摘要
目的探讨胸腰椎结核一期病灶清除、植骨融合、内固定治疗的临床疗效。方法回顾分析自2002年9月至2008年7月我院手术治疗并获得随访的79例胸腰椎结核患者,病变范围为T5～S1,病灶累及1～2个椎体72例,大于等于3个椎体7例,其中跳跃性脊柱结核4例。手术方法:a)经前路病灶清除,椎体间植骨融合并内固定术;b)后路椎弓根固定术并前路病灶清除、椎体间植骨融合术。术后佩戴支具3～6个月,抗结核药物治疗12～18个月。定期门诊随访,进行实验室检查和影像学观察。结果该组患者随访2～9年,均获临床治愈。79例前路植骨病例,界面骨性融合时间平均4.7个月,后凸畸形平均矫正18.7°,随访期内丢失2°。合并截瘫29例,术后神经症状均得到明显改善。结论一期结核病灶清除、植骨融合内固定术是治疗脊柱结核的重要手段,有效的抗结核化疗是脊柱结核治愈的基础。
Objective To explore the clinical efficacy of onestage debridement,bone graft fusion and internal fixation in thoracolumbar spinal tuberculosis.Methods Seventy-nine patients with thoracolumbar spinal tuberculosis were treated surgically by a single stage procedure in our department from Sep 2002 to Jul 2008,there are 1～2 vertebral body lesions involved in 72 cases,≥3 vertebrae in 7 cases,leap spinal tuberculosis in 4 cases.The surgical procedures included：a）anterior debridement,fusion with autograft and internal fixation.b）posterior pedicle fixation and anterior debridement,interbody fusion.All patients wore the brace for 3～6 months,12～18 months anti-TB drugs postoperatively.Regular outpatient follow-up,laboratory tests and imaging observations.Results All patients were followed up for 2～9 years,were clinically cured.Spinal solid fusion at the interface between graft and adjacent vertebral bodies was shown radiologically in mean 4.7 months.There was a kyphosis correction of 18.70° after operation.There was a 2° loss of kyphosis correction during follow-up period.Symptoms of 29 paraplegia cases were significantly improved.Conclusion One-stage debridement,bone graft fusion and internal fixation is an important treatment of spinal tuberculosis.Effective anti-TB chemotherapy is the basis for cure of spinal tuberculosis.
出处
《实用骨科杂志》
2012年第5期398-401,共4页
Journal of Practical Orthopaedics
关键词
脊柱结核
植骨
内固定
化疗
spinal tuberculosis
bone graft
internal fixation
chemotherapy
