经胸一期前路病灶清除植骨融合内固定治疗胸椎结核  

Anterior focus clearance with autograft bone fusion and internal fixation via thoracic in treating of thoracic vertebra tuberculosis in one-stage

作　　者：刘丰胜[1] 石宝全[1] 郭梅秀[1] 赵静茹[1] 张国山[1] 贾晨光[1] 李卓[1] 高建国[1] 

机构地区：[1]河北省胸科医院骨科,石家庄市050041

出　　处：《河北医药》2008年第9期1276-1278,共3页Hebei Medical Journal

摘　　要：目的探讨经胸一期前路病灶清除植骨融合内固定治疗胸椎结核的手术方式及治疗效果。方法采用前路钢板固定29例（髂骨植骨14例、肋骨植骨5例、钛网植骨10例），采用单钉棒内固定5例（髂骨植骨2例、钛网植骨3例）。对34例采用经胸一期前路病灶清除、椎体间植骨、内固定术的胸椎结核患者随访12—24个月，观察术后局部疼痛缓解、脊髓功能恢复、后凸畸形矫正及脊柱稳定性情况，对手术方式、治疗效果进行回顾性分析。结果病灶局部疼痛于术后半年消失，8例截瘫患者术后4个月截瘫基本恢复至正常。术前脊柱后凸Cobb角5．2～41.5°，平均27．3°，术后Cobb角0～28．4°，平均10．7°，较术前平均矫正度数16.6°。术后1年Cobb角丢失0～8°，平均丢失2.5°。随访12～24个月，33例达到植骨融合标准；1例虽未达到标准但疼痛消失，植骨内固定稳定，恢复日常生活。无手术感染及结核复发。结论一期前路病灶清除植骨融合内固定治疗胸腰椎结核，具有病灶清除彻底、直视下减压安全充分、复发率低、矫正后凸畸形满意、早期恢复脊柱稳定性等优点，临床效果满意。Objective To evaluate the method and clinical effect of anterior focus clearance with autograft bone fusion and internal fixation via thoracic in treating of thoracic vertebra tuberculosis in one-stage. Methods 29 cases underwent anterior plate fixation （14 cases with iliac bone graft,5 cases with rib bone graft, 10 cases with titanium mesh cage full of bone autograft）.5 cases underwent internal fixation with screw-rod system（2 cases with iliac bone graft, 3 cases with titanium mesh cage full of bone autogTaft）. 34 cases of thoracic vertebra tuberculosis, who had been treated with anterior focus clearance, intervertebral autograft and internal fixation were followed-up for 12 - 36 months. Relief of pain, the spinal function, kyphosis correction and spinal stability were evaluated respectively. The method and clinical efficacy were analyzed retrospectively. Results Pain disappeared in half a year after operation. 8 cases with paraplegia recovered basically in 4 months after operation. The Cobb angle of preoperative kyphosis was 5.2 - 41.5° （ the average was 27.3°）, and the postoperation Cobb angle was 0 - 28.4°（the average was 10.7°）. The average correction Cobb angle was 16.6°. The loss of correction Cobb angle was 0 - 8°in one year, （the average was 2.5°）. 33 cases achieved the standard of spinal fusion of grafted bone, and 1 case got pain relief and normal daily life although the standard recovery was not achieved. There was no infection of operation and recurrence of tuberculosis. Conclusion The treatment of thoracic vertebra tuberculosis by anterior focus clearance, intervertebral autograft and internal fixation in one-stage is effective. Our current study indicates that such treatment possess a lot of advantages, such as broad view of operation, satisfied focus clearance, accelerated recovery of stabilization of the spinal junction, lower recurrent rate and SO on.

关 键 词：胸椎 结核 内固定 椎间植骨 病灶清除 

分 类 号：R529.2[医药卫生—内科学] R683.42[医药卫生—临床医学]