后路一期病灶清除植骨短节段固定治疗脊柱结核

[目的]总结采用后路单切口双入路一期彻底病灶清除植骨,经椎弓根固定矫正畸形和重建脊柱稳定治疗脊柱结核的疗效。[方法]1999年4月～2006年6月间采用该手术方法治疗胸腰椎结核56例,其中38例A-F固定,18例GSS固定;36例采用钛网植骨,20例用三面皮质髂骨植骨。[结果]平均手术时间155min,平均出血量370ml,后凸畸形矫正率84.2%,平均随访18个月,植骨融合率达100%,结核全部治愈,无复发,矫正无丢失,脊髓神经功能恢复良好。[结论]该术式能在同一切口中完成病灶清除,植骨融合及内固定,手术创伤小;稳定的脊柱为彻底病灶清除提供保障;后路经椎弓根固定能充分矫正后凸畸形及提供坚强内固定,提高结核愈合率及植骨融合率。

CLEARING ONE STAGE POSTERIOR FOCUS WITH SHORT SEGMENT INTERNAL FIXA-TION IN TREATMENT OF SPINAL TUBERCULOSIS

[Objective] To review the clinic effects in the spinal tuberculosis treatment by one incision and two approach to focus remove and pedicel screw fixation as well as reconstructing spinal stabilization. [Methods] From April 1999 to June 2006,56 patients with thorathicolumbar tuberculosis were treated,38 cases were treated with A-F fixation,18 cases were fixed with GSS fixation,36 cases accepted bone graft of titanium mesh,as well as 20 cases got bone graft from three cortical iliaum. [ Results] The average operation time was 155 min,with the average blood lose of 370ml,the correcting rate of kyphotic deformity for 84.2%,the average follow-up duration of 18 months,as well as the fusion rate of 100%. Also,no recurrence happened,no correction was loseing,and the neurological function well recovered. [Conclusion] This approach can completely remove focus of infection,bone graft and internal fixation simultaneously with minimally surgical trauma. It is safe to remove the focus of infection completely under the stable spine. The posterior pedicel fixation can correct the kyphotic deformity with firmly fixation,increase the tuberculosis cure rate and fusion rate.