一期前路病灶清除内固定治疗胸腰椎结核

目的探讨一期前路病灶清除并钛网植骨重建术在胸腰椎结核治疗中的临床疗效.方法2002年1月～2005年1月对46例胸腰椎结核采用一期前路病椎切除,钛网植骨加前路节段固定,并进行正规术后抗痨治疗.结果所有患者疼痛症状均消除,33例伴瘫痪症状的患者神经功能平均恢复2级(Frankel分级),无一例出现感染和复发等并发症,结核治愈率100%;术后3个月时骨性融合率60%,6个月时95%,9个月时达100%.后凸畸形平均矫正度数为23.6°,且随访时纠正度无明显丢失.结论一期前路病灶清除,钛网植骨加节段固定器治疗严重胸腰椎结核具有减压彻底、重建可靠和复发率低等优点.

Treatment of thoracolumbar spinal tuberculosis by single stage anterior vertebrectomy and reconstraction with titanium mesh cage

[Objection] To explore the clinical efficacy of anterior vertebrectomy and reconstraction with titanium mesh cage in thoracic and lumbar tuberculosis. [Method] A total of 46 patients with severe neurologicaldeficit were operated with a combination of vertebrectomy, interbody fusion with titanium mesh cage and anterior internal fixation and antituberculousis therapy. [Result] All cases were followed up from 1 to 2.5 years (mean 1.8 years) postoperatively. 33 cases with incomplete paraplegia improved 2 grades in average with Frankel neurological classifications. 65% of all the 46cases got solid fusion in 3 months, 95% of them got fusion in 6 months, 100% of them got fusion in 9 months. Kyphosis deformity was corrected mean 23.60 without any recurrence. [Conclusion] Patients with severe thoracolumbar spinal tuberculosis can be successfully treated by single anterior vertebrectomy and titanium mesh cage interbody fusion with segmental system. The procedure allows complete decomperation, satisfaction correction of kyphosis and lower recurrence.