经胸膜外侧前方病灶清除椎间植骨融合后路内固定治疗胸椎体结核  

One-stage debridement and interbody thoracic fusion via anterolateral extrapleural approach and posterior pedicle screw internal fixation in treating thoracic spinal tuberculosis

作　　者：孙道植[1] 万世勇[1] 梁柱[1] 徐健[1] 王宏磊[1] 殷立东[1] 

机构地区：[1]中国人民解放军第二〇三医院骨科,黑龙江齐齐哈尔161006

出　　处：《中国伤残医学》2014年第4期14-17,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨经胸膜外侧前方入路病灶清除，椎间植骨融合后路经椎弓根内固定术治疗胸椎结核的疗效。方法：对27例胸椎结核患者，术前四联抗结核治疗3周后，采取侧前方入路行1期病灶清除、前路减压、椎间植骨及钉板系统内固定术。术后抗结核药物治疗9个月。观察切口1期愈合率，结核复发率，椎间植骨融合率，脊髓功能恢复程度，术后后凸成角均矫正及畸形矫正丢失角度。结果：随访1～6年，患者切口均1期，植骨全部融合，结核治愈无复发。神经功能明显恢复，Fankel分级在D级的2例，E级17例。 Cobb角由术前23～50°矫正至术后5～20°。末次随访平均丢失2．5°。结论：经胸膜外侧前方入路病灶清除椎间植骨融合经椎弓根内固定术治疗胸椎结核是有效方法。能够1期完成病灶清除、脊髓减压、矫正后凸畸形，重建脊柱稳定性。Objective：To evaluate the clinical efficacy of one -stage debridement and interbody thoracic fusion via anterolateral extra-pleural approach and posterior pedicle screw internal fixation in treating thoracic spinal tuberculosis .Methods：After 3 weeks systemic anti-tuberculosis treatment , 27 adult patients with thoracic tuberculosis were underwent one -stage debridement and interbody thoracic fu-sion via anterolateral extrapleural approach and posterior pedicle screw internal fixation in same incisions , and followed anti-tuberculosis treatment for 9 months.Rate of primary healing of incision, tuberculosis recurrence, interbody fusion, neurological function, rate of de-formity correction and loss of corrected angle were investigated .Results：All cases were followed up for 1-6 years.All had primary heal-ing of incision.The rate of bone fusion was 100%, with a 100%cure rate.Patients whose neurological function improved significantly , there were 2 cases of grade D and 17 cases of grade E , according to Frankel classification .The Cobb angle of the kyphosis were corrected from （13-50°） to （5-20°）, and loss of corrected angle were average 2.5°.Conclusion：One-stage debridement and interbody tho-racic fusion via anterolateral extrapleural approach and posterior pedicle screw internal fixation could successfully remove the focus of tu -berculosis with complete interbody thoracic fusion after operation , which restores spinal stability .

关 键 词：椎弓根 内固定 胸椎结核 病灶清除 胸膜外 

分 类 号：R529.2[医药卫生—内科学]