内固定应用于脊柱结核治疗的安全性探讨  

The efficiency and safety of instrumentation to treat spinal tuberculosis

作　　者：朱勇[1] 赵宏[1] 邱贵兴[1] 王以朋[1] 仉建国[1] 沈建雄[1] 田野[1] 胡建华[1] 李书纲[1] 

机构地区：[1]北京协和医院骨科,100730

出　　处：《中华骨科杂志》2009年第7期634-638,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨内固定应用于脊柱结核治疗的安全有效性。方法1985年4月至2005年5月，51例脊柱结核患者行一期或二期病灶清除、植骨及前路或后路钉棒系统内固定术，男25例，女26例；年龄2～80岁，平均44．8岁。病灶分布：C3-S2，其中颈椎6例，胸椎19例，胸腰段16例，腰骶椎10例。单节段6例，双节段30例，三节段11例，四节段及以上4例。神经功能按Frankel分级：B级2例，C级8例，D级36例，E级5例。所有患者术前均行至少两周的抗结核治疗。手术清除脓液，刮除干酪样坏死物，摘除椎间盘，用骨刀切除坏死骨质直至有正常血运的骨组织。使用内固定Luque6例，Z—plate3例，TSRH8例，Ventrofix5例，Kenada4例，Moss—Miami5例，Isola6例，CDH3例，Caspaz2例，C—D2例，Zielke、Dick、Oriell、Ozion、Zephir、Tenor、USS各1例。术后继续三联抗结核治疗1年。结果术后患者腰背部疼痛明显缓解，术前有神经损害的患者术后均有不同程度的恢复。1例术后复发，经清创及调整药物治疗后未再复发。1例胸椎结核术后伤口延迟愈合，出现脓肿窦道，经长期换药后愈合。1例T10椎体结核，术前双下肢肌力3级，术后降为0级，经保守治疗2周后双下肢肌力逐渐恢复至术前水平。所有患者均获得随访，随访时间3．2-23．5年，平均8.3年。所有患者植骨均融合。24例术前伴后凸畸形的患者，后凸角从入院时乎均34．17°矫正至术后平均10．45°，末次随访矫形平均丢失3.2°。结论内固定应用于脊柱结核的治疗安全、有效。Objective To investigate the efficiency and safety of instrumentation to treat spinal tuberculosis. Methods Fifty-one patients of spinal tuberculosis were treated with one-stage or two-stage debridement, strut autografting, and anterior or posterior instrumentation with screw rod system, combined with one-year triple agents postoperative antituberctdous chemotherapy from April 1985 to May 2005. There were 6 in cervical spine, 19 in thoracic spine, 16 in thoracolumbar spine and 10 in lumbosacral spine. The level of the lesion were 6 cases for single vertebrae, 30 for two vertebrae, 11 for three vertebrae and 4 for more than four vertebrae. All patients were given triple agents antituberculous chemotherapy at least two weeks before operation. The operative procedures included cervical anterior approaches in 6 eases for debridement, fusion and plate-screw fixation, upper lateral transthoracie procedures for debridement, fusion and screw rod fixation in 11, posterior debridement, fusion and transpedieular screw system fixation in 6, two-stage anterior and posterior operation in 18 cases. The instrumentation included 6 Luque, 3 Z-plate, 8 TSRH, 5 Ventrofix, 4 Kenada, 5 Moss-Miami, 6 Isola, 3 CDH, 2 Caspaz, 2 C-D, 1 Zielke, 1 Dick, 10riell, 10zion, 1 Zephir, 1 Tenor, and 1 USS. Results All patients were followed up prospectively for 3.2 to 23.5 years postoperatively. The back pain was obviously relieved postoperatively. Patients with neurological function deficiency improved. The solid fusion was achieved in all patients, except one patient due to tuberculosis recurrence. The major complication included one sinus formation and one case with temporary deterioration of neurological function, recovered with appropriate treatment. Average preoperative kyphosis angle was 34.17°, and that was 10.45° immediately after surgery. There was a 3.2° loss of kyphosis correction during follow-up period. Conclusion Spinal tuberculosis treated with instrumentation is effective and safe.

关 键 词：脊柱 结核 内固定器 外科手术 

分 类 号：R686[医药卫生—骨科学]