病灶清除植骨内固定术治疗脊柱结核临床分析

目的探讨不同方法病灶清除植骨内固定术治疗脊柱结核的临床效果。方法据病灶部位的不同对64例脊柱结核患者采用不同的入路及内固定方法进行手术治疗。随访18个月,观察对比手术前后患者病灶、植骨融合、内固定、后凸畸形及骨髓损害情况。结果前路病灶清除一期植骨钢板内固定35例,前路病灶清除一期植骨后路经弓根钉棒内固定21例,前路病灶清除一期植骨前路钢板后路钉棒联合内固定8例。治疗后X线检查显示病灶情况、植骨融合情况、内固定情况、后凸畸形情况、合并脊髓损害者术后神经功能改善情况均取得较满意效果,3种入路及内固定方法间的治疗效果比较差异无统计学意义（P〉0.05）。结论病灶清除植骨内固定术能明显缓解脊柱结核的症状,有效清除病灶,改善神经功能,并且术后植骨融合良好,内固定稳定,治疗效果明显,但应注意据患者的病灶部位等选择合适的入路和内固定方式。

The clinical analysis of debridement and bone grafting internal fixation in spinal tuberculosis

Objective To explore the clinical effect of different kinds of debridement and bone grafting internal fixation in spinal tuberculosis.Methods 64 cases patients with spinal tuberculosis were treated by different approach with internal and bone grafting internal fixation,and follow-up of 18 months.After treatment,compared the situation of lesions,bone fusion,internal fixation,kyphosis,and bone marrow damage.Results 35 cases patients were treated by anterior debridement and a bone graft anterior plate internal fixation,21 cases patients were treated by passing pedicle screw and rod fixation after anterior debridement a bone graft,8 cases patients were treated by a bone graft anterior plate posterior screw-rod anterior debridement combined with internal fixation.After treatment,all of the patients were examined by X-ray,compared the situation of lesion,bone graft fusion,internal fixation,kyphosis and the recovery of neurological function after spinal cord damage.Conclusion Debridement and bone grafting internal fixation can significantly alleviate the symptoms of spinal tuberculosis and removal of disease,improve the neurological function,insure interbody fusion,keep the internal fixation stable.Should be choose the right approach and internal fixation on the lesion site visits.