一期前后路联合手术治疗颈胸段多节段脊柱结核

目的一期前后路联合手术治疗颈胸段脊柱结核并对其临床疗效进行评价。方法2007年3月-2008年3月5例颈胸段脊柱结核患者行一期颈椎后路人工骨植骨及钉棒系统内固定联合前路病灶清除及髂骨植骨钛板内固定术。术后继续抗结核治疗〉9个月。结果手术出血量为325mL±25mL。5例均获得随访，随访时间为12—15个月，随访期间均未见结核复发和内固定失败。脊髓及神经根压迫症状均有不同程度的改善，JOA评分由术前的10．6±1．2分提高到术后的15．2±0．7分。结论一期前后路联合手术治疗颈胸段多节段脊柱结核可获得满意的初期疗效。病灶的彻底清除、360°的植骨、前后联合内固定以及系统的抗结核治疗均是获得满意疗效的关键。

Surgical treatment of multiple cervicothoracic spinal tuberculosis by one-stage combined anterior and posterior approaches

Objective To study surgical treatment of cervicothoracic spinal tuberculosis by one-stage combined anterior and posterior approaches, and to evaluate its curative effect. Methods From March 2007 to March 2008, 5 patients with cervicothoracic spinal tuberculosis had been treated by one-stage cervical posterior artificial bone grafting and nail-rod internal fixation combined with anterior focus debridement and iliac bone grafting with titanium plate fixation. Anti-tuberculosis treatment continued for more than 9 months after the operation. Results The blood loss during the operation was 325 mL±25 mL. All the cases were followed up for 12-15 months. There was no recurrence of spinal tuberculosis and no internal fixation failure during the follow-up. Compression symptom of spinal cord and nerve root was relieved in some degree. The JOA scores were 15.2±0.7 after the operation, and 10.6±1.2 before the operation. Conclusion Surgical treatment by one-stage combined anterior and posterior approaches for cervicothoracic spinal tuberculosis can get a good clinical effect in the initial stage. There are some important factors for successful treatment including thorough debridement of tuberculose focus, 360° bone grafting, combined anterior and posterior internal fixation and systematic anti-tuberculosis treatment.