow-up period was 18 months.Operative incisions of 44 cases were primary healing.4 cases appeared tuberculous sinus after operation for 1 to 3 months,and 2 cases recurred.Preoperative average posterior convex angle was 11.8°,while it achieved 2.4° postoperatively,and 8.4° was corrected.The rest of the 47 cases met the standards of tuberculosis healed within 6 months with 94% recovery rate,except 1 case continued dressing change for sinus formation and 2 cases had anterior-lateral debridement for recurrence.Conclusion Single-stage posterior debridement combined with single segment interbody bone grafting and internal fixation is an effective method,and it is one of feasible method to treat the tuberculosis of lumbar spine.