一期后路病灶清除植骨融合内固定联合局部置管化疗治疗胸腰椎结核临床疗效观察  

One-stage posterior debridement, bone grafting and internal fixation combined with local chemotherapy for treatment of thoracolumbar tuberculosis

作　　者：孟羿彬[1] 吴起宁[1] 贺欣[1] 黄云飞[1] 贾帅军[1] 

机构地区：[1]西安交通大学医学部附属红会医院脊柱外科腰椎病区,710054

出　　处：《美中国际创伤杂志》2017年第1期22-24,29,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：探讨一期行后路病灶清除椎间植骨融合内固定联合局部置管化疗治疗胸腰椎结核临床疗效观察，并评价其安全性和有效性。方法：回顾性分析2011年1月至2015年12月26例脊椎结核患者的相关资料，男18例，女8例；年龄26—62岁，平均46岁。胸椎8例，腰椎18例，单节段受累22例，双节段6例。12例合并椎胖脓肿，26例存在不同程度的脊髓神经功能损害，8例合并后凸畸形。均采用后路病灶清除椎间融合内固定术并置管局部化疗治疗。术后予标准抗结核化疗，术后经局部置管处，局部化疗注射用异烟肼0．2g／d，至术后2-4w。定期随访观察结核治愈、神经功能改善及畸形矫正、CRP及血沉情况。结果：26例患者均获得随访，随访时间24-30个月，平均26个月。术前存在脊髓神经功能损害者，均有不同程度恢复。术前后凸畸形平均为（25．1±12．5）O7术后矫正至（10．6±9．5）°，末次随访时（11．8±8．5）°。CRP及血沉均降低，6月后均正常。结论：后路病灶清除椎间植骨融合内固定术并局部置管化疗对于脊椎结核是一种安全、有效的术式，且术后复发率低，临床效果较为满意，唯一不足之处为局部置管化疗，要求定期消毒、局部注射等麻烦，对于随访26例患者无1例出现结核复发及局部感染。Objective： To observe the clinical effect of one-stage posterior debridement, bone grafting and internal fixation combined with local chemotherapy in treatment of thoracolumbar tuberculosis, and to evaluate its safety and effectivity. Methods： The data of 26 patients with thoracolumbar tuberculosis was analyzed retrospectively between Jan. 2011 and Dec. 2015. Among them, including 18 male, 8 female; aging 26-62 years; thoracic vertebra in 8 cases, lumbar vertebra in 18 cases; single segment involved in 22 cases, dou- ble segments involved in 6 cases; combined with beside the vertebral abscess, different degrees spinal nerves functional lesion, kyphosis deformity in 12, 26 and 8 cases respectively. All patents underwent posterior debridement, bone grafting and internal fixation combined with postoperative local catheterization for standard anti-tuberculosis chemotherapy （isoniazide 0.2g/d for 2-4 weeks）. Regular follow-up was carried out to ob- serve the neural function, deformity correction, CRP and blood sedimentation rate. Results： All patients were followed up for 24-30 months （mean 26 months）, the results showed as following： spinal nerves function recovered in different degrees, kyphosis deformity was corrected from mean （25.1±12.5）° to （10.6±9.5）°postoperatively and was （11.8±8.5）° at the last follow-up, both CRP and blood sedimentation rate decreased postop-eratively and reach to normal 6 months later, without tuberculosis recurrence or local infection etc. happened. Conclusion： One-stage posterior debridement, bone grafting and internal fixation combine with local chemotherapy for treatment of thoracolumbar tuberculosis is a safe and effective method. Furthermore, it can obtain a low postoperative recurrence rate and a satisfactory clinical effect, only one disadvantage is regular local injection and catheter sterilization.

关 键 词：胸腰椎结核 一期手术 局部置管化疗 疗效 

分 类 号：R473.6[医药卫生—护理学]