脊柱结核合并截瘫再手术32例分析  

Analysis of failure reasons for postoperative patients of spinal tuberculosis complicated with paraplegia of 32 cases

作　　者：秦世炳[1] 董伟杰[1] 范俊[1] 兰汀隆[1] 管波清[1] 徐双铮[1] 关骅[1] 

机构地区：[1]北京市结核病胸部肿瘤研究所骨科 北京骨关节结核诊疗中心,101149

出　　处：《中华外科杂志》2007年第18期1237-1239,共3页Chinese Journal of Surgery

摘　　要：目的探讨脊柱结核合并截瘫手术失败的原因及再次手术方法。方法回顾性分析2001年1月至2006年12月收治的既往手术治疗失败的脊柱结核合并截瘫患者32例(占同期患者的19%),由前路开胸减压手术17例,肋骨横突切除侧后方减压15例;术后22例给予抗结核治疗。结果 23例选择前路开胸病灶清除减压术、植骨治疗,有9例行钛板内固定;5例行侧后方经胸廓胸膜外减压术;2例复发病灶清除术;2例行单纯瘘管搔刮病灶清除术。术后继续抗结核治疗,其中26例截瘫完全恢复,5例部分恢复,1例无明显改善。结论对于脊柱结核合并截瘫患者,再次手术时行开胸病灶清除术解除脊髓压迫效果仍佳,而对于体质或肺功能状态差者可行经胸廓胸膜外手术治疗。Objective To discuss the failure reasons of operation for spinal tuberculosis complicated with paraplegia and methods of the second operation. Methods Spinal tuberculosis paraplegic patients（ 18 males, 14 females） were reviewed retrospectively. They have been treated with failing decompressive surgery from January 2001 to December 2006. Seventeen patients received anterior debridement surgery via transpleural approach while the other 15 patients received posterolateral decompression surgery via costotransverse approach. Twenty-two patients got chemotherapy after the surgery. Results Twenty-three patients were treated by anterior debridement, decompression and graft placement via transpleural approach （9 received the single-stage posterior instrumentation）. Five patients received posterolateral debridement and decompression via extrapleural approach. Two patients, recur focus be eliminated. Two patients were given sinus debridement surgery alone. All patients were given anti-tuberculosis chemotherapy. The paraplegia was recovered completely in 26 patients, and partly in 5 patients. Conclusions Inadequate treatment results in defeated operative. The proper selection of operative modalities and timing on the basis of systematically anti-tuberculosis chemotherapy remains the best mode of therapy for spinal tuberculosis complicated with paraplegia. And it is also essential to choose a radical debrldement surgery to decompress the spinal cord and to reconstruct the stability of spine.

关 键 词：结核 脊柱 外科手术 截瘫 

分 类 号：R687.3[医药卫生—骨科学]