前路一期病灶清除椎间植骨前路内固定治疗胸腰椎结核54例  

One-stage anterior debridement,bone grafting and internal fixation treating thoracolumbar tuberculosis

作　　者：罗鹏[1] 李志刚[1] 张勇 方忠 李锋 

机构地区：[1]湖北省新华医院,武汉市430015 [2]重庆市九龙坡区第三人民医院,400080 [3]湖北省武汉市同济医院,430030

出　　处：《实用医学杂志》2011年第22期4100-4102,共3页The Journal of Practical Medicine

摘　　要：目的:探讨一期病变椎体切除椎体间植骨前路内固定治疗胸腰椎结核的手术的方法和临床效果。方法:54例病变累及1-5椎节的胸腰椎结核患者,术前正规抗结核化疗2～4周,一期行前路病灶彻底清除,病变椎体切除或半切除,椎管减压,自体髂骨、肋骨椎体间植骨,脊柱前路内固定重建脊柱稳定性,术后卧床4～8周,继续正规化疗12～18个月左右。观察术后腰背部疼痛缓解、脊髓神经功能恢复、植骨融合及结核有无复发情况。结果:随访1～4年,平均3.5年,结核病灶顺利愈合,术前伴有脊髓功能障碍的18例患者术后神经功能均基本恢复,植骨均融合,内固定无失效,畸形明显矫正,无复发病例。结论:前路一期病灶彻底清除、椎体间植骨、内固定的手术方式有利于病变切除彻底,椎管减压满意,脊柱稳定性重建可靠,术后结核无复发。Objective To discuss the clinical efficacy in treatment of thoracolumbar tuberculosis with one- stage anterior debridement,bone grafting and internal fixation. Method Fifty-four cases with thoracolumbar tuberculosis received regular antituberculosis therapy for 2 to 4 weeks preoperative.All the cases were treated with one-stage debridement, decompression, bone grafting and internal fixation. All the cases lay in bed for 4 to 8 weeks, and the regular chemotherapy was continued for 12 to 18 months or so. Pain relieve,neurological function, bone fusion, kyphosis deformity and recurrence of tuberculosis were observed. Results These patients were followed up for 3.5 years in average （ranging from 1 to 4 years）, tuberculosis was successful healed. Eighteen cases with neurological dysfunction have recovered, all eases acquired bone fusion, and no internal fixation lost. There was no recurrence of spinal turhercu]osis or loss of Cobb angulation. Conclusion One-stage anterior debridement, bone grafting and internal fixation can guaranty the recovery of spinal cord and spine stability, reduce the recurrenee rate of tuberculosis.

关 键 词：结核 脊柱 椎间植骨 前路手术 内固定 

分 类 号：R687.3[医药卫生—骨科学]