一期病灶清除及前路内固定治疗胸腰椎结核  

Anterior Debridement and Instrumentation for the Treatment of Thoracolumbar Tuberculosis

作　　者：辛兵[1] 周冰[1] 郭开今[1] 

机构地区：[1]徐州医学院附属医院骨科,江苏徐州221002

出　　处：《实用骨科杂志》2007年第9期519-522,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨前路内固定技术在治疗胸腰椎结核中的临床意义，并对其手术时机、手术指征进行初步分析。方法对2001年3月至2005年12月收治胸腰椎结核患者42例进行随访分析，42例患者中男27例、女15例，年龄22-58岁，平均37.6岁。病灶累及2个椎体28例，3个椎体14例。手术方式为前路病灶清除植骨Z-P late内固定术，术后三联抗结核治疗1年。术后平均随访时间1年，以植骨融合情况及神经功能分级作为主要观测指标。结果手术切口一期愈合，无窦道形成，无局部复发。除4例脊髓功能无明显恢复外，38例患者脊髓功能均有不同程度的恢复。植骨均获得骨性融合，平均愈合时间为4个月。脊柱后凸角平均矫正10°。随访未出现明显后凸畸形加重及矫正角度丢失。结论在严格手术指征的前提下一期病灶清除减压、植骨并应用前路内固定器，能够早期重建脊椎稳定性，矫正脊柱畸形，无明显并发症发生。Objective To evaluate the clinical efficacy of debridement and anterior instrumentation for the treatment of thoracolumbar spinal tuberculosis. Methods 42 adult patients with thoracolumbar tuberculosis were treated surgically between 2001 and 2005. There were 27 males and 15 females with an average age 37.6 years. The lesion ranged from T6-L1, and involved two vertebral bodys in 28 cases, three vertebral bodys in 14 cases. All patients were underwent anterior debridement and Z-plate instrumnentation. The chemotherapy was given for 12 months postoperatively in all patients. The bone fusion and neurological function were evaluated. Results All patients were followed up with 1 year postoperatively. All patients＇ incision healed without chronic infection, sinus formation and any recurrence. The solid fusion was observed in an average 4 months postoperatively. All cases with kyphotic deformity had an average correction of 10°, and neurological deficits had an improvement of neurological function postoperatively. Conclusion Satisfactory results can be achieved by anterior debridement and instrumentation in treatment of thoracolumbar spinal tuberculosis. Anterior internal fixation are found helpful for restoration of the stability of spine and correction of the kyphotic deformity.

关 键 词：脊柱 胸腰椎 结核 前路内固定 

分 类 号：R529.2[医药卫生—内科学]