一期后路病灶清除植骨融合内固定治疗胸腰椎结核的临床疗效分析  

Clinical Efficacy of Single-stage Posterior Debridement and Interbody Fusion and Internal Fixation in the Treatment of Thoracolumbar Tuberculosis

作　　者：高鑫峰[1] 刘明[1] 李鹏[1] 赵志刚[1] 

机构地区：[1]武汉市普爱医院,湖北武汉430033

出　　处：《武汉大学学报（医学版）》2014年第2期302-306,共5页Medical Journal of Wuhan University

摘　　要：目的:探讨对胸腰椎结核患者行一期后路病灶清除、植骨融合内固定术治疗的临床效果。方法:回顾性分析我院于2006-2011年期间采用该术式治疗的患者31例,其中男13例,女18例,平均年龄42岁。胸椎20例,腰椎6例,胸腰椎同时受累5例。病灶累及2个节段的有21例,3个节段有6例,3个以上节段的有4例。脊髓损伤ASIA分级:A级0例,B级4例,C级5例,D级7例,E级15例。所有患者均采用一期后路病灶清除、融合、内固定术治疗。术后随访20-48个月,分析患者结核转归,以及神经功能、脊柱畸形等恢复情况。结果:术中胸膜破裂1例,脑脊液漏1例,未见伤口感染、不愈合及窦道形成病例。随访期间,1例患者结核症状无改善,二次前路清创后愈合。1例患者椎体不融合,内固定失效,假关节形成。其余患者均获临床愈合,平均椎体融合时间4.5月。术后复查Cobb’s角改善约9.5°。术后1年ASIA神经功能分级明显改善。无病灶复发病例。结论:该术式操作相对简单,创伤较小,易于纠正后凸畸形和维持稳定。Objective： To explore the clinical effect of the treatment of thoracolumbar tuberculosis through single-stage posterior debridement and interbody fusion and internal fixation. Methods： We retrospectively analyzed 31 thoracolumbar tuberculosis treated by this way in our hospital during year 2006-2011, including 13 males and 18 females, with an average age of 42 years. Of the 31 thoracolumbar tuberculosis cases, 20 were located in thoracic vertebra, 6 in lumbar, and 5 in thoracolumbar. Two segments involvement was most common （21 cases）, three segments were involved in 6 cases, and 4 cases had more than three segments involvement. And there were three cases with skipped lesions. By the classification of American Spinal Injury Association （ASIA）, none in grade A, 4 cases in grade B, 5 cases in grade C,7 cases in grade D, and 15 cases in grade E. During the operation and followed-up for 20-48 months, the outcome of tuberculosis, as well as the recovery of nerve function and spinal deformity were evaluated. Results： There was respectively one case of pleural rupturing and one case of cerebrospinal fluid leaking occurred during operation. No wound infection, nonunion and sinus formation cases were found, except one case of unfused vertebras and formation to pseudarthrosis. The Cobb angle improvement was approximately 9.5°, and ASIA neurological function classification improved significantly. No recurrence were found. Conclusion： The technique was simple, less invasive and easy to correct the kyphosis.

关 键 词：胸腰椎结核 病灶清除 植骨融合 内固定 

分 类 号：R529.2[医药卫生—内科学]