病灶清除植骨内固定治疗相邻多椎体脊柱结核

Debridement and fusion with bone grafting and instrumentation in the treatment of multiple-level contiguous spinal tuberculosis

中文关键词:  脊柱结核  多椎体  病灶清除  植骨  内固定

英文关键词:Spinal tuberculosis  Multiple-level  Focal debridement  Bone grafting  Internal fixation

中文摘要:

  【摘要】 目的：探讨病灶清除、植骨及内固定术治疗相邻多椎体脊柱结核的疗效。方法：1999年1月～2007年1月手术治疗27例相邻多椎体脊柱结核患者，病变累及3个椎体15例，4个椎体7例，5个及以上椎体5例。病变单纯累及胸椎者5例，单纯累及腰椎者7例，累及胸腰椎者11例，累及腰骶椎者4例。术前有神经功能损害者11例，Frankel分级B级1例，C级2例，D级8例。后凸Cobb角26°~43°，平均35°±7°。术前均采用口服异烟肼（H）、利福平（R）、乙胺丁醇（E）并肌注链霉素（S）四联药物方案（HRES）抗结核治疗3周，一期后路内固定、前路病灶清除植骨16例，前路病灶清除植骨融合内固定11例。术后继续HRES抗结核治疗3个月，然后口服HRE三联药物方案抗结核治疗9个月。采用吴启秋骨结核治愈标准对疗效进行评估。结果:手术时间150～300min，平均240min；术中出血量600～1400ml，平均1000ml。术后无神经功能障碍加重及脑脊液漏等并发症。1例术后伤口出现窦道Ⅱ期愈合，其余均Ⅰ期愈合。脊柱后凸Cobb角恢复至12°～20°，平均15°±5°。27例均获随访，随访时间14～48个月，平均18个月，有神经功能损害者于术后8个月内恢复至正常；植骨全部融合，融合时间5～14个月，平均7个月。随访期间内固定无松动及折断。末次随访时所有患者均获临床治愈。结论：在有效抗结核药物治疗的基础上，多椎体脊柱结核采用彻底病灶清除、植骨融合及内固定术加强脊柱稳定，可提高植骨融合率和治愈率，获得满意的疗效。

英文摘要:

  【Abstract】　Objective：To investigate the results of surgical treatment for multi-level spinal tuberculosis with focal debridement，bone grafting and primary internal fixation.Method：27 cases of multi-level spinal tuberculosis treated by operation from January 1999 to January 2007 were reviewed retrospectively.3 vertebral bodies involved in 15 cases，4 vertebral bodies involved in 7 cases，5 vertebral bodies involved at least in 5 cases.Of these，there were 5 cases in thoracic vertebra，7 cases in lumbar vertebra，11 cases in thoracolumbar vertebra，4 cases in lumbosacral vertebra.11 cases showed neurological deficit before surgery，According to the Frankel classification，Frankel B in 1 case，Frankel C in 2，Frankel D in 8.The preoperative average Cobb angle of kyphosis was 35°±7°（range，26°-43°）.The focal debridement，bone grafting and primary internal fixation were performed for all patients.Among these protocols，16 cases underwent one staged posterior spinal internal fixation and anterior focal debridement，bone grafting.11 cases had anterior spinal internal fixation with focal debridement and bone grafting.All patients received anti-TB chemotherapy before and after operation.Anti-TB chemotherapy protocols consisting of combinations of rifampin，isoniazid，ethambutol and streptomycin were administered for 3 months which including 3 weeks before the operation and 3 months after the operation，followed by rifampin，isoniazid and ethambutol for a total of 9 months.The clinical outcomes were evaluated according to the criteria designed by WU Qiqiu et al.Result：The average surgical time was 240 minutes（range，150-300min），with the average intraoperative blood loss of 1000ml（range，600-1400ml），There was no complication such as nerve injury and cerebrospinal fluid leakage.The incision in 1 case presented sinus which had a secondary healing later on，others obtained primary healing.The average postoperative Cobb angle of kyphosis was 15°±5°（range，12°-20°）.All cases were followed up for an average of 18 months（range，14-48 months）.The patients with paraplegia recovered to the normal in 8 months.Bony fusion was achieved in all cases with mean fusion period of 7 months（range，5-14 months） with no incidence of hardware failure.At the final follow-up，all patients had evidence of clinical heal and the solid bony fusion.Conclusion：Focal debridement，bone grafting and primary internal fixation is reliable in dealing with multi-level spinal tuberculosis.