儿童脊柱结核的手术治疗

目的 分析儿童脊柱结核手术治疗的重要性和手术方式的选择.方法 对2001年1月至2006年12月收治的16岁以下28例儿童脊柱结核进行手术治疗,采用前路病灶清除,椎管减压,植骨融合,后突畸形矫正和后路内同定,椎板植骨融合和适当的切骨矫形等手术方式.结果 2例复发,复发率7.14%.Cobb角由平均35.8°,矫正为术后平均12.6°,最后一次随访统计平均15.8°,瘫痪者12例明显恢复,最后一次随访,Frankel瘫痪分级C级2例,D级2例,E级8例.结论 儿童脊柱结核采用手术治疗是必要的,降低脊柱畸形和神经功能障碍的发生率.

Surgical operation on spinal tuberculosis in children

Objective To analyze the importance and operational techniques on spinal tuberculosis in children. Methods From Jan. 2001 to Dec. 2006, 28 cases of spinal tuberculosis were analyzed. There were 18 boys and 10 girls with an average age of 9 years (3-16 year). The lesions of tuberculosis were cervical vertebrae (5), thoracic vertebrae (10), thoracic-lumbar vertebrae (5), lumbar vertebrae (7) and sacral vertebrae (1). All cases were associated with cold abscess. Twelve cases were complicated with paralysis. The surgical procedures included anterior focal cleaning, vertebral canal decompression, bone grafting fusion, kyphosis correction with posterior internal fixation, and osteotomy. Results Two cases relapsed after operation (7. 14%). The average Cobb's angle was corrected from 35. 8 to 12. 6. The mean Cobb's angle was 15.8 at the last follow-up. Twenty cases of paralysis have recovered noticeably. According to the Frankel paralytic classification, there were 2 cases in degree C, 2 cases in degree D, and 8 in degree E during the last follow-up. Conclusions The surgical treatment is necessary for spinal tuberculosis in children. The morbidity of nervous disturbance and vertebral malformations can be reduced after operation.