一期前路病灶清除并内固定治疗脊柱结核83例疗效观察  

Anterior debridement and fixation for 83 cases of spinal tuberculosis

作　　者：田建洪[1] 鲍锐[1] 吴森[1] 周波[1] 韦涌[1] 

机构地区：[1]贵阳市肺科医院骨科,贵州贵阳550003

出　　处：《临床骨科杂志》2011年第6期617-619,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨脊柱结核一期前路病灶清除并内固定手术可行性。方法对83例颈、胸、腰椎(C4～L5)结核患者施行一期前路病灶清除和植骨内固定加病灶局部置管注药。结果手术时间1.5～3 h;术中失血量均<300 ml,成人患者均未输血。矫正脊柱后凸畸形均>15°,随访12～20个月无病灶复发,内固定无松脱。神经功能恢复ASIA分级:A级13例,恢复至C级1例、D级4例、E级8例;B级16例,恢复至D级7例、E级9例;C级15例,恢复至D级4例、E级11例;D级18例全部恢复至E级。复查CT显示病灶愈合。结论前路手术病灶清除彻底(含对侧病灶和流注脓肿),椎管减压充分,椎间植骨可恢复椎体高度并矫正脊柱后凸畸形;前路固定能提供较好的稳定,适合病灶累及1～3个椎体的患者。Objective To evaluate the feasibility about the operation of anterior debridement and internal fixation operation in the treatment of spinal tuberculosis in one-stage.Methods 83 patients with cervical thoracic and lumbar tuberculosis C4~L5 were undergone anterior debridement and bone grafting,internal fixation and catheter injection of local lesions with anti-tuberculosis drugs.Results Operative time was 1.5~3 h.The blood loss <300 ml,and adult patients did not received blood transfusion.The average correction of kyphosis was greater than 15°.In 12 to 20 months follow-up,no recurrences,fixation loosening were found.Recovery of neurological function ASIA grade: In A grade 13 cases,recovered to C in 1 case,D 4,E 8;In B grade 16 cases,7 cases recovered to D,E 9;In C grade in 15 cases,4 cases recovered to D,E 11;In D level 18 patients,all returned to the E.CT showed lesions healed.Conclusions The operation of anterior debridement is effective(including contra lateral lesions and far injection abscess),and spinal decompression is adequate.Graft bone is able to restore vertebral height and correct the kyphosis angle in large extent,and anterior fixation can better maintain the stability of spine,which is more suitable for paralyzed patients and patients with severe vertebral lesions 1~3.

关 键 词：结核 脊柱 前路病灶清除 内固定 

分 类 号：R52[医药卫生—内科学]