一期前后路手术治疗胸腰椎活动性结核的临床疗效

目的总结一期经前后联合手术入路治疗胸腰椎活动性结核的临床疗效。方法回顾分析2007年1月~2012年12月收治的21例活动性脊柱结核患者的临床资料,包括男性8例,女性13例,平均年龄25.8(5~66)岁。结核病变位于胸椎12例(57.1%),后凸角度平均51.5°(30°~81°);胸腰段4例(19.0%),后凸角度平均56.8°(30°~80°);腰椎5例(23.8%),后凸角度平均23.6°(15°~34°)。Frankel分级:B级2例,C级3例,D级7例,E级9例。3例患者括约肌功能受损,8例患者伴有轻重不一的神经根刺激症状。联合化疗2周以后,行一期后路内固定并后外侧融合、前路病灶清除、植骨融合术。结果本组手术时间平均335(270~420)min,术中出血1 150(800~1 800)ml。平均随访22.5(12~84)个月。术前ESR平均68(37~122)mm/h,术后3~6周起逐渐下降,6个月随访时所有患者ESR均恢复至正常水平。围手术期并发伤口浅层感染1例(4.8%),随访期发生椎弓根螺钉松动1例(4.8%)。本组均无神经损害加重、植骨融合失败等严重并发症。所有患者最终均获得了良好的骨性融合,无结核复发的病例。末次随访时术后平均后凸角度矫正86.3%,末次随访时角度丢失1.7°,最终矫正率为82.3%。胸椎、胸腰段和腰椎节段的后凸角度矫正率分别为58.6%,59.6%和160%。术后患者平均Frankel分级上升1.1级,神经根刺激症状均得到缓解。结论一期经前后联合手术入路可以早期治疗胸腰椎活动性结核,纠正后凸畸形,防止疾病进展,促进神经功能恢复。

The Clinical Effect of One-stage Surgery in Treating Active Tuberculosis of Thoracic and Lumbar Spinevia Combined Anterior and Posterior Approach

dObjective To summarize the efficacy of the one-stage surgery （ including posterior internal fixation and anterior debridement, fusion procedure） for the treatment of active spinal tuberculosis. Methods From January 2007 to December 2012, a total of 21 consecutive patients with active spinal tuberculosis, included 8 males and 13 females, aged from 5 to 66 years, were enrolled in this retrospective study. The tuberculose focus located at thoracic vertebrae region in 12 cases with average kyphosis angle of 51.5°（ranged from 30° to 81°）, located at thoracolumbar region in 4 cases with average kyphosis angle of 56.8°（ranged from 30° to 80°） , and located at lumbar region in other 5 cases with average kyphosis angle of 23.6° （ranged from 15° to 34°）. According to the Frankel′s scoring system, there were 2 patients with Frankel Grade B, 3 with Grade C, 7 with Grade D, and 9 with Grade E. Sphincter disturbance was observed in 3 patients, and nerve root irritation in 8 patients. All patients underwent one-stage posterior internal fixation, post-lateral bone grafting, and anterior debridement, decompression and fusion. Results The mean operative duration was 335 minutes （ranged from 270 to 420 minutes）, and the mean blood loss was 1 150 ml （ranged from 800 to 1 800 ml）. All cases were followed up for 12 to 84 months with an average of 22. 5 months. The ESR was recovery from68 mm/h averagely before the surgery to normal 6 months after operation. Superficial wound infection was found in one case during the perioperative period, and pedicle screws loosen in one case in the follow-up period. All cases obtained successful bony fusion without tuberculosis recurrence and other serious complications. The total rate of kyphotic correction was 86.3%, and loss of correction was 1.7° with final correction rate of 82.3%. The correction rate of thoracic, thoracolumbar and lumbar region was 58.6%, 59.6% and 160% respectively. The nerve function was improved 1.1 level according to Frankel score system,