后路内固定、1期或2期前路病灶清除术治疗重度脊柱结核  

one or two -stage combinea anterio -posterior surgery used in Severe spinal tuberculosis

作　　者：任龙龙[1] 雷云峰[1] 马永刚[1] 贺加明 高智[1] 

机构地区：[1]榆林市第二医院骨二科,陕西榆林719000

出　　处：《中国伤残医学》2014年第16期5-7,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨后路内固定、1期或2期前路病灶清除术在治疗重度脊柱结核中的作用。方法：2006年1月-2012年6月收治了重度脊柱结核18例。年龄14岁～65岁，平均年龄41岁。男8例；女10例。病变部位：胸椎4例，胸腰椎段9例，腰椎5例。入院前病史1个月～12个月。病变仅累及单节段的3例，累及2个节段的10例，累及3个节段的5例。18例中合并冷脓肿形成者14例，伴有双下肢不全瘫者3例。脊柱后突畸形8例，Cobb’s角10^。-40^。结果：随访6个月～2年半。按骨愈合的Bridwell判断标准：I级，11例；Ⅱ级，5例；Ⅲ级，2例。伴有双下肢不全瘫3例，术前Frankel分级D级2例，E级1例，术后均恢复正常。18例中，1例术后7个月内固定松动、脱落、异体骨塌陷。1例胸10～12椎体结核患者术后10个月出现轻度后突，Cobb’s角约15。。结论：对于破坏严重、多节段、后凸畸形的重度脊柱结核患者，后路椎弓根螺钉内固定、1期或2期前路病灶清除植骨术为适合选择。Objective：To investigate the One or two -stage combined anterio -posterior surgery used in Severe spinal tuberculosis. Methods ： 18 cases of spinal tuberculosis were collected from January 2006 to June2012, aged 14 years to 65 years old. While , the average age was 41 years,among them 8 cases were men and 10 was women, 4 in thoracic, 9 in Thoracolumbar and 5 in lumbar spine. In the 18 cases in children, accompanied by the formation of cold abscess were 14 eases, associated with incomplete paralysis of both lower extremi- ties were 3 cases, and combined with kyphosis deformity whose Cobb＇s angle was 10^.-40^.were 3 cases. Results：All of the subjects were followed up for 6 months to 2 ？ years, bone the degree of fusion by Bridwel] criteria： I grade, 11 cases ; II grade, 5 ; Ill grade, 2, preoperative Frankel grade D had 2 cases and E had 1 case among the 3 eases of incomplete paralysis of both lower extremities, which all returned to normal after operation . “Debridement surgery” and “ Fixation removal and allogeneic bone graft surgery” were respectively implemented in 7 months after operation on one case because of sinus formation ,fixation fall of and allogeneic bone collapse. There was 1 case of thoracic vertebral tuberculosis 10 - 12 which showed up mild Kyphotic deformity in 10 months after surgeon and the Cobb＇s angle was about 15^.. Conclusion：It might be safe and feasible to carry out On or two - stage combined anterio - posterior surgery used in Se- vere spinal tuberculosis.

关 键 词：结核 脊柱 内固定 

分 类 号：R529.2[医药卫生—内科学]