病灶清除植骨内固定加灌注冲洗局部化疗治疗胸腰椎结核24例临床分析  

Debridement Bone Graft and Internal Fixation with Irrigation and Local Chemotherapy in the Treatment of Thoracic and Lumbar Tuberculosis:Clinical Analysis of 24 Cases

作　　者：王剑龙[1] 孙建锋[1] 

机构地区：[1]中南大学湘雅三医院骨科,湖南长沙410000

出　　处：《中国医药指南》2013年第10期425-426,共2页Guide of China Medicine

摘　　要：目的总结病灶清除植骨内固定术加置管灌注冲洗局部化疗治疗脊柱结核的疗效。方法 24例脊柱结核并脓肿患者,全部患者在全身化疗的同时,采用病灶清除(前路),后路(或前路)内固定,取髂骨植骨,病灶部位放置灌注冲洗管进行灌注冲洗和持续局部化疗,并同时置一硬膜外导管于体外,局部注射抗结核药物。结果 24例脊柱结核并脓肿患者经过6～30个月随访,其中1例术后1个月出现伤口裂开,清创换药20天后痊愈。余23例疗效满意,无结核复发。所有患者内固定牢靠、无松动及断裂,术后6个月左右见植骨已骨性融合。结论病灶清除植骨内固定加置管灌注冲洗局部化疗对胸腰椎结核治疗效果良好。病灶清除植骨内固定能有效矫正脊柱畸形、加强脊柱稳定性、促进植骨融合,缩短卧床时间,及早下地行走,减少并发症。置管灌注冲洗局部化疗,使病灶清除更彻底,减少复发。Objectives To summary the curative effect of lesion clearance, bone transplantation internal fixation ,local chemotherapy and persistent local drainage on spinal tuberculosis. Methods 24 cases of spinal tuberculosis with abscess, all given systemic chemotherapy, were accepted lesion clearance, posterior （anterior） internal fixation ,auto-iliac bone graft, placing perfusion tube for local drainage and putting into a epidural catheter for local chemotherapy. Results 24 cases of spinal tuberculosis with abscess ,followed up for 6 months to 30 months, of which 23 cases had satisfactory effects,had no relapse ,had stable internal fixation without fixation relaxation and fracture, and got solid fusion within 6 months .Only one case occurred wound dehiscence one month after the surgery, and healed after debridement and wound dressing. Conclusion The curative effect of lesion clearance, bone transplantation internal fixation ,local chemotherapy and persistent local drainage had obvious effect in treatment of spinal tuberculosis. Lesion clearance bone transplantation internal fixation could effectively correct the spine deformity, stabilize the spine,promote spinal bone transplantation crasis, shorten in- bed time, walk as soon as possible,reduce complications, local chemotherapy and persistent local drainage could clear the focus away thoroughly,reduce the chance of relapse.

关 键 词：脊柱结核 病灶清除 内固定 灌注冲洗 局部化疗 

分 类 号：R687.3[医药卫生—骨科学]