颈椎结核合并四肢瘫的外科治疗

目的:探讨颈椎结核合并四肢瘫外科治疗的临床疗效与安全性。方法:对21例颈椎结核合并四肢瘫患者采用早期前路病灶清除、减压、植骨、内固定手术并行联合化疗。术前Frankel分级:B级12例,C级5例,D级4例。结果:术后随访4～36个月,平均8个月,死亡2例,其中术后4个月死于突发肺部感染1例,1年后死于脑血管意外1例。所有患者术后脊髓功能均有不同程度恢复,Frankel分级:D级12例,E级9例。3～6个月X线片显示无骨质破坏复发,植骨处均已骨性融合,无内置物松动、脱落或断裂。结论:颈椎结核合并四肢瘫宜在联合化疗的基础上尽早外科干预;在细致的围手术期管理、正确熟练的手术操作技术下,颈前路病灶清除、减压、植骨、内固定治疗颈椎结核并四肢瘫是安全有效的。

Surgical treatment for cervical tuberculosis complicated with quadriplegia

Objective： To explore the effect and safety of surgical treatment for patients with cervical tuberculosis complicated by quadriplegia. Methods： Anterior ＇radiael focal debridement, deeompressiom, bone graft, internal fixation combined with chemotherapy were employed for 21 cases with cervical tuberculosis and quadriplegia. According to Frankel classification standard, 12 cases were at grade B, 5 cases were C, and 4 cases were D. Results： Following-up of 4-36 months, averaged 8 months showed 2 death： one died of sudden lung infection 4 months later after surgery, and the other died of cerebrovascular accident 1 year later. All patients＇ spinal function had recovery at different degree after surgery, including 12 cases at D, 9 cases at E. X-ray at 3-6 months later showed bone fusion at graft spot, no reoccurrence of bone destruction, and no loosening, shedding or fracture internal fixer. Conclusion： Combined with chemotherapy, surgical intervention should be employed as soon as possible for patients with cervical tuberculosis complicated and quadriplegia. With careful perioperative treatment and accurate operation, the treatment including anterior radical debridment, decompression, bone graft, and internal fixation is effective and safe for treating cervical tuberculosis complicated with quadriplegia.