摘要
目的探讨胸腰椎结核病灶清除植骨、椎弓根螺钉内固定的疗效及其适应证。方法采用一个切口一期完成病灶清除、椎弓根固定治疗胸腰椎结核16例,观察手术前后Cobb角变化、神经功能恢复情况、术后植骨融合时间及近期脊柱序列保持情况。结果15例获得随访,时间13～36个月。术前Cobb角10°～40.3°(25.6°±14.2°),术后Cobb角0°～27.2°(10.4°±5.3°),末次随访Cobb角0°～27.5°(10.5°±3.8°)。8例神经功能障碍者Frankel分级:C级2例恢复到D级1例、E级1例;D级6例恢复到E级5例,1例无恢复。脊柱畸形均有不同程度矫正。随访期间植骨块无移位,椎体序列及高度保持良好。术后2～3个月可见植骨融合。结论采用一个切口一期完成病灶清除、椎弓根螺钉内固定治疗胸腰椎结核,创伤小,效果好,但应严格把握手术适应证。
Objective To investigate the curative effect and clinical indication of one-stage trans-pedicular screw system internal fixation and radical debridement with interbody autograft in the treatment of thoracic and lumbar spinal tuberculosis through a posterior procedure.Methods A total of 16 patients with thoracic or lumbar tuberculosis were treated by this procedure.The pre-operative and post-operative Cobb＇s angle,the recovery of the nervous system,the fusion time and the spine sequence in the near future were observed.Results 15 patients were followed up for 13～36 months,except one who suffered drug toxic action and was lost.The pre-operative Cobb＇s angle was 10°～40.3°（25.6°±14.2°）,and was restored to 0°～27.2°（10.4°±5.3°） immediately after operation,to 0°～27.5°（10.5°±3.8°） at the last follow-up.There was no nerve injury deteriorated of the 8 Frankel scale classified patients：1 of the 2 Grade C patients recovered to Grade D,the other recovered to Grade E.5 of the 6 Grade D patients recovered to Grade E,the other one did not recover.The abnormalities of spine were rectified more or less.During the followed period,radiography showed no loosening of the shaft bone,and the contented curvature and height of the vertebra were retained.Successful interbody fusion are observed during the 2～3 months after operation.Conclusions It is a feasible and effective procedure to treat thoracic and lumbar spinal tuberculosis in selected cases by this procedure.Compared with combined anterior and posterior procedure,this surgical technique may decrease injuries and has better result.
出处
《临床骨科杂志》
2009年第5期510-513,共4页
Journal of Clinical Orthopaedics
