一期前路病灶清除植骨内固定治疗脊柱结核

目的探讨经前路病灶清除植骨一期前路内固定术治疗脊柱结核的临床效果。方法对43例脊柱结核患者,行前路病灶彻底清除、椎间植骨、一期前路内固定术。结果脊柱结核复发2例（4.7%）,植骨不融合3例（7.0%）。植骨融合时间3～8个月。脊柱后凸畸形平均矫正70.2%±11.4%。11例截瘫患者神经功能Frankel分级术后恢复情况：术前A级3例术后恢复至B级1例、2例无恢复;B级5例恢复至C级1例、D级2例、E级1例、1例无恢复;C级3例恢复至D级1例、E级2例。结论经前路病灶清除植骨一期前路内固定术治疗脊柱结核能彻底清除结核病灶,充分减压,矫正脊柱后凸畸形,提高脊柱结核的治愈率。

One stage anterior radical debridement,interbody autografting fusion and instrumentation in surgical management of spinal tuberculosis

Objective To evaluate the results of one-stage interbody autografting and anterior instrumentation following anterior radical debridement in the surgical management of the spinal tuberculosis. Methods 43 patients were treated with anterior radical debridement and decompression,interbodv fusion with iliae or costal bone grafting and anterior instrumentation. Results 2 patients recurred（4. 7% ）. 3 patients did not achieved solid fusion. The fusion rate was of 93.0% and the average fusion time was 5 （ 3 - 8） months. The average correction rate of the kyphosis deformity was 70.2% ±11.4%. Of the 11 patients with paraplegia,the Frankel scale was used to evaluate before and after operation. Of 3 grade A patients, 1 improved to B and 2 unchanged;Of 5 grade B patients, 1 improved to C,2 improved D, 1 improved to E and 1 unchanged;Of 3 grade C patients, 1 improved to D and 2 improved to E. Conclusions One-stage anterior radical debridement and stabilization with interbody autografting and anterior instrumentation in surgical management of spinal tuberculosis spondylitis can get fully focus clearance,completely decompression, correction of the kyphosis deformity, stabilization the spine and improvement of the fusion rate and the clinical results.