前路病灶清除植骨内固定治疗胸腰椎结核  

Treatment of Thoracolumbar Spinal Tuberculosis With Anterior Debridement,Iliac Grafting and Internal Fixation

作　　者：蒲育[1] 蔡海东[1] 何敏[1] 

机构地区：[1]成都市第十人民医院/成都市传染病医院骨外科,四川成都610061

出　　处：《职业卫生与病伤》2009年第1期10-12,共3页Occupational Health and Damage

摘　　要：目的探讨前路病灶清除,髂骨植骨钛钢板内固定治疗胸腰椎结核的临床效果。方法2007-01/2008-04采用前路病灶清除,髂骨植骨钛钢板内固定治疗胸腰椎结核16例。男10例,女6例,年龄10 59岁,平均32岁。影像学显示单椎体破坏塌陷2例,双椎体破坏塌陷楔形变11例,3椎体破坏3例,胸腰脊柱后凸畸形9例,Cobb’s角10°25°,平均16°。血沉38 86 mm/h。术前抗结核药物治疗2 3周。术后继续抗结核药物治疗10 12月。结果切口均一期愈合,随访6 16月,平均10个月。椎间植骨5 7月均获骨性融合,植骨块无移位和吸收,钢板螺钉无松动、脱出与折断。9例胸腰脊柱后凸角度平均矫正10°。血沉于术后3 5月恢复到正常。随访期内结核病灶无复发。结论胸腰椎结核行前路病灶清除、髂骨植骨钛钢板内固定可有效矫正后凸畸形,重建脊柱稳定性,获得骨性融合,临床效果良好。Objective To study the clinical outcome in treating the thoracolumbar spinal tuberculosis with debridement, iliac grafting and internal fixation. Method Sixteen patients with thoracolumbar spinal tuberculosis were treated by anterior debridement of the diseased vertebrae, iliac grafting and internal fixation from Jan 2007 to Apr 2008. There were 10 males and 6 females and mean age was 32 years old （10-59 years old）. Image examination showed there were 2 cases with single pyramid collapse, 11 cases with double pyramid collapse, 3 cases with pyramid injury and 9 cases had spinal kyphosis deformity with Cobb＇s angles of the thora- columbar spine ranged 10 -25 （average of 16 ）. Their ESR ranged 38 -86 mm/h. All patients received anti-tubercolosis chemotherapy for 2 - 3 weeks before operation. Anti-tuberculosis chemotherapy was given for 10 - 12 months after surgery. Results All patients were followed up for 6 - 16 months （ average 10 months）. Their lesion was eliminated completely. The wound healed after surgery. The graft fused 5 -7 months after surgery. The internal fixation not loosely breaks off. nine cases with kyphosis were corrected partly, with average of 10° . The ESR of these patients decreased to a nomal level 3 to 5 months after surgery. Conclusion For patient with thoraco lumbar spinal tuberculosis, anterior debridement with iliac grafting and internal fixation appears to be effective in correcting spinal kyphosis, recomstructing the stability of spine and improving clinical outcome.

关 键 词：结核 胸腰椎 病灶清除 髂骨植骨 内固定 

分 类 号：R681.5[医药卫生—骨科学]