一期后路病灶清除混合植骨内固定术治疗胸腰椎结核  

One-stage posterior debridement,mixed bone graft and internal fixation in the treatment of thoraco-lumbar spinal tuberculosis

作　　者：陈勇忠[1] 王剑火[1] 张朋[1] 黄哲[1] 龚衍丁 周清碧[1] 

机构地区：[1]南京军区福州总医院476临床部骨科中心,福建福州350002

出　　处：《临床骨科杂志》2014年第6期626-628,632,共4页Journal of Clinical Orthopaedics

摘　　要：目的：探讨一期后路病灶清除、自体骨及硫酸钙人工骨混合植骨、内固定术治疗胸腰椎结核的疗效及安全性。方法对21例胸腰椎结核患者在正规抗结核的基础上采用一期后路病灶清除、含链霉素的硫酸钙人工骨与自体骨混合植骨及内固定术治疗；观察患者局部切口、有无不良反应及临床症状恢复情况。定期影像学检查对植骨融合和后凸畸形矫正的情况进行分析。结果患者术后伤口均一期愈合,临床症状明显缓解,后凸畸形获得不同程度的矫正,矫正角度无明显丢失,无全身不良反应。21例均获随访,时间9-18个月。20例患者一次手术治愈,1例患者于术后9个月结核复发再次行前路手术后治愈。胸腰椎X线检查：术后1周硫酸钙人工骨粒显影清楚,术后3个月显影不清,术后6-9个月植骨部位获骨性愈合。结论一期后路病灶清除、自体骨与含链霉素的硫酸钙人工骨混合植骨融合、内固定术治疗胸腰椎结核是安全、可行的方法。Objective To study the clinical effect and safety of one-stage posterior debridement, medical grade calci-um sulfate artificial bone and autogenetic bone graft and internal fixation in thoraco-lumbar spinal tuberculosis. Meth-ods 21 cases with thoraco-lumbar spinal tuberculosis were treated with one-stage posterior debridement, medical grade calcium sulfate artificial bone in corporaed with streptomycin and autogenetic bone graft,and internal fixation on the basis of regular anti-tuberculosis. Incision healing, adverse reactions and the change of clinical symptoms were re-corded. Bone fusion and deformity correction were analyzed by the regular X-ray examination. Results All patients acquired satisfactory incision healing without obvious general adverse reactions. Clinical symptoms were differently re-lieved. Kyphosis was corrected to some degree and the correction was no loss. 21 cases were followed up for 9-18 months. 20 patients were cured. Tuberculosis recurred in one patient 9 months postoperatively, and was cured after the anterior surgery. X-ray examination showed that the calcium sulfate artificial bone was clear 1 week after surgery and unclear 3 months after surgery. Bone fusion appeared 6-9 months after operation. Conclusions One-stage pos-terior debridement, medical grade calcium sulfate artificial bone with streptomycin and autogenetic bone graft and in-ternal fixation is a safe and effective method of treating thoraco-lumbar spinal tuberculosis.

关 键 词：脊柱结核 硫酸钙 后路手术 链霉素 骨移植替代材料 自体骨移植 

分 类 号：R529.2[医药卫生—内科学] R687.3[医药卫生—临床医学]