一期后路病灶清除椎间植骨融合内固定术治疗跳跃型胸腰椎结核  

Single-stage posterior debridement,interbody bone grafting,internal fixation in treatment of thoracic and lumbar multilevel noncontiguous spinal tuberculosis

作　　者：张宏其[1] 沈恺颖[1,2] 王昱翔[1] 葛磊[1] 郭超峰[1] 唐明星[1] 刘少华[1] 邓盎[1] 吴建煌[1] 刘金洋[1] 

机构地区：[1]中南大学湘雅医院脊往外科湘雅脊柱外科中心,湖南410008 [2]上海交通大学附属上海儿童医学中心骨科

出　　处：《脊柱外科杂志》2011年第1期17-22,共6页Journal of Spinal Surgery

基　　金：湖南省社会发展科技支撑计划重点项目(2009SK2012)

摘　　要：目的评价一期后路病灶清除椎间植骨融合内固定术治疗跳跃型胸腰椎脊柱结核的临床疗效。方法回顾性分析2005年9月~2009年7月收治的脊柱结核患者539例,其中行一期后路病灶清除植骨融合内固定术治疗的跳跃型胸腰椎脊柱结核患者共13例（男9例,女4例）。术前平均后凸角21.5;°Frankel分级为B级1例,C级4例,D级6例,E级2例。入院后经个体化抗结核治疗后手术。记录术前、术后血沉、后凸角、神经功能评估和植骨融合情况。术后继续抗结核治疗12~18个月。结果术后平均随访24.3个月,全部患者术后后凸角、神经功能改善,血沉正常。术后6~12个月均获得植骨融合。结论一期后路病灶清除椎间植骨融合内固定术对于胸腰椎跳跃型脊柱结核患者是一种安全有效的治疗方法。Objective To evaluate the efficacy of surgical management single-stage posterior debridement,interbody bone grafting,internal fixation in the treatment of the thoracic and lumbar multilevel noncontiguous spinal tuberculosis.Methods A consecutive series of 539 cases of spinal tuberculosis from September 2005 to July 2009 were studied retrospectivly.Of all the patients,13 patients（9 male and 4 female） with thoracic and lumbar multilevel noncontiguous spinal tuberculosis who underwent single-stage posterior debridement,interbody bone allografting and internal fixation were evaluated.The preoperative mean kyphosis angle was 21.5°.Frankel classification was used to evaluate the neurological deficits：1 case in B grade,4 cases in C grade,6 cases in D grade and 2 cases in E grade.Patients were received anti-TB chemotheraphy individually.The erythrocyte sedimentation rate（ESR）,kyphosis angle,neural function status and graft fusion condition were recorded.All patients were administered anti-TB chemotheraphy for 12-18 months after operation.Results The average follow-up period was 24.3 months.The clinical symptoms of all the patients after operation were disappeared or released.ESR and neurological status were improved.Bone fusion was obtained within 6-12 months.Conclusion Single-stage posterior debridement,interbody bone grafting and internal fixation is a safe and effective method in the treatment of thoracic and lumbar multilevel noncontiguous spinal tuberculosis.

关 键 词：胸椎 腰椎 结核 脊柱 内固定器 清创术 骨移植 脊柱融合术 

分 类 号：R529.23[医药卫生—内科学]