后路一期病灶清除结合内固定治疗多节段脊柱结核  

Surgical Treatment with Posterior Pedicle Screw Fixation,Focal Cleaning,Titanium Mesh and Bone Graft Fusion for Multi-segmental Spinal Tuberculosis

作　　者：杨启远[1] 冯敬[1] 杨雯栋[1] 罗小丽[1] 李英博[1] 雷超 冯志[1] 赖显金[1] 

机构地区：[1]绵阳市第三人民医院脊柱外科,四川绵阳621000

出　　处：《实用骨科杂志》2016年第4期293-298,共6页Journal of Practical Orthopaedics

摘　　要：目的探讨后路一期椎弓根螺钉内固定病灶清除钛网植骨治疗多节段脊柱结核临床疗效。方法回顾分析2009年1月至2014年12月收治的16例多节段脊柱结核患者,其中男7例,女9例;年龄19-56岁,平均36.5岁。结核病灶累及2个椎体6例,3个椎体7例,4个椎体2例,5个椎体1例。其中胸椎9例,胸腰椎5例,腰椎2例。病变节段后凸Cobb角28°-53°,平均37.6°。术前Frankel神经功能评估,A级0例,B级1例,C级2例,D级6例,E级7例。术前四联抗结核药物治疗2-4周后,所有病例均行后路一期椎弓根螺钉内固定病灶清除钛网植骨。术后继续抗结核药物治疗12-18个月。结果手术时间160-290 min,平均215 min,术中失血量400-1 800 mL,平均780mL。全部患者随访6个月-2年,平均随访1年7个月。术后并发脑脊液漏1例,无切口感染及窦道形成。所有病例植骨均融合良好,内固定无松动、移位、断裂。术后后凸Cobb角8°-27°,平均28.2°,平均矫正率75%。术后神经功能恢复：B级1例恢复至C级;C级2例,1例恢复至D级,1例恢复至E级;D级6例,4例恢复至E级,2例未恢复。结论后路一期椎弓根螺钉内固定病灶清除钛网植骨治疗多节段脊柱结核是一种固定牢固、植骨融合良好、安全可靠的方法,可获得良好的临床效果。Objective To study the clinical effect of Surgical treatment with posterior pedicle screw fixation,focal cleaning,titanium mesh and bone graft fusion for multi-segmental spinal tuberculosis. Methods The clinical data from 16 patients with multi-segmental spinal tuberculosis from January 2009 to December 2014 were retrospectively analyzed. There were 7males and 9 females,ranging in age from 19 to 56 years with an average of 36. 5 years old. 2 vertebral bodies involved in 6 cases,3 vertebral bodies in 7 cases,4 vertebral bodies in 2 eases,and 5 vertebral bodies in 1case. Among these cases,there were9 cases of thoracic vertebra,5 cases of thoracolumbar vertebra,2 cases of lumbar vertebra. The kyphosis angel of diseased segments was 28° to 53°,37. 6° in average. According to the Frankel classification before operation,there were Frankel A in 0case,Frankel B in 1 cases,Frankel C in 2 cases,Frankel D in 6 cases,Frankel E in 7 cases. After intensive anti-tuberculosis medication（ HRSZ） for 2 to 4 weeks before operation,all patients were treated with posterior pedicle screw fixation,focal cleaning,titanium mesh and bone graft fusion. After operation,the anti-tuberculosis medication was continued for 12 - 18 months.Results The operation time ranged from 160 mins to 290 mins,215 mins in average. The blood loss ranged from 400 to 1 800 m L,780 m L in average. All the cases were followed up for 6 months to 2 years with the average of 1 year and 7 months. 1 cases was complicated with CSF leakage. No wound infection and sinus tract formation were noted. All the cases showed excellent bone graft fusion,all internal fixation had good position without looseness,displacement and breakage. The Mean kyphosis angle was 28. 2°（ range,8°to 27°） after operation,with an average correction rate of 75%. Neurologic status of all patients with preopertative neurologic deficit was ： 1 with grade B recovered to grade C; 2 with grade C,1 recovered to grade D and 1 recovered to grade E; 6 with grade D,4 recovered to grade E and 2

关 键 词：脊柱结核 多节段 后路 内固定 病灶清除 植骨 

分 类 号：R529.2[医药卫生—内科学]