前路病灶清除同种异体冻干骨植入内固定治疗小儿脊柱结核

背景：采用前路内固定在重建脊柱前、中柱稳定性和支撑功能的同时,可给植骨床与植骨块之间提供压应力,促进植骨融合。 目的：探讨前路病灶清除同种异体冻干骨植入内固定在治疗小儿脊柱结核中的应用。 方法：回顾性分析采用前路病灶清除同种异体骨植入内固定治疗小儿脊柱结核27例,内固定后继续抗痨治疗12~18个月,观察内固定疗效及骨愈合情况。 结果与结论：随访6个月~2年半。Bridwell判断标准：Ⅰ级,14例;Ⅱ级,11例;Ⅲ级,2例。伴有双下肢不全瘫5例,内固定前Frankel分级D级3例,E级2例,内固定后均恢复正常。27例中1例C6~7椎体结核,内固定后3个月伤口窦道形成行“病灶清除”,6个月时因内固定松动、脱落、异体骨塌陷,再次内固定植骨。1例T9~11椎体结核患儿置入后6个月开始出现轻度后突,Cobb’s角：20°,行前路内固定取除,后路植骨融合骨生长阻滞。说明在全身抗痨治疗的基础上,前路病灶清除同种异体冻干骨植入内固定治疗小儿脊柱结核是安全可行的。

Anterior debridement and fusion with freeze-dried bone allografts in children with spinal tuberculosis

BACKGROUND:The anterior fixation can reconstruct the stability and support functions of the spinal column, and meanwhile, promote fusion through providing compressive stress between the bone grafts bed and bone graft. OBJECTIVE:To study the application of anterior debridement and fusion with freeze-dried bone allografts in treating pediatric spinal tuberculosis. METHODS:Twenty-seven children with spinal tuberculosis were collected and analyzed retrospectively. All the patients were treated by anterior debridement, allogeneic bone grafting and internal fixation. Then, anti-tuberculosis treatment lasted for 12-18 months in all the 27 cases. RESULTS AND CONCLUSION:All of the patients were followed up for 6 months to 2.5 years. According to Bridwell criteria, there were 14 cases of Ⅰ grade, 11 cases of Ⅱ grade, two cases of Ⅲ grade. Five of the 27 cases were accompanied by incomplete paralysis of the lower limbs and recovered after internal fixation, including three cases of grade D and two cases of grade E according to Frankel grading. Debridement surgery and internal fixation with allogeneic bone grafting were respectively implemented at 3 months and 6 months after operation in one case of C6-7 tuberculous because of sinus formation, fixation loosening and shedding and allogeneic bone collapse. Another case of thoracic spine tuberculosis at T9-11 segments presented with mild kyphotic deformity that the Cobb’s angle was 20°, as well as bone growth retardation occurred after the anterior fixation was removed and posterior interbody fusion was performed. These findings indicate that it is safe and feasible to carry out anterior debridement and fusion with freeze-dried bone allografts in children with spinal tuberculosis on the basis of systemic anti-tuberculosis.