前路病灶清除植骨内固定术治疗胸腰椎结核

目的探讨在胸、腰椎结核外科治疗中,前路病灶清除植骨内固定术对清除结核病灶,对脊髓神经的减压及重建脊柱稳定性的重要性。方法对2000年10月~2004年6月共收治的胸、腰椎结核患者46例,采用前路病灶清除自体髂骨植骨38例,异体深冻骨植骨并胸、腰椎前路钛钢板内固定8例。结果经过平均18个月的随访,长达1~1.5年的抗结核治疗,44例患者结核治愈,植骨融合时间平均为5.2个月。术前截瘫、不全瘫或伴有神经症状者均有不同程度的恢复;1例内固定松动、异体深冻骨植骨未融合;1例复发,但其异体深冻骨植骨块及内固定位置良好,经继续抗结核治疗6个月后结核治愈。结论前路病灶清除,自体髂骨植骨,钛钢板内固定对胸、腰椎结核疗效肯定,异体深冻骨植骨存在融合慢或不融合的问题。

Surgical treatment of thoracic or lumbar tuberculosis by anterior focus clearance and bone graft with internal fixation

ObjectiveTo explore the importance of surgical treatment of anterior focus clearance and bone graft with internal fixation for the decompression of spinal nerve and the reconstruction of spinal stability in thoracic or lumbar tuberculosis.MethodsFrom October 2000 to January 2004,46 patients of thoracic or lumbar tuberculosis were treated.Thirty-eight patients got anterior focus clearance and interbody fusion by autograft with iliac bone,and 8 patients got anterior internal fixation by Ti-plate combined with allograft of freeze-dried bone for thoracic or lumbar spine.ResultsAfter followed up for a mean period of 18 months,44 cases were healed with antituberculosis therapy for 1-1.5 years.The average fused time for bone graft was 5.2 months.The preoperative conditions like paraplegia,incomplete paraplegia or other neural symptoms were all improved in different degree.One case had internal fixator loose and allograft of freeze-dried bone not fused.One case had a relapse,but the position of freeze-dried graft bone and internal fixator was still in good condition.These two cases were healed after continuing antituberculosis therapy for 6 months.Conclusion The curative effect of anterior focus clearance,autograft with iliac bone and internal fixation by Ti-plate in the treatment of thoracic or lumbar tuberculosis is positive,but the existing problem is that freeze-dried graft bone is of postponded fusion or nonfusion.