后路一期病灶清除加重建治疗老年脊柱结核

目的：评价后路一期病灶清除加重建手术治疗老年脊柱结核的疗效。方法回顾性分析2005年10月～2011年10月行后路一期病灶清除加重建手术治疗的107例老年脊柱结核患者（≥70岁）的临床资料，从手术时间、出血量、术后3个月内并发症、植骨融合情况、瘫痪恢复情况、疼痛视觉模拟量表（ visual analog scale， VAS）评分和结核是否复发等方面来评估手术疗效。结果手术平均时间135 min，术中平均出血量315 mL。随访12～42个月，术后3个月内并发症的发生率为14．9％，与手术直接相关的并发症发生率为4．7％。所有病例椎间植骨均获得骨性融合，融合时间平均6．3个月。 Cobb角手术平均矫正7．1°，随访期内平均角度丢失1．9°。术后瘫痪改善率87．8％。疼痛VAS评分术前平均6．3分，术后1个月平均3．5分，末次随访时平均2．1分，均较术前明显改善。所有患者脊柱结核均临床治愈，末次随访时未发现结核复发。结论后路一期病灶清除加重建手术疗效可靠，适用老年脊柱结核的治疗。

Posterior one-stage debridement and reconstruction for senile patients with spinal tuberculosis

Objective To evaluate the clinical efficacy of one-stage posterior debridement and reconstruction operation in senile patients with spinal tuberculosis.Methods Clinical data of 107 cases of spinal tuberculosis （≥70 years old） treated with one-stage posterior debridement and reconstruction from October 2005 to October 2011 were analyzed r etrospectively.The operation time, bleeding volume, postoperative complications within 3 months, bone fusion, paralysis recovery, visual analog scale （ VAS） score of pain and the recurrence of tuberculosis were recorded to evaluate the effect of operation.Results The average operation time was 135 min.The average amount of bleeding during the operation was 315 mL.The incidence of com-plications within 3 months after operation was 14.9%, and the complication rate directly related with the operation was 4.7%. All patients were followed up for 12 to 42 months.All cases got interbody bony fusion, and the average fusion time was 6.3 months.The Cobb’s angle was corrected by average 7.1°and lost 1.9°in follow-up.The postoperative paralysis improvement rate was 87.8%.The average VAS score was improved from preoperative 6.3 to postoperative 3.5, and became 2.1 at the final follow-up.All patients with spinal tuberculosis were clinically cured and no recurrence of tuberculosis occurred. Conclusion The curative effect of posterior one-stage debridement and reconstruction is reliable in treatment of senile pa-tients with spinal tuberculosis.