后路病灶清除、椎间植骨融合内固定治疗复杂性胸、腰椎结核  

Clinical outcomes of posterior debridement, bone graft and internal fixation for complicated thoracolumbar tuberculo-sis

作　　者：赵晨[1] 蒲小兵[2] 周强[1] 代飞[1] 张劲松[1] 罗飞[1] 张泽华[1] 侯天勇[1] 李虎进[1] 黄兴舟 许建中[1] 

机构地区：[1]第三军医大学西南医院骨科,重庆400038 [2]广东省潮州市解放军第188医院脊柱外科

出　　处：《中华骨科杂志》2014年第2期109-115,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨后路病灶清除、椎间植骨融合内固定治疗复杂性胸、腰椎结核的手术适应证、技术要点及临床疗效，并评价其安全性和有效性。方法回顾性分析2008年6月至2012年8月28例复杂性胸腰椎结核患者的相关资料，男15例，女13例；年龄7～58岁，平均34岁。胸椎12例，胸腰段7例，腰椎9例。单节段受累13例，双节段12例，三节段或以上者3例。7例合并腰大肌脓肿，13例存在不同程度的脊髓神经功能损害，17例合并后凸畸形。均采用后路经椎间孔及椎旁病灶清除，联合椎间植骨融合内固定治疗。术后予标准抗结核化疗。定期随访观察结核治愈、神经功能改善及畸形矫正情况。结果28例患者均获得随访，随访时间12~57个月，平均20．7个月。26例术后12～18个月获得临床治愈；1例术后结核复发2次，经再手术后治愈；另1例发生内固定移位，但骨质愈合良好。术前存在脊髓神经功能损害者除1例末次随访时ASIA分级为D级外，余均恢复至完全正常。术前后凸畸形平均为37．1°±18．5°，术后矫正至13．6°±9．8°，末次随访时15．8°±10．30°。围手术期发生严重并发症2例，1例为术中大出血，行介入栓塞治疗，再次手术后治愈；另1例为术区感染，经再次手术后治愈。结论后路病灶清除、椎间植骨融合内固定对于复杂性胸、腰椎结核是一种安全、有效的术式，且手术创伤相对较小，但病灶清除技术难度较高，学习曲线较长，并存在损伤前方大血管的潜在风险。Objective To assess the clinical effect, safety, indications and techniques of posterior debridement, bone graft and internal fixation for complicated thoracolumbar tuberculosis. Methods Twenty-eight patients from June 2008 to August 2012 were retrospectively analyzed. 15 males and 13 females with an average age of 34 （7 to 58） years old were evaluated. Thorac- ic, thoracolombar and lumbar lesions were found in 12, 7 and 9 cases, repectively. There are 12 cases with single segment, 12 cas- es with two segments and 3 cases with at least three segments. 7 cases with psoas abscess, 13 with neurological defect and 17 with kyphosis. All patients had undergone posterior debridement transforaminally and paravertebrally, combined with bone graft and in- ternal fixation. Anti-TB treatment was given to all patients. The curative effect of tuberculosis, neurologic function and angle of ky- phosis were observed in regular follow-up time. Results All patients were followed up for an average of 20.7 （12 to 57） months. 26 cases were cured 12 to 18 months postoperatively. One patient had two recurrence, which were successfully treated with reoper- ations. Although one child was found with loosening of internal fixation, she got full fusion. Only one case was evaluated to be grade D in ASIA scoring, while others were completely recovered. The average preoperative kyphosis angle was 37.1 °± 18.5°, com- pared to 13.6°±9.8° postoperatively. At the final follow-up time, the average kyphosis angle was 15.8°±10.3°. Serious periopera- tive complications occurred in 2 cases. One with massive hemorrhage was cured after interventional embolization and reoperation, while the other with infection was cured after reoperation. Conclusion The clinical outcomes of posterior debridement, bone graft and internal fixation for complicated thoracolumbar tuberculosis are satisfactory. Effective lesions debridement, canal decom- pression, kyphosis correction, bone graft and stable fixation can be achieved in this operaion with fewer tr

关 键 词：胸椎 腰椎 结核 脊柱 

分 类 号：R687.3[医药卫生—骨科学]