两种术式治疗胸腰椎结核的疗效观察

目的　比较病灶清除术与前路病灶清除椎间植骨内固定术治疗胸腰椎结核的临床疗效。方法　全组 6 8例 ,平均年龄 37岁。病灶清除术组 33例 ,病灶清除植骨内固定术组 35例 ;其中胸椎结核 2 1例 ,胸腰段结核 18例 ,腰椎结核 2 9例。病灶清除术采用经胸、胸膜外或腹膜外入路 ,清除病灶后 ,骨缺损大于 5 mm者取髂骨植骨 ;小于 5 mm者不植骨。病灶清除植骨内固定术采用经胸或腹膜外入路 ,彻底清除病灶 ,髂骨或填塞自体肋骨粒的钛网椎间植骨融合 ,一期前路内固定。术后抗结核治疗 12～ 18个月。结果　平均随访 2 7个月。病灶清除术组中 5例术后结核局部复发 ,再次手术治疗。病灶清除植骨内固定术组无结核局部复发 ,脊柱后凸畸形改善 ,矫正角度 15°;无内固定器械断裂。结论　前路病灶清除植骨内固定术 ,可重建脊柱的稳定性 ,利于结核病灶的稳定与修复 ,减少结核复发 ,矫正后凸畸形 ,较病灶清除术能取得更好的临床疗效。

Assessment of Two Surgical Techniques in the Treatment of Thoracolumbar Spinal Tuberculosis

Objective To compare the clinical results of the classic radical debridement to anterior radical debridement with anterior interbody fusion and anterior internal fixation in surgical management in thoracolumbar spinal tuberculosis. Methods There were 68 patients in this series. The mean age was 37 years. 33 patients of thoracolumbar spinal tuberculosis were radical focus debrided with or without anterior iliac bone transplantation. 35 patients were operated with a combination of anterior debridement,interbody fusion and anterior internal fixation with Z-plate,Profile,Ventrofix,TSRH,CDH or Moss Miami instrumentations. Results The period of follow-up lasted 27 months. 5 patients were needed another operations because of the reccurrence of tuberculosis after classic radical focus debridement. After anterior debridement and spinal fusion with internal fixation,there was no patient with recurrence of tuberculosis. 15 degree of the kyphosis deformity was improved without associated complication. Conclusion Anterior instrumentation with anterior autologous strut grafting following anterior radical debridement can reconstruct the spinal stability and it is a good treatment option with low complication rate,high correction rate in local kyphosis,and high fusion rate.