胸腰椎结核伴截瘫39例治疗分析

目的探讨胸腰段多椎体脊柱结核伴瘫痪一期前方病灶清除植骨融合和／或内固定治疗的疗效。方法回顾我院2004年3月至2006年8月，应用一期前方病灶清除、植骨加／或内固定植骨治疗39例胸腰椎结核伴截瘫患者。男20例，女19例，年龄3～74岁，平均38．7岁。病程3个月至12年。病变节段为：T2～L5，累及椎体数目：1个椎体2例，2个椎体20例，3个椎体4例，4个椎体8例，5个椎体4例，8个椎体1例。6例伴完全截瘫。所有病例术前均进行适当的抗痨治疗。术后39例随访12～41个月，平均24个月。结果术后伤口全部一期愈合，胸椎后凸畸形均明显改善，随访时无加重，随访1年时均获骨性融合。33例不完全性截瘫患者，Frankel分级平均恢复1．36级，6例完全截瘫患者有3例部分恢复，3例无恢复。结论活动性胸腰椎结核伴截瘫的一期椎体间自体骨植骨稳定并全部融合，内固定治疗可行、有效，减少了脊柱后凸畸形，促进截瘫恢复。

Spinal Tuberculosis with A Type Pott's Paraplegia: 39 Cases Report

Objective To predict the prognosis of Pott＇s paraplegic patients that were reviewed retrospectively after being treated with anterior decompressive surgery and chemotherapy and/or inter fixed. Methods All cases were treated in department of orthopedic surgery the first affiliated hospital of xinjiang medical university from 2004 to 2006. In this study,there were 39 patients（twenty male and nineteen female）,ranging from 3 to 74 years age. （average, 38.7 years）They developed spinal tuberculosis at the age of two years（range, 3 months to twelve years）,at lesion level of T2--L5 ;including lesion stage ：one stage has two cases;two stages have twenty cases;three stages have four cases ;four stages have eight cases ;five stages have four cases ;eight stages have one cases. There are six patients suffered entirely paraplegia. All patients had triple chemotherapy for two weeks to six months. The follow-up was ranged from 15 to 41 months,average 24 months. Results All patients were healed,thoracic vertebra kyphos obviously became little. There was no significant progression of kyphosis. At the final follow up,all of the results showed successful inter-body fusion. Among 33 cases inoomplete paraplegia improved 1.36 grades in average with Frankel neurological classification,All of 6 cases,of whom complete paraplegia was partially recovered in 3 cases,had no change in 3. Conclusion It concluded that internal fixation anterior/posterior and autograft bone fusion procedures were found to be helpful in strengthening the stability and providing successful recovery of A type Port＇s paraplegia,and effective fixation can correct the kpyhosis and decrease progression of kpyhosis.