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,interbady auto-bone grafting fusion and internal fixation.

作　　者：王亚全[1] 周德春[1] 尹东坡 程跃[1] 王美福[1] 郑蔓琳 

机构地区：[1]眉山市中医医院骨科,四川眉山620010

出　　处：《四川医学》2010年第6期787-789,共3页Sichuan Medical Journal

摘　　要：目的探讨前路病灶清除、植骨钛钢板内固定治疗胸腰椎结核的临床效果。方法 2006年1月～2008年1月采用前路病灶清除、椎间自体骨植骨钛钢板内固定治疗胸腰椎结核24例。影像学显示单椎体破坏塌陷6例,双椎体破坏塌陷楔形变18例,胸腰脊柱后凸畸形15例,cobb′s角14～39°,平均21°。不全截瘫11例。血沉35～104mm/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个月。结果切口均一期愈合,随访1.1～3年,平均1.6年。椎间植骨5～8个月均获骨性融合。11例不全截瘫者术后2～4个月恢复到E级。15例胸腰脊柱后凸角度平均矫正16°。血沉于术后3～5个月恢复到正常。结论对胸腰椎结核患者行前路病灶清除、椎间自体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,interbady auto-bone grafting fusion and internal fixation.Methods 24 patients with thoracolumbar spinal tuberculosis were treated by anterior debridement of the diseased vertebrae,interbady auto-bone grafting fusion and internal fixation from Jan 2006 to Jan 2008.15 patients had spinal kyphosis deformity with Cobb′s angles of the thoracolumbar spine were ranged from 14°～39°（average of 21°）.Their ESR ranged from 35～104mm/h.11 patients had lnparaplegia.All patients received anti-tubercolosis chemotherapy for 2～3 weeks before operation.Anti-tuberculosis chemotherapy regularly was given for 10～12 months after surgery.Results All patients were followed up for 1.1～3 years（average 1.6 years）.Their Lession were eliminated completely.The wound healed after surgery.The graft fused 5～8 months after surgery,11 paraplegia patients recovered completely 2～4 months postoperation and 15 cases with kyphosis was corrected partly,average of 16°.The ESR of these patients decreased to a nomal level 2.5to 4.5 months after surgery.Conclusion For patient with thoracalumbar spinal tuberculosis,anterior debridement with interbody auto-bone grafting fusion and internal fixation appears to be effective in correcting spinal kyphocis,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：R687.34[医药卫生—骨科学]