单一体位后前联合入路治疗胸腰椎结核的临床观察

目的探索单一体位行后路内固定、前路病灶清除植骨术治疗胸腰椎结核的可行性。方法自2008年1月至2009年12月对9例胸腰椎结核病人行单一体位前后联合病灶清除植骨内固定术。男6例,女3例,平均年龄42岁（27～61岁）。胸腰段2例,腰椎7例;累及2个节段8例,3个节段1例;5例伴有不同程度的脊髓和/或神经根受压的症状。所有病例均在抗结核治疗2～3周后行单一体位后路内固定、前路病灶清除植骨手术治疗。结果所有病例获得平均15个月随访（6～30月）。1例患者术后半年复发。8例均未出现复发和窦道形成,并于术后6个月复查时见植骨完全融合。5例术前伴有神经症状的患者术后完全恢复。结论单一体位下后路固定、前路病灶清除植骨术是一种治疗胸腰椎结核可行的方法。病变位于T12-L3为最佳部位,术者必须熟练掌握侧卧位的椎弓根钉植入技术。

Combined posterior and anterior approach for thoracolumbar spinal tuberculosis in one position.

Objective To explore the clinical value of combined posterior and anterior operation for thoracolumbar spinal tuberculosis in one position.Methods Data of 9 patients with thoracolumbar tuberculosis undergoing the operation of debridement and fusion with instrumentation in one position between Jan,2008 to Dec,2009 were documented retrospectively.There were 6 males and 3 females with the mean age of 42 years old （27~61 years old）.2 patients with thoracolumbar,and 7 patients with lumbar spinal tuberculosis;2 spinal segments were involved in 8 patients,3 segments in 1 patient.5 patients with different spinal cord or never root injury symptoms.Patients should be adopted anti-tuberculosis therapy for 2~3 weeks preoperatively,the combined operations,posterior spinal internal fixation and anterior lesion debridement and grafting fusion surgery in one position were performed in 9 cases.Results All patients were followed-up 6~30 months with the mean time of 15 months.one patient developed recurrence 6 months postoperatively.8 patients got bony fusion at the average of 6 months after operation.The neurological function recovered postoperatively.Conclusion The combined posterior and anterior operation for thoracolumbar tuberculosis in one position was a feasible method.T12 to L3 was the best lesion position for this operation.The surgeon should be familiar with the pedicle screw insertion technique in lateral position.