一期前路病灶清除支撑植骨内固定治疗胸椎结核

目的评价一期前路病灶清除支撑植骨内固定治疗胸椎结核的临床效果。方法采用一期前路病灶清除支撑植骨内固定治疗胸椎结核21例患者,病灶位于胸5～12,均有程度不同的后凸畸形,后凸角27～57°,平均31.7°;术前15例患者伴脊髓不全损伤,按Frankel分级：B级2例,C级6例,D级7例。所有病例术后均给予至少12月的系统抗结核治疗。结果 21例患者均成功完成一期病灶清除、支撑植骨及固定;随访9～24个月,平均15.6个月;术后切口均一期愈合,无术后复发及螺钉松动,所有病例均获得植骨愈合,植骨融合时间平均6.8个月,后凸畸形平均矫正19.4°,随访期内未见明显丢失,脊髓不全损伤术后神经功能平均恢复1.33级,除3例术后出现胸腔积液、肺不张外,余无严重并发症出现。结论一期前路病灶清除支撑植骨内固定治疗胸椎结核能够有效清除病灶减少复发,并能有效重建和维持脊柱稳定性,为神经功能恢复创造条件,是一种安全、有效的术式。

One stage anterior debridement and instrumentation in treatment of thoracic spinal tuberculosis

Objective To evaluate efficacy of one stage anterior debridement,strut graft and instrumentation in treatment of thoracic spinal tuberculosis.Methods 21 patients with thoracic spinal tuberculosis,including 14 males and 7 females,were treated with debridement and strut graft with iliac bone combined with instrumentations.The locations of lesions located at the level of T5-12.Kyphosis deformity presented in all the patients with an average Cobb angle of 31.7°（range form 27°to 57°）.The neurological symptoms were developed in 15 patients,encompassing 2 cases of grade B,6 cases of grade C and 7 cases of grade D（rated by Frankel grading）.Anti-tuberculosis chemotherapy was continued for at least 12 months postoperatively.Results Debridement,strut graft and fixation were successfully completed in all the 21 patients.Incisions were healed at one stage.Except for 3 cases of postoperative pleural effusion and atelectasis,no serious complications occurred.15 patients with preoperative neurologic deficit had their Frankel grading improved for an average of 1.33 grades.Correction of kyphosis by an average of 19.4 °was achieved,without loss of correction during the follow-up period.Bone healing was obtained in all the patients in average of 6.8 months after surgery.Conclusions one stage anterior debridement,strut graft and internal fixation is a safe and effective procedure in treatment of thoracic spinal tuberculosis,which can effectively remove the focus,reconstruct and maintain the spinal stability and creates a suitable condition for the recovery of neurological functions.