一期前路病灶清除植骨加后路内固定术治疗胸腰椎脊柱结核  

Anterior debridement,bone graft and posterior internal fixation in the treatment of thoraciclumbar spinal tuberculosis

作　　者：朱文骏[1] 丁亮华[1] 孙晓亮[1] 何双华[1] 

机构地区：[1]常州市第一人民医院骨科,江苏常州213003

出　　处：《江苏大学学报（医学版）》2012年第2期144-146,154,共4页Journal of Jiangsu University：Medicine Edition

摘　　要：目的:评价一期前路病灶清除植骨后路内固定术治疗胸腰椎脊柱结核的临床疗效。方法:胸、腰椎结核患者20例,男10例,女10例;经2～4周正规抗结核治疗后行一期前路结核病灶清除,椎间植骨,一期后路内固定术,术后继续抗结核治疗1年。计算20例胸腰椎结核患者术前、术后1周及末次随访时Cobb角,采用配对t检验进行统计学分析。分析术前与术后脊髓神经功能ASIA分级情况。结果:术后随访时间10个月～3年,平均15个月。1例脊柱结核复发。植骨愈合时间3～10个月,平均6个月。脊柱后凸畸形较术前均有不同程度的矫正。术后并发手术切口感染形成慢性窦道1例,经窦道清除术后痊愈。术前与术后Cobb角差异有统计学意义。术后所有病例神经功能均获得改善。结论:经前路病灶清除植骨一期后路内固定术治疗脊柱结核能彻底清除结核病灶,矫正脊柱后凸畸形,促进脊髓及神经功能恢复。Objective： To evaluate the clinical efficacy of anterior debridement, bone graft and posterior internal fixation in the treatment of thoracic lumbar spinal tuberculosis. Methods： Twenty patients, inclu- ding 10 males and 10 females; after routine 2 to 4 weeks anti-tuberculosis chemotherapy, the patients were treated with anterior debridement, with iliac or rib bone graft and posterior internal fixation, continued anti- tuberculosis chemotherapy for one year after operation. Calculated the preoperation and postoperation kypho- sis cobb angle （x ± s） of the patients, analyze d the difference in statistics. Analyzed the preoperation and postoperation spinal cord and neurologie function in ASIA classification. Results： The postoperation follow up time was 10 months to 3 years, average 15 months. Recurrence of the disease in 1 patient. The average fu- sion time was 6 （3 -10） months. The complication was chronic sinus in 1 patient, fully recovered after si- nus debridement. Analyzed the preoperation and postoperation kyphosis cobb angle （S ± s） of the patients, the difference was significant in statistics （ P 〈 0.05 ）. All cases both acquired improvement in neurologic function. Conclusion： One stage anterior debridement, bone graft and posterior internal fixation in the treat- ment of thoracic lumbar spinal tuberculosis can get fully clearance completely, correction of the kyphosis deformity, improvement of the neurologic function.

关 键 词：清除术 内固定 胸腰椎 结核 植骨 

分 类 号：R529.2[医药卫生—内科学]