前路病灶彻底清除植骨内固定治疗胸腰椎结核

目的 :探讨病灶彻底清除椎间植骨融合内固定治疗胸腰椎结核的疗效及结核病灶内植入内固定器械的安全性。方法 :全组 16例 ,平均 4 5岁。其中胸椎结核 7例 ,胸腰段结核 5例 ,腰椎结核 4例。采用经胸或腹膜外入路 ,彻底清除病灶 ,髂骨椎间植骨融合 ,同期内固定。应用TSRH 8例 ,Ventrofix 3例 ,Z -plate 5例 ,术后卧床 8周 ,不需支具外固定 ,抗结核治疗 12～ 18月。结果 :平均随访 19个月 ,疗效满意 ,伤口均一期愈合 ,脊柱后凸畸形改善 ,矫正角度 13°;无植骨块松动脱落 ,无内固定器械断裂 ,结核病灶愈合 ,无结核局部复发 ,无窦道形成。结论 :彻底病灶清除椎间植骨并内固定 ,可重建脊柱的稳定性 ,利于结核病灶的稳定与修复 ;在结核病灶内植入内固定器械是安全可行的。

Anterior radical debridement and interbody autografting with internal fixation for the treatment of thoracolumbar spinal tuberculosis

Objective:To evaluate the clinical efficacy of radical debridement and spinal fusion with internal fixation and to discuss the safety of anterior instrumentation in surgical management in thoracolumbar spinal tuberculosis.Methods:There were 16 cases in this series.The mean age was 45 years.16 cases of thoracolumbar spinal tuberculosis were radical focus debrided and grafted with iliac bone.8 cases were fixed with TSRH,3 cases with Ventrofix and 5 cases with Z-plate.No brace was needed after surgery.Results:The period of follow-up lasted 19 months.All patients had good results.The incision of all cases were cured for the first term.No case had sinus.13 degree of the kyphosis deformity was improved without associated complication.All patients had no recurrence of tuberculosis.Conclusion:The results show that the radical focal debridement and anterior bone transplantation with internal fixation can reconstruct the spinal stability and it is safe to implant anterior instrumentation in tuberculosis foci.