内固定系统在脊柱结核治疗中的应用

目的　评价内固定在脊柱结核治疗中的应用价值。方法　 2 0 0 1年到 2 0 0 3年采用侧前方手术病灶清除加内固定系统治疗胸、腰椎脊柱结核患者 16例 ,其中后路病灶外内固定 12例 (TSRH钉棒横桥系统 5例、TSRH钩棒横桥系统 7例 ) ,前路病灶野内Z -Plate钉板内固定系统 4例 ,椎体间皆采用自体植骨融合。所有患者均采用标准化疗方案。术后随访 18至 2 4个月 (平均 2 0个月 )。结果　 16例患者切口均Ⅰ /甲愈合 ,1例并发单侧胸膜外后方脊旁积液(自愈 ) ,无结核病灶复发 ,椎体间植骨均获融合 ,无内固定失败。有脊髓压迫表现者 ,Frankel评分均获提升。结论　传统脊柱结核手术与内固定系统结合运用具有病灶清除彻底、固定坚强、矫正畸形、融合率高、减少卧床时间、安全的早期功能锻炼、总体医疗费用降低以及后期并发症低等优点 ,而复发率保持不变 ,具有很高的临床应用价值

Application of internal fixation in the treatment of spinal tuberculosis

Objective To evaluate the clinical efficacy of internal fixation used in the treatment of spinal tuberculosis. Methods 16 patients with thoracic, thoracolumber spinal tuberculosis were treated surgically by internal fixation from June 2001 to June 2003, including posterior out-of-focus instrumentation 12 cases (5 cases with TSRH pedicle screw-stick-bridge system, 7 cases with TSRH hook-stick-bridge system), and anterior in-focus instrumentation 4 cases, with Z-plate system. All the cases were performed with bony autografting. All the patients were followed up by 18~24 months after surgery(20 months on average). Results 16 cases had their incision healed at first intention and only one occurred single pleural effusion beside spine, but soon healed itself. No recurrence of spinal tuberculosis was noted during the follow-up period. Spinal solid fusion at the interface between the graft and adjacent vertebral bodies was shown radiologically. No internal fixation failure was found. The Frankel grade of those who had signs of spinal cord pression was raised. Conclusion Internal fixation combined with traditional surgery is a good choice of surgical treatment for spinal tuberculosis. It has such advantages as rigid fixation, less time in bed, early exercises, high rate of spinal solid fusion, less fee in hospital.And the rate of recurrence is similar,which has very high value in clinical use.