经前路手术治疗胸腰椎结核15例临床分析

目的：探讨经前路一期病灶清除植骨内固定治疗胸腰椎结核的可行性及临床疗效。方法：对15例胸腰椎结核患者进行一期前路病灶清除植骨内固定。术前强化抗痨治疗2～4周,术中彻底清除病灶,均行前路植骨内固定。术后继续抗痨治疗1～2年。结果：全部病例随访0.5～2.5年,平均1.5年,术后切口均甲级愈合。术后融合节段后凸角为（8.1±3.2）°。神经功能均有不同程度恢复。结论：经前路一期病灶清除植骨内固定治疗胸腰椎结核,术前要进行充分有效抗痨治疗,术中彻底清除病灶,通过植骨内固定来重建脊柱的稳定,临床疗效可靠。

Clinical evaluation of anterior operation for treatment of 15 cases of thoracic or lumbar tuberculosis

Objective：To analyze the feasibility and clinical effect of treating thoracic or lumbar tuberculosis by one stage anterior radical debridement,bone graft and internal fixation.Method： Fifteen patients with thoracic or lumbar tuberculosis were treated by one stage anterior radical debridement,bone graft and internal fixation from July 2005 to December 2008.There were ten males and five females with an average age of 40.5 years（range 20～65 years）.The location of lesions were T6~10 in 4,T11～Ll in 6,L2~5 in 5.The preoperative kyphosis angle was（20.5 ±3.5）°.all the patients had spinal compression,Frankel grade was that 1 cases with grade B,3cases with grade C,11cases with grade D.After intensive anti-tuberculosis medication for 2～4 weeks before operation.then underwent radical debridement thoroughly.All patients were reconstructed with bone and anterior internal fixation.After operation,the anti-tuberculosis medication was continued for（1~2） year.Result： All the patients were followed up for 0.5 to 2.5 years postoperatively,with the average of 1.5 years.All the wounds healed in the first stage.The postoperative kyphosis angle was（8.1±3.2）°.The neural symptoms were all improved in different degrees.Conclusion： Radical debridement and sufficient anti-tuberculosis medication are essential for anterior approach operation of thoracic or lumbar tuberculosis.Defect of vertebra can be implanted by bone and anterior internal fixation,which can reconstruct stabilization of spin.Clinical effect of the treatment is satisfactory.