胸椎或胸腰段脊柱结核后路手术后复治患者的外科治疗  

Surgical treatment of recrudescent thoracic or thoracolumbar spinal tuberculosis after posterior fixation

作　　者：陈兴[1] 余方圆[1] 马远征[1] 李宏伟[1] 

机构地区：[1]解放军总医院第二附属医院骨科,北京市100091

出　　处：《中国脊柱脊髓杂志》2008年第8期589-593,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨胸椎或胸腰段脊柱结核后路内固定术后复治患者的外科治疗方法及疗效。方法:2004年6月～2007年12月共收治胸椎或胸腰段脊柱结核后路手术后复治患者15例,其中神经症状未缓解或加重、结核中毒症状持续6例,Frankel分级B级3例,C级1例,D级2例;切口窦道形成9例。经调整抗结核用药2～8周后,5例一期取出椎弓根内固定,同时行标准前路手术(经胸或经胸腹入路病灶清除、肋骨或钛网植骨、钢板内固定);1例患者未取出椎弓根内固定,直接行前路病灶清除、钛笼植骨术;9例先行窦道切除、病灶清除、椎弓根内固定取出术,伤口愈合2周后再行标准前路手术。术后根据药敏结果进行个体化的化疗1～1.5年。随访观察患者病灶有无复发、植骨融合及神经功能恢复情况。结果:15例患者均顺利康复,切口均一期愈合。7例术后出现肋间神经疼痛或麻木。术中清除病灶组织送病理检测均确诊脊柱结核。8例培养出结核杆菌(57.1%),4株耐药,其中1株耐多药。随访3～32个月,平均18个月。末次随访时6例有神经损害的患者中2例由术前Frankel B级恢复到D级,其余神经症状均完全恢复,随访期内结核未见复发,8例随访1年以上者X线片显示植骨融合。结论:对后路手术后复治的胸椎或胸腰段脊柱结核患者,在有针对性的化疗基础上行前路彻底地病灶清除可取得较好效果。Objective：To explore the surgical measurements and curative effects in the treatment of recrudescent thoracic or thoracolumbar spinal tuberculosis treated by posterior fixation.Method：Fifteen cases of recrudescent thoracic or thoracolumbar spinal tuberculosis treated with posterior fixation in recent 3 years were analyzed retrospectively.Six cases were because of non-remission or aggravation of neurological deficits and worse tubercular toxic symptom.According to the Frankel grading,B grade for 3 cases,C for 1,D for 2.Nine cases presented sinuses.The anti-tuberculosis therapy was used for those patients according to the adjusted plans for 2-8 weeks before re-operation.Five cases were performed dislodgment of transpedicular screw system and routinely surgical treatment by anterior approach（debridement,fusion with rib or Ti-mesh,and plate-screw fixation） in one stage,1 case of 72 years old underwent debridement,Ti-mesh implantation and bone grafting directly without removal of the transpedicular screw systems.Nine cases received sinuses excision,debridement and dislodgment of transpedicular screw system at first time,then the standard anterior approaches were performed on the patients 2 weeks after healing of incision.The patients were given anti-tuberculosis therapy for 1-1.5 years according to the results of drug sensitivity test.The relapse rate,fusion of the bone graft,the status of neurological restoring were all observed in the follow-up.Result：All 15 cases recovered from perioperation. All incisions healed primarily.Seven cases were complicated with intercostal neuralgia.Bacillus tuberculosis in- fection in all cases were confirmed by pathology.Bacillus tuberculosis was detected and cultured successfully in 8 cases（57.1%）.Four strains were drug resistant and in which 1 strain was multi-drug resistant.The time of follow-up ranged from 3 to 32 months（mean,18 months ）.Six of 15 cases with the neurological deficits recovered partially or completely.No relapse occurred within follow-up period an

关 键 词：脊柱结核 后路手术 复发 外科治疗 

分 类 号：R529.2[医药卫生—内科学]