一期病灶清除植骨内固定手术治疗胸腰椎结核

目的探讨前路一期病灶清除、植骨、前路或后路内固定手术治疗胸腰椎结核的疗效。方法自1998年-2006年对91例胸腰椎结核患者进行一期病灶清除植骨内固定,病变节段：T4-T1032例,T11-L128例,L2-L426例,L55例。其中病变累及1个椎体40例,累及2个椎体36例,跳跃型和累及3个椎体15例,应用Kaneda钢板内固定32例,Z-PlateⅡ钛板内固定26例,CDHM8系统内固定28例,AllFix系统内固定5例。术后抗结核治疗不少于1年。结果随访86例,随访时间6个月～8年,平均3.6年,手术切口均1期愈合,术后全身症状及局部疼痛消失,神经症状有不同程度恢复,所有病灶愈合,植骨融合,内固定牢固,矢状面Cobb角平均矫正15°。结论一期病灶清除植骨内固定手术结合规范药物抗痨治疗胸腰椎结核的临床疗效显著、可靠。

Operative treatment thoracolumbar tuberculosis by one-stage debridement bone graft and internal fixation

Objective To evaluate the clinical effect of the one-stage debridement,bone graft and internal fixation for the operative treatment of thoracolumbar spinal tuberculosis. Methods Ninty-one thoracolumbar spinal tuberculosis cases from 1998 to 2006 were operated by one-stage debridement,bone graft and internal fixation. The location of lesions were T4-T10 in 32 cases,T11-L1 in 28 cases,L2-L4 in 26 cases,L5 in 5 cases. In all patients,40 cases were involved in single vertebra,36 cases were involved in 2 vertebrae,15 cases were involved in 3 vertebrae or the type of jumping style. There were 32 cases treated with Kaneda,26 cases with the Z-plate Ⅱ ,28 cases with CDH M8 system and 5 cases with All Fix system. Anti-tuberculosis chemotherapy was regularly given for over 1 year after surgery. Results 86 cases were followed up 6 months to 8 years with an average 3.6 years. All the incisions acquired primary healing. The systematic and local symptoms were released postoperatively. Neurological function recovered in different degrees. All the infective focus had healed,the bone graft had fused and internal fixation had firmed. The average correction of kyphosis angle were 15°. Conclusion The curative effect of the one-stage debridement. bone graft and internal fixation with anti-tuberculosis chemotherapy regularly for the treatment of thoracolumbar spinal tuberculosis is satisfactory and reliable.