Ⅰ期后前方入路治疗胸腰椎结核效果分析  

One-stage posterior and anterior surgical management of thoracolumbar spinal tuberculosis

作　　者：邓仲元[1] 黄山虎[2] 江振华[1] 李春华[1] 舒勇[2] 

机构地区：[1]广州医学院附属深圳沙井医院骨科,518104 [2]南昌大学第一附属医院骨科

出　　处：《中国综合临床》2009年第5期523-525,共3页Clinical Medicine of China

摘　　要：目的探讨通过Ⅰ期手术，即后方入路内固定联合前方入路进行胸腰椎结核病灶清除加自体骨移植治疗胸腰椎结核的疗效。方法自2003年9月至2007年9月对16例胸腰椎椎体结核患者采用Ⅰ期后路切开内固定，联合前路暴露病灶，彻底清除结核肉芽组织、脓液、死骨等进行脊髓减压，植入自体髂骨块或肋骨重建前柱；观察植骨融合情况，术前、术后测量影像学胸腰椎Cobbs角，采用美国脊柱损伤学会（A—SIA）神经功能分级评估神经恢复情况。结果随访10—36个月，平均12个月，16例患者均获骨性愈合，结核病变无复发，生理弧度无明显丢失；6例有神经症状的患者，术后均有一定程度的恢复。结论Ⅰ期后前方入路治疗胸腰椎结核，具有牢固内固定，能彻底清除病灶防止结核复发，重建胸腰椎稳定性，矫正后凸畸形可靠的优势。Objective To explore the therapeutic efficacy of posterior internal fixation and anterior debridemerit with autogenous bone grafts at one stage on tuberculosis of thoracic or lumbar spine . Methods 16 cases of thoracic or lumbar spinal tuberculosis patients were treated with combined anterior （ radical debridement and bone autograft） and posterior （instrumentation） surgeries in one stage between September 2003 and September 2007. The degree of the kyphosis （Cobb angle） was measured and the interbody fusion was observed preoperatively and postoperatively. The ASIA grading system was used to assess the neurological status. Results All patients were followed up for 10 months to 36 months, on average of 12 months. All patients showed sucessful interbody fusion, but Cobb angle was not progressed. No recurrence or wound infection was found. 6 cases all got nerve function recovery. Conclusion Thoracic or lumbar tuberculosis treated with this surgical technique can achieve stable internal fixation and a high satisfactory rate with restoring the spinal stability, arresting the disease early, providing early fusion, correcting the kyphosis particularly.

关 键 词：胸腰段结核 自体骨 内固定 

分 类 号：R687.3[医药卫生—骨科学]