一期经后路病灶清除植骨融合内固定治疗脊柱结核

目的探讨一期经单一后入路行结核病灶清除、植骨融合、椎弓根螺钉内固定治疗脊柱结核的临床疗效。方法采用一期后路病灶清除植骨融合内固定治疗42例脊柱结核患者,记录后凸角、神经功能及融合率,监测血沉(ESR)、C-反应蛋白(CRP)。结果手术时间为75~140 min,术中出血量为500~1 000 ml。患者均获得随访,时间17~41个月。后凸角度矫正率术后为85.5%,末次随访时为79.8%。21例神经功能障碍者术后情况:2例A级恢复至B级1例、D级1例;5例B级恢复至C级2例、D级1例,2例未恢复;6例C级恢复至D级4例、E级1例,1例未恢复;8例D级恢复至E级6例,2例未恢复。术后3个月ESR为5.0~14.0 mm/1 h、CRP为4.0~9.0 mg/L。随访1年后患者均获得骨性融合。结论一期经后路病灶清除植骨融合内固定治疗脊柱结核能有效矫正后凸畸形,改善患者神经功能,是一种安全、有效的治疗方法。

Surgical treatment by posterior debridement,bone grafting,interbody fusion and posterior internal fixation for spinal tuberculosis

Objective To investigate the clinical efficacy of spinal vertebrae tuberculosis treated by posterior debride lnent, bone grafting, interbody fusion and posterior internal fixation. Methods 42 patients who diagnosed with spi hal tuberculosis were perforlned posterior debridelnent, bone grafting, interbody fusion and internal fixation via poste riot single approach. Following parameters including Cobb angle, neurological function, fusion ratio, etythrocyte sed imentation rate and C reactive protein. Results The operation time was 75 ～ 140 minutes and blood loss was 500 ～ 1000 ml. All cases were followed up for 17 ～41 months. The postoperative correction rate was 85.5%, at the last follow up visit, the correction rate was 79.8%. Neurologic status of the 21 patients with preoperative neurologic deft cit was： 2 with grade A, 1 recovered to grade B and 1 recovered to D; 5 with grade B, 2 recovered to grade C and 1 recovered to D, 2 did not recover; 6 with grade C, 4 recovered to grade D and 1 recovered to E, 1 did not recover; 8 with grade D, 6 recovered to grade E and 2 did not recover. The 3 months after operation, ESR was 5.0 ～ 14. 0 mm/1 h and CRP was 4. 0 ～ 9.0 mg/L. All patients got bone fusion after 1 year. Conclusions Surgical treatment by posterior debridelnent, bone grafting, interbody fusion and posterior internal fixation for spinal tuberculosis is a safe,effective and feasible technique.