耐药胸腰椎结核的外科治疗

目的探讨耐药胸腰椎结核的手术治疗及疗效。方法回顾分析2005年3月-2008年4月收治的32例耐药胸腰椎结核的临床资料。男21例,女11例,年龄17-75岁,平均45.2岁。术前Franke1分级A级1例、B级2例、C级8例、D级16例、E级5例。后凸角度（Cobb角）为5°-58°,平均29.2°。根据病灶部位及病变程度,选择经前路、肋横突或后路病灶清除、植骨、内固定,在药敏试验及耐药基因检测指导下抗结核治疗18-24个月。随访1.5-4.6年,平均3.4年。结果所有患者均耐受手术,1例术后复发,经再次手术治愈,X线或CT检查提示全部植骨融合。后凸Cobb角平均矫正19°,26例神经功能恢复至E级,5例恢复至D级,1例恢复至C级。结论在合理的抗结核药物治疗基础上,对耐药胸腰椎结核手术治疗有较好疗效。

Surgical treatment of drug-resistant thoracolumbar spinal tuberculosis

Objective To study the curative effect of surgical treatment on drug-resistant thoracolumbar spinal tuberculosis.Methods Clinical data about 32 drug-resistant thoracolumbar spinal tuberculosis patients（21 males and 11 females）at the average age of 45.2 years,admitted to our hospital in March 2005-April 2008,were retrospectively analyzed.The patients were classified into Franke l stages A-E in 1,2,8,16 and 5 cases,respectively.The Cobb＇s angle ranged 5°-58° mean 29.2°）.According to the severity and location of infection,the patients underwent anterior and posterolateral costotransversectomy or posterior debridement and bony grafting with anterior or posterior fixation,followed by anti-tuberculosis chemotherapy for 18-24 months based on conventional and genotypic drug susceptibility testing.The patients were followed up for 3.4 years（range 1.5-4.6 years）.Results All the patients tolerated the operation.Recurrence was found in 1 case who was cured after second operation.X-ray and CT examination showed that the bone was fused in all patients.The average Cobb＇s angle was corrected to 19°.Franke l stages E,D and C were observed in 26,5 and 1 cases,respectively.Conclusion The therapeutic effect of surgical treatment is good on drug-resistant thoracolumbar spinal tuberculosis after rational anti-tuberculosis chemotherapy.