一期前路手术矫正胸腰段脊柱结核后凸畸形  

TREATMENT OF THORACO-LUMBAR SPINAL TUBERCULOSIS WITH KYPHOTIC DEFORMITY THROUGH ANTERIOR APPROACH 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] 

机构地区：[1]河北省胸科医院骨科,河北石家庄050041

出　　处：《河北医科大学学报》2008年第6期822-825,共4页Journal of Hebei Medical University

基　　金：河北省2006年科学技术研究与发展指导计划课题(062761190)

摘　　要：目的探讨胸腰段脊柱结核一期前路病灶清除、椎间植骨、内固定矫正脊柱后凸畸形的疗效及并发症的处理。方法本组25例,病变节段胸11-腰2。取胸腹联合切口、一期前路病灶清除、椎体间植骨、脊柱前路钢板内固定。植骨材料选用肋骨、髂骨或充填自体骨的钛网。术后随访12-24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,对治疗效果进行回顾性分析评价。结果术后切口一期愈合23例,手术感染1例。早期寒性脓肿未愈1例。随访12-24个月,平均18个月,骨病灶愈合率100%。24例达到植骨融合标准,1例虽未达到植骨融合标准,但局部疼痛消失,植骨内固定稳定,恢复日常生活。Cobb角术前平均34.2°,术后平均14.3°,平均矫正19.9°,1年后Cobb角丢失0°-10.4°,平均3.1°。3例截瘫患者术后3个月截瘫恢复。结论一期前路手术矫正脊柱胸腰段结核后凸畸形效果满意,并具有手术视野清楚、病清减压彻底、复发率低、早期恢复脊柱稳定性等优点。临床上有应用价值。Objective To evaluate the clinic effective and complication treatment of thoraco- lumbar spinal tuberculosis with kyphotic deformity by focus clearance,interbody autografting and internal fixation through anterior approach in one-stage. Methods Twenty-five cases involved T11 to L2 which were followed-up for 12-24 months were treated with thoraco-abdominal incision, anterior focus clearance,interbody autografting and internal fixation. The graft material referred to rib,ilium and cage with autogenic morselized bone. Relief of pain, the neurological function, kyphosis correction and spinal stabilty were evaluated. The clinic effective was analyzed retrospectively. Results Twenty-three cases acquired incision primary healing. The infection of operation was observed in 1 case. There was 1 case that tuberculous abscess was not healing in early stage. Follow-up period extended from 12 months to 24 months,averaged 18 months. The rate of focus healing was 100%. Twenty-four cases got interbody fusion. One case experienced disappearance of pain and recovery of daily life even if could not achieve the standard. The preoperation average Cobb angle was 34.2° and the postoperation average Cobb angle was 14.3°. The average correction Cobb angle was 19.9°. The loss of correction Cobb angle was 0°-10.4° in one year,the average 3.1°. Three cases with paraplegia recovered in 3 months after operation.Conclusion The trea clearance, interbody effective. It can get decrease the rate of tment of thoraco-lumbar spinal tuberculosis with kyphotic deformity by focus autografting and internal fixation through anterior approach in one-stage is a wide view and focus clearance completely in operation, which is useful in recurrence and stabilize the spinal junction in early stage.

关 键 词：结核 骨关节 外科手术 畸形 

分 类 号：R529.2[医药卫生—内科学] R682.305[医药卫生—临床医学]